Transferable enzymatic resistance to third-generation cephalosporins during nosocomial outbreak of multiresistant Klebsiella pneumoniae

Lancet. 1987 Aug 8;2(8554):302-6. doi: 10.1016/s0140-6736(87)90891-9.

Abstract

Klebsiella pneumoniae strains that were resistant to third-generation cephalosporins and amikacin were recovered from 62 of 395 patients (15.7%) during 1986. 25 isolates (40%) caused urinary tract infections. The outbreak involved three intensive care units (54 isolates), and spread from one unit to another and then to four wards (8 isolates). K pneumoniae of various serotypes and strains of different Enterobacteriaceae demonstrating the same antibiotic resistance pattern were isolated, which suggests dissemination of an R-factor. The isolates had low-level resistance to third-generation cephalosporins (mode minimum inhibitory concentration of cefotaxime, 2 mg/l) but remained sensitive to cephamycins. Cefotaxime was effective in cases of uncomplicated urinary tract infection, but failed in major infections at other sites. 1-5 mg/l of the beta-lactamase inhibitors clavulanic acid or sulbactam restored normal activity to cefotaxime against the multiresistant strains. Resistance to third-generation cephalosporins was mediated by a new broad-spectrum enzyme of isoelectric point 6.3. Resistance to beta-lactams and aminoglycosides was transferable to Escherichia coli. The emergence of transferable enzymatic resistance to newer beta-lactams in K pneumoniae strains indicates a major risk of spread of such resistance to otherwise sensitive strains.

MeSH terms

  • Amikacin / therapeutic use
  • Cefotaxime / therapeutic use
  • Cephalosporins / pharmacology*
  • Cephalosporins / therapeutic use
  • Cross Infection / epidemiology
  • Cross Infection / microbiology*
  • Disease Outbreaks*
  • Drug Resistance, Microbial
  • Enterobacteriaceae / isolation & purification
  • Escherichia coli / drug effects
  • Humans
  • Klebsiella Infections / epidemiology
  • Klebsiella Infections / microbiology*
  • Klebsiella pneumoniae / drug effects*
  • Klebsiella pneumoniae / genetics
  • Klebsiella pneumoniae / isolation & purification
  • Paris
  • Recurrence
  • Urinary Tract Infections / drug therapy
  • beta-Lactamases / analysis

Substances

  • Cephalosporins
  • Amikacin
  • beta-Lactamases
  • Cefotaxime