Monitoring, epidemiology and molecular analysis of extended-spectrum b-lactamase producing Klebsiella pneumoniae strains isolated at a large hospital in Budapest during a four-month period
Abstract number: P621
Tirczka T., Tóth Á., Damjanova I., Szilágyi E., Korom J., Bukovszki F.
Objectives: Comprehensive multilevel investigation of outbreaks caused by extended-spectrum b-lactamase producing Klebsiella pneumoniae (ESBL-KP) in a large tertiary hospital in Budapest during period of four months.
Methods: During the study period ESBL-KP strains were recovered from 18 different hospital wards. Altogether 270 samples were examined, of these 48 environmental and 163 patient and staff samples, respectively. Antimicrobial susceptibility testing was performed by disk diffusion method according to the recommendations of the CLSI. On the basis of preliminary phage typing results ESBL-KP isolates were tested by PFGE. Molecular typing was performed by SHV, CTX-M and TEM PCRs, plasmid profile analysis, transfer of resistance determinants and sequencing of resistance genes.
Results: 132 ESBL-producing clinical isolates of Gram-negative pathogens (GNPs) were collected from October 2006 to January 2007 from 82 patients and hospital staff as follow: Klebsiella pneumoniae (n = 86), Escherichia coli (EC) (n = 35) and other species (n = 11). One of 48 enviromental samples was positive for ESBL-KP.
70% of samples recovered from the Neonatal Intensive Care Unit (NICU), 50% of samples from the Neurosurgery and the Chronic Internal Medicine Ward (CIMW), respectively, and 30% of samples from the Intensive Care Unit (ICU) proved ESBL-producers.
The molecular characterisation of ESBL-KP strains isolated from the NICU showed that all of them belonged to the same pulsotype (X clone) and harboured blaSHV-5 gene on plasmid of app. 90 kb.
PFGE analysis of ESBL-KP strains isolated from 9 adult wards revealed parallel existence of three different genetic clones: the Hungarian Epidemic Clone (HEC, pulsotype N), the Epidemic clone III (EC III, pulsotype S) and the clone L. All of them harboured blaCTX-M-15 on large plasmids ranged from 50 to 90 kb.
Conclusion: Three parallel outbreaks caused by ESBL-KP were detected in the NICU, the ICU and the Neurosurgery from October to December of 2006. Additionally high colonisation rate (32%) with ESBL-KP was found in the CIMW.
|Session name:||18th European Congress of Clinical Microbiology and Infectious Diseases|
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