New Delhi metallo-β-lactamase 1 was STA-9090 mouse searched for using specific primers [13]. PMQR genes qnrA, qnrB, qnrC, qnrD, qnrS, qepA and aac(6′)-Ib-cr were investigated by PCR as previously described [5]. Identity of the β-lactamase and quinolone resistance genes was confirmed by DNA sequence analysis. Twenty-seven of the 31 isolates for which information was available were from adult and four from pediatric cases. All but one patient were hospitalized and 24 were receiving imipenem treatment. There was only one instance

of two isolates with different susceptibility patterns from the same patient. A high proportion of isolates was from fecal samples (14/31), followed by exudates and blood (6 and 5, respectively) and other normally sterile sites. All isolates were confirmed by E-test to be resistant to cefotaxime and/or ceftazidime. Only one isolate was resistant to carbapenems. Fourteen and 24 isolates were resistant to gentamicin and ciprofloxacin, respectively. The E. coli isolates were unevenly distributed into the four phylogenetic groups,

23 belonging to group D, 7 to A and 1 each to B1 and B2 (Table 1). Consistent with previous reports from Egypt and other low-resource countries, phylogroups A and D were predominant, whereas the hyperepidemic strain B2-ST131 was under-represented [8]. Rep-PCR fingerprinting enabled the identification of four clusters, including 15 phylogroup D isolates,

Lenvatinib and 17 single patterns (Fig. 1). This suggests that the observed over-representation of phylogroup D might be at least Terminal deoxynucleotidyl transferase partially explained by intra-hospital cross-transmission. In contrast, the heterogeneity of group A isolates which, along with group B1, are reportedly frequently associated with commensal organisms, suggests a prominent epidemiological role for this phylogroup in the region under study. According to MLST one cluster belonged to ST405 and the remaining three to ST68. All but one of the non-clustered phylogroup D isolates were also attributed with ST68. Isolates D/ST405 have been repeatedly reported to express a multiresistant phenotype [2, 8]. In contrast, isolates D/ST68 carrying blaCTX-M-15 and aac(6′)-Ib-cr were an unexpected finding. Indeed, only two D/ST68 isolates containing blaCMY-2 have been reported recently, both from wild coastline birds in Miami Beach, Florida, USA [14]. The B2 strain belongs to the worldwide spread ST131 [2]. All but one isolate in cluster 1 and 13 non clustered isolates showed a blaCTX-M-15 gene, which was consistent with the global predominance of this ESBL [2]. SHV-12 and CMY-2 were detected in only four and three non-clustered isolates, respectively. Three isolates co-produced OXA-48 and/or VIM carbapenemases (Table 1). Although carbapenemases have been infrequently detected in E.