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Journal of Clinical Microbiology, December 2002, p. 4666-4669, Vol. 40, No. 12
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.12.4666-4669.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Molecular Epidemiology of Extended-Spectrum ß-Lactamase-Producing, Fluoroquinolone-Resistant Isolates of Klebsiella pneumoniae in Taiwan

Division of Medical Microbiology, Department of Pathology, University of Iowa, College of Medicine, Iowa City, Iowa 52242,¹ The Jones Group/JMI Laboratories, North Liberty, Iowa 52317,³ Tufts University School of Medicine, Boston, Massachusetts 02111,⁴ Division of Infectious Diseases, Department of Medicine, China Medical College Hospital, Taichung, Taiwan²

Received 27 June 2002/ Returned for modification 5 August 2002/ Accepted 25 September 2002

Strains of extended-spectrum ß-lactamase-producing Klebsiella pneumoniae (ESBL-KP) have emerged worldwide. Concomitant ciprofloxacin resistance with ESBL production in K. pneumoniae isolates would severely restrict treatment options. Among 39 (18.5%) of 211 ESBL-KP isolates resistant to ciprofloxacin (MIC, 4 µg/ml), 37 (95%) were high level resistant (MIC, 16 µg/ml). These isolates were also cross resistant to the newer fluoroquinolones, including levofloxacin, gatifloxacin, gemifloxacin, and garenoxacin (BMS 284756). Sitafloxacin was most active against these ciprofloxacin-resistant ESBL-KP isolates with MICs for 67% of the isolates being 2 µg/ml. The molecular epidemiology of these multiresistant isolates was investigated by automated ribotyping and pulsed-field gel electrophoresis (PFGE). Ribotyping identified 18 different strains among the 39 ciprofloxacin-resistant ESBL-KP isolates. The majority (67%) of these isolates were contained in six ribogroups which were further confirmed by PFGE. The distribution of the six major strains of ciprofloxacin-resistant ESBL-KP within Taiwan included one (ribogroup 255.3-PFGE type E) with a nationwide distribution and several institution-specific strains. Interhospital cooperation appears necessary, with strict infection control practices coupled with restriction of fluoroquinolone and extended-spectrum ß-lactam use to control both the major epidemic strain and the more diverse strains observed within individual institutions.

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