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Journal of Clinical Microbiology, December 2001, p. 4433-4439, Vol. 39, No. 12
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.12.4433-4439.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Outbreak of Infection with Multidrug-Resistant Klebsiella pneumoniae Carrying blaIMP-8 in a University Medical Center in Taiwan

Jing-Jou Yan,1 Wen-Chien Ko,2 Shu-Huei Tsai,1 Hsiu-Mei Wu,3 and Jiunn-Jong Wu3,*

Departments of Pathology1 and Medicine,2 National Cheng Kung University Medical Center, and Department of Medical Technology,3 National Cheng Kung University Medical College, Tainan, Taiwan

Received 5 July 2001/Returned for modification 14 September 2001/Accepted 27 September 2001

Klebsiella pneumoniae strains with the transferable carbapenem-hydrolyzing metallo-beta -lactamases, which include IMP- and VIM-type enzymes, remain extremely rare. To investigate whether IMP- or VIM-producing K. pneumoniae isolates had spread at a university medical center in Taiwan, a total of 3,458 clinical isolates of K. pneumoniae consecutively collected in 1999 and 2000 were tested by the agar diffusion method, colony hybridization, PCR, and nucleotide sequencing. A total of 40 isolates (1.2%), or 17 nonrepetitive isolates, from 16 patients were found to carry blaIMP-8, a metallo-beta -lactamase gene recently identified from a K. pneumoniae strain in Taiwan. Carriage of blaVIM or other blaIMP genes was detected in none of the remaining isolates. Of the 17 nonrepetitive blaIMP-8-positive isolates, 15 isolates (88.2%) appeared susceptible to imipenem (MICs, <= 4 µg/ml) and meropenem (MICs, <= 1 µg/ml), indicating the difficulty in detecting blaIMP-8 in K. pneumoniae by routine susceptibility tests; 14 isolates (82.4%) produced SHV-12 as well; and 14 isolates (82.4%) were also resistant to fluoroquinolones. The organisms caused wound infections in eight patients and bloodstream infections in three patients. They were not directly associated with the death of nine patients. Before the recovery of the blaIMP-8-positive isolates, all 16 patients had undergone various surgical procedures, and 15 patients had been admitted to the surgical intensive care unit, suggesting a nosocomial outbreak. Two major patterns were observed by pulsed-field gel electrophoresis for 14 of the 17 nonrepetitive isolates, indicating that the clonal spread was mainly responsible for the outbreak.

* Corresponding author. Mailing address: Department of Medical Technology, National Cheng Kung University Medical College, No. 1 University Rd., Tainan, Taiwan 70101. Phone: 886-6-2353535, ext. 5775. Fax: 886-6-2363956. E-mail: jjwu{at}mail.ncku.edu.tw.

Journal of Clinical Microbiology, December 2001, p. 4433-4439, Vol. 39, No. 12
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.12.4433-4439.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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