3) 2 (4.1) 2 (4.1) 6 (12.2) 14 (28.6) 8 (16.3) 5 (10.2) 2 (4.1) 1 (2) 27 (55.1) 10 (20.4) 10 (20.4) 2 (4.1) *Other: CSF, sputum. IPM: Pasteur Institute Medical Laboratory. HJRA: Joseph Ravoahangy Andrianavalona Hospital. HOMI: Military Hospital. Antimicrobial susceptibility analyses showed that all isolates were resistant to all

the β-lactams used but were susceptible to cefoxitin and imipenem. Resistance to cefoxitin in all E. cloacae isolates was due to the inducible production of AmpC β-lactamase from a chromosomal gene. All ESBL-producing isolates were also multidrug-resistant and most of them were resistant to: aminoglycosides (87.7% to gentamicin, 93.8% to tobramycin), trimethoprim-sulfamethoxazole (100%) and quinolones (75.5% to nalidixic acid, 69.3% to ciprofloxacin). Molecular epidemiology ERIC-PCR and rep-PCR analyses

revealed different restriction patterns for each isolate and showed that they were not clonally related (data not shown). Molecular CFTRinh-172 in vitro analysis Nucleotide sequence analysis of the bla CTX-M and bla SHV genes showed that only the CTX-M-15 and SHV-12 genes were present in these isolates. Only TEM-1 and OXA-1 were identified in the TEM- and OXA-producing isolates. The CTX-M-15 gene was detected in 37 isolates (75.5%) and the SHV-12 gene in 19 (38%). The ISEcp1 insertion sequence was identified in all 37 bla CTX-M-carrying isolates. Of the 37 isolates positive selleckchem for CTX-M-15, ten (27%) also SBI-0206965 mw carried only TEM-1, nine (24.3%) also carried

only OXA-1, and 16 (43.2%) carried TEM-1 and OXA-1 genes (Table 1). Of the 19 SHV-12-positive isolates, six (31.6%) also carried only TEM-1, four (20.1%) also carried only OXA-1 and six (31.6%) carried TEM-1 and OXA-1 genes (Table 1). Eight isolates (16.3%) (two E. coli, five K. pneumoniae and one E. cloacae) carried both bla CTXM-15 and bla SHV-12 and six of 17-DMAG (Alvespimycin) HCl these were additionally TEM-1- and OXA-1-positive. The resistance genes most frequently present were aac(6 ′ )-Ib (n=35, 71.4%) (33 were aac(6 ′ )-Ib-cr, 67.3%), sul1 and sul2 (n=25, 51%), tetA (n=24, 48.9%), qnrB (n=12, 24.5%) and qnrA (n=1, 2%). Among the six isolates carrying bla CTXM-15, bla SHV-12, bla TEM-1 and bla OXA-1, all of these also carried aac(6 ′ )-Ib (5 were aac(6 ′ )-Ib-cr), sul1-sul2, and five harbored tetA. Overall β-lactam resistant isolates harbored β-lactamases genes (CTX-M-15, SHV-12, TEM-1 and/or OXA-1) as well as trimethoprim-sulfamethoxazole resistant isolates sulfamide genes (sul1 and/or sul2). Ten (27.8%) of ciprofloxacin resistant isolates and 3 (25%) of ciprofloxacin susceptible isolates were qnr positive. Twenty five (69.2%) of ciprofloxacin resistant isolates and 8 (61.5%) of ciprofloxacin susceptible isolates were aac(6 ′ )-Ib-cr positive And, 27 (71%) of amikacin susceptible isolates and 8 (72.7%) of amikacin resistant isolates were aac(6 ′ )-Ib positive. Forty-eight isolates were positive for the class-1 integron gene and it was absent in only one K. oxytoca isolate.