JAC Advance Access published online on May 29, 2003
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkg281
© 2003 by The British Society for Antimicrobial Chemotherapy
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Original article
1 Servicio Antimicrobianos,
Dpto. Bacteriología, INEI-ANLIS ‘Dr Carlos G.
Malbrán', Av. Velez Sársfield 563 (1281),
Buenos Aires
* Corresponding author. E-mail: mgalas{at}anlis.gov.ar.
Received 6 December 2002
; revised 2 April 2003
; accepted 7 April 2003
Klebsiella pneumoniae M1803, isolated
from a paediatric patient with chronic urinary infection, presented nine
antimicrobial resistance mechanisms harboured on two conjugative
megaplasmids, in addition to the chromosomally mediated SHV-1
Keywords: CTX-M-2, PER-2, In35, Tn3,
Tn1331
Multiple antibiotic-resistance mechanisms including
a
novel combination of extended-spectrum
-lactamases
in a
Klebsiella pneumoniae clinical strain isolated in Argentina
2 Dpto. Microbiología,
Facultad de Medicina, Universidad Nacional de Buenos Aires, Paraguay
2155, P. 12 (1120), Buenos Aires
3 Servicio de Bacteriología, Hospital ‘Gobernador
Centeno',
Calle 17 y 108, General Pico, Provincia de La Pampa, Argentina
-lactamase. These nine antimicrobial
resistance mechanisms comprised two extended-spectrum -lactamases
(ESBLs) (PER-2 and CTX-M-2), TEM-1-like, OXA-9-like, AAC(3)-IIa, AAC(6')-Ib, ANT(3'')-Ia
and resistance determinants to tetracycline and chloramphenicol.
During fluoroquinolone treatment, a variant derived from M1803 (named
M1826) was selected, with an overall increase of MICs, in particular
of cefoxitin and carbapenems. No enzymic activity against these
latter drugs was found. Mutations in the region analogous to the
quinolone resistance-determining region were not found. Strain M1826
was deficient in OmpK35/36 expression, which produced the decrease
in the susceptibility to cefoxitin, carbapenems and fluoroquinolones.
The blaCTX-M-2 gene was located in an
unusual class 1 integron, which includes Orf513, as occurred in
the recently described In35. In addition, Tn3 and
Tn1331 were detected in both K. pneumoniae isolates.
This is the first report of in vivo selection of
an OmpK35/36 deficiency in a K. pneumoniae strain
that produced a novel combination of two ESBLs (CTX-M-2 and PER-2)
during fluoroquinolone treatment in a paediatric patient with chronic
urinary infection.
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