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Journal of Clinical Microbiology, September 2002, p. 3121-3126, Vol. 40, No. 9
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.9.3121-3126.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.

Emergence of Klebsiella pneumoniae Isolates Producing Inducible DHA-1 ß-Lactamase in a University Hospital in Taiwan

Jing-Jou Yan,1 Wen-Chien Ko,2 Yun-Chih Jung,3 Chin-Luan Chuang,1 and Jiunn-Jong Wu4*

Departments of Pathology,1 Internal Medicine,2 Medical Technology, College of Medicine, National Cheng Kung University,4 Department of Pathology, Sinlau Christian Hospital, Tainan, Taiwan3

Received 26 March 2002/ Returned for modification 25 May 2002/ Accepted 22 June 2002

Ten nonrepetitive clinical isolates of Klebsiella pneumoniae exhibiting an unusual inducible ß-lactam resistance phenotype were identified between January 1999 and September 2001 in a university hospital in Taiwan. In the presence of 2 µg of clavulanic acid, the isolates showed a one to four twofold concentration increase in the MICs of ceftazidime, cefotaxime, and aztreonam but remained susceptible to cefepime (MICs, <=0.5 µg/ml) and imipenem (MICs, <=0.5 µg/ml). PCR, sequence analysis, and isoelectric focusing revealed production by these isolates of TEM-1, SHV-11, and DHA-1, a plasmid-encoded inducible AmpC ß-lactamase originally found in a Salmonella enterica serovar Enteritidis strain. Transfer of the resistance by conjugation experiments was not successful, but Southern hybridization showed that blaDHA-1 was located on 70-kb plasmids, suggesting that the blaDHA-1-containing plasmids in the K. pneumoniae isolates were non-self-transmissible. Five isolates were recovered from patients in two surgery wards and two intensive care units. Acquisition of the DHA-1 producers could be traced back to previous hospitalizations 1 to 5 months earlier for the other five patients. Six and seven patterns among the isolates were demonstrated by plasmid analysis and ribotyping, respectively, indicating that the spread of the DHA-1 producers was due to both horizontal transfer of blaDHA-1 and dissemination of endemic clones.

* Corresponding author. Mailing address: Department of Medical Technology, College of Medicine, National Cheng Kung University, 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, September 2002, p. 3121-3126, Vol. 40, No. 9
0095-1137/02/$04.00+0     DOI: 10.1128/JCM.40.9.3121-3126.2002
Copyright © 2002, American Society for Microbiology. All Rights Reserved.



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