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Journal of Clinical Microbiology, November 2000, p. 3946-3952, Vol. 38, No. 11
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Outbreak of Nosocomial Infections Due to Extended-Spectrum beta -Lactamase-Producing Strains of Enteric Group 137, a New Member of the Family Enterobacteriaceae Closely Related to Citrobacter farmeri and Citrobacter amalonaticus

John R. Warren,1,* J. J. Farmer III,2 Floyd E. Dewhirst,3 Karen Birkhead,2 Teresa Zembower,1 Lance R. Peterson,1 Lola Sims,1 and Mondira Bhattacharya1

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 beta -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.


Journal of Clinical Microbiology, November 2000, p. 3946-3952, Vol. 38, No. 11
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.



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