Emergence of Gentamicin-Resistant
            <i>Klebsiella</i>
            in a General Hospital

Rennie, R. P.; Duncan, I. B. R.

doi:10.1128/aac.11.2.179

Cited by 56 publications

(32 citation statements)

References 15 publications

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“…Moreover, this original plasmid appeared to be the one which entered ODC-E. cloacae in 1981 since the four other variants of pBWH1 observed in that strain were Tra-and the first of these was not seen until 3 months after the outbreak began; also, aminoglycoside-susceptible isolates of ODC-E. cloacae did not contain plasmid DNA. The four Tra-variants of pBWH1 seen in ODC-E. cloacae isolates from burn unit patients over the last 7 months of the outbreak may exemplify a tendency of plasmids to lose transferability after becoming established in a strain (22). That one particular variety of pBWH1 among the many Tra+ variants observed was the first to enter the hospital and then the first to enter this new strain 6 years later suggests that it encodes advantageous properties.…”

Section: Resultsmentioning

confidence: 99%

Molecular evolution, species distribution, and clinical consequences of an endemic aminoglycoside resistance plasmid

Mayer¹,

Hopkins²,

Gilleece³

et al. 1986

Antimicrob Agents Chemother

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During the first 6 years after appearing in one hospital, a 92-kilobase conjugative plasmid, pBWHl, which encoded resistance to chloramphenicol and sulfonamides and determined TEM-1 beta-lactamase and 2"-aminoglycoside nucleotidyltransferase, underwent a variety of molecular changes. It was most prevalent initially in isolates of Klebsiella pneumoniae, then in isolates of Serratia marcescens, and finally, after nearly disappearing, in isolates of Enterobacter cloacae. Evolutionary changes in the plasmid did not account for its shifts in species distribution, since the original molecule was found in isolates of each species. The late resurgence of pBWHl occurred after a copy of its original molecule entered a distinctive ornithine decarboxylase-negative strain of E. cloacae, new to the hospital. The resulting transconjugant strain, chromosomally resistant to topical silver salts and to cephalosporins, and with the addition of pBWH1-encoded aminoglycoside resistance, spread in the hospital by causing an outbreak of sepsis in the burn unit, where these were commonly used antibacterial agents. Thus, an endemic plasmid became prevalent in a new host species because one of its genes supplemented the fitness of an uncommon strain of the species for a particular clinical niche.The percentages of clinical isolates of different bacterial species resistant to specific antibiotics are frequently calculated to delineate the usefulness of these drugs. Such tabulations will reflect in large part the distribution of resistance plasmids among strains of the species being surveyed, since a majority of resistance genes are carried by plasmids (4). The distribution of the plasmids may be determined by properties of the plasmids themselves such as their transferability, host range, or stability or the selective advantages conferred by their resistance genes or other cryptic genes (4,5). Also, properties of the host strains such as their fitness to occupy niches in which they come in contact with antibiotics might contribute to the observed distribution of plasmids.The surveillance of antibiotic resistance plasmids has been aided by plasmid fingerprinting, using restriction endonucleases (6,9,10,15,24,27)

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Section: Resultsmentioning

confidence: 99%

Molecular evolution, species distribution, and clinical consequences of an endemic aminoglycoside resistance plasmid

Mayer¹,

Hopkins²,

Gilleece³

et al. 1986

Antimicrob Agents Chemother

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“…Development of bacterial resistance to Aminoglycosides has been documented to be slowest amongst the antibiotics (Rennie RP et al, 1977). In Toronto, the first Gentamycin resistance was documented 7 years after first use (Curie K et al, 1978).…”

Section: Discussionmentioning

confidence: 99%

High Prevalence of Multi-Drug Resistant Klebsiella Pneumoniae in a Tertiary Teaching Hospital in Western Kenya

Apondi

Oduor

Gye

et al. 2016

AJID

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Introduction: Klebsiella pneumoniae is a gram negative enterobacteriaciae commonly associated with nosocomial infections. Multidrug resistant strains are increasingly being reported with corresponding increase in morbidity and mortality. The study outlines the epidemiology and antibiotic resistance pattern of K. pneumonia over a 10 year period in Moi Teaching and Referral Hospital, Eldoret, Kenya. Methodology and Study Design:This is a retrospective analysis of all the blood culture results for K. pneumoniae isolates in the hospital for the period 2002-2013. Results: K. pneumoniae accounted for 23% of the hospital isolates (231/1356) during the study period; of these, 82.6% were from the New Born Unit. Most of the isolates were multi drug resistant with highest resistance of over 80% to Penicillins, Cephalosporins, Macrolides, Tetracyclines, Sulphonamides, Lincosamides and Chloramphenicol. Aminoglycoside and Quinolone resistance was also high at 49.2% and 41.3% respectively. The lowest resistance rates were documented for Carbapenems (23.2%). For specific antibiotics, there was high resistance to commonly used antibiotics (over 80% for Ceftriaxone, Cefipime, Gentamycin and Ceftazidime). The antibiotics with least resistance were Amikacin and Meropenem (21% and 7 % respectively). Conclusion:There was a high prevalence of multidrug resistant K. pneumoniae isolates in the hospital, the majority originated from the New Born Unit. Resistance to third generation Cephalosporins and Gentamycin was high while Meropenem and Amikacin had the least resistance.

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“…The emergence of klebsiella strains resistant to several antibiotics, including gentamicin (Martin, Ikari, Zimmerman & Weitz, 1971;Rennie & Duncan, 1977), has reinforced the need for a clearer understanding of the epidemiology of these organisms in this group of vulnerable patients. Published studies of common-source outbreaks (Bassett, 1971; Meers, Calder, Mazhar & Lawrie, 1973) have shed little light on the more subtle epidemiology of endemic klebsiella infection.…”

Section: Introductionmentioning

confidence: 99%

Epidemiological patterns of klebsiella colonization and infection in an intensive care ward

Casewell

Phillips

1978

J. Hyg.

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Emergence of Gentamicin-Resistant Klebsiella in a General Hospital

Cited by 56 publications

References 15 publications

Molecular evolution, species distribution, and clinical consequences of an endemic aminoglycoside resistance plasmid

Molecular evolution, species distribution, and clinical consequences of an endemic aminoglycoside resistance plasmid

High Prevalence of Multi-Drug Resistant Klebsiella Pneumoniae in a Tertiary Teaching Hospital in Western Kenya

Epidemiological patterns of klebsiella colonization and infection in an intensive care ward

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