A total of 33 clinical isolates encoding TEM-3 (CTX-1) from four French hospitals were studied. The strains belonged to seven species, Klebsiella pneumoniae (n = 24), Escherichia coli (n = 3), Serratia marcescens (n = 2), Citrobacterfreundii (n = 1), Enterobacter aerogenes (n = 1), Enterobacter cloacae (n = 1), and Klebsiella oxytoca (n = 1). All the strains harbored an Inc7 or M self-transferable plasmid with a size of approximately 85 kilobases. The plasmids had closely related EcoRI, HincH, HindIll, and PvuH restriction endonucleasegenerated patterns and conferred resistance to all P-lactams, except cephamycins and imipenem; to tetracycline, because of the presence of the genes blatem3 and tetC, respectively, as determined by hybridization with specific probes; and to sulfonamide. Depending on the presence or absence and level of expression of the genes aacA4, aadA, and dfrl and of insertion element IS15, four types of plasmids could be distinguished.Plasmid pCFF04, the prototype plasmid encoding TEM-3, was widespread and appeared, by Southern hybridization, as the progenitor of the other types of replicons. The plasmid epidemic responsible for dissemination of TEM-3 in clinical isolates of members of the family Enterobacteriaceae may have originated in S. marcescens since pCFF04 was first detected in this species.In 1983, Knothe et al. (9) described the first transferable resistance to broad-spectrum cephalosporins in clinical isolates of Klebsiella pneumoniae and Serratia marcescens. This new resistance phenotype was due to production of a broad-spectrum P-lactamase, SHV-2, which evolved from the chromosomal SHV-l enzyme (8). Since 1984, strains of K. pneumoniae that produce a novel, transferable, broadspectrum P-lactamase have been isolated in Clermont-Ferrand hospitals (21). The enzyme was designated CTX-1 because of its high hydrolytic activity against cefotaxime. It was later shown to be derived from the TEM-2 enzyme (23) and was therefore redesignated TEM-3. In an earlier study (22), we screened 490 members of the family Enterobacteriaceae isolated between 1984 and 1987 that exhibited an antibiotic resistance phenotype similar to that of the first TEM-3-producing strains (21). We concluded that P-lactam resistance via synthesis of TEM-3 spread into seven different bacterial genera and was due to dissemination of a single 85-kilobase (kb) Inc7 or M plasmid, pCFF04. Here we report the molecular characterization of the plasmids isolated in 33 clinical isolates representative of the TEM-3-producing strains obtained from Clermont-Ferrand hospitals and three other geographically distant French hospitals.
MATERIALS AND METHODSBacterial strains and plasmids. Twenty-eight strains of members of the family Enterobacteriaceae (22) were selected to represent all species of bacteria involved, different times of isolation over a 3-year period, different wards in which infection with TEM-3-producing bacteria occurred, and different biotypes (API 50 CH; API System S.A., Montalieu-Vercieu, France) of the most important ...