Multiplicity of TEM-derived beta-lactamases from Klebsiella pneumoniae strains isolated at the same hospital and relationships between the responsible plasmids

Chanal, C.; Sirot, D.; Petit, Agnès; Labia, Roger; Morand, A.; Sirot, J.; Cluzel, R

doi:10.1128/aac.33.11.1915

Cited by 65 publications

(50 citation statements)

References 20 publications

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“…Recently, Manavathu et al (8) reported an in vitro mutant of the TEM-1 1-lactamase with a 110-fold increase in resistance to clavulanic acid as a result of a single amino acid substitution. These enzyme mutations with altered hydrolytic capabilities also exhibit changes in pIs on isoelectric focusing (4,5,8,14,17,21). In this report we described an in vivo P-lactamase mutation that resulted in resistance to P-lactamase inhibitors and that resembled the in vitro mutation reported by Manavathu et al (8).…”

Section: Discussionsupporting

confidence: 47%

Acquired resistance of Nocardia brasiliensis to clavulanic acid related to a change in beta-lactamase following therapy with amoxicillin-clavulanic acid

Steingrube

Wallace

Brown

et al. 1991

Antimicrob Agents Chemother

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Previous studies have demonstrated that Nocardia brasiliensis is susceptible to amoxicillin-clavulanic acid and that its I8-lactamases are inhibited in vitro by, clavulanic acid. A cardiac transplant patient with disseminated infection caused by N. brasiliensis was treated with this drug combination with good response, but relapsed while still on therapy. The relapse isolate was found to be identical to the initial isolate by using genomic DNA restriction fragment patterns obtained by pulsed field gel electrophoresis, but it was resistant to amoxicillin-clavulanic acid. On isoelectric focusing, the ,I-lactamase from the relapse isolate exhibited a shift in the isoelectric point (pl) of its major band from 5.10 to 5.04 compared with the enzyme from the pretreatment isolate. As determined by using values of the amount of ,-lactamase inhibitor necessary to give 50 5% inhibition of P-lactamase-mediated hydrolysis of 50 FM nitrocefin, the I8-lactamase of the relapse isolate was also 200-fold more resistant than the enzyme from the pretreatment isolate to clavulanic acid and was more resistant to sulbactam, tazobactam, cloxacillin, and imipenem. The I-lactamase of the relapse isolate exhibited a 10-fold decrease in hydrolytic activity for cephaloridine and other hydrolyzable cephalosporins compared with that for nitrocefin. Acquired resistance to amoxicillin-clavulanic acid in this isolate of N. brasiliensis appears to have resulted from a mutational change affecting the inhibitor and active site(s) in the I8-lactamase.

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Section: Discussionsupporting

confidence: 47%

Acquired resistance of Nocardia brasiliensis to clavulanic acid related to a change in beta-lactamase following therapy with amoxicillin-clavulanic acid

Steingrube

Wallace

Brown

et al. 1991

Antimicrob Agents Chemother

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“…All four clinical isolates and transconjugants produced at least one ␤-lactamase of pI 6.5, consistent with that of TEM-24 ␤-lactamase (6).…”

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confidence: 69%

Production of a TEM-24 Plasmid-Mediated Extended-Spectrum β-Lactamase by a Clinical Isolate of Pseudomonas aeruginosa

Marchandin

Jean-Pierre

Champs

et al. 2000

Antimicrob Agents Chemother

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Several Pseudomonas aeruginosa strains, including one urinary isolate producing an extended-spectrum ␤-lactamase TEM-24, were isolated from a long-term-hospitalized woman. Three TEM-24-producing enterobacterial species (Enterobacter aerogenes, Escherichia coli, and Proteus mirabilis) were isolated from the same patient. TEM-24 and the resistance markers for aminoglycosides, chloramphenicol, and sulfonamide were encoded by a 180-kb plasmid transferred by conjugation into E. coli HB101.Extended-spectrum ␤-lactamases (ESBLs) conferring resistance to expanded-spectrum cephalosporins were recently identified in Pseudomonas aeruginosa (17). Most of them are non-SHV, non-TEM-type ESBLs, such as PER-1 (class A enzyme), IMP-1 (class B enzyme), and oxacillinases (class D ␤-lactamases). All of these ␤-lactamases are plasmid and/or integron located, with the exception of . This ESBL was encoded by a 18-kb nonconjugative plasmid. In this report, we describe TEM-24 from a P. aeruginosa isolate. The multiplicity of TEM-24-producing bacteria recovered from the same patient strongly suggests the in vivo transfer of this plasmid-mediated ESBL from Enterobacteriaceae to P. aeruginosa.Several ESBL-producing bacteria were isolated from a 66-year-old woman transferred to an intensive care unit (ICU) for severe septic complication after surgery on the sigmoid flexure. Reanimation required mechanically assisted ventilation and central veinous and urinary catheterization. During her hospitalization period (3 months), several infections occurred at various body sites: the postsurgical wound, the central veinous catheter, and the respiratory and urinary tracts. Different antibiotic agents were administered, including imipenem and ceftazidime. At various times during hospitalization, rectal swabs were taken and cultured on Drigalski agar with ceftazidime (4 mg/liter); the different ESBL-producing bacteria were recovered, with the exception of the P. aeruginosa strains. Isolated strains, sites of infection, and antimicrobial treatments are summarized in Table 1.Susceptibility tests were first determined by disk diffusion assay on Mueller-Hinton agar according to the recommendations of the Société Française de Microbiologie. ESBL-producing P. aeruginosa appeared to be more resistant to ceftazidime than to cefotaxime. Double-disk synergy tests performed with a 30-mm spacing between the disks (9) were slightly positive when ceftazidime or cefepime disks were used. This test was modified for Enterobacter aerogenes strains with disks placed 20 mm apart or with quartered disks for Proteus mirabilis (14, 16). The three ESBL-producing Enterobacteriaceae strains were susceptible to gentamicin and were resistant to tobramycin, netilmicin, and amikacin, suggesting the production of an AAC (6Ј)-I enzyme. ESBL-producing P. aeruginosa showed higher levels of resistance to tobramycin and netilmicin than to gentamicin.In order to compare different isolates from the same species, chromosomal DNA was analyzed by pulsed-field gel electrophoresis (PFGE). Thi...

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confidence: 99%

“…In France, plasmid-mediated extended-spectrum beta-lactamases (ESBLs) have been mostly described from strains of Klebsiella pneumoniae (1,2,3,6,7,15), but more recently infections caused by strains of Enterobacter spp. producing the TEM-24 ESBL have increased (5,14,24).…”

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Evidence of In Vivo Transfer of a Plasmid Encoding the Extended-Spectrum β-Lactamase TEM-24 and Other Resistance Factors among Different Members of the Family Enterobacteriaceae

et al. 2001

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The epidemiological study of several multidrug-resistant Enterobacteriaceae isolated from five patients demonstrated in vivo dissemination of a 100-kb plasmid encoding the extended-spectrum ␤-lactamase TEM-24 from a clonal strain of Enterobacter aerogenes to different strains of Klebsiella pneumoniae, Escherichia coli, Proteus vulgaris, Proteus mirabilis, and Serratia marcescens.In France, plasmid-mediated extended-spectrum beta-lactamases (ESBLs) have been mostly described from strains of Klebsiella pneumoniae (1,2,3,6,7,15), but more recently infections caused by strains of Enterobacter spp. producing the TEM-24 ESBL have increased (5,14,24). The same phenomenon was observed in our University Hospital (2,000 beds, in Dijon, France). In 1996, 1997, and 1998 we isolated, respectively, 16, 37, and 50 Enterobacter aerogenes strains producing TEM-24 among totals of 78, 70, and 70 nonrepetitive ESBLproducing strains. All these strains were analyzed by pulsedfield gel electrophoresis (PFGE). During our continuous survey we found that five patients were cocolonized or coinfected with different multidrug-resistant species of enterobacteria. Following the use of imipenem, two strains of Proteus mirabilis and E. aerogenes resistant to this molecule were recovered from one patient. We report here the epidemiological study and the ␤-lactamase characterization of all the strains isolated from the five patients.The origins of the strains are given in Table 1. The detection of ESBL production was performed by the double-disk synergy test (19) but with a quarter of the disk containing third-generation cephalosporin for Proteus sp. (9).Analyses of chromosomal DNAs by PFGE were performed as described previously (15) but with a pulse range from 40 to 5 s for 20 h at 180 V for strains of E. aerogenes, K. pneumoniae, Serratia marcescens, and Escherichia coli. For P. mirabilis and Proteus vulgaris, we used a pulse range from 25 to 5 s for 20 h at 180 V ( Fig. 1 and 2). A single profile was found for the strains of E. aerogenes, similar to that of the epidemic strain described in 1996 (24). For the other enterobacteria, strains from the same species (ESBL or not ESBL producing) isolated from the same patient shared concordant PFGE patterns, suggesting their clonal origin. Nevertheless, the strains of the same species isolated from the five patients were not related. This result excluded the possibility that resistant strains of K. pneumoniae, E. coli, or P. vulgaris were disseminated between the patients or that there was a common source of contamination.A large plasmid of about 100 kb was isolated by the method of Birnboim and Doly from the ESBL-producing strains (4). The restriction patterns obtained after digestion of the plasmid by EcoRI were very similar. The plasmid was easily transferred

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Multiplicity of TEM-derived beta-lactamases from Klebsiella pneumoniae strains isolated at the same hospital and relationships between the responsible plasmids

Cited by 65 publications

References 20 publications

Acquired resistance of Nocardia brasiliensis to clavulanic acid related to a change in beta-lactamase following therapy with amoxicillin-clavulanic acid

Acquired resistance of Nocardia brasiliensis to clavulanic acid related to a change in beta-lactamase following therapy with amoxicillin-clavulanic acid

Production of a TEM-24 Plasmid-Mediated Extended-Spectrum β-Lactamase by a Clinical Isolate of Pseudomonas aeruginosa

Evidence of In Vivo Transfer of a Plasmid Encoding the Extended-Spectrum β-Lactamase TEM-24 and Other Resistance Factors among Different Members of the Family Enterobacteriaceae

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