Molecular Epidemiology of Extended-Spectrum β-Lactamase-Producing
            <i>Klebsiella pneumoniae</i>
            Isolates in a District Hospital in Taiwan

Liu, Peter Yuk-Fong; Tung, Jai-Chin; Ke, Se-Chin; Chen, Shun-Liang

doi:10.1128/jcm.36.9.2759-2762.1998

Cited by 56 publications

(19 citation statements)

References 26 publications

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“…Although the prevalence of TEM-1 in Taiwan was not studied, considering the worldwide distribution of TEM-1 and the finding that, in 1998, 82% of the E. coli isolates in our hospital were ampicillin resistant, as determined by the routine disk diffusion method, the existence of TEM-1 in our E. coli isolates seems reasonable. The gene for SHV-5 has been reported to be the most common ESBL gene in K. pneumoniae isolates in another Taiwan hospital (22) and was the predominant ESBL gene in our K. pneumoniae isolates as well. That the spread of ESBL is mainly by patient-to-patient transfer rather than by direct selection of point mutation derivatives has been postulated on the basis of a clinical intervention study (34).…”

Section: Discussionsupporting

confidence: 57%

Bacteremia Due to Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae in a Pediatric Oncology Ward: Clinical Features and Identification of Different Plasmids Carrying both SHV-5 and TEM-1 Genes

Siu

Lu²,

Hsueh³

et al. 1999

J Clin Microbiol

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Thirteen patients who had 16 episodes of bacteremia were observed between 1993 and 1997 in a pediatric oncology ward with a high background isolation rate of cefotaxime- or aztreonam-resistant gram-negative bacteria. Four blood isolates were Escherichia coli and 12 were Klebsiella pneumoniae, and these isolates harbored extended-spectrum β-lactamases (ESBLs). All episodes of bacteremia were nosocomial, all except one of the episodes occurred in neutropenic patients, and all patients were treated with piperacillin or ceftazidime with amikacin and cefazolin prior to the onset of bacteremia. Nine of 13 patients were receiving extended-spectrum β-lactam treatment when the bacteremias caused by ESBL producers occurred. Molecular studies revealed that four K. pneumoniae SHV-2-producing isolates from 1994 were of the same clone. Other ESBL producers, including six that carried both TEM-1 and SHV-5, five that carried SHV-5, and one that carried SHV-2 alone, were unrelated. In conclusion, SHV-5 was present in 11 of the 16 isolates and coexisted with TEM-1 in 6 isolates. Acquisition of resistance genes probably occurred under antibiotic selection pressure. This study highlights the importance of routine checks for and detection of ESBL producers. Effective therapy against ESBL producers should be considered early for children who have malignancies and neutropenia and who are septic, despite treatment with a regimen that includes an extended-spectrum β-lactam, in a clinical setting of an increased incidence of ESBL-producing bacteria.

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Section: Discussionsupporting

confidence: 57%

Bacteremia Due to Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae in a Pediatric Oncology Ward: Clinical Features and Identification of Different Plasmids Carrying both SHV-5 and TEM-1 Genes

Siu

Lu²,

Hsueh³

et al. 1999

J Clin Microbiol

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“…SHV-derived ESBLs have been found to be prevalent among ESBL-producing K. pneumonia isolates (75%) in Taiwan (22,41). In this study, it was interesting to find that, unlike K. pneumoniae, only 3 (15.8%) of 19 E. coli isolates that produced classical ESBLs carried SHV-derived enzymes, whereas 15 isolates (78.9%) harbored non-TEM and non-SHV ESBLs.…”

Section: Discussionmentioning

confidence: 77%

“…SHV-derived enzymes have been identified as the most common ESBLs among clinical isolates of K. pneumoniae in Taiwan (22,41); however, little is known about the prevalence and characteristics of ESBLs among E. coli isolates in this country. The present study was conducted to determine the prevalence and genotypes of classical ESBLs (resistant to extended-spectrum cephalosporins and susceptible to inhibition by ␤-lactam inhibitors) among clinical isolates of E. coli in southern Taiwan.…”

mentioning

confidence: 99%

Dissemination of CTX-M-3 and CMY-2 β-Lactamases among Clinical Isolates of Escherichia coli in Southern Taiwan

Yan

Tsai³

et al. 2000

J Clin Microbiol

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A total of 1,210 clinical isolates of Escherichia colicollected from a university hospital in southern Taiwan were screened for production of extended-spectrum β-lactamases (ESBLs). Expression of classical ESBLs (resistant to extended-spectrum β-lactam agents and susceptible to β-lactam inhibitors) was inferred in 18 isolates by the phenotypic confirmatory test. These included 10 isolates producing CTX-M-3, 2 strains carrying SHV-12, 1 strain harboring SHV-5, 1 strain expressing TEM-10, and 4 strains producing unidentifiable ESBLs with a pI of 8.05, 8.0, or 7.4. Eighteen isolates that showed decreased susceptibilities to ceftazidime and/or cefotaxime, negative results for the confirmatory test, and high-level resistance to cefoxitin (MICs of ≥128 μg/ml) were also investigated. Five isolates were found to produce CMY-2 AmpC enzymes, one isolate carried both CTX-M-3 and CMY-2, and the remaining three and nine isolates expressed putative AmpC β-lactamases with pIs of >9.0 and 8.9, respectively. Thus, together with the isolate producing CTX-M-3 and CMY-2, 19 (1.6%) isolates produced classical ESBLs. Pulsed-field gel electrophoresis revealed that all isolates carrying CTX-M-3 and/or CMY-2 were genetically unrelated, indicating that dissemination of resistance plasmids was responsible for the spread of these two enzymes amongE. coli in this area. Among the 16 isolates expressing CTX-M-3 and/or CMY-2, 5 might have colonized outside the hospital environment. Our data indicate that CTX-M-3 and CMY-2, two β-lactamases initially identified in Europe, have been disseminated to and are prevalent in Taiwan.

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“…Thus the gene encoding ESBL most likely had been disseminated via transfer of the resistance determinant among clinical isolates. Previously, ESBL-producing K. pneumoniae isolates collected from a district hospital in central Taiwan were also found to be genetically unrelated (Liu et al, 1998). However, clonal dissemination of ESBLproducing K. pneumoniae isolates (both inter-hospital and intra-hospital dissemination) did occur among several regions in Taiwan (Yu et al, 2004b).…”

Section: Pfge Patternmentioning

confidence: 99%

Genotypic detection and molecular epidemiology of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a regional hospital in central Taiwan

Lin

Hsu

Chen

et al. 2010

Journal of Medical Microbiology

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This study was conducted to detect the genes encoding extended-spectrum b-lactamases (ESBLs) and determine the epidemiological relatedness of 69 Escherichia coli and 33 Klebsiella pneumoniae isolates collected from a regional hospital in central Taiwan, mostly from inpatients (E. coli 87.0 %; K. pneumoniae 88.0 %). The phenotypes of these isolates were examined according to the combination disc method recommended by the Clinical and Laboratory Standards Institute. Most of the ESBL-producing E. coli and K. pneumoniae isolates (98.6 % and 97 %, respectively) could be detected using cefotaxime discs with and without clavulanate. Genotyping was performed by PCR with type-specific primers. CTX-M-14 type (53.6 %) was the most prevalent ESBL among E. coli isolates while SHV type (57.6 %) was the most dominant among K. pneumoniae isolates. Six E. coli and three K. pneumoniae isolates did not carry genes encoding ESBLs of types TEM, SHV, CTX-M-3, CTX-M-14, CMY-2 and DHA-1. The co-existence of two or more kinds of ESBL in a single isolate was common, occurring in 40.6 % and 72.7 % of E. coli and K. pneumoniae isolates, respectively. PFGE analysis revealed that ESBL producers isolated in this setting were genetically divergent. INTRODUCTIONSince the first report in Germany in 1983 (Knothe et al., 1983), the emergence of extended-spectrum b-lactamase (ESBL)-producing Klebsiella pneumoniae and Escherichia coli has become a serious problem in hospitalized patients worldwide (Hawser et al., 2009;Livermore et al., 2007;Paterson & Bonomo, 2005). In Taiwan, the prevalence of ESBL producers has increased in recent years, ranging from 8.5 to 50.7 % in K. pneumoniae and 1.5 to 25.4 % in E. coli (Jean et al., 2009;Kuo et al., 2008;Yu et al., 2006).According to Ambler's classification, ESBLs belong to the class A b-lactamases, which possess an active-site serine residue essential for the inactivation of b-lactam antimicrobial drugs (Ambler, 1980). The term 'extendedspectrum b-lactamase' was originally applied to describe the TEM and SHV variants that can hydrolyse oxyiminocephalosporins (Paterson & Bonomo, 2005). The 'extended spectrum' of activity is defined in terms of hydrolysing oxyimino-cephalosporins or aztreonam at more than 10 % of the activity of hydrolysing benzylpenicillin. Generally, ESBLs confer resistance to all penicillins, first-to-fourth generation cephalosporins and monobactams, but not to cephamycins or carbapenems. However, like many other class A b-lactamases, ESBLs are inactivated by the blactamase inhibitors, such as clavulanate (Bradford, 2001). Most of the genes encoding ESBLs are plasmid-borne and are often located in the transposons and integrons (Eckert et al., 2006), facilitating their mobilization with other resistance determinant. Thus the genes encoding ESBLs may be easily transferred between bacteria.The most prevalent ESBLs are included in three groups: TEM, SHV and CTX-M. The SHV enzymes are named Isoelectric focusing. Bacteria cultured in Mueller-Hinton broth for 20 h were centrifuged and the pellet...

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Molecular Epidemiology of Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae Isolates in a District Hospital in Taiwan

Cited by 56 publications

References 26 publications

Bacteremia Due to Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae in a Pediatric Oncology Ward: Clinical Features and Identification of Different Plasmids Carrying both SHV-5 and TEM-1 Genes

Bacteremia Due to Extended-Spectrum β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae in a Pediatric Oncology Ward: Clinical Features and Identification of Different Plasmids Carrying both SHV-5 and TEM-1 Genes

Dissemination of CTX-M-3 and CMY-2 β-Lactamases among Clinical Isolates of Escherichia coli in Southern Taiwan

Genotypic detection and molecular epidemiology of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a regional hospital in central Taiwan

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