**7. References**

Akpaka PE, Legall B, Padman J. 2010. Molecular detection and epidemiology of extendedspectrum beta-lactamase genes prevalent in clinical isolates of *Klebsiella pneumoniae* and *E coli* from Trinidad and Tobago. West Indian Med J. 59(6):591-6.

be long and this can also be a point against the use of PFGE. But despite the longer turnaround time PFGE method in performing molecular epidemiology of bacterial isolates

Using the questionnaire to retrospectively review the laboratory and medical records, it was observed that these isolates did not significantly share the same patient demographics and occurrence periods. Despite being isolated mostly from urine of patients admitted in the medical and surgical facilities of the hospitals sharing significant patient demographics and isolate characteristics yet the ESBL enzymes differed. This clearly indicated that most ESBLproducing isolates were not sporadic but that multiple clones were widespread in the hospitals. The occurrence of these ESBL producing pathogens were definitely not from spread from one patient to another or from one ward to another. It must probably therefore be as a result of antibiotic use pressure stemming from the use and overuse of antibiotics such as third generation cephalosporins in these facilities and hospitals as already has been reported in the country **[Pinto Pereira LM et al, 2004; Akpaka PE et al, 2010].** This therefore calls for a need for continuous and active surveillance measures; and effective infection controls practices, most especially antibiotic stewardship which is nonexistent in these

This is the first study to report bla*TEM*, bla*SHV* and bla*CTX-M* in the country that reveals that phylogenetic group 1 is the predominant CTX-M types prevalent in the hospitals. This study clearly indicated that CTX-M, mainly CTX-M-1 for ESBL-producing *E. coli* and *K. pneumoniae* was highly prevalent and probably endemic in Trinidad & Tobago. Most ESBL producers were resistant to oxyiminocephalosporins and other non-beta-lactam agents at high levels and exhibited a high rate of the MDR phenotype. The spread of ESBL-producing bacteria appeared to be polyclonal, and none of the major epidemic strains were identified.

In summary, this study reports the first extensive study regarding the prevalence and molecular characterization of ESBL genes and the epidemiology of ESBL-producing *E. coli* and ESBL-producing *K. pneumoniae* isolates causing infections in Trinidad and Tobago that

The authors wish to acknowledge the several laboratory technicians from the microbiology laboratory of the regional hospitals in Trinidad and Tobago who assisted in collecting the

Akpaka PE, Legall B, Padman J. 2010. Molecular detection and epidemiology of extended-

and *E coli* from Trinidad and Tobago. West Indian Med J. 59(6):591-6.

spectrum beta-lactamase genes prevalent in clinical isolates of *Klebsiella pneumoniae*

was specifically and clearly delineated by the use of the PFGE method.

still remains a gold standard for now.

hospitals.

**5. Conclusions** 

**6. Acknowledgement** 

**7. References** 

bacterial isolates used in this study. **Conflicts of Interests:** None to declare


**Part 3** 

**Electrophoresis Application in the Analysis of** 

**Protein-Nucleic Acid Interaction and** 

**Chromosomal Replication** 

