Molecular Epidemiology of an SHV-5 Extended-Spectrum  -Lactamase in Enterobacteriaceae Isolated from Infants in a Neonatal Intensive Care Unit

Venezia, Richard A.; Scarano, Frank J.; Preston, Karen E.; Steele, Lea; Root, Timothy P.; Limberger, Ronald J.; Archinal, W A; Kacica, Marilyn A.

doi:10.1093/clinids/21.4.915

Cited by 87 publications

(58 citation statements)

References 29 publications

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“…The clinical details of 26 patients previously reported (2,4,8,15,17,18,19,21,22,23,28) are reported in Table 3. When the data for the 10 patients from the international K. pneumoniae bacteremia study were combined with those for the 26 previously reported patients, data for a total of 36 patients were available for analysis.…”

Section: Resultsmentioning

confidence: 99%

Outcome of Cephalosporin Treatment for Serious Infections Due to Apparently Susceptible Organisms Producing Extended-Spectrum β-Lactamases: Implications for the Clinical Microbiology Laboratory

et al. 2001

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Although extended-spectrum beta-lactamases (ESBLs) hydrolyze cephalosporin antibiotics, some ESBLproducing organisms are not resistant to all cephalosporins when tested in vitro. Some authors have suggested that screening klebsiellae or Escherichia coli for ESBL production is not clinically necessary, and when most recently surveyed the majority of American clinical microbiology laboratories did not make efforts to detect ESBLs. We performed a prospective, multinational study of Klebsiella pneumoniae bacteremia and identified 10 patients who were treated for ESBL-producing K. pneumoniae bacteremia with cephalosporins and whose infecting organisms were not resistant in vitro to the utilized cephalosporin. In addition, we reviewed 26 similar cases of severe infections which had previously been reported. Of these 36 patients, 4 had to be excluded from analysis. Of the remaining 32 patients, 100% (4 of 4) patients experienced clinical failure when MICs of the cephalosporin used for treatment were in the intermediate range and 54% (15 of 28) experienced failure when MICs of the cephalosporin used for treatment were in the susceptible range. Thus, it is clinically important to detect ESBL production by klebsiellae or E. coli even when cephalosporin MICs are in the susceptible range (< 8 g/ml) and to report ESBL-producing organisms as resistant to aztreonam and all cephalosporins (with the exception of cephamycins).

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Section: Resultsmentioning

confidence: 99%

Outcome of Cephalosporin Treatment for Serious Infections Due to Apparently Susceptible Organisms Producing Extended-Spectrum β-Lactamases: Implications for the Clinical Microbiology Laboratory

et al. 2001

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“…Pulsed-field gel electrophoresis of chromosomal DNA is probably the most widely used method of genotyping ESBL-producing organisms (15,17,57,68,85,113,128,132,149,207,218,222,234,235,256,268,298,328,334,341,348,351,358,374,381,408,426,431,439). These references describe the restriction enzymes used for various organisms harboring ESBLs.…”

Section: Use Of Typing Methodsmentioning

confidence: 99%

“…As was noted in the pre-ESBL era, neonatal intensive care units can also be a focus of infections with multiply resistant klebsiellae (6,38,121,217,348,386,387,408). Intensive care units in tertiary referral hospitals may acquire patients already colonized with ESBLproducing organisms, thereby triggering an outbreak of infection (147,363,364).…”

Section: Molecular Epidemiology Of Nosocomial Infections With Esbl-prmentioning

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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“…Irrespective of the primary source, it seems that the most significant reservoir of the microorganism is the digestive tract of colonized patients and that transmission occurs mostly via the hands of nursing staff (3,8). During the past decade, strains of K. pneumoniae exhibiting resistance to newer cephalosporins due to the production of extended-spectrum ␤-lactamases (ESBLs) have been frequently implicated in outbreaks in pediatric hospitals and neonatal intensive care units (NICUs) (1,15,16,20). These strains usually exhibit cross-resistance to other antibiotics, such as aminoglycosides.…”

mentioning

confidence: 99%

Extended-Spectrum β-Lactamase-ProducingKlebsiellapneumoniaein a Neonatal Intensive Care Unit in the High-Prevalence Area of Athens, Greece

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Tassios

et al. 2002

J Clin Microbiol

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Extended-spectrum ␤-lactamase-producing Klebsiella pneumoniae (EPKP) strains are frequently implicated in outbreaks in neonatal intensive care units (NICUs). During the period from 1997 to 1998, 21 infections and 23 colonizations with EPKP were recorded in the NICU of a children's hospital in Athens, Greece. Seventeen of the infected and 12 of the colonized neonates had been referred from other hospitals. The remaining infections and colonizations occurred during the current hospitalization. Pulsed-field gel electrophoresis typing showed that the latter cases were due to an outbreak strain that persisted in the unit, while the repeated introduction of EPKP carriers was mostly due to clonal outbreaks in two maternity hospitals.

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Molecular Epidemiology of an SHV-5 Extended-Spectrum -Lactamase in Enterobacteriaceae Isolated from Infants in a Neonatal Intensive Care Unit

Cited by 87 publications

References 29 publications

Outcome of Cephalosporin Treatment for Serious Infections Due to Apparently Susceptible Organisms Producing Extended-Spectrum β-Lactamases: Implications for the Clinical Microbiology Laboratory

Outcome of Cephalosporin Treatment for Serious Infections Due to Apparently Susceptible Organisms Producing Extended-Spectrum β-Lactamases: Implications for the Clinical Microbiology Laboratory

Extended-Spectrum β-Lactamases: a Clinical Update

Extended-Spectrum β-Lactamase-ProducingKlebsiellapneumoniaein a Neonatal Intensive Care Unit in the High-Prevalence Area of Athens, Greece

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