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Dissemination of extended-spectrum β-lactamase-producing Klebsiella pneumoniae and Escherichia coli in Thai hospitals

  • Original Article
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Journal of Infection and Chemotherapy

Abstract

Fifty clinical isolates of Klebsiella pneumoniae and Escherichia coli with reduced susceptibility to third-generation cephalosporins, collected from 11 hospitals in Thailand, were studied. All isolates were found to produce extended-spectrum β-lactamase (ESBL), as judged by double-disk synergy and combination disk methods. Most ESBL-producing K. pneumoniae isolates were resistant to ceftazidime (94%) and aztreonam (90%). In contrast, most ESBL-producing E. coli isolates were resistant to ceftriaxone (95%) and cefotaxime (74%). Plasmid DNA was isolated and β-lactamase genes were identified by PCR and sequencing. We found that SHV-12 and CTX-M-14 were the main ESBLs responsible for resistance in K. pneumoniae and E. coli, respectively. SHV-27, SHV-28, and CTX-M-14 were detected in three, two, and four K. pneumoniae isolates, respectively. A high genetic diversity among ESBL-producing K. pneumoniae and E. coli isolates was observed. In addition, the finding of a few isolates that produced identical restriction patterns on pulsed field gel electrophoresis (PFGE) suggests the clonal spread of resistant bacteria within the hospital.

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References

  1. Paterson DL, Bonomo RA. Extended-spectrum β-lactamases: a clinical update. Clin Microbiol Rev 2005;18:657–686.

    Article  PubMed  CAS  Google Scholar 

  2. Henshke-Bar-Meir R, Yinnon AM, Rudensky B, Attias D, Schlesinger Y, Raveh D. Assessment of the clinical significance of production of extended-spectrum β-lactamases (ESBL) by Enterobacteriaceae. Infection 2006;34:66–74.

    Article  PubMed  CAS  Google Scholar 

  3. Bonnet R. Growing group of extended-spectrum β-lactamases: the CTX-M enzymes. Antimicrob Agents Chemother 2004;48:1–14.

    Article  PubMed  CAS  Google Scholar 

  4. Chanawong A, M’Zali FH, Heritage J, Lulitanond A, Hawkey PM. SHV-12, SHV-5, SHV-2a and VEB-1 extended-spectrum β-lactamases in Gram-negative bacteria isolated in a university hospital in Thailand. J Antimicrob Chemother 2001;48:839–852.

    Article  PubMed  CAS  Google Scholar 

  5. Girlich D, Poirel L, Leelaporn A, Karim A, Tribuddharat C, Fennewald M, et al. Molecular epidemiology of the integronlocated VEB-1 extended-spectrum β-lactamase in nosocomial enterobacterial isolates in Bangkok, Thailand. J Clin Microbiol 2001;39:175–182.

    Article  PubMed  CAS  Google Scholar 

  6. Kusum M, Wongwanich S, Dhiraputra C, Pongpech P, Naenna P. Occurrence of extended-spectrum β-lactamase in clinical isolates of Klebsiella pneumoniae in a university hospital, Thailand. J Med Assoc Thai 2004;87:1029–1033.

    PubMed  Google Scholar 

  7. Apisarnthanarak A, Kiratisin P, Saifon P, Kitphati R, Dejsirilert S, Mundy LM. Clinical and molecular epidemiology of community-onset, extended-spectrum β-lactamase-producing Escherichia coli infections in Thailand: a case-case-control study. Am J Infect Control 2007;35:606–612.

    Article  PubMed  Google Scholar 

  8. Chanawong A, Lulitanond A, Kaewkes W, Lulitanond V, Srigulbutr S, Homchampa P. CTX-M extended-spectrum β-lactamases among clinical isolates of Enterobacteriaceae in a Thai university hospital. Southeast Asian J Trop Med Public Health 2007;38:493–500.

    PubMed  CAS  Google Scholar 

  9. Kiratisin P, Apisarnthanarak A, Saifon P, Laesripa C, Kitphati R, Mundy LM. The emergence of a novel ceftazidime-resistant CTX-M extended-spectrum β-lactamase, CTX-M-55, in both community-onset and hospital-acquired infections in Thailand. Diagn Microbiol Infect Dis 2007;58:349–355.

    Article  PubMed  CAS  Google Scholar 

  10. Kiratisin P, Apisarnthanarak A, Laesripa C, Saifon P. Molecular characterization and epidemiology of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae causing healthcare-associated infection in Thailand: an endemic area of CTX-M. Antimicrob Agents Chemother 2008;52:2818–2824.

    Article  PubMed  CAS  Google Scholar 

  11. Jarlier V, Nicolas MH, Fournier G, Philippon A. Extended broadspectrum β-lactamases conferring transferable resistance to newer β-lactam agents in Enterobacteriaceae: hospital prevalence and susceptibility patterns. Rev Infect Dis 1988;10:867–878.

    PubMed  CAS  Google Scholar 

  12. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibilty testing: eighteenth informational supplement. CLSI document M100-D18 (ISBN 1-56238-653-0). Wayne, PA: Clinical and Laboratory Standards Institute; 2008.

    Google Scholar 

  13. Coque TM, Oliver A, Pérez-Díaz JC, Baquero F, Cantón R. Genes encoding TEM-4, SHV-2, and CTX-M-10 extended-spectrum β-lactamases are carried by multiple Klebsiella pneumoniae clones in a single hospital (Madrid, 1989 to 2000). Antimicrob Agents Chemother 2002;46:500–510.

    Article  PubMed  CAS  Google Scholar 

  14. Ma L, Ishii Y, Chang FY, Yamaguchi K, Ho M, Siu LK. CTXM-14, a plasmid-mediated CTX-M type extended-spectrum β-lactamase isolated from Escherichia coli. Antimicrob Agents Chemother 2002;46:1985–1988.

    Article  PubMed  CAS  Google Scholar 

  15. Xiong Z, Zhu D, Wang F, Zhang Y, Okamoto R, Inoue M. Investigation of extended-spectrum β-lactamase in Klebsiellae pneumoniae and Escherichia coli from China. Diagn Microbiol Infect Dis 2002;44:195–200.

    Article  PubMed  CAS  Google Scholar 

  16. Biedenbach DJ, Johnson DM, Jones RN. In vitro evaluation of cefepime and other broad-spectrum β-lactams in eight medical centers in Thailand. The Thailand Antimicrobial Resistance Study Group. Diagn Microbiol Infect Dis 1999;35:325–331.

    Article  PubMed  CAS  Google Scholar 

  17. Paterson DL. Resistance in gram-negative bacteria: Enterobacteriaceae. Am J Infect Control 2006;34(5 Suppl 1):S20–S28.

    Article  PubMed  Google Scholar 

  18. Koh TH, Sng LH, Babini GS, Woodford N, Livermore DM, Hall LM. Carbapenem-resistant Klebsiella pneumoniae in Singapore producing IMP-1 β-lactamase and lacking an outer membrane protein. Antimicrob Agents Chemother 2001;45:1939–1940.

    Article  PubMed  CAS  Google Scholar 

  19. Palasubramaniam S, Karunakaran R, Gin GG, Muniandy S, Parasakthi N. Imipenem resistance in Klebsiella pneumoniae in Malaysia due to loss of OmpK36 outer membrane protein coupled with AmpC hyperproduction. Int J Infect Dis 2007;11:472–474.

    Article  PubMed  CAS  Google Scholar 

  20. Nüesch-Inderbinen MT, Kayser FH, Hächler H. Survey and molecular genetics of SHV β-lactamases in Enterobacteriaceae in Switzerland: two novel enzymes, SHV-11 and SHV-12. Antimicrob Agents Chemother 1997;41:943–949.

    PubMed  Google Scholar 

  21. Jacoby GA, Munoz-Price LS. The new β-lactamases. N Engl J Med 2005;352:380–391.

    Article  PubMed  CAS  Google Scholar 

  22. Corkill JE, Cuevas LE, Gurgel RQ, Greensill J, Hart CA. SHV-27, a novel cefotaxime-hydrolysing β-lactamase, identified in Klebsiella pneumoniae isolates from a Brazilian hospital. J Antimicrob Chemother 2001;47:463–465.

    Article  PubMed  CAS  Google Scholar 

  23. Mendonça N, Ferreira E, Caniça M. Occurrence of a novel SHV-type enzyme (SHV-55) among isolates of Klebsiella pneumoniae from Portuguese origin in a comparison study for extendedspectrum β-lactamase-producing evaluation. Diagn Microbiol Infect Dis 2006;56:415–420.

    Article  PubMed  Google Scholar 

  24. Ndugulile F, Jureen R, Harthug S, Urassa W, Langeland N. Extended spectrum β-lactamases among Gram-negative bacteria of nosocomial origin from an intensive care unit of a tertiary health facility in Tanzania. BMC Infect Dis 2005;5:86.

    Article  PubMed  Google Scholar 

  25. Pai H, Choi EH, Lee HJ, Hong JY, Jacoby GA. Identification of CTX-M-14 extended-spectrum β-lactamase in clinical isolates of Shigella sonnei, Escherichia coli, and Klebsiella pneumoniae in Korea. J Clin Microbiol 2001;39:3747–3749.

    Article  PubMed  CAS  Google Scholar 

  26. Chanawong A, M’Zali FH, Heritage J, Xiong JH, Hawkey PM. Three cefotaximases, CTX-M-9, CTX-M-13, and CTX-M-14, among Enterobacteriaceae in the People’s Republic of China. Antimicrob Agents Chemother 2002;46:630–637.

    Article  PubMed  CAS  Google Scholar 

  27. Cao V, Lambert T, Nhu DQ, Loan HK, Hoang NK, Arlet G, et al. Distribution of extended-spectrum β-lactamases in clinical isolates of Enterobacteriaceae in Vietnam. Antimicrob Agents Chemother 2002;46:3739–3743.

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Microbiology and Parasitology, Faculty of Medical Science, Naresuan University, Phitsanulok, 65000, Thailand

    Pannika R. Niumsup, Uttapoln Tansawai & Nitsara Boonkerd

  2. Department of Medical Sciences, National Institute of Health, Nonthaburi, Thailand

    Pitimon Polwichai & Surang Dejsirilert

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  1. Pannika R. Niumsup
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  2. Uttapoln Tansawai
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  3. Nitsara Boonkerd
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  5. Surang Dejsirilert
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Correspondence to Pannika R. Niumsup.

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Niumsup, P.R., Tansawai, U., Boonkerd, N. et al. Dissemination of extended-spectrum β-lactamase-producing Klebsiella pneumoniae and Escherichia coli in Thai hospitals. J Infect Chemother 14, 404–408 (2008). https://doi.org/10.1007/s10156-008-0642-z

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  • DOI: https://doi.org/10.1007/s10156-008-0642-z

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