Journal of Antimicrobial Chemotherapy, Vol 41, 527-539, Copyright © 1998 by The British Society for Antimicrobial Chemotherapy
M Yuan, H Aucken, LM Hall, TL Pitt and DM Livermore
Extended-spectrum beta-lactamases (ESBLs) are an increasing cause of
resistance to oxyimino-aminothiazolyl cephalosporins, especially in
klebsiellae. In a recent survey we detected ESBLs in 220 (23%) of 966
consecutive klebsiellae from 35 intensive care units (ICUs) in southern and
western Europe. The present study examined the extent to which this
distribution reflected epidemic strain spread, as against the distribution
of ESBL genes into unrelated strains. All 220 ESBL producers were subjected
to capsular serotyping and pulsed-field gel DNA electrophoresis (PFGE).
Beta-Lactamases were typed for strains isolated on three or more occasions,
with the emphasis on SHV enzymes, as these were commoner than TEM variants.
Serotyping and PFGE typing defined 85 distinct strains, from 23 of the 35
participating centres. Of 14 centres that contributed five or more ESBL
producers, all sent representatives of more than one strain, and two
centres sent members of ten or more different strains in contributions of
17-21 ESBL- producing isolates. Nevertheless, epidemic strains-defined as
those represented by three or more isolates-accounted for a majority (61%)
of the collection. Fifty-two isolates of the same serotype K25
(occasionally acapsular) strain with SHV-4 beta-lactamase were recovered at
two French hospitals and one in Belgium. This strain has been found by
others in France, and has become particularly widespread. Another single
strain was found in two separate Portuguese centres, and many individual
hospitals had one or more epidemic strain(s), as well as a scatter of
diverse ESBL producers. Major variation in antibiogram and plasmid profile
was apparent within strains, with some intra-strain variation in
beta-lactamase type. These data imply a fluid situation, with resistance
determinants being gained, modified or lost. The endemicity of ESBL
producers is disturbing since it limits the potential for control by
blocking strain spread, while the diversity within strains is disturbing
because it complicates the design of antibiotic policies even during
'single strain' outbreaks.
ORIGINAL ARTICLES
Epidemiological typing of klebsiellae with extended-spectrum beta- lactamases from European intensive care units
Antibiotic Group, Department of Medical Microbiology, St Bartholomew's and the Royal London School of Medicine and Dentistry, Whitechapel Site, London, UK.
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