Epidemiology and Infection

Original Papers

Pneumococci, Klebsiella, Pseudomonas, and Staphylococci

The emergence of multidrug-resistant Klebsiella pneumoniae of international clones ST13, ST16, ST35, ST48 and ST101 in a teaching hospital in the Paris region

G. MARCADEa1, S. BRISSEa2, S. BIALEKa3a4a5, E. MARCONa3, V. LEFLON-GUIBOUTa3, V. PASSETa2, R. MOREAUa5 and M.-H. NICOLAS-CHANOINEa3a4a5 c1

a1 Microbiology Department, Hôpital L. Mourier, AP-HP, Colombes, France

a2 Institut Pasteur, Plateforme Génotypage des Pathogènes et Santé Publique, Paris, France

a3 Microbiology Department, Hôpital Beaujon, AP-HP, Clichy, France

a4 Faculté de Médecine D. Diderot, Université Paris VII, France

a5 Inserm U773, Centre de Recherche Biologique Bichat-Beaujon (CRB3), Paris, France

SUMMARY

Despite infection control measures, an important increase in the extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae incidence density occurred in our hospital from 2006 onwards. This study, focusing on the 2005–2007 period, was performed in an attempt to explain this increase. ESBLs were characterized, isolates were typed by ERIC2-PCR, and sequence type (ST) of clustered isolates was determined. Temporal-spatial relationships of patients were analysed to assess possible cross-contamination. Of the 74 ESBL-producing isolates, 30 (40%) were detected at admission, 53 (71·5%) produced CTX-M enzymes, 40 displayed unique ERIC2-PCR profiles and 34 were assigned into six clusters: ST16 (n = 21), ST101, ST48, ST35, ST13, and ST436. Relationships were identified in 22 of the 34 patients harbouring clustered isolates. This study highlights the complex epidemiology of ESBL-producing K. pneumoniae in the mid-2000s with potential cross-contamination for only 30% of the 74 patients in our hospital, and the emergence of clones that are currently spreading worldwide.

(Received June 27 2012)

(Revised August 16 2012)

(Accepted August 16 2012)

(Online publication October 04 2012)

Key words

  • Antibiotic resistance;
  • hospital-acquired (nosocomial) infections;
  • infectious disease epidemiology;
  • Klebsiella ;
  • molecular epidemiology

Correspondence

c1 Author for correspondence: Professor M.-H. Nicolas-Chanoine, Service de Microbiologie, Hôpital Beaujon, 92110 Clichy, France. (Email: mhn.chanoine@bjn.aphp.fr)

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