JAC Advance Access originally published online on November 10, 2005
Journal of Antimicrobial Chemotherapy 2006 57(1):142-145; doi:10.1093/jac/dki389
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First outbreak of multidrug-resistant Klebsiella pneumoniae carrying blaVIM-1 and blaSHV-5 in a French university hospital
1 Service de Microbiologie, Hôpital Paul Brousse, France; 2 Equipe Opérationnelle d'Hygiène, Hôpital Paul Brousse, France; 3 UPRES EA n°2392, Faculté de Médecine Saint Antoine, France; 4 Centre Hépato-Biliaire, Hôpital Paul Brousse, Assistance Publique—Hôpitaux de Paris, France
Received 24 August 2005; returned 26 September 2005; revised 28 September 2005; accepted 28 September 2005
* Correspondence address. Service de Bactériologie, Faculté de Médecine Saint Antoine, 27 rue Chaligny 75012 Paris, France. Tel: +33-1-40-01-14-46; Fax: +33-1-49-28-24-72; E-mail: dominique.decre{at}chusa.jussieu.fr
Objectives: We studied eight imipenem-resistant isolates of Klebsiella pneumoniae involved in an outbreak in a French teaching hospital.
Methods: The eight isolates were recovered from clinical specimens or rectal swabs. Antibiotic susceptibilities were determined using standard agar diffusion and dilution methods including synergy tests. PFGE was used to study the relatedness of isolates. Genes encoding ß-lactamases were characterized by transfer assays, specific amplification and cloning.
Results: The eight isolates were closely related by PFGE analysis and highly related to a K. pneumoniae strain from Greece. They were highly resistant to ß-lactams, including aztreonam and imipenem (MIC 
32 mg/L), and were positive by the imipenem-EDTA disc synergy test. Isolates were also resistant to aminoglycosides, newer quinolones and sulfamethoxazole, and showed an intermediate level of resistance to tetracycline. VIM-1 and SHV-5 ß-lactamases were revealed in all isolates by PCR. The analysis of plasmid contents of Escherichia coli DH10B electroporants expressing the VIM-1 ß-lactamase or the SHV-5 ß-lactamase confirmed that the two enzymes were coded by two different plasmids. The blaVIM-1 gene was part of a class 1 integron that also included aac6, dhfrI and aadA genes and was similar to those reported from strains isolated in Greece.
Conclusions: This study confirms the potential risk of spread of multiresistant bacteria with international transfer of patients.
Keywords: imipenem resistance , class I integrons , liver transplants
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