• Jesús Rodríguez-Baño, Elisenda Miró, Macarena Villar, Alicia Coelho, Mónica Gozalo, Nuria Borrell, Germán Bou, M Carmen Conejo, Virginia Pomar, Belén Aracil, Nieves Larrosa, Jesús Agüero, Antonio Oliver, Ana Fernández, Jesús Oteo, Alvaro Pascual, and Ferran Navarro.
• Unidad Clínica de Enfermedades Infecciosas y Microbiología, Hospital Universitario Virgen Macarena, Avda Dr Fedriani 3, 41009 Sevilla, Spain. jesusrb@us.es
• J. Infect. 2012 Feb 1; 64 (2): 176-83.

ObjectivesTo investigate the epidemiology and clinical features of infections caused by Enterobacteria producing plasmid-mediated AmpC β-lactamases (pAmpC), which are emerging as a cause of resistance to extended-spectrum cephalosporins.MethodsA prospective multicentre cohort of patients with infection/colonisation due to pAmpC-producing Enterobacteriaceae was performed in 7 Spanish hospitals from February throughout July 2009. pAmpCs were characterised by PCR and sequencing.Results140 patients were included; organisms isolated were Escherichia coli (n = 100), Proteus mirabilis (n = 20), Klebsiella pneumoniae (n = 17), and others (n = 3). Overall, 90% had a chronic underlying condition. The acquisition was nosocomial in 43%, healthcare-associated in 41% (14% of those were nursing home residents), and community in 16%. Only 5% of patients had no predisposing feature for infection with multidrug-resistant bacteria. Nineteen percent of patients were bacteraemic. Inappropriate empirical therapy was administered to 81% of bacteraemic patients, who had a crude mortality rate of 48%. The most frequent enzyme was CMY-2 (70%, predominantly in E. coli and P. mirabilis) followed by DHA-1 (19%, predominantly in K. pneumoniae).ConclusionpAmpC-producing Enterobacteriaceae caused nosocomial, healthcare-associated and community infections mainly in predisposed patients. Invasive infections were associated with high mortality which might be partly related to inappropriate empirical therapy.Copyright © 2011 The British Infection Association. Published by Elsevier Ltd. All rights reserved.

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