During the first quarter of 1996, a major outbreak of clinical infection caused by multiresistant Klebsiella pneumoniae (MRKP) occurred in the neonatal ward of the 'Maternité Wassila Bourguiba' in Tunis, Tunisia. In total, 32 isolates of MRKP, comprising 23 clinical isolates and nine surveillance isolates, were recovered during this period and analysed for epidemiological relatedness. The isolates were compared with 17 other isolates of MRKP that were recovered during 1995. Macrorestriction profiles of total genomic DNA following XbaI restriction endonuclease digestion were analysed by PFGE; this typing classified 56 % of the 32 isolates recovered in 1996 into two major clusters. Cluster A included ten isolates from 1996 and three isolates recovered in 1995, whereas cluster B included eight isolates from the outbreak of 1996. The remaining isolates were genetically unrelated to those of clusters A and B; they constituted sporadic strains. The two major clusters were also evident using other molecular typing methods, such as random amplification of polymorphic DNA (RAPD) and enterobacterial repetitive intergenic consensus (ERIC)-PCR , where isolates of clusters A and B could be identified on the basis of their discriminative patterns. This investigation showed the predominance of two epidemic strains, and illustrated the ease with which MRKP strains can disseminate and persist within a single ward.

We developed a Western blot assay using purified human c-myc protein expressed in E. coli in order to look for circulating anti-c-myc antibodies in human sera. The presence of IgG antibodies against c-myc was observed in 25 out of 44 sera from patients with colorectal cancer diagnosed and treated at the Hôpital Curie in Paris, compared to the sera of 46 normal donors of which only 8 samples were positive (p = 0.001).

Previous genotypic investigations of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae recovered in a Tunisian neonatal ward revealed the spread of two epidemic strains and a high number of genetically unrelated isolates. The aim of the present study was to determine the role of the dissemination of self-transferrable plasmids harboring bla genes in the outbreaks experienced by the ward. The 49 previously identified clinical isolates of ESBL-producing K. pneumoniae were examined for relationships between their enzymes and plasmids. Analysis of crude extracts by isoelectric focusing showed four beta-lactamase-activities at pI 8.2, 7.6, 6, and 5.4. Clinical isolates contained large plasmids that could be transferred by conjugation and transformation conferring resistance to expanded-spectrum cephalosporins. DNA amplification and sequencing were performed to confirm the identities of transferred beta-lactamases. Nucleotide sequence analysis of SHV-specific PCR products from six isolates identified two bla(SHV) genes corresponding to SHV derived ESBLs, SHV-12 and SHV-2a. PstI digestion of plasmid DNA from transformants revealed six restriction patterns. The occurrence of the prevalent plasmid pattern in both epidemic strains and unrelated isolates indicated that diffusion and endemic persistence of the bla(SHV-ESBL) genes in the ward were due to concomitant spread of epidemic strains and plasmid dissemination among unrelated strains.