title: Intra- and inter-generic plasmid-mediated spread of cephalosporin and aminoglycoside resistance amongst Klebsiella aerogenes K41 and other enterobacteria.
abstract: Klebsiella aerogenes K41, resistant to third generation cephalosporins and aminoglycosides, was isolated from clinical samples of 153 in-patients. Blood cultures accounted for 24 (15.7%) of isolates. The MIC(90) of ceftazidime for the isolates of 84 patients was >512 mg/l and was reduced to 2.0 by 4 mg/l of clavulanic acid, but only to 64 by 4 mg/l of sulbactam. Isolates of K. aerogenes K41 produced extended-spectrum beta-lactamase (ESBL) SHV-5 and TEM-1, identified by isoelectric focusing. Plasmid profiles showed that co-dissemination of cephalosporin and aminoglycoside resistance, plus ESBL production, coincided with the acquisition of a 116-kb plasmid. This plasmid was transferable in vitro from K. aerogenes K41 to other serotypes and genera of the Enterobacteriaceae.
authors.affiliation: Dulwich Public Health Laboratory and Medical Microbiology, Guy's, King's and St. Thomas' School of Medicine, King's College Hospital, Bessemer Road, SE5 9PJ, London, UK.
authors.forename: A
authors.initials: A
authors.lastname: Verma
authors.forename: N
authors.initials: N
authors.lastname: Desai
authors.forename: K
authors.initials: K
authors.lastname: Shannon
authors.forename: J
authors.initials: J
authors.lastname: Philpott-Howard
authors.forename: R L
authors.initials: RL
authors.lastname: Hill
mesh_terms: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents / Q000494:pharmacology* / Q000627:therapeutic use; D016470:Bacteremia / Q000188:drug therapy / Q000382:microbiology; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000494:pharmacology; D003227:Conjugation, Genetic; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D021902:Enterobacter aerogenes / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008826:Microbial Sensitivity Tests; D010403:Penicillin Resistance; D010957:Plasmids; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D002511:Cephalosporins; C117193:beta-lactamase SHV-5; D001618:beta-Lactamases; C034413:beta-lactamase TEM-1