This Article
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrowReprints and Permissions
Right arrow Copyright Information
Right arrow Books from ASM Press
Right arrow MicrobeWorld
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by French, G. L.
Right arrow Articles by Simmons, N.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by French, G. L.
Right arrow Articles by Simmons, N.

 Previous Article  |  Next Article 

Journal of Clinical Microbiology, 02 1996, 358-363, Vol 34, No. 2
Copyright © 1996 by the American Society for Microbiology. All rights reserved.

Hospital outbreak of Klebsiella pneumoniae resistant to broad-spectrum cephalosporins and beta-lactam-beta-lactamase inhibitor combinations by hyperproduction of SHV-5 beta-lactamase

GL French, KP Shannon and N Simmons
Department of Microbiology, UMDS and Guy's and St. Thomas's Hospital Trust, London, United Kingdom.

An aminoglycoside- and ceftazidime-resistant strain of Klebsiella pneumoniae K2 producing the extended-spectrum beta-lactamase SHV-5 infected or colonized 14 pediatric patients at Guy's Hospital. The patients were mostly neonates recovering from cardiac surgery for congenital defects. The organism was also isolated from a nurse and from the father of one of the children. Four patients had septicemia, and two septicemic neonates with postoperative renal failure died. Aminoglycoside and cephalosporin resistance transferred to Escherichia coli in vitro on a 160-kb plasmid, and a similar resistant E. coli strain was isolated from the stools of one of the affected children. The epidemic organism colonized the bowel and skin and was probably transmitted via staff hands. Five wards were involved because of extensive patient movements. The outbreak was controlled by patient isolation and attention to handwashing. All of the isolates of the outbreak strain were identical by phage typing, ribotyping, plasmid profiling, and biochemical and serological testing, but they varied in their production of SHV-5. Some isolates produced normal amounts of SHV- 5 and were susceptible to beta-lactam-beta-lactamase inhibitor combinations. Others, including the single isolate of multiresistant E. coli, produced up to five times as much enzyme as "normal" isolates. This hyperproduction resulted in increased resistance to several penicillins and cephalosporins and to the beta-lactam-beta-lactamase inhibitor combinations amoxicillin-clavulanic acid, ampicillin- sulbactam, piperacillin-tazobactam, and ceftazidime-clavulanic acid. The hyperproduction of SHV-5 by K. pneumoniae and E. coli seen in this outbreak suggests that beta-lactam-beta-lactamase inhibitor combinations may be unreliable for the treatment of organisms producing extended-spectrum beta-lactamases.


This article has been cited by other articles:

  • Bratu, S., Landman, D., Martin, D. A., Georgescu, C., Quale, J. (2008). Correlation of Antimicrobial Resistance with {beta}-Lactamases, the OmpA-Like Porin, and Efflux Pumps in Clinical Isolates of Acinetobacter baumannii Endemic to New York City. Antimicrob. Agents Chemother. 52: 2999-3005 [Abstract] [Full Text]  
  • Moubareck, C., Lecso, M., Pinloche, E., Butel, M. J., Doucet-Populaire, F. (2007). Inhibitory Impact of Bifidobacteria on the Transfer of {beta}-Lactam Resistance among Enterobacteriaceae in the Gnotobiotic Mouse Digestive Tract. Appl. Environ. Microbiol. 73: 855-860 [Abstract] [Full Text]  
  • Paterson, D. L., Bonomo, R. A. (2005). Extended-Spectrum {beta}-Lactamases: a Clinical Update. Clin. Microbiol. Rev. 18: 657-686 [Abstract] [Full Text]  
  • Shannon, K. P., French, G. L. (2004). Increasing resistance to antimicrobial agents of Gram-negative organisms isolated at a London teaching hospital, 1995-2000. J Antimicrob Chemother 53: 818-825 [Abstract] [Full Text]  
  • Miranda, G., Castro, N., Leanos, B., Valenzuela, A., Garza-Ramos, U., Rojas, T., Solorzano, F., Chihu, L., Silva, J. (2004). Clonal and Horizontal Dissemination of Klebsiella pneumoniae Expressing SHV-5 Extended-Spectrum {beta}-Lactamase in a Mexican Pediatric Hospital. J. Clin. Microbiol. 42: 30-35 [Abstract] [Full Text]  
  • Ben-Hamouda, T., Foulon, T., Ben-Cheikh-Masmoudi, A., Fendri, C., Belhadj, O., Ben-Mahrez, K. (2003). Molecular epidemiology of an outbreak of multiresistant Klebsiella pneumoniae in a Tunisian neonatal ward. J Med Microbiol 52: 427-433 [Abstract] [Full Text]  
  • Gruteke, P., Goessens, W., van Gils, J., Peerbooms, P., Lemmens-den Toom, N., van Santen-Verheuvel, M., van Belkum, A., Verbrugh, H. (2003). Patterns of Resistance Associated with Integrons, the Extended-Spectrum {beta}-Lactamase SHV-5 Gene, and a Multidrug Efflux Pump of Klebsiella pneumoniae Causing a Nosocomial Outbreak. J. Clin. Microbiol. 41: 1161-1166 [Abstract] [Full Text]  
  • Mrowczynski, W., Wojtalik, M., Zawadzka, D., Sharma, G., Henschke, J., Bartkowski, R., Pawelec-Wojtalik, M., Wodzinski, A., Westerski, P. (2002). Infection Risk Factors in Pediatric Cardiac Surgery. Asian Cardiovasc. Thorac. Ann. 10: 329-333 [Abstract] [Full Text]  
  • Sahloff, E. G., Martin, S. J. (2002). Extended-Spectrum {beta}-Lactamase Resistance in the ICU. Journal of Pharmacy Practice 15: 96-105 [Abstract]  
  • Thomson, K. S., Moland, E. S. (2001). Cefepime, Piperacillin-Tazobactam, and the Inoculum Effect in Tests with Extended-Spectrum beta -Lactamase-Producing Enterobacteriaceae. Antimicrob. Agents Chemother. 45: 3548-3554 [Abstract] [Full Text]  
  • Silva, J., Gatica, R., Aguilar, C., Becerra, Z., Garza-Ramos, U., Velazquez, M., Miranda, G., Leanos, B., Solorzano, F., Echaniz, G. (2001). Outbreak of Infection with Extended-Spectrum {beta}-Lactamase-Producing Klebsiella pneumoniae in a Mexican Hospital. J. Clin. Microbiol. 39: 3193-3196 [Abstract] [Full Text]  
  • Steward, C. D., Rasheed, J. K., Hubert, S. K., Biddle, J. W., Raney, P. M., Anderson, G. J., Williams, P. P., Brittain, K. L., Oliver, A., McGowan, J. E. Jr., Tenover, F. C. (2001). Characterization of Clinical Isolates of Klebsiella pneumoniae from 19 Laboratories Using the National Committee for Clinical Laboratory Standards Extended-Spectrum {beta}-Lactamase Detection Methods. J. Clin. Microbiol. 39: 2864-2872 [Abstract] [Full Text]  
  • Tenover, F. C., Mohammed, M. J., Stelling, J., O'Brien, T., Williams, R. (2001). Ability of Laboratories To Detect Emerging Antimicrobial Resistance: Proficiency Testing and Quality Control Results from the World Health Organization's External Quality Assurance System for Antimicrobial Susceptibility Testing. J. Clin. Microbiol. 39: 241-250 [Abstract] [Full Text]  
  • Tenover, F. C., Mohammed, M. J., Gorton, T. S., Dembek, Z. F. (1999). Detection and Reporting of Organisms Producing Extended-Spectrum beta -Lactamases: Survey of Laboratories in Connecticut. J. Clin. Microbiol. 37: 4065-4070 [Abstract] [Full Text]  
  • Palucha, A., Mikiewicz, B., Gniadkowski, M. (1999). Diversification of Escherichia coli Expressing an SHV-Type Extended-Spectrum beta -Lactamase (ESBL) during a Hospital Outbreak: Emergence of an ESBL-Hyperproducing Strain Resistant to Expanded-Spectrum Cephalosporins. Antimicrob. Agents Chemother. 43: 393-396 [Abstract] [Full Text]  
  • Royle, J., Halasz, S., Eagles, G., Gilbert, G., Dalton, D., Jelfs, P., Isaacs, D. (1999). Outbreak of extended spectrum beta  lactamase producing Klebsiella pneumoniae in a neonatal unit. Arch. Dis. Child. Fetal Neonatal Ed. 80: 64F-68 [Abstract] [Full Text]  
  • Podschun, R., Ullmann, U. (1998). Klebsiella spp. as Nosocomial Pathogens: Epidemiology, Taxonomy, Typing Methods, and Pathogenicity Factors. Clin. Microbiol. Rev. 11: 589-603 [Abstract] [Full Text]  
  • Shannon, K., Stapleton, P., Xiang, X., Johnson, A., Beattie, H., El Bakri, F., Cookson, B., French, G. (1998). Extended-Spectrum beta -Lactamase-Producing Klebsiella pneumoniae Strains Causing Nosocomial Outbreaks of Infection in the United Kingdom. J. Clin. Microbiol. 36: 3105-3110 [Abstract] [Full Text]  
  • Gaillot, O., Maruéjouls, C., Abachin, E., Lecuru, F., Arlet, G., Simonet, M., Berche, P. (1998). Nosocomial Outbreak of Klebsiella pneumoniae Producing SHV-5 Extended-Spectrum beta -Lactamase, Originating from a Contaminated Ultrasonography Coupling Gel. J. Clin. Microbiol. 36: 1357-1360 [Abstract] [Full Text]  
  • Tzouvelekis, L., Tzelepi, E, Prinarakis, E, Gazouli, M, Katrahoura, A, Giakkoupi, P, Paniara, O, Legakis, N. (1998). Sporadic emergence of Klebsiella pneumoniae strains resistant to cefepime and cefpirome in Greek hospitals [In Process Citation]. J. Clin. Microbiol. 36: 266-268 [Abstract] [Full Text]  


Copyright © 2009 by the American Society for Microbiology.   For an alternate route to Journals.ASM.org, visit: http://intl-journals.asm.org | More Info»