Transmission of a Klebsiella pneumoniae clone harbouring genes for CTX-M-15-like and SHV-112 enzymes in a neonatal intensive care unit of a Kuwaiti hospital

Abstract

The spread of antibiotic-resistant bacteria has become a large problem in most countries including Kuwait. This antibiotic resistance is usually due to the production of extended-spectrum b-lactamase (ESBL) enzymes such as SHV, TEM and CTX-M. This study reports the emergence and spread of an ESBL-producing Klebsiella pneumoniae clone in a neonatal intensive care unit (NICU) in a Kuwaiti hospital. Eight ESBL-producing K. pneumoniae isolates were from blood cultures of seven neonates, and two were from the fingers of two healthcare workers in a NICU in Al Jahra Hospital, Kuwait. All isolates were obtained in February-March 2006, except for one, which was obtained in August 2005. Identification of the bacteria was based on traditional bacteriological and biochemical tests using the Vitek system. Antibiotic susceptibility was tested by the disc diffusion method using 16 different antibiotics. ESBLs were detected using disc approximation and double-disc synergy methods and confirmed as ESBLs using Etest. PCR and DNA sequencing were performed to determine the genotypes and mutations in the b-lactamase genes (bla TEM , bla SHV and bla CTX-M). Genetic relatedness was determined by PFGE. All isolates were confirmed to have ESBLs by the Vitek system, disc approximation test, double-disc diffusion test and Etest, being resistant to cefotaxime, ceftazidime, cefepime, gentamicin, tobramycin and ciprofloxacin but susceptible to tetracycline and trimethoprim-sulfamethoxazole. Molecular studies showed the isolates to have TEM-1 b-lactamase, a CTX-M-15-like ESBL and the newly discovered SHV-112 ESBL. PFGE showed that all isolates had identical banding patterns. The results indicate that a single clone of ESBL-producing K. pneumoniae caused bloodstream infections among babies in a NICU of a Kuwaiti hospital, and may have emerged at least 5 years ago. This clone was also present on the hands of healthcare workers, suggesting that they may have been involved in its transmission. Further studies are recommended to determine whether this clone is also spreading in other Kuwaiti hospitals.

Molecular characterization of extended-spectrum beta-lactamase producing Enterobacteriaceae in a Saudi Arabian tertiary hospital

“…The presence of more than one ESBL in a single isolate is being increasingly detected [17,38,42]. In this study, coexistence of bla SHV and bla CTX-M genes was detected in 20.5 % of the strains.…”

β-Lactamase Production in Key Gram-Negative Pathogen Isolates from the Arabian Peninsula

“…These findings imply that VEB-type ESBLs are common in the Middle East. The identification of SHV-112 as a novel ESBL variant has been reported only from Kuwait (83,84). The novel PME-1 ESBL, a PER-7 variant, and the rare GES ESBL produced by Acinetobacter and P. aeruginosa from UAE and Saudi Arabia are other examples of the emerging and rare ␤-lactamases found in the Gulf states (23-25, 57, 58) (Fig.…”

“…It is well known that the ESBL type CTX-M-15 is ubiquitous in the Indian subcontinent (167)(168)(169)(170)(171). If inpatients are colonized with ESBL-or carbapenemases-positive bacteria, endogenous infections and/or patientto-patient transmission can occur, which may account for the high prevalence of CTX-M-15 producers isolated from hospitals in Gulf countries (52,54,56,76,84).…”

“…Novel SHV-like enzymes have emerged, and some were first identified in Kuwait, for example, SHV-112 (83). Ten K. pneumoniae isolates caused outbreaks in a neonatal intensive care unit (NICU) and were found to be carrying bla TEM-1 , bla CTX-M-15 , and bla SHV-112 (84). Another SHV-112-producing K. pneumoniae isolate caused an outbreak in 3 different wards and in an ICU at a single hospital in Kuwait during a period of 2 months in 2007 (Table 3).…”

Detection of the SHV genotype polymorphism of the extended-spectrum β-lactamase-producing Gram-negative bacterium

“…As opposed to methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci, ESBLs-producing strains are another class of primary pathogenic bacteria (17,18). ESBLs mediated by plasmids are common in Enterobacteriaceae, particularly in E. coli and K. pneumoniae, which have been reported to cause serious infections in hospitals, as well as in the community in different parts of the world (19,20).…”