Thirteen independent isolates of Serratia marcescens associated with nosocomial urinary tract infections were obtained from the clinical microbiology laboratory at Hines Veterans Administration Hospital. The isolates were resistant to at least ampicillin, carbenicillin, gentamicin, and tobramycin. They could be divided into two groups on the basis of their antibiotypes. Group I (9 strains) showed resistance to 13 antibiotics, including 3 beta-lactams, 6

SUMMARY.Of 3952 clinical isolates of Enterobacteriaceae, 246 exhibited resistance to at least carbenicillin, gentamicin and tobramycin. All these isolates, representing eight genera, were resistant to at least nine antimicrobial agents in common, including the three key antibiotics and streptomycin, kanamycin, sisomycin, ampicillin, cephalothin and sulphonamide. The strains could be subdivided into seven groups depending upon additional resistance traits and some were resistant to as many as 15 antibiotics. When mated with a standard strain of Escherichia coli, 85% of 1 23 randomly selected donors transferred resistance to at least the nine core antibiotics. Some donors occasionally transferred resistance to two additional antibiotics, neomycin and tetracycline, while one Citrobacter freundi donor always transferred linked resistance to all 11 drugs. Although many donors were found to harbour more than one species of plasmid DNA, all except a strain of C. freundi contained at least a plasmid of mol. wt 89 x lo6. Analysis of E. coli transconjugants showed this plasmid to be responsible for transferable resistance to the nine core antibiotics. Restriction-endonuclease analysis indicates that the 89 x lo6 plasmids originating from different isolates were essentially identical with each other. These results show that a particular R plasmid has established itself among the Enterobacteriaceae at Hines VA Hospital. This R plasmid appears to be the predominant genetic element responsible for linked resistance to carbenicillin, gentamicin and tobramycin among these hospitalassociated bacteria.

Hospital isolates of Serratia marcescens able to transfer resistance to up to 11 antibiotics were found to contain conjugative R plasmids. One set of strains harbors only a single R plasmid with a mass of 89 megadaltons (Mdal). This plasmid codes for resistance to nine antibiotics including ampicillin, carbenicillin, cephalothin, streptomycin, kanamycin, gentamicin, tobramycin, sisomycin, and sulfonamides. The 2nd set of strains harbors 2 R plasmids, 1 with a mass of 89 Mdal, the other 57 Mdal. Analysis of progeny from genetic crosses indicates that the larger R plasmid codes for resistance to the same antibiotics as does the 89-Mdal plasmid described above. The 57-Mdal species codes for resistance to ampicillin, carbenicillin, cephalothin, kanamycin, neomycin, and tetracycline. The 89- and 57-Mdal R plasmids appear unrelated by a number of genetic and physical criteria. The 89-Mdal plasmid, but not the 57-Mdal species, is transferable by conjugation to Pseudomonas aeruginosa, and renders this species stably resistant to carbenicillin, streptomycin, kanamycin, gentamicin, tobramycin, and sisomycin.

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