title: An outbreak of CTX-M-15-producing Klebsiella pneumoniae isolates in an intensive care unit of a teaching hospital in Kuwait.
abstract: OBJECTIVE
  This study reports an outbreak of Klebsiella pneumoniae infections in 14 patients during a 2-month period (August-September, 2008) in the intensive care unit (ICU) of a teaching hospital in Kuwait.
  
  
  METHODS
  The clinical sources were blood (9), urine (3) and respiratory secretions (2) identified by the automated VITEK-2 ID System. Susceptibility testing was performed by the E-test method. Extended-spectrum β-lactamase (ESBL) production was assessed using the ESBL E-test and confirmed by PCR. Carriage of bla genes was determined by PCR and sequence analysis. The transferability of resistance phenotypes was demonstrated by conjugation experiments and clonal relatedness was determined by PFGE.
  
  
  RESULTS
  The isolates were susceptible to imipenem, meropenem, and tigecycline and produced ESBL. All isolates yielded an amplicon of 499 bp with universal consensus primers (MA primers). DNA sequence analysis showed that they all harboured bla CTX-M-15 and bla TEM-1 genes. The environmental isolate obtained from a suction machine was also CTX-M-15/TEM-1 producer. The resistance phenotypes were transferrable to the Escherichia coli J53 r strain. PFGE, revealed two clones, A and B, related with a Dice coefficient of >94.1%. A mortality rate of 21.4% was recorded.
  
  
  CONCLUSIONS
  The outbreak was contained by robust and aggressive infection control measures. This study highlights the first outbreak of CTX-M-15-producing K. pneumoniae associated with high mortality in an adult medical ICU in Kuwait.
authors.affiliation: Department of Microbiology, Faculty of Medicine, Kuwait University, P. O. Box 24923, Safat 13110, Kuwait. nalsweih@hsc.edu.kw
authors.forename: N
authors.initials: N
authors.lastname: Al Sweih
authors.forename: M F
authors.initials: MF
authors.lastname: Salama
authors.forename: W
authors.initials: W
authors.lastname: Jamal
authors.forename: G
authors.initials: G
authors.lastname: Al Hashem
authors.forename: V O
authors.initials: VO
authors.lastname: Rotimi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015373:Bacterial Typing Techniques; D001431:Bacteriological Techniques; D001769:Blood / Q000382:microbiology; D003227:Conjugation, Genetic; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D022761:Gene Transfer, Horizontal; D005838:Genotype; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D007730:Kuwait / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D013183:Sputum / Q000382:microbiology; D014556:Urine / Q000382:microbiology; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics
chemical_list: C473109:beta-lactamase CTX-M-15; D001618:beta-Lactamases