title: Molecular epidemiology of extended-spectrum beta-lactamase-producing, fluoroquinolone-resistant isolates of Klebsiella pneumoniae in Taiwan.
abstract: Strains of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) have emerged worldwide. Concomitant ciprofloxacin resistance with ESBL production in K. pneumoniae isolates would severely restrict treatment options. Among 39 (18.5%) of 211 ESBL-KP isolates resistant to ciprofloxacin (MIC, >/=4 micro g/ml), 37 (95%) were high level resistant (MIC, >/=16 micro g/ml). These isolates were also cross resistant to the newer fluoroquinolones, including levofloxacin, gatifloxacin, gemifloxacin, and garenoxacin (BMS 284756). Sitafloxacin was most active against these ciprofloxacin-resistant ESBL-KP isolates with MICs for 67% of the isolates being </=2 micro g/ml. The molecular epidemiology of these multiresistant isolates was investigated by automated ribotyping and pulsed-field gel electrophoresis (PFGE). Ribotyping identified 18 different strains among the 39 ciprofloxacin-resistant ESBL-KP isolates. The majority (67%) of these isolates were contained in six ribogroups which were further confirmed by PFGE. The distribution of the six major strains of ciprofloxacin-resistant ESBL-KP within Taiwan included one (ribogroup 255.3-PFGE type E) with a nationwide distribution and several institution-specific strains. Interhospital cooperation appears necessary, with strict infection control practices coupled with restriction of fluoroquinolone and extended-spectrum beta-lactam use to control both the major epidemic strain and the more diverse strains observed within individual institutions.
authors.affiliation: Division of Medical Microbiology, Department of Pathology, University of Iowa, College of Medicine, Iowa City, Iowa 52242, USA.
authors.forename: W-L
authors.initials: WL
authors.lastname: Yu
authors.forename: R N
authors.initials: RN
authors.lastname: Jones
authors.forename: R J
authors.initials: RJ
authors.lastname: Hollis
authors.forename: S A
authors.initials: SA
authors.lastname: Messer
authors.forename: D J
authors.initials: DJ
authors.lastname: Biedenbach
authors.forename: L M
authors.initials: LM
authors.lastname: Deshpande
authors.forename: M A
authors.initials: MA
authors.lastname: Pfaller
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D002939:Ciprofloxacin / Q000494:pharmacology*; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000145:classification / Q000201:enzymology / Q000235:genetics*; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D021521:Ribotyping; D013624:Taiwan / Q000453:epidemiology; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis*
chemical_list: D000890:Anti-Infective Agents; D002939:Ciprofloxacin; D001618:beta-Lactamases