title: Nosocomial spread of ceftazidime-resistant Klebsiella pneumoniae strains producing a novel class a beta-lactamase, GES-3, in a neonatal intensive care unit in Japan.
abstract: Klebsiella pneumoniae strain KG525, which showed high-level resistance to broad-spectrum cephalosporins, was isolated from the neonatal intensive care unit (NICU) of a Japanese hospital in March 2002. The ceftazidime resistance of strain KG525 was transferable to Escherichia coli CSH-2 by conjugation. Cloning and sequence analysis revealed that production of a novel extended-spectrum class A beta-lactamase (pI 7.0), designated GES-3, which had two amino acid substitutions of M62T and E104K on the basis of the sequence of GES-1, was responsible for resistance in strain KG525 and its transconjugant. The bla(GES-3) gene was located as the first gene cassette in a class 1 integron that also contained an aacA1-orfG fused gene cassette and one unique cassette that has not been described in other class 1 integrons and ended with a truncated 3' conserved segment by insertion of IS26. Another five ceftazidime-resistant K. pneumoniae strains, strains KG914, KG1116, KG545, KG502, and KG827, which were isolated from different neonates during a 1-year period in the same NICU where strain KG525 had been isolated, were also positive for GES-type beta-lactamase genes by PCR. Pulsed-field gel electrophoresis and enterobacterial repetitive intergenic consensus-PCR analyses displayed genetic relatedness among the six K. pneumoniae strains. Southern hybridization analysis with a GES-type beta-lactamase gene-specific probe showed that the locations of bla(GES) were multiple and diverse among the six strains. These findings suggest that within the NICU setting genetically related K. pneumoniae strains carrying the bla(GES) gene were ambushed with genetic rearrangements that caused the multiplication and translocation of the bla(GES) gene.
authors.affiliation: Department of Bacterial Pathogenesis and Infection Control, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashi-Murayama, Tokyo 208-0011, Japan. yarakawa@nih.go.jp
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Wachino
authors.forename: Yohei
authors.initials: Y
authors.lastname: Doi
authors.forename: Kunikazu
authors.initials: K
authors.lastname: Yamane
authors.forename: Naohiro
authors.initials: N
authors.lastname: Shibata
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yagi
authors.forename: Takako
authors.initials: T
authors.lastname: Kubota
authors.forename: Hideo
authors.initials: H
authors.lastname: Ito
authors.forename: Yoshichika
authors.initials: Y
authors.lastname: Arakawa
mesh_terms: D000595:Amino Acid Sequence; D015139:Blotting, Southern; D002442:Ceftazidime / Q000494:pharmacology*; D018550:Cephalosporin Resistance; D002511:Cephalosporins / Q000494:pharmacology*; D003001:Cloning, Molecular; D003428:Cross Infection / Q000382:microbiology* / Q000635:transmission*; D004269:DNA, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D006801:Humans; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal; D007525:Isoelectric Focusing; D007564:Japan; D007710:Klebsiella Infections / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D016297:Mutagenesis, Site-Directed; D010957:Plasmids / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D002511:Cephalosporins; D004269:DNA, Bacterial; D047090:beta-Lactams; D002442:Ceftazidime; D001618:beta-Lactamases; C487649:beta-lactamase GES-3, Klebsiella pneumoniae