The first major extended‐spectrum β‐lactamase outbreak in Scandinavia was caused by clonal spread of a multiresistant Klebsiella pneumoniae producing CTX‐M‐15

Abstract

Between May and December 2005, 64 multidrug-resistant isolates of Klebsiella pneumoniae were detected from patients admitted to Uppsala University Hospital. This represented a dramatic increase in ESBL-producing K. pneumoniae compared to previous years. To investigate the epidemiology and to characterize the resistance mechanisms of the isolates, a study was initiated. Antibiotic susceptibility was determined by means of the Etest and the disc diffusion method. Extended-spectrum beta-lactamase (ESBL) production was identified by clavulanic acid synergy test and confirmed with PCR amplification followed by DNA sequencing. DNA profiles of the isolates were examined with pulsed-field gel electrophoresis (PFGE). All isolates were resistant or exhibited reduced susceptibility to cefadroxil, cefuroxime, cefotaxime, ceftazidime, aztreonam, piperacillin/tazobactam, ciprofloxacin, tobramycin, and trimethoprim-sulfamethoxazole. They produced ESBL of the CTX-M-15 type, and the involvement of a single K. pneumoniae clone was shown. This is the first major clonal outbreak of multiresistant ESBL-producing K. pneumoniae in Scandinavia. The outbreak demonstrates the epidemic potential of enterobacteria containing ESBLs of the CTX-M type, even in a country with a relatively low selective pressure and a low prevalence of multiresistant bacteria.

Silver Resistance Genes Are Overrepresented among Escherichia coli Isolates with CTX-M Production

“…All isolates with phenotypic ESBL production were screened for genes encoding bla CTX-M phylogenetic lineage groups I, II, III, and IV and for bla TEM and bla SHV genes with PCR, as described by Pitout et al or elsewhere (11,30). Isolates positive for CTX-M genes were further typed by sequencing (11). Amplified products were purified by using the ExoSAP-IT purification kit (Amersham Biosciences, United Kingdom).…”

“…After overnight incubation at 35°C, E. coli was identified using standard laboratory procedures or the Vitek 2AutoMicrobic system (bioMérieux, USA). Collection and culture of the remaining isolates were performed as described earlier (9,11,23,25,26). All isolates were frozen at Ϫ70°C before further analysis.…”

“…During the years 2005 to 2007, there was a major outbreak at Uppsala University Hospital caused by a CTX-M-15-producing Klebsiella pneumoniae strain (11). A 41-kbp resistance region, highly similar to the resistance regions of two plasmids isolated previously from E. coli strains belonging to the outbreak lineage ST131, was found on one of its plasmids.…”

Gram-Negative Bacteria That Produce Carbapenemases Causing Death Attributed to Recent Foreign Hospitalization

“…However, only the ST16 isolate was transmitted to other patients. K. pneumoniae ST16 was first described in Paris during the early 2000s (30) and had been responsible for nosocomial outbreaks of CTX-M-15-producing K. pneumoniae in Sweden (36) and Denmark (37) during the mid-to late 2000s. This sequence type had also been reported with KPC-2 from Brazil (38) and with OXA-48 from Spain (39).…”

Sensitivity of urinary pathogens to antimicrobial therapy in patients from primary health care

“…extended spectrum β-lactamase) sojeva Escherichia coli i Klebsiella spp. u početku, pojava ESBl je bila karakteristična za bolničke sojeve, a pokazana je povećana učestalost ovih sojeva kod urinarnih infekcija u opštoj populaciji (prvi slučajevi su bile mlade, zdrave osobe koje nisu bile lečene u bolnici) (9,10). Jedan od najozbiljnijih problema u terapiji urinarnih infekcija jeste neadekvatna upotreba antibiotika, što uzrokuje selekciju rezistentnih sojeva mikroorganizama.…”