Hospital outbreak of MEN-1-derived extended spectrum β-lactamase-producing Klebsiella pneumoniae

Komatsu, Masaru; Ikeda, Norio; Aihara, Masanori; Nakamachi, Yuji; Kinoshita, Syouhiro; Yamasaki, Katsutoshi; Shimakawa, Kouichi

doi:10.1007/s101560100015

Cited by 20 publications

(10 citation statements)

References 28 publications

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“…Nevertheless, to the best of our knowledge, this is the first report of a large outbreak by CTX-M-1-producing Enterobacteriaceae and, curiously, the first documented description in the literature of CTX-M-1 in K. pneumoniae, despite the fact that this enzyme has been found in multiple species, including E. coli, P. mirabilis, M. morganii, and C. amalonaticus. A hospital outbreak due to a K. pneumoniae strain producing an ESBL related to CTX-M-1 was described in Japan (23), but since the gene encoding the ESBL was not sequenced and CTX-M-1 has not been reported in the Far East, it is more likely that the enzyme involved was actually one of its close relatives, either CTX-M-3 or CTX-M-15, both of which were already found in Japanese hospitals (3).…”

Section: Discussionmentioning

confidence: 99%

Characterization of a Large Outbreak by CTX-M-1-Producing Klebsiella pneumoniae and Mechanisms Leading to In Vivo Carbapenem Resistance Development

et al. 2006

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All extended-spectrum ␤-lactamase (ESBL)-producing Enterobacteriaceae isolates from patients admitted to and adult intensive care unit were prospectively documented from 2002 to 2005, when a large outbreak (51 patients affected) of multiresistant ESBL-producing Klebsiella pneumoniae infection was detected. The involvement of a single K. pneumoniae clone was demonstrated by pulsed-field gel electrophoresis. In addition to the ESBL-mediated resistance, the epidemic strain uniformly showed crossresistance to ciprofloxacin, gentamicin, tobramycin, trimethoprim-sulfamethoxazole, and tetracycline, whereas resistance to the ␤-lactam-␤-lactamase inhibitor combinations was variable. The ESBL involved was CTX-M-1, as demonstrated by isoelectric focusing, PCR amplification, and sequencing. CTX-M-1 as well as the aminoglycoside resistance determinants were encoded in a 50-kb plasmid that could be transferred to Escherichia coli only by transformation. In two of the infected patients, carbapenem resistance development (MICs of 8 to 12, 16, and >32 g/ml for imipenem, meropenem, and ertapenem, respectively) was documented, both in clinical samples and in intestinal colonization studies. The analysis of the outer membrane proteins of the carbapenem-susceptible and -resistant isolates revealed that the former expressed only one of the two major porins, OmpK36, whereas the latter did not express either of them. In one of the cases, the lack of expression of OmpK36 was demonstrated to be mediated by the interruption of the coding sequence by the insertion sequence IS26. This is the first report of a large outbreak of CTX-M-1-producing Enterobacteriaceae and, curiously, the first documented description in the literature of CTX-M-1 in K. pneumoniae, despite the fact that this enzyme has been found in multiple species. Furthermore, we document and characterize for the first time carbapenem resistance development in CTX-M-1-producing Enterobacteriaceae.

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Section: Discussionmentioning

confidence: 99%

Characterization of a Large Outbreak by CTX-M-1-Producing Klebsiella pneumoniae and Mechanisms Leading to In Vivo Carbapenem Resistance Development

et al. 2006

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“…CTX-M-type enzymes, whose presence is now described all over the world, appear to be a new challenge for the medical community, as they occur in a wide range of species and in clones of given species and plasmids, probably in relation to the fact that the corresponding genes are located downstream of an insertion sequence element (an ISEcp1-like element) which seems to act as a key factor in the dissemination of bla CTX-M type genes and as a strong positive factor for the expression of these genes (35). However, to our knowledge, outbreaks due to CTX-M-type enzyme-producing isolates have essentially been described so far in countries where CTX-Mtype-producing isolates are endemic, notably, Japan (20,26) and South America (37). The present article, which reports on the dissemination of clonally related CTX-M-15-producing E. coli strains in a French 650-bed geriatric hospital, might prefigure the near future for Western European countries, which now seem to be concerned with CTX-M-type enzymes.…”

Section: Discussionmentioning

confidence: 99%

Emergence and Spread of Three Clonally Related Virulent Isolates of CTX-M-15-Producing Escherichia coli with Variable Resistance to Aminoglycosides and Tetracycline in a French Geriatric Hospital

Leflon‐Guibout¹,

Jurand

Bonacorsi

et al. 2004

Antimicrob Agents Chemother

115

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Three types of multidrug-resistant Escherichia coli isolates, called GEN S, GEN R, and AMG S, according to their three different aminoglycoside resistance patterns, were responsible for urinary tract colonization or infection in 87, 12, and 13 new patients, respectively, in a French 650-bed geriatric hospital over a 13-month period. The three E. coli types belonged to the same clone and phylogenetic group (group B2) and had identical transferable plasmid contents (a 120-kb plasmid), ␤-lactam and fluoroquinolone resistance genotypes (bla TEM-1B , bla CTX-M-15 , and double mutations in both the gyrA and the parC genes), and virulence factor genotypes (aer, fyuA, and irp2). They disseminated in the geriatric hospital, where the antibiotics prescribed most often were fluoroquinolones and ceftriaxone, but not in the affiliated acute-care hospital, where isolation precautions were applied to the transferred patients. Thus, E. coli isolates, both CTX-M-type ␤-lactamase producers and fluoroquinolone-resistant isolates, might present a new challenge for French health care settings.For the last 10 years, sporadically but regularly, the microbiology literature has reported on multidrug-resistant (MDR) bacteria in geriatric hospitals, long-term-care facilities, and nursing homes (14,26,30,44). The emergence of these bacteria in such health care facilities has become a public health concern because implementation of isolation precautions, which is the principal measure recommended in acute-care hospitals to avoid cross-transmission (12), is often considered deleterious for the quality of life of elderly people living in long-term-care facilities. Moreover, the elderly patients carrying MDR bacteria represent a reservoir of these bacteria in acute-care hospitals when they are transferred to them. The very least that can be done to address this double concern is to survey long-term-care facilities for the emergence and incidence of MDR bacteria and to inform clinicians in acute-care hospitals of the real or potential existence of these isolates in patients transferred from long-term-care facilities. Such a twofold approach, observation and an infection control program, is certainly more easily managed when the same microbiological department, as in Hôpital A. Paré, is in charge of the patients in both types of care settings.This article reports on molecular analyses performed with three types of MDR Escherichia coli isolates which successively emerged and spread in the 650-bed geriatric hospital which is affiliated with a 450-bed acute-care hospital, Hôpital A. Paré.It also describes the particular hygiene measures which were successfully established in the acute-care hospital to avoid secondary cases of MDR E. coli colonization or infection from the patients transferred from the geriatric hospital. MATERIALS AND METHODSPopulation and collection of bacteria. From October 2001 to October 2002, each first isolate of the family Enterobacteriaceae displaying an extended-spectrum ␤-lactamase (ESBL) production phenotype according to...

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“…Newly described SHV-type ESBLs have recently been reported from Taiwan and Japan (82,202). However, the appearance of CTX-M ESBLs in India (189,318) and China (81,414,425), and more frequent reports of outbreaks of infection with CTX-M-type ESBLs in Japan (200,226), Korea (284), and Taiwan (436), raise suspicions that these may indeed be the dominant ESBL types in Asia. Plasmid-mediated non-TEM, non-SHV ESBLs, showing homology to the chromosomal ␤-lactamases of Klebsiella oxytoca (Toho-1 and Toho-2), have been detected in Japan (173,227).…”

Section: Global Epidemiologymentioning

confidence: 99%

Extended-Spectrum β-Lactamases: a Clinical Update

2005

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SUMMARY Extended-spectrum β-lactamases (ESBLs) are a rapidly evolving group of β-lactamases which share the ability to hydrolyze third-generation cephalosporins and aztreonam yet are inhibited by clavulanic acid. Typically, they derive from genes for TEM-1, TEM-2, or SHV-1 by mutations that alter the amino acid configuration around the active site of these β-lactamases. This extends the spectrum of β-lactam antibiotics susceptible to hydrolysis by these enzymes. An increasing number of ESBLs not of TEM or SHV lineage have recently been described. The presence of ESBLs carries tremendous clinical significance. The ESBLs are frequently plasmid encoded. Plasmids responsible for ESBL production frequently carry genes encoding resistance to other drug classes (for example, aminoglycosides). Therefore, antibiotic options in the treatment of ESBL-producing organisms are extremely limited. Carbapenems are the treatment of choice for serious infections due to ESBL-producing organisms, yet carbapenem-resistant isolates have recently been reported. ESBL-producing organisms may appear susceptible to some extended-spectrum cephalosporins. However, treatment with such antibiotics has been associated with high failure rates. There is substantial debate as to the optimal method to prevent this occurrence. It has been proposed that cephalosporin breakpoints for the Enterobacteriaceae should be altered so that the need for ESBL detection would be obviated. At present, however, organizations such as the Clinical and Laboratory Standards Institute (formerly the National Committee for Clinical Laboratory Standards) provide guidelines for the detection of ESBLs in klebsiellae and Escherichia coli. In common to all ESBL detection methods is the general principle that the activity of extended-spectrum cephalosporins against ESBL-producing organisms will be enhanced by the presence of clavulanic acid. ESBLs represent an impressive example of the ability of gram-negative bacteria to develop new antibiotic resistance mechanisms in the face of the introduction of new antimicrobial agents.

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Hospital outbreak of MEN-1-derived extended spectrum β-lactamase-producing Klebsiella pneumoniae

Cited by 20 publications

References 28 publications

Characterization of a Large Outbreak by CTX-M-1-Producing Klebsiella pneumoniae and Mechanisms Leading to In Vivo Carbapenem Resistance Development

Characterization of a Large Outbreak by CTX-M-1-Producing Klebsiella pneumoniae and Mechanisms Leading to In Vivo Carbapenem Resistance Development

Emergence and Spread of Three Clonally Related Virulent Isolates of CTX-M-15-Producing Escherichia coli with Variable Resistance to Aminoglycosides and Tetracycline in a French Geriatric Hospital

Extended-Spectrum β-Lactamases: a Clinical Update

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