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Surveillance in Taiwan Using Molecular Epidemiology for Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae

Published online by Cambridge University Press:  02 January 2015

Wen-Liang Yu ,
Patricia L. Winokur ,
Ronald N. Jones  and
Hélio S. Sader
Wen-Liang Yu
Affiliation:
Departments of Critical Care Medicine and Medical Research, Chi-Mei Medical Center, Yungkang City, Taiwan
Patricia L. Winokur
Affiliation:
Division of Medical Microbiology, University of Iowa College of Medicine, The Veterans Affairs Medical Center, Iowa City, Iowa
Ronald N. Jones
Affiliation:
JONES GROUP/JMI Laboratories, North Liberty, Iowa
Hélio S. Sader*
Affiliation:
JONES GROUP/JMI Laboratories, North Liberty, Iowa
*
345 Beaver Kreek Centre, Suite A, North Liberty, IA 52317
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Abstract

Objective:

To evaluate intrahospital and interhospital clonal dissemination of extended-spectrum beta-lactamase (ESBL)-producing strains of Klebsiella pneumoniae.

Setting:

Eight tertiary-care university hospitals and 16 regional hospitals in Taiwan.

Methods:

Two hundred eleven confirmed ESBL-producing isolates of K. pneumoniae were collected from January 1998 to June 2000. The isolates were characterized by various typing methods, including antibiogram (9 antimicrobial agents), computer-based ribotyping, pulsed-field gel electrophoresis (PFGE), and isoelectric focusing of beta-lactamase.

Results:

Ribotyping identified 70 distinct ribogroups among 200 isolates evaluated. Forty-three of these ribogroups were unique. Eleven ribogroups, comprising 115 isolates, were detected in more than one hospital (interhospital dissemination), whereas 16 groups (42 isolates) were detected in more than one patient within a hospital (intrahospital dissemination). The combination of ribotyping and PFGE identified two large epidemic clones, which were called 691.5/PFGE-G and 595.7/PFGE-A. These epidemic clones were detected mainly in the hospitals located in the northern and central regions of Taiwan. However, variation of the profiles of antibiograms and isoelectric focusing was apparent within each clone. In addition, isolates with the same isoelectric focusing profile (isoelectric points 7.9, 8.2, and 8.4) and antibiogram (resistance to 9 compounds evaluated) were present among different molecular-typed clones.

Conclusions:

Our results showed that clonal dissemination (both interhospital and intrahospital dissemination) is occurring in several regions of Taiwan. Rapid computer-based ribotyping associated with PFGE demonstrated multiple epidemic clones of ESBL-producing K. pneumoniae in Taiwan. The combination of phenotypic and molecular methods has proved useful to characterize these epidemic clones.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 10 , October 2004 , pp. 812 - 818
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004 

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References

1. Jacoby, GA. Extended-spectrum beta-lactamases and other enzymes providing resistance to oxyimmo-beta-lactams. Infect Dis Clin North Am 1997;11:875–887.10.1016/S0891-5520(05)70395-0Google Scholar
2. Liu, PY, Tung, JC, Ke, SC, Chen, SL. Molecular epidemiology of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae isolates in a district hospital in Taiwan. J Clin Microbiol 1998;36:2759–2762.10.1128/JCM.36.9.2759-2762.1998Google Scholar
3. Siu, LK, Lu, PL, Hsueh, PR, et al. Bacteremia due to extended-spectrum beta-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. J Clin Microbiol 1999;37:4020–4027.10.1128/JCM.37.12.4020-4027.1999Google Scholar
4. Barroso, H, Freitas-Vieira, A, Lito, LM, et al. Survey of Klebsiella pneumoniae producing extended-spectrum beta-lactamases at a Portuguese hospital: TEM-10 as the endemic enzyme. J Antimicrob Chemother 2000;45:611–616.10.1093/jac/45.5.611Google Scholar
5. Gouby, A, Neuwirth, C, Bourg, G, et al. Epidemiological study by pulsed-field gel electrophoresis of an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a geriatric hospital. J Clin Microbiol 1994;32:301–305.10.1128/jcm.32.2.301-305.1994Google Scholar
6. Weller, TM, MacKenzie, FM, Forbes, KJ. Molecular epidemiology of a large outbreak of multiresistant Klebsiella pneumoniae . J Med Microbiol 1997;46:921–926.10.1099/00222615-46-11-921Google Scholar
7. Gori, A, Espmasse, F, Deplano, A, Nonhoff, C, Nicolas, MH, Struelens, MJ. Comparison of pulsed-field gel electrophoresis and randomly amplified DNA polymorphism analysis for typing extended-spectrum beta-lactamase-producing Klebsiella pneumoniae . J Clin Microbiol 1996;34:2448–2453.10.1128/jcm.34.10.2448-2453.1996Google Scholar
8. Monnet, DL, Biddle, JW, Edwards, JR, et al. Evidence of interhospital transmission of extended-spectrum beta-lactam-resistant Klebsiella pneumoniae in the United States, 1986 to 1993. Infect Control Hosp Epidemiol 1997;18:492–498.10.2307/30141189Google Scholar
9. Arlet, G, Rouveau, M, Casin, I, Bouvet, PJ, Lagrange, PH, Philippen, A. Molecular epidemiology of Klebsiella pneumoniae strains that produce SHV-4 beta-lactamase and which were isolated in 14 French hospitals. J Clin Microbiol 1994;32:2553–2558.10.1128/jcm.32.10.2553-2558.1994Google Scholar
10. Saurina, G, Quale, JM, Manikal, VM, Oydna, E, Landman, D. Antimicrobial resistance in Enterobacteriaceae in Brooklyn, NY: epidemiology and relation to antibiotic usage patterns. J Antimicrob Chemother 2000;45:895–898.10.1093/jac/45.6.895Google Scholar
11. Yuan, M, Aucken, H, Hall, LM, Pitt, TL, Livermore, DM. Epidemiological typing of klebsiellae with extended-spectrum beta-lactamases from European intensive care units. J Antimicrob Chemother 1998;41:527–539.10.1093/jac/41.5.527Google Scholar
12. Chang, SC, Hsieh, WC, Liu, CY. High prevalence of antibiotic resistance of common pathogenic bacteria in Taiwan. Diagn Microbiol Infect Dis 2000;36:107–112.10.1016/S0732-8893(99)00109-1Google Scholar
13. Biedenbach, DJ, Johnson, DM, Jones, RN. In vitro evaluation of cefepime and other broad-spectrum beta-lactams in Taiwan medical centers. Diagn Microbiol Infect Dis 1999;35:299–305.10.1016/S0732-8893(99)00106-6Google Scholar
14. Su, LH, Leu, HS, Chiu, YP, et al. Molecular investigation of two clusters of hospital-acquired bacteremia caused by multi-resistant Klebsiella pneumoniae using pulsed-field gel electrophoresis and infrequent restriction site PCR. J Hosp Infect 2000;46:110–117.10.1053/jhin.2000.0815Google Scholar
15. Yu, WL, Jones, RN, Hollis, RJ, et al. Molecular epidemiology of extended-spectrum beta-lactamase-producing, fiuoroquinolone-resistant isolates of Klebsiella pneumoniae in Taiwan. J Clin Microbiol 2002;40:4666–4669.10.1128/JCM.40.12.4666-4669.2002Google Scholar
16. Yu, WL, Winokur, PL, Von Stein, DL, Pfaller, MA, Wang, JH, Jones, RN. First description of Klebsiella pneumoniae harboring CTX-M beta-lactamases (CTX-M-14 and CTX-M-3) in Taiwan. Antimicrob Agents Chemother 2002;46:1098–1100.10.1128/AAC.46.4.1098-1100.2002Google Scholar
17. National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically, ed. 4. Wayne, PA: National Committee for Clinical Laboratory Standards; 2003. Approved standard M7-A6.Google Scholar
18. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA: National Committee for Clinical Laboratory Standards; 2003. Supplemental tables M100-S13.Google Scholar
19. Pfaller, MA, Wendt, C, Hollis, RJ, et al. Comparative evaluation of an automated ribotyping system versus pulsed-field gel electrophoresis for epidemiological typing of clinical isolates of Escherichia coli and Pseudomonas aeruginosa from patients with recurrent gram-negative bacteremia. Diagn Microbiol Infect Dis 1996;25:1–8.10.1016/0732-8893(96)00082-XGoogle Scholar
20. Silbert, S, Boyken, L, Hollis, RJ, Pfaller, MA. Improving typeability of multiple bacterial species using pulsed-field gel electrophoresis and thiourea. Diagn Microbiol Infect Dis 2003;47:619–621.10.1016/S0732-8893(03)00164-0Google Scholar
21. Tenover, FC, Arbeit, RD, Goering, RV. How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: a review for healthcare epidemiologists. Infect Control Hosp Epidemiol 1997;18:426–439.10.2307/30141252Google Scholar
22. Cartwright, SJ, Waley, SG. Purification of beta-lactamases by affinity chromatography on phenylboronic acid-agarose. Biochem J 1984;221:505–512.10.1042/bj2210505Google Scholar
23. Mathew, A, Harris, AM, Marshall, MJ, Ross, GW. The use of analytical isoelectric focusing for detection and identification of beta-lactamases. J Gen Microbiol 1975;88:169–178.10.1099/00221287-88-1-169Google Scholar
24. Shen, D, Biedenbach, DJ, Winokur, PL, Pfaller, MA, Jones, RN. Phenotypic and genotypie characterizations of Chinese strains of Escherichia coli producing extended-spectrum beta-lactamases. Diagn Microbiol Infect Dis 1999;34:159–164.10.1016/S0732-8893(99)00018-8Google Scholar
25. Paterson, DL, Ko, WC, Von Gottberg, A, et al. Outcome of cephalosporin treatment for serious infections due to apparently susceptible organisms producing extended-spectrum beta-lactamases: implications for the clinical microbiology laboratory. J Clin Microbiol 2001;39:2206–2212.10.1128/JCM.39.6.2206-2212.2001Google Scholar
26. Bingen, EH, Desjardins, P, Arlet, G, et al. Molecular epidemiology of Plasmid spread among extended broad-spectrum beta-lactamase-producing Klebsiella pneumoniae isolates in a pediatric hospital. J Clin Microbiol 1993;31:179–184.10.1128/jcm.31.2.179-184.1993Google Scholar
27. Neuwirth, C, Siebor, E, Lopez, J, Pechinot, A, Kazmierczak, A. Outbreak of TEM-24-producing Enterobacter aerogenes in an intensive care unit and dissemination of the extended-spectrum beta-lactamase to other members of the family Enterobacteriaceae. J Clin Microbiol 1996;34:76–79.10.1128/jcm.34.1.76-79.1996Google Scholar
28. Yan, JJ, Wu, SM, Tsai, SH, Wu, JJ, Su, IJ. Prevalence of SHV-12 among clinical isolates of Klebsiella pneumoniae producing extended-spectrum beta-lactamases and identification of a novel AmpC enzyme (CMY-8) in Southern Taiwan. Antimicrob Agents Chemother 2000;44:1438–1442.10.1128/AAC.44.6.1438-1442.2000Google Scholar
29. Yan, JJ, Ko, WC, Tsai, SH, Wu, HM, Jin, YT, Wu, JJ. Dissemination of CTX-M-3 and CMY-2 beta-lactamases among clinical isolates of Escherichia coli in southern Taiwan. J Clin Microbiol 2000;38:4320–4325.10.1128/JCM.38.12.4320-4325.2000Google Scholar
30. Martinez-Martinez, L, Hernandez-Alles, S, Alberti, S, Tomas, JM, Benedi, VJ, Jacoby, GA. In vivo selection of porin-deficient mutants of Klebsiella pneumoniae with increased resistance to cefoxitin and expanded-spec-trum cephalosporins. Antimicrob Agents Chemother 1996;40:342–348.Google Scholar
31. Thomson, KS. Controversies about extended-spectrum and AmpC beta-lactamases. Emerg Infect Dis 2001;7:333–336.10.3201/eid0702.010238Google Scholar