title: Epidemiological typing of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae isolates responsible for five outbreaks in a university hospital.
abstract: Thirty-seven isolates of extended-spectrum beta-lactamase-producing (ESBL) Klebsiella pneumoniae implicated in five nosocomial outbreaks (I-V) on three distinct wards of our hospital were compared using capsular typing, biotyping, antibiotyping, enzyme electrophoresis typing and DNA macrorestriction analysis with Xba I resolved by pulsed-field gel electrophoresis. The isolates from each outbreak had common phenotypic and genotypic characteristics indicating that they were related epidemiologically. Isolates from outbreaks I (four patients) and V (13 patients), although they occurred in two different wards (neurology and surgery) and three years apart, produced the same ESBL with a pI of 7.8 (SHV-4) and were of serotype K25. The Xba I patterns were closely related. The isolates of outbreaks II (seven patients), III (four patients) and IV (seven patients), which occurred in a single surgical intensive care unit, produced an ESBL with a pI of 6.3 (TEM-3). Isolates from outbreaks III and IV, which occurred six months apart, were of serotype K68 and had similar Xba I patterns suggesting that the two outbreaks were due to a single strain which persisted endemically in the ward. The isolates from outbreak II were of serotype K62, and had distinct characteristics from the two later outbreaks. The Xba I patterns of the isolates from outbreaks "I and V', II and "III and IV' had Dice similarity coefficients under 40% showing that the three groups were genetically distant. DNA macrorestriction analysis was a useful complement to phenotypic methods for identifying K. pneumoniae strains responsible for outbreaks harbouring a common ESBL.
authors.affiliation: Laboratoire de Microbiologie, Hôpital Beaujon, Clichy, France.
authors.forename: C
authors.initials: C
authors.lastname: Branger
authors.forename: B
authors.initials: B
authors.lastname: Bruneau
authors.forename: A L
authors.initials: AL
authors.lastname: Lesimple
authors.forename: P J
authors.initials: PJ
authors.lastname: Bouvet
authors.forename: P
authors.initials: P
authors.lastname: Berry
authors.forename: J
authors.initials: J
authors.lastname: Sevali-Garcia
authors.forename: N
authors.initials: N
authors.lastname: Lambert-Zechovsky
mesh_terms: D003428:Cross Infection / Q000382:microbiology*; D004269:DNA, Bacterial / Q000032:analysis; D004196:Disease Outbreaks; D004352:Drug Resistance, Microbial; D006785:Hospitals, University; D006801:Humans; D017053:Infection Control; D007710:Klebsiella Infections / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000145:classification* / Q000235:genetics; D012703:Serotyping; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D004269:DNA, Bacterial; D001618:beta-Lactamases