Outbreak of Infection with Extended-Spectrum Lactamase Producing Klebsiella pneumoniae in a Mexican Hospital (original) (raw)
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Journal of Clinical Microbiology, 2001
Thirty-one strains of Klebsiella pneumoniae (including 10 duplicates) from 21 septicemic pediatric patients (age, <2 months) were studied during a 4-month period (June to October 1996) in which the fatality rate was 62% (13 of 21). These isolates identified by the API 20E system yielded the same biotype. Pulsed-field gel electrophoresis experiments revealed the same clone in 31 strains. The isolates were multidrug-resistant but were still susceptible to ciprofloxacin, imipenem, and cefoxitin. A 135-kb plasmid was harbored in all of the isolates. No transconjugants were obtained that were resistant to ampicillin, cefotaxime, tetracycline, or gentamicin. Isoelectric focusing for β-lactamases was performed on all strains, and three bands with pIs of 5.4, 7.6, and 8.2 were obtained. Of these, the pI 8.2 β-lactamase had an extended-spectrum β-lactamase phenotype. PCR amplification of both TEM- and SHV-type genes was obtained. The sequence analysis of the SHV PCR product indicated a mu...
Antimicrobial Agents and Chemotherapy, 2002
Over a 12-year period (1989 to 2000), 159 Klebsiella pneumoniae isolates harboring extended-spectrum -lactamases (ESBLs) (4.8% of the total number of K. pneumoniae isolates obtained) were recovered from 58 patients, who were mainly hospitalized in intensive care and surgery units. For 62 representative isolates from 58 patients, 31 clonal types harboring TEM-4 (n ؍ 5), SHV-2 (n ؍ 7), SHV2a (n ؍ 4), SHV-5 (n ؍ 1), CTX-M-10 (n ؍ 13), or CTX-M-9 (n ؍ 1) -lactamases were identified by pulsed-field gel electrophoresis. This is the first report to document the presence of the CTX-M-10 or the CTX-M-9 -lactamase in K. pneumoniae. These -lactamases were previously identified in Escherichia coli isolates from Spain. Only two of five K. pneumoniae TEM-4 clones caused more than a single case of infection, with one of them spreading for 9 months. A single plasmid was detected among these TEM-4 clones. Only two of seven K. pneumoniae clones containing SHV-2 and three of four strains harboring SHV-2a were detected in more than one case of infection. Plasmids encoding SHV-2 or SHV-2a were unrelated. Four of 13 K. pneumoniae CTX-M-10 clones were found in more than one patient, with two of them recovered 2 and 5 years apart. As in the case of the SHV-2 isolates, we were unable to document a common transmissible genetic element that could explain the polyclonal structure of our isolates. Nevertheless, the spread of a single gene may be suggested by the presence of a conserved set of noncoding polymorphisms in the sequences. Most ESBL-producing K. pneumoniae clones were ephemeral, being poorly selected and maintained in the hospital setting, but the genes encoding ESBL persisted successfully over the years that the strains were recovered, probably as a minority gene population in the hospital metagenome.
Journal of Medical Microbiology, 2009
The emergence of multidrug-resistant (MDR) and extended-spectrum b-lactamase (ESBL)producing Klebsiella pneumoniae poses a serious antibiotic management problem as resistance genes are easily transferred from one organism to another. Fifty-one strains of K. pneumoniae isolated from sporadic cases in various hospitals throughout Malaysia were analysed by antimicrobial susceptibility testing, PCR detection of ESBL-encoding genes and DNA fingerprinting. Although 27 of the 51 K. pneumoniae strains were MDR (i.e. resistant to three or more classes of antibiotics), the majority of the strains (98 %) were sensitive to imipenem. PCR detection using ESBL gene-specific primers showed that 46 of the K. pneumoniae strains harboured bla SHV , 19 harboured bla CTX-M , 5 harboured bla OXA-1 and 4 harboured bla TEM-1 . Class 1 integron-encoded intI1 integrase was detected in 21 of the 51 K. pneumoniae strains and amplification of the integron 59CS region showed the presence of several known antibiotic resistance gene cassettes of various sizes. Results of conjugation and transformation experiments indicated that some of the ESBL-encoding genes (i.e. bla SHV , bla CTX-M and bla TEM-1 ) were transmissible and were likely plasmid-encoded. DNA fingerprinting using PFGE and PCR-based methods indicated that the 51 K. pneumoniae strains were genetically diverse and heterogeneous.
The emergence of multidrug-resistant (MDR) and extended-spectrum b-lactamase (ESBL)producing Klebsiella pneumoniae poses a serious antibiotic management problem as resistance genes are easily transferred from one organism to another. Fifty-one strains of K. pneumoniae isolated from sporadic cases in various hospitals throughout Malaysia were analysed by antimicrobial susceptibility testing, PCR detection of ESBL-encoding genes and DNA fingerprinting. Although 27 of the 51 K. pneumoniae strains were MDR (i.e. resistant to three or more classes of antibiotics), the majority of the strains (98 %) were sensitive to imipenem. PCR detection using ESBL gene-specific primers showed that 46 of the K. pneumoniae strains harboured bla SHV , 19 harboured bla CTX-M , 5 harboured bla OXA-1 and 4 harboured bla TEM-1 . Class 1 integron-encoded intI1 integrase was detected in 21 of the 51 K. pneumoniae strains and amplification of the integron 59CS region showed the presence of several known antibiotic resistance gene cassettes of various sizes. Results of conjugation and transformation experiments indicated that some of the ESBL-encoding genes (i.e. bla SHV , bla CTX-M and bla TEM-1 ) were transmissible and were likely plasmid-encoded. DNA fingerprinting using PFGE and PCR-based methods indicated that the 51 K. pneumoniae strains were genetically diverse and heterogeneous. %paper no. jmm011114 charlesworth ref: jmm011114&
Antimicrobial Agents and Chemotherapy, 2001
-Lactamase production was investigated in cultures of 25 Klebsiella pneumoniae isolates isolated at a hospital in Durban, South Africa, in 1994 and 1996. Twenty of these isolates gave ceftazidime MIC/ceftazidime plus clavulanate MIC ratios of >8, implying production of extended-spectrum -lactamases (ESBLs), and DNA sequencing identified an ESBL gene (bla TEM-53 ) in a further two isolates. Pulsed-field gel electrophoresis (PFGE) defined 4 distinct strains among the 12 isolates collected in 1994 and 9 distinct strains among the 13 isolates collected in 1996. In three cases, multiple isolates from single patients varied in their PFGE profiles and antibiograms, implying mixed colonization or infection. Isoelectric focusing and DNA hybridization found both TEM and SHV enzymes and their genes in all 25 isolates. Many isolates had multiple identical or different -lactamase gene variants, with at least 84 bla SHV and bla TEM gene copies among the 25 organisms. Sequencing identified the genes for the SHV-1, -2, and -5 enzymes and for four new SHV types (SHV-19, -20, -21, and -22). These new SHV variants had novel mutations remote from sites known to affect catalytic activity. Sequencing also found the genes for TEM-1, TEM-53, and one novel type, TEM-63. All the isolates had multiple and diverse plasmids. These complex and diverse patterns of ESBL production and strain epidemiology are far removed from the concept of an ESBL outbreak and suggest a situation in which ESBL production has become endemic and in which evolution is generating a wide range of enzyme combinations. This complexity and diversity complicates patient management and the design of antibiotic use policies.
Extended-spectrum β-lactamases from Klebsiella pneumoniae strains isolated at an Italian hospital
European Journal of Epidemiology, 1994
Eighteen strains ofKlebsiella pneumoniae recently isolated from hospitalized patients were resistant or moderately resistant to oxyimino-cephalosporins (ceftazidime and/or cefotaxime), aztreonam, cefoxitin and all but one were susceptible to imipenem. Analysis of enzymes produced by these clinical isolates revealed a wide pattern of extended-spectrum β-lactamases. All isolates produced one or more β-lactamases that were characterized preliminarily by their isoelectric point. Strains isolated early were from patients in the Intensive Care Unit and produced an ESβ-lactamase with an apparent pI of 7.6, whereas the later isolates were from surgical and medical wards of the same hospital and produced ESβ-lactamases with apparent pI of 8.2 and 8.4, repectively. This suggests the emergence of SHV-5 and MIR-1 β-lactamases in our hospital. Agarose gel electrophoresis of plasmid DNA revealed the presence of a similar plasmid of approximate size 60 Kb in all isolates.
Al-Mustansiriyah Journal of Science, 2024
Background: Multi-Drug-ResistantKlebsiella pneumoniae (MDR K. pneumoniae) is considered as an important opportunistic pathogen, which causes life threatening infections. K. pneumoniae is known to causes life-threatening infections. Objective: The objective of this study is to detect some β-lactamase genes inKlebsiella pneumoniae. Methods: Thirty-five K. pneumoniae isolates were obtained from some hospitals in Baghdad City between October 2022 and February 2023. The identification of K. pneumoniae isolates was done phenotypically by the automated VITEK II system and genotypically by amplification of the rpob gene. The antibiotic susceptibility and detection of some β-lactamase genes were tested for all isolates. Results: The results showed that the K. pneumoniae isolates were resistant to most antibiotics used. A high percentage of K. pneumoniae isolates were resistant to cefixime, cefpodoxime, norfloxacin and doxycycline as 100% followed by ceftriaxone, ceftazidime, ticarcillin/clavulanate, ticarcillin, ceftazidime, tobramycin, and moxifloxacin (97.2%, 91.7%, 91.7%, 94.4%, 94.4%, and 94.4%, respectively). Furthermore, approximately 94.4% of the isolates were MDR. In addition, the molecular methods only detected the bla N DM and bla T EM genes as 33.3% and 75.6% of in the K. pneumoniae isolates, respectively, while the bla V IM , bla CT X−M , and bla KP C genes were not observed in K. pneumoniae isolates. Conclusions: β-lactam antibiotics, including carbapenems, are widely used to treat bacterial infections; however, an increase in antibiotic resistance due to β-lactamases limits the effectiveness of these antibiotics. Therefore, alternative treatment methods are required to control these resistant isolates.