Dissemination of an antibiotic resistance plasmid in hospital patient flora

The 2'' aminoglycoside nucleotidyltransferase, AAD (2''), which adenylates gentamicin, tobramycin, and kanamycin, became prevalent over several months in multiple strains and species of Enterobacteriaceae isolated at one hospital. Eight plasmids with the gene for this enzyme purified from different strains and species isolated at different times had similar EcoRI digestion fragments, indicating that the gene had disseminated on one plasmid without transposition. This 56.5-megadalton plasmid of incompatibility group M, which also carried three other resistance genes, spread, at first, largely in one strain of Klebsiella pneumoniae, which later disappeared. It transferred to some strains which tended not to colonize other patients and later circulated predominantly in Serratia marcescens. Computer surveillance of routine hospital laboratory results was able to detect and trace the gene and the plasmid and measure their effect on resistance prevalence.