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Journal of Clinical Microbiology, November 2000, p. 3946-3952, Vol. 38, No. 11
Departments of Pathology and Medicine,
Northwestern University Medical School, and the Clinical Microbiology
Laboratory, Veterans Administration Chicago Health Care System Lakeside
Division, Chicago, Illinois 606111;
Enteric Reference Laboratory, Foodborne and Diarrheal Diseases
Laboratory Section, Division of Bacterial and Mycotic Diseases,
National Center for Infectious Diseases, Centers for Disease Control
and Prevention, Atlanta, Georgia 303332; and
Department of Molecular Genetics, The Forsyth Institute,
Boston, Massachusetts 021153
Received 24 May 2000/Returned for modification 1 July 2000/Accepted 31 July 2000
A member of the Enterobacteriaceae initially identified
as Kluyvera cryocrescens by the MicroScan Gram-Negative
Combo 13 panel caused an outbreak of nosocomial infections in four
patients (pneumonia, n = 2; urinary tract infection,
n = 1; wound infection, n = 1) and
urinary tract colonization in one patient. When the strains were tested
by the Enteric Reference Laboratory of the Centers for Disease Control
and Prevention, biochemical results were most compatible with
Yersinia intermedia, Kluyvera cryocrescens, and Citrobacter farmeri but identification scores were low and
test results were discrepant. However, when the biochemical test
profile was placed in the computer database as a new organism, all
strains were identified as the organism with high identification scores (0.999968 to 0.999997) and no discrepant test results. By 16S rRNA
sequence analysis the organism clustered most closely with, but was
distinct from, Citrobacter farmeri and Citrobacter
amalonaticus. Based on its unique biochemical profile and rRNA
sequence, this organism is designated Enteric Group 137. Restriction
endonuclease analysis and taxonomic antibiograms of strains causing the
outbreak demonstrated a single clone of Enteric Group 137, and
antibiotic susceptibility testing revealed the presence of
extended-spectrum
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.
Outbreak of Nosocomial Infections Due to Extended-Spectrum
-Lactamase-Producing Strains of Enteric Group 137, a New Member
of the Family Enterobacteriaceae Closely Related to
Citrobacter farmeri and Citrobacter
amalonaticus
-lactamase (ESBL) resistance. Enteric Group 137 appears to be a new opportunistic pathogen that can serve as a source
of ESBL resistance in the hospital.
*
Corresponding author. Mailing address: Department of
Pathology, Northwestern University Medical School, 303 East Chicago
Ave., Chicago, IL 60611. Phone: (312) 908-2417. Fax: (312) 908-4559. E-mail: jwarren{at}nmh.org.
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