Extended-spectrum beta-lactamases in clinical isolates of Klebsiella pneumoniae from Zagreb, Croatia

Forty clinical isolates of Klebsiella pneumoniae, from various clinical specimens, with reduced susceptibility to ceftazidime, were tested for extended-spectrum beta-lactamase (ESBL) production. ESBL production was demonstrated by an 8-fold reduction in the minimum inhibitory concentration (MIC) of ceftazidime combined with clavulanate (2 mg/L) compared to ceftazidime alone in all strains. The aim of this investigation was the biochemical and molecular characterization of the ESBL produced by K. pneumoniae strains and their Escherichia coli transconjugants. Transfer of ceftazidime resistance was demonstrated in 23 of 40 strains. Thirteen strains produced an ESBL with the isoelectric point of 8.2 which was encoded by a self-transferable multiresistance plasmid of 150 kb. The substrate profile was similar to that of the SHV-5 isolated initially in Chile. Seven of these 12 strains had an additional TEM beta-lactamase. Six isolates and their transconjugants produced a plasmid-encoded ESBL with an isoelectric point close to 5.4. The remaining 21 strains produced an ESBL with an isoelectric point of 7.6 (thus probably SHV-2) which was encoded on a plasmid transferable to E. coli in 4 strains only. Four of those strains possessed an additional plasmid encoded TEM beta-lactamase with an isoelectric point close to 5.4. The transconjugants harbored a multiresistance plasmid of 150 kb. Thus SHV-2 and SHV-5 enzymes appear to have been the most common ESBLs in K. pneumoniae from Zagreb during 1994-1995.     

Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae strains causing nosocomial outbreaks of infection in the United Kingdom

Representative isolates from 10 distinct extended-spectrum beta-lactamase-producing strains of Klebsiella pneumoniae that caused hospital outbreaks in the United Kingdom from 1991 to 1994 were examined for relationships between their enzymes and plasmids. The beta-lactamases were identified by a combination of isoelectric focusing and gene sequencing. SHV-2 beta-lactamase was produced by isolates from four outbreaks, SHV-5 was involved in three, and SHV-4, TEM-15, and TEM-26 were involved in one outbreak each. All of the extended-spectrum beta-lactamases were encoded by self-transmissible plasmids, with sizes ranging from about 70 to 160 kb. No similarities between the restriction digest patterns of the extended-spectrum beta-lactamase-encoding plasmids were detected, except to some extent between those that produced TEM-15 and TEM-26. Thus, outbreaks of hospital infection with these organisms in the United Kingdom from 1991 to 1994 involved distinct organisms and resistance plasmids and appeared to be unrelated.     

First characterization of inhibitor-resistant TEM (IRT) beta-lactamases in Klebsiella pneumoniae strains

Two clinical strains of Klebsiella pneumoniae, TP 01 and TP 02, presented resistance to amoxicillin-clavulanate and were fully susceptible to cephalothin. These strains produced two beta-lactamases, SHV-1 and a TEM enzyme with a pI of 5.2. The previously described changes Arg-244-->Cys and Arg-244-->Ser in IRT-1 and IRT-2 (A. Belaaouaj, C. Lapoumeroulie, M. M. Cani?a, G. Vedel, P. Nevot, R. Krishnamoorthy, and G. Paul, FEMS Microbiol. Lett. 120:75-80, 1994) were found in TEM enzymes from the TP 01 and TP 02 strains, respectively. This is the first report of inhibitor-resistant TEM (IRT) in species other than Escherichia coli from the family Enterobacteriaceae.     

Plasmid profiles of Klebsiella pneumoniae isolated from horses

Plasmid profiles of Klebsiella pneumoniae isolated from horses were examined. Thirty-nine strains of K. pneumoniae capsular type 1 (K1) isolated from cervical swabs of mares suffering from metritis, and from semen of stallions showed similar plasmid profile patterns, and all strains possessed a 125 megadaltons (Md) plasmid. There was no difference in plasmid profiles between the heavily-encapsulated and the less heavily-encapsulated strains of K. pneumoniae K1. Non-capsulated variants derived from the strains of K1 showed the same plasmid profile pattern as the parent strains. Plasmid profiles of K. pneumoniae other than K1 were various, and none of these strains possessed the 125 Md plasmid.     

Study of an outbreak of cefoxitin-resistant Klebsiella pneumoniae in a general hospital

During a 3-month period, six Klebsiella pneumoniae isolates resistant to cefoxitin and penicillin-inhibitor combinations were derived from patients in the intensive care unit of a hospital in Athens, Greece. Enterobacterial repetitive intergenic consensus PCR and pulsed-field gel electrophoresis provided evidence of the clonal origin of the isolates. Conventional techniques and ribotyping were inadequate in proving that the isolates were related. Resistance was due to a plasmidic class C beta-lactamase.     

Variability of chromosomally encoded beta-lactamases from Klebsiella oxytoca

The beta-lactamase genes of Klebsiella oxytoca were previously divided into two main groups: bla(OXY-1) and bla(OXY-2). The two beta-lactamase groups were each represented by beta-lactamases with four different pIs. In each group, one form of beta-lactamase is more frequent than the others combined. The beta-lactamase gene of each representative beta-lactamase with a different pI that was not yet sequenced (pIs 5.7, 6.8 [OXY-2], 7.1, 8.2, and 8.8 [OXY-1]) was cloned and sequenced. The susceptibility patterns as well as relative rates and kinetic parameters for beta-lactam hydrolysis revealed that OXY-2 enzymes hydrolyzed several of the beta-lactams that were examined (carbenicillin, cephalothin, cefamandole, ceftriaxone, and aztreonam) at a greater rate than the OXY-1 enzymes did. Comparison of K. oxytoca beta-lactamases with plasmid-mediated extended-spectrum beta-lactamases MEN-1 and TOHO-1 implied that the threonine at position 168 present in OXY-2 beta-lactamase instead of the alanine in OXY-1 could be responsible for its modified substrate hydrolysis. In each group, the beta-lactamase with a variant pI differs from the main form of beta-lactamase by one to five amino acid substitutions. The substrate profile and the 50% inhibitory concentrations revealed that all substitutions differing from the main form of beta-lactamase were neutral except one difference in the OXY-1 group. This substitution of an Ala to a Gly at position 237 increases the hydrolysis of some beta-lactams, particularly aztreonam; decreases the hydrolysis of benzylpenicillin, cephaloridine, and cefamandole, and decreases the susceptibility to clavulanic acid (fivefold increase in the 50% inhibitory concentration).     

Energy-dependent accumulation of fluoroquinolones in quinolone-resistant Klebsiella pneumoniae strains

The intracellular accumulation of norfloxacin and pefloxacin in Klebsiella pneumoniae was evaluated. The roles of lipopolysaccharide, capsule, and outer membrane proteins were not important for the intrabacterial accumulation of fluoroquinolones in isogenic strains with known outer membrane alterations. In fluoroquinolone-resistant clinical isolates also expressing GyrA alterations, an active efflux leading to decreased accumulation of the drugs enhanced their resistance to these agents.     

Ceftazidime-resistant Klebsiella pneumoniae and Escherichia coli isolates producing TEM-10 and TEM-43 beta-lactamases from St. Louis, Missouri

Ceftazidime-resistant Escherichia coli and Klebsiella pneumoniae (49 and 102 isolates, respectively) were collected from Barnes-Jewish Hospital, St. Louis, Mo., from 1992 to 1996. They were uniformly resistant to ceftazidime, generally resistant to aztreonam, and variably susceptible to cefotaxime. Four representative E. coli strains and 15 Klebsiella strains were examined. From one to four beta-lactamases were produced per strain, with three possible enzymes related to ceftazidime resistance: enzymes with pI values of 5.6, 6.1, or 7.6. By pulsed-field gel electrophoresis there were at least 13 different Klebsiella strain types and 3 different E. coli strain types, indicating that the outbreak was not clonal. After cloning and sequencing of the beta-lactamase-encoding genes, the enzyme with a pI of 5.6 was identified as TEM-10. The enzyme with a pI of 6.1 was a novel TEM variant (TEM-43) with Lys at 104, His at 164, and Thr at 182. TEM-43 showed broad-spectrum hydrolytic activity against all penicillins, with the highest hydrolysis rate for ceftazidime compared to those for the other expanded-spectrum cephalosporins. Aztreonam was also a good substrate for TEM-43, with hydrolytic activity similar to that of ceftazidime and affinity higher than that of ceftazidime. The TEM-43 beta-lactamase was well inhibited by clavulanic acid and tazobactam at concentrations of < 10 nM. Sulbactam was less effective than the other inhibitors. The Thr182 mutation previously reported in an inhibitor-resistant beta-lactamase did not cause the TEM-43 enzyme to become resistant to any of the inhibitors.     

Molecular markers for differentiation of multiresistant Klebsiella pneumoniae isolates in a pediatric hospital

OBJECTIVE: To study the spread of extended-spectrum beta-lactamase-producing, but aminoglycoside-susceptible, Klebsiella pneumoniae strains in our hospital over an 8-month period, by using two genotypic markers. DESIGN: Ribotyping (using two endonucleases) and randomly amplified polymorphic DNA analysis (RAPD; using two different 10-mer primers) were applied to the epidemiological typing of clinical K pneumoniae isolates from stools, ileal fluid, or urine of hospitalized children. SETTING AND PATIENTS: The surgical intensive-care ward (S1: 9 patients, 17 isolates), surgical unit (S2: 2 patients, 2 isolates), and gastroenterology ward (GE: 1 patient, 1 isolate) of the Robert Debré Hospital of Paris, France. RESULTS: Ribotyping of the 20 clinical isolates, the type strain of the species, and two epidemiologically unrelated isolates with EcoRI and HindIII revealed 6 and 5 different patterns, respectively. Six ribotypes were identified by using these two enzymes. RAPD generated 6 distinct patterns, in complete agreement with ribotyping. Our genotypic results showed that 11 patients from wards S1, S2, and GE harbored genotypically related strains, suggesting nosocomial transmission and cross-colonization between and within the three wards. CONCLUSIONS: Ribotyping and RAPD appear to be reliable methods for distinguishing K pneumoniae strains. The spread of one strain of K pneumoniae in different units of our hospital was demonstrated by both methods. However, RAPD has the advantage of simplicity and rapidity conferred by polymerase chain reaction.     

A case of Klebsiella pneumoniae endophthalmitis metastasized from prostatitis

A case of Klebsiella pneumoniae endophthalmitis metastasized from prostatitis is reported. A 58-year-old alcoholismic man with diabetic diathesis suffered from endophthalmitis which required enucleation of his left eye, when he interrupted the treatment of prostatitis. Metastatic bacterial endophthalmitis from urinary tract infection is rare.     

ADP-ribosylation of an approximately 70-kilodalton protein of Klebsiella pneumoniae

An approximately 70-kDa protein in the culture supernatant of a human pathogenic strain of Klebsiella pneumoniae was labeled in the presence of [32P-adenylate]NAD. Labeling was significantly increased by the addition of dithiothreitol ( > 1 mM) but prevented by treatment of the culture supernatant for 3 min at 56 degrees C. The addition of unlabeled NAD, but not of ADP-ribose, blocked labeling of the approximately 70-kDa protein. The radioactive label was released by formic acid but not by HgCl2 (1 mM) or neutral hydroxylamine (0.5 M). The addition of homogenates of human platelets, human neutrophils, rat brain, rat lung, or rat spleen tissues to the culture supernatant did not induce labeling of eukaryotic proteins. The data indicate that the K. pneumoniae strain produces ADP-ribosyltransferase which modifies an endogenous protein.     

Arylsulfatase from Klebsiella pneumoniae carries a formylglycine generated from a serine

Eukaryotic sulfatases share an unusual posttranslational protein modification, which converts a cysteine into alpha-formylglycine. The alpha-formylglycine is essential for the catalytic activity. Klebsiella pneumoniae expresses an inducible arylsulfatase for which the DNA predicts a serine at the position occupied by the alpha-formylglycine residue in eukaryotic sulfatases. Structural analysis showed that the majority of the arylsulfatase polypeptides from K. pneumoniae carries the alpha-formylglycine, whereas the remaining arylsulfatase polypeptides contain the predicted serine residue. This demonstrates the evolutionary conservation between prokaryotes and eukaryotes of this novel protein modification that so far has been found only in sulfatases. alpha-Formylglycine in Klebsiella is generated from a serine and not from a cysteine as in eukaryotes.     

Molecular epidemiology of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae isolates in a district hospital in Taiwan

Thirty-one of 104 clinical isolates of Klebsiella pneumoniae collected over a period of 8 months were found to be putative extended-spectrum beta-lactamase (ESBL) producers. Isoelectric focusing and an iodine overlay agar method were used for preliminary identification of the ESBLs. They were further identified by DNA sequencing. Seventy-one percent of the isolates were found to produce SHV-5. The variation in the ESBL patterns of these isolates was slight, with only five patterns being identified. The strains were typed by pulsed-field gel electrophoresis (PFGE), and 16 different genotypes were identified. When the PFGE patterns were analyzed by the algorithmic clustering method called the unweighted-pair group method using arithmetic averages, five clusters were found. However, significant genetic variations were found among 11 isolates and between each cluster. A plasmid of 36 kb was found in all clinical isolates and in the transconjugants. Our results indicate that the increase in the number of ESBL-producing K. pneumoniae isolates in this hospital is due mainly to the dissemination of a resistance plasmid rather than to the clonal spread of a few epidemic strains.     

Identification of the plasmid-mobilization potential of the strain Klebsiella pneumoniae ozenae KIIIA isolated from a polluted aquatic environment

Gro Harlem Brundtland, who became Director General of the World Health Organization in July 1998, has created a small revolution at the WHO headquarters in Geneva. She is in the process of changing how WHO works, how it interacts with other parts of the United Nations system, and how it enlists ministries, whole governments, universities, and other private organizations to improve health in the world. Here, the Editor describes the reorganization, the new people and resources, and prospects for setting a precedent in United Nations reform.     

Klebsiella and Enterobacter organisms isolated from horses

An account is given of K. pneumoniae capsule types occurring in horses, with particular reference to strains originating from the genital tract in the mare and the external genitalia of the stallion. A survey of the prevalence of K. pneumoniae and E. aerogenes strains in the preputial flora of healthy stallions is described. The majority of horses were found to be carriers of these organisms. The cultural characteristics of these preputial strains are described and compared with those of K. pneumoniae strains associated with epidemic metritis in mares. The epidemiological significance of certain K. pneumoniae capsule types is discussed.     

The beta-lactamases of Moraxella (Branhamella) catarrhalis isolated from Danish children

Two distinct beta-lactamases have been isolated from Moraxella catarrhalis: the stronger acting BRO-1 enzyme and the weaker acting BRO-2. Several reports have noted an effect of penicillin and ampicillin on infections caused by M. catarrhalis in spite of the presence of beta-lactamase production. The purpose of this work was to charaterize the beta-lactamases of M. catarrhalis isolated from Danish children regarding type and susceptibility, and to relate these findings to the eradication of beta-lactamases-producing strains by use of antibiotic treatment with penicillin or ampicillin. MICs for penicillin V, ampicillin, cefuroxime and amoxicillin/clavulanic acid (2:1) were determined in 70 strains of M. catarrhalis: 46 strains from children with lower respiratory tract infection (LRTI) and 24 strains from respiratory healthy children, beta-lactamase production was found in 59 strains. The BRO-1 enzyme was identified by isoelectric focusing in 55 strains (93.2%) and BRO-2 in 3 strains (5.1%); in 1 strain no isoelectric bands were produced. All strains were susceptible to cefuroxime and amoxicillin/clavulanic acid, and non-beta-lactamase-producing strains were susceptible to penicillin and ampicillin. For the beta-lactamase-producing strains, MIC50 of penicillin was 8.0 micrograms/ml, while MIC50 of ampicillin was 1.0 microgram/ml and MIC90 of ampicillin was 2.0 micrograms/ml. M. catarrhalis was more often eradicated from the children who received antibiotic treatment with penicillin or ampicillin than from those who did not receive any treatment, indicating an in vivo effect of penicillin and ampicillin in spite of the beta-lactamase production.     

Molecular typing of Klebsiella pneumoniae isolates from a neonatal intensive care unit

The epidemiological features of 60 multiresistant K. pneumoniae strains isolated from 1991 to 1995 in a neonatal ward are described. Antibiotic. Susceptibility testing and plasmid profile analysis were used as subtyping procedures. Antibiotic susceptibility typing was not informative enough since discrimination among isolates was typically poor. Plasmid profile analysis demonstrated that 58 out of 60 strains harboured one or more plasmid DNA bands, of different molecular weights ranging between 1.8 and 150 Mda. Small plasmids were best visualized after the alkaline lysis procedure, while large plasmids by the Kado and Liu method. A combination of plasmid patterns obtained by the two extraction procedures was used to define the final plasmid profile for each strain. Thirteen different plasmid profiles were identified among the collection of K. pneumoniae isolates from newborn patients of the same intensive care unit. The investigation showed that the strains were not responsible for a single outbreak.     

Production and characterization of guluronate lyase from Klebsiella pneumoniae for applications in seaweed biotechnology

Cultures of Klebsiella pneumoniae fermenting sodium alginate produce an extracellular guluronate-specific alginate lyase. This enzyme production was studied in stirred-tank fermentors. Different alginate substrates gave moderate differences in growth and enzyme yield. Alginates with low guluronic content gave reduced biomass but favored enzyme production. Low molecular weight (down to DPn approximately 270) also favored enzyme production. Excessive depolymerization of substrates occurred during heat sterilization of culture media. The enzyme was characterized by its specificity and sensitivity to pH, salt, and calcium. Improved yields of viable protoplasts were documented for Laminaria digitata (Huds.) Lamour.     

AI-2 Key Enzyme S-Ribosylhomocysteinase from Strain Klebsiella pneumoniae CICC 10011 Producing 2,3-Butanediol

S-Ribosylhomocysteinase(LuxS) is the key enzyme in the synthetic pathway of a quorum sensing autoinducer AI-2. LuxS from a 2,3-butanediol produced strain Klebisella pneumoniae CICC 10011 was cloned and characterized. The luxS gene is composed of 540 bp with 172 amino acids encoded. The Km value for S-ribosylhomocysteine(SRH) was (27+1) μmol/L, kcat was (0.112+0.004) s-1 and kcat/Km was 4.4×103 L·mol-1· s-1 at 25℃. LuxS was activated by divalent metal ions, the highest activity was detected with Co2+ form, followed by Mg2+, Ba2+, Mn2+, Fe2+ and Ca2+, and activation constant for Co2+ is (16+2) μmol/L.     

The mitochondrial toxin produced by Streptomyces griseus strains isolated from an indoor environment is valinomycin

Actinomycete isolates from indoor air and dust in water-damaged schools and children's day care centers were tested for toxicity by using boar spermatozoa as an indicator. Toxicity was detected in extracts of four strains which caused a loss of sperm motility, and the 50% effective concentrations (EC50) were 10 to 63 ng (dry weight) ml of extended boar semen-1. The four strains were identified as Streptomyces griseus strains by 16S ribosomal DNA and chemotaxonomic methods. The four S. griseus strains had similar effects on sperm cells, including loss of motility and swelling of mitochondria, but we observed no loss of plasma membrane integrity or depletion of cellular ATP. None of the effects was observed with sperm cells exposed to extracts of other indoor actinomycete isolates at concentrations of >/=5,000 to 72,000 ng ml-1. The toxin was purified from all four strains and was identified as a dodecadepsipeptide, and the fragmentation pattern obtained by tandem mass spectrometry was identical to that of valinomycin. Commercial valinomycin had effects in sperm cells that were identical to the effects of the four indoor isolates of S. griseus. The EC50 of purified toxin from the S. griseus strains were 1 to 3 ng ml of extended boar semen-1, and the EC50 of commercial valinomycin was 2 ng ml of extended boar semen-1. To our knowledge, this is the first report of the presence of ionophoric toxin producers in an indoor environment and the first report of valinomycin-producing strains identified as S. griseus.