Klebsiella pneumoniae infections in Greek hospitals. Dissemination of plasmids encoding an SHV-5 type β-lactamase

Legakis, Nicholas J.; Tzouvelekis, L. S.; Hatzoudis, George; Tzelepi, E.; Gourkou, A.; Pitt, T. L.; Vatopoulos, A.

doi:10.1016/0195-6701(95)90064-0

Cited by 33 publications

(34 citation statements)

References 23 publications

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“…Of the 205 isolates that gave a positive reaction for capsule in CIE, 67 patterns (single serotypes or combinations of serotypes) were observed. Some of the isolates reacted in combinations of patterns that have been noted in previous studies (19,25) (Table 1). Isolates which show cross-reactivity with several anticapsular sera have been thought to have greater resistance to antimicrobials (19); however, this was not the case in this series.…”

Section: Discussionmentioning

confidence: 70%

“…Some of the isolates reacted in combinations of patterns that have been noted in previous studies (19,25) (Table 1). Isolates which show cross-reactivity with several anticapsular sera have been thought to have greater resistance to antimicrobials (19); however, this was not the case in this series. Despite the use of enriched media to encourage capsule growth, 30% of the isolates were nontypeable and many of these appeared as small, dry colonies and therefore seemed to lack a capsule entirely.…”

Section: Discussionmentioning

confidence: 70%

“…As with other capsule-based vaccines, e.g., 23-valent pneumococcus vaccine, the efficacy of similar K. pneumoniae vaccines will depend on the distribution of capsule or "K" serotypes (5,6). The capsular distribution for K. pneumoniae K types is known to differ worldwide (3,9,16,19,29), but an acceptable explanation for this phenomenon has yet to be found.…”

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confidence: 99%

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Seroepidemiology ofKlebsiella pneumoniaein an Australian Tertiary Hospital and Its Implications for Vaccine Development

et al. 2006

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The aim of this study was to determine the diversity of Klebsiella pneumoniae capsular serotypes in an Australian setting. Consecutive (n ‫؍‬ 293) nonrepetitive isolates of K. pneumoniae from a large teaching hospital laboratory were analyzed. The majority of isolates were from urinary specimens (60.8%); the next most common source was sputum (14.3%), followed by blood (14%). Serotyping revealed a wide range of capsule types. K54 (17.1%), K28 (4.1%), and K17 (3.1%) were the most common, and K54 isolates displayed a high degree of clonality, suggesting a common, nosocomial source. In vitro, one K54 isolate was more adherent to urinary catheters and HEp-2 cells than four other tested isolates; it was slightly more resistant to chlorhexidine but was more susceptible to drying than heavily encapsulated strains. This is the first seroprevalence survey of K. pneumoniae to be performed on Australian isolates, and the high level of diversity of serotypes suggests that capsule-based immunoprophylaxis might not be useful for Australia. In addition there are significant differences in the predominance of specific serotypes compared to the results of surveys performed overseas, which has important implications for capsule-based immunoprophylaxis aimed at a global market.

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 70%

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Seroepidemiology ofKlebsiella pneumoniaein an Australian Tertiary Hospital and Its Implications for Vaccine Development

et al. 2006

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“…They have been responsible for outbreaks, particularly in intensive care units and in chronic care facilities, but have occasionally spread also to medical and surgical wards [7-131. Hospital colonisation by ESBL-producing bacteria can reflect dissemination of a few clones, or the spread of plasmids and resistance genes [13][14][15][16][17][18][19][20][21], facilitated by antibiotic pressure and inadequate infection-control practice [9-10, [22][23][24]. Several outbreaks of nosocomial infections caused by ESBL-producing K. pneumoniae occurred in our hospital between 1988 and 199 1.…”

Section: Introductionmentioning

confidence: 99%

Long-term investigation of the clonal dissemination of Klebsiella pneumoniae isolates producing extended-spectrum -lactamases in a university hospital

Branger

Lesimple²,

Berry³

et al. 1998

Journal of Medical Microbiology

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Seventy isolates of Klebsiellu pneumoniae with extended-spectrum /3-lactamases (ESBLs) were compared. These were isolated from 51 patients on 10 separate wards in one hospital over an 18-month period between 1992 and 1994. Antibiograms were determined and the isolates were typed by pulsed-field gel electrophoresis of their DNA digestion with Xbu I. The isolates were compared to three genotypically different epidemic strains responsible for previous outbreaks at the hospital between 1988 and 1991. Isolates from 84% of the present patients had closely related Xbul patterns, and most (74%) produced an ESBL with an iso-electric point (PI) of 7.0. A similar pattern was found for one of the previous epidemic strains, but it produced an ESBL with a PI of 7.8; isolates with this latter enzyme variant were found only in six of the present patients. The two other previous epidemic strains had ESBLs with a PI of 6.3 and organisms related to them were found in one and two of the present patients, respectively.

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“…Indeed, an outbreak of nosocomial infections due to the spread of TEM-21-producing enterobacteria and a TEM-21-encoding plasmid among different species of the family Enterobacteriaceae has previously been demonstrated for other patients in this nursing home during a 6-month survey in 1999 (3). Outbreaks of ESBL-producing enterobacteria due to the spread of resistant plasmids have been described in hospitals (9,10,20,26,36) as well as in long-term-care facilities (49), but the persistence of the ESBL-producing enterobacteria in the nursing home described here during at least a 6-year period reflected an endemic situation that has, until now, been reported only in hospitals (19,29). Among the ESBLs elaborated by enterobacteria, TEM-21 is less frequent than TEM-24 and TEM-3 in France (11,12,19), but it has been already detected in the Bordeaux area (3,46) and was unknown in P. aeruginosa until our description (14).…”

Section: Discussionmentioning

confidence: 99%

Prolonged Outbreak of Infection Due to TEM-21-Producing Strains ofPseudomonas aeruginosaand Enterobacteria in a Nursing Home

Dubois

Arpin

Noury³

et al. 2005

J Clin Microbiol

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Over a 6-year period, 24 extended-spectrum ␤-lactamase (ESBL)-producing isolates of Pseudomonas aeruginosa were collected from 18 patients living in a nursing home. These isolates had a delayed development of a red pigment and exhibited a similar antibiotype (resistance to all ␤-lactams except for imipenem and to gentamicin, tobramycin, netilmicin, ciprofloxacin, and rifampin) associated with the production of the TEM-21 ␤-lactamase and a type II 3-N-aminoglycoside acetyltransferase [AAC(3)-II] enzyme. Surprisingly, serotyping showed that these isolates belonged to four successive serotypes (P2, P16, P1, and PME), although molecular typing by PCR methods and pulsed-field gel electrophoresis yielded identical or similar profiles. Moreover, in all isolates the bla TEM-21 gene was part of a chromosomally located Tn801 transposon truncated by an IS6100 element inserted within the resolvase gene, and the aac(3)-II gene was adjacent to this structure. During the same period, 17 ESBL-producing isolates of enterobacteria were also collected from 10 of these patients. These isolates harbored a similar large plasmid that contained the bla TEM-21 and the aac(3)-II genes and that conferred additional resistance to sulfonamides and chloramphenicol, as well as to kanamycin, tobramycin, netilmicin, and amikacin, conveyed by an AAC(6)-I enzyme. The bla TEM-21 gene was part of the Tn801 transposon disrupted by IS4321. Thus, a single clone of P. aeruginosa that had undergone a progressive genetic drift associated with a change in serotype appeared to be responsible for an outbreak of nosocomial infections in a nursing home. This strain has probably acquired the bla TEM-21 -encoding plasmid that was epidemic among the enterobacteria at the institution, followed by chromosomal integration and genomic reorganization.Pseudomonas aeruginosa is a saprophytic organism widespread in nature, particularly in moist environments (water, soil, plants, and sewage). This bacterial species is endowed with only a weak pathogenic potential in immunocompetent persons (2, 17, 21, 23) but can cause severe and even fatal infections in patients with impaired specific or nonspecific defense systems (40). Thus, P. aeruginosa is rarely involved in community-acquired infections, while it is responsible for a wide range of hospital-acquired infections, such as pneumonia, urinary tract infections (UTIs), and bacteremia. Moreover, a series of outbreaks due to this important and frequent nosocomial pathogen has been reported in hospital intensive care, burn wound, and cancer units (6, 13, 42). In contrast, little has been reported on P. aeruginosa-induced infections in long-term-care facilities, including nursing homes; and most of the studies that have reported such infections have described sporadic cases rather than outbreaks (16,22,44).Linked to its nosocomial status, P. aeruginosa is intrinsically resistant to most antimicrobials. In addition, resistance to the main active agents, i.e., ␤-lactams and aminoglycosides, by gene acquisition is common. However...

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Klebsiella pneumoniae infections in Greek hospitals. Dissemination of plasmids encoding an SHV-5 type β-lactamase

Cited by 33 publications

References 23 publications

Seroepidemiology ofKlebsiella pneumoniaein an Australian Tertiary Hospital and Its Implications for Vaccine Development

Seroepidemiology ofKlebsiella pneumoniaein an Australian Tertiary Hospital and Its Implications for Vaccine Development

Long-term investigation of the clonal dissemination of Klebsiella pneumoniae isolates producing extended-spectrum -lactamases in a university hospital

Prolonged Outbreak of Infection Due to TEM-21-Producing Strains ofPseudomonas aeruginosaand Enterobacteria in a Nursing Home

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