Extended-Spectrum b-Lactamase-Producing Klebsiella pneumoniae Strains Causing Nosocomial Outbreaks of Infection in the United Kingdom

Representative isolates from 10 distinct extended-spectrum b-lactamase-producing strains of Klebsiella pneumoniae that caused hospital outbreaks in the United Kingdom from 1991 to 1994 were examined for relationships between their enzymes and plasmids. The b-lactamases were identified by a combination of isoelectric focusing and gene sequencing. SHV-2 b-lactamase was produced by isolates from four outbreaks, SHV-5 was involved in three, and SHV-4, TEM-15, and TEM-26 were involved in one outbreak each. All of the extended-spectrum b-lactamases were encoded by self-transmissible plasmids, with sizes ranging from about 70 to 160 kb. No similarities between the restriction digest patterns of the extended-spectrum b-lactamaseencoding plasmids were detected, except to some extent between those that produced TEM-15 and TEM-26. Thus, outbreaks of hospital infection with these organisms in the United Kingdom from 1991 to 1994 involved distinct organisms and resistance plasmids and appeared to be unrelated.

[1]  I. Phillips,et al.  Incidence and Mechanisms of Resistance to the Combination of Amoxicillin and Clavulanic Acid in Escherichia coli , 1998, Antimicrobial Agents and Chemotherapy.

[2]  S. Haeggman,et al.  An allelic variant of the chromosomal gene for class A beta-lactamase K2, specific for Klebsiella pneumoniae, is the ancestor of SHV-1 , 1997, Antimicrobial agents and chemotherapy.

[3]  G. French,et al.  Mechanism and stability of hyperproduction of the extended-spectrum beta-lactamase SHV-5 in Klebsiella pneumoniae. , 1997, The Journal of antimicrobial chemotherapy.

[4]  R. Gaynes,et al.  Evidence of Interhospital Transmission of Extended-Spectrum β-Lactam-Resistant Klebsiella pneumoniae in the United States, 1986 to 1993 , 1997, Infection Control & Hospital Epidemiology.

[5]  A. Lesimple,et al.  Epidemiological typing of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae isolates responsible for five outbreaks in a university hospital. , 1997, The Journal of hospital infection.

[6]  F. Kayser,et al.  Survey and molecular genetics of SHV beta-lactamases in Enterobacteriaceae in Switzerland: two novel enzymes, SHV-11 and SHV-12 , 1997, Antimicrobial agents and chemotherapy.

[7]  I. Stemplinger,et al.  Molecular epidemiology of Klebsiella pneumoniae producing SHV-5 beta- lactamase: parallel outbreaks due to multiple plasmid transfer , 1996, Journal of clinical microbiology.

[8]  G L French,et al.  Hospital outbreak of Klebsiella pneumoniae resistant to broad-spectrum cephalosporins and beta-lactam-beta-lactamase inhibitor combinations by hyperproduction of SHV-5 beta-lactamase , 1996, Journal of clinical microbiology.

[9]  J. Knox,et al.  Extended-spectrum and inhibitor-resistant TEM-type beta-lactamases: mutations, specificity, and three-dimensional structure , 1995, Antimicrobial agents and chemotherapy.

[10]  T. Pitt,et al.  Klebsiella pneumoniae infections in Greek hospitals. Dissemination of plasmids encoding an SHV-5 type beta-lactamase. , 1995, The Journal of hospital infection.

[11]  R. Venezia,et al.  Molecular epidemiology of an SHV-5 extended-spectrum beta-lactamase in enterobacteriaceae isolated from infants in a neonatal intensive care unit. , 1995, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[12]  J. Heritage,et al.  Molecular epidemiology of ceftazidime resistant Enterobacteriaceae from patients on a paediatric oncology ward. , 1995, The Journal of antimicrobial chemotherapy.

[13]  Barry W. Walsh,et al.  International inter- and intrahospital patient spread of a multiple antibiotic-resistant strain of Klebsiella pneumoniae. , 1995, The Journal of infectious diseases.

[14]  J. Lemeland,et al.  Clonal outbreaks of extended-spectrum beta-lactamase-producing strains of Klebsiella pneumoniae demonstrated by antibiotic susceptibility testing, beta-lactamase typing, and multilocus enzyme electrophoresis , 1994, Journal of clinical microbiology.

[15]  P. Lagrange,et al.  Molecular epidemiology of Klebsiella pneumoniae strains that produce SHV-4 beta-lactamase and which were isolated in 14 French hospitals , 1994, Journal of clinical microbiology.

[16]  K. Bush,et al.  Multiply resistant Klebsiella pneumoniae strains from two Chicago hospitals: identification of the extended-spectrum TEM-12 and TEM-10 ceftazidime-hydrolyzing beta-lactamases in a single isolate , 1994, Antimicrobial Agents and Chemotherapy.

[17]  K. Bush,et al.  Identification of TEM-26 beta-lactamase responsible for a major outbreak of ceftazidime-resistant Klebsiella pneumoniae , 1994, Antimicrobial Agents and Chemotherapy.

[18]  S. B. Singer,et al.  Outbreak of Ceftazidime Resistance Due to a Novel Extended-Spectrum β-Lactamase in Isolates from Cancer Patients , 1993, Antimicrobial Agents and Chemotherapy.

[19]  I. Phillips,et al.  Prevalence of resistance to β-lactam antibiotics in Escherichia coli isolated from blood from 1969–1991 , 1992 .

[20]  J. Heritage,et al.  Transposition of the gene encoding a TEM-12 extended-spectrum beta-lactamase , 1992, Antimicrobial Agents and Chemotherapy.

[21]  R. George,et al.  Outbreak of infection in two UK hospitals caused by a strain of Klebsiella pneumoniae resistant to cefotaxime and ceftazidime. , 1992, The Journal of hospital infection.

[22]  G. Jacoby,et al.  More extended-spectrum beta-lactamases , 1991, Antimicrobial Agents and Chemotherapy.

[23]  A. Darfeuille‐Michaud,et al.  Translocation of antibiotic resistance determinants including an extended-spectrum beta-lactamase between conjugative plasmids of Klebsiella pneumoniae and Escherichia coli , 1991, Antimicrobial Agents and Chemotherapy.

[24]  S. Amyes,et al.  Transferable resistance to extended-spectrum beta-lactams: a major threat or a minor inconvenience? , 1991, The Journal of antimicrobial chemotherapy.

[25]  G. Jacoby,et al.  Properties of plasmids responsible for production of extended-spectrum beta-lactamases , 1991, Antimicrobial Agents and Chemotherapy.

[26]  P. Courvalin,et al.  Development of "oligotyping" for characterization and molecular epidemiology of TEM beta-lactamases in members of the family Enterobacteriaceae , 1990, Antimicrobial Agents and Chemotherapy.

[27]  A. Huletsky,et al.  Nucleotide sequence and phylogeny of SHV-2 beta-lactamase , 1990, Antimicrobial Agents and Chemotherapy.

[28]  G. Gerbaud,et al.  Klebsiella pneumoniae and other Enterobacteriaceae producing novel plasmid-mediated beta-lactamases markedly active against third-generation cephalosporins: epidemiologic studies. , 1988, Reviews of infectious diseases.

[29]  S. T. Liu,et al.  Rapid procedure for detection and isolation of large and small plasmids , 1981, Journal of bacteriology.

[30]  I. Phillips,et al.  The in vitro antibacterial activity of cefotaxime compared with that of cefuroxime and cefoxitin. , 1980, The Journal of antimicrobial chemotherapy.

[31]  H. Birnboim,et al.  A rapid alkaline extraction procedure for screening recombinant plasmid DNA. , 1979, Nucleic acids research.

[32]  I. Phillips,et al.  Aminoglycoside resistance among Enterobacteriaceae and Acinetobacter species. , 1978, The Journal of antimicrobial chemotherapy.

[33]  G. French,et al.  Rarity of transferable-lactamase production by Klebsiella species , 1997 .

[34]  P. Ronza,et al.  Extended-spectrum beta-lactamases from Klebsiella pneumoniae strains isolated at an Italian hospital. , 1994, European journal of epidemiology.

[35]  P. Attwood,et al.  Characterization of an SHV‐5 related extended broad‐spectrum beta‐lactamase in enterobacteriaceae from western australia , 1993, Pathology.

[36]  A. Bauernfeind,et al.  Spread of Klebsiella pneumoniae producing SHV-5 beta-lactamase among hospitalized patients. , 1993, Infection.

[37]  J. Waitz.  Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically , 1990 .

[38]  J. Saunders,et al.  Genetics and evolution of antibiotic resistance. , 1984, British medical bulletin.

[39]  R. Hedges,et al.  The nature of the genetic determinant for the SHV-1 beta-lactamase. , 1979, Molecular & general genetics : MGG.

[40]  G. Jacoby,et al.  Nomenclature of TEM-lactamases , 2022 .