Patterns of Resistance Associated with Integrons, the Extended-Spectrum β-Lactamase SHV-5 Gene, and a Multidrug Efflux Pump of Klebsiella pneumoniae Causing a Nosocomial Outbreak
| Autor: | Paul Gruteke, Marga van Santen-Verheuvel, Paul G. H. Peerbooms, Wil H. F. Goessens, Nicole Lemmens-den Toom, Alex van Belkum, Henri A. Verbrugh, Jan van Gils |
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| Přispěvatelé: | Medical Microbiology & Infectious Diseases |
| Rok vydání: | 2003 |
| Předmět: |
Adult
DNA Topoisomerase IV Male Microbiology (medical) ATP Binding Cassette Transporter Subfamily B Klebsiella pneumoniae Statistics as Topic Microbial Sensitivity Tests Integron DNA gyrase beta-Lactamases Disease Outbreaks Integrons Microbiology Drug Resistance Bacterial medicine Humans Cefoxitin Typing Aged Netherlands Aged 80 and over Cross Infection biology Genetic strain Outbreak Bacteriology biochemical phenomena metabolism and nutrition Middle Aged bacterial infections and mycoses biology.organism_classification Virology Anti-Bacterial Agents Klebsiella Infections Ciprofloxacin DNA Gyrase biology.protein Female medicine.drug |
| Zdroj: | Journal of Clinical Microbiology, 41(3), 1161-1166. American Society for Microbiology |
| ISSN: | 1098-660X 0095-1137 |
| Popis: | Multiresistant Klebsiella pneumoniae caused a nosocomial outbreak. Resistance patterns of the presumed outbreak isolates varied among and within patients. In order to control the outbreak, screening for extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae was commenced. A number of susceptible K. pneumoniae strains were stored to serve as controls in genetic strain typing. Typing by pulsed-field gel electrophoresis proved the clonality of the strains in the recognized outbreak patients. Typing of the control strains by pulsed-field gel electrophoresis showed that at least one patient had been missed by the ESBL screening procedure. Further genetic typing confirmed the presence of the SHV-5 ESBL gene in all but one of the outbreak strains. Variable presence of integrons that carried the aminoglycoside resistance genes aadB and aadA2 was found. A gyrA mutation in codon 83 was present in all outbreak strains tested, despite considerable differences in ciprofloxacin MICs. The MICs of ciprofloxacin and the chemically unrelated drug cefoxitin were correlated ( r = 0.86, P < 0.01) and were compatible with the overexpression of an efflux pump in a subset of the outbreak strains. We conclude that outbreak strains that express an ESBL gene only at a low level may pass unnoticed in a screening procedure, when the laboratory is unaware of variable ESBL expression. In this particular outbreak, screening for strains for which ciprofloxacin MICs were ≥0.25 μg/ml would in retrospect have been the most sensitive method for detection of the K. pneumoniae outbreak strain. |
| Databáze: | OpenAIRE |
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