First outbreak of multidrug-resistant Klebsiella pneumoniae producing both SHV-12-type extended-spectrum β-lactamase and DHA-1-type AmpC β-lactamase at a Korean Hospital

Abstract

Purpose: Coexistence of different classes of β-lactamases in a single bacterial isolate may pose diagnostic and therapeutic challenges. We investigated a spread of Klebsiella pneumoniae isolates co-producing an AmpC β-lactamase and an extended-spectrum β-lactamase (ESBL) in a Liniversity hospital. Materials and Methods: Over a three-month period, a total of 11 K pneumoniae isolates, which exhibited resistance to cefotaxime, aztreonam, and cefoxitin, were isolated. These isolates showed positive to ESBIs by double disk tests. Minimal inhibitory concentrations (MICs) were determined by broth microdilution testing. All isolates were examined by isoelectric focusing, PCR and sequence analysis to identify blaSHV and blaDHA, and molecular typing by pulsed-field gel electrophoresis (PFGE). Results: All 11 isolates were highly resistant (MIC, ≥ 128 μ g/ml) to ceftazidime, aztreonam, and cefoxitin, while they were susceptible (MIC, ≤2 μg/ml) to imipenem. The blaSHV-12 and blaDHA-1 genes were detected by PCR and sequence analysis. PFGE revealed a similar pattern in 10 of the 11 strains tested. Conclusion: This is the first outbreak report of K pneumoniae in Korea which co-produced SHV-12 and DHA-1 β-lactamase, and we suggest a clonal spread of multidrug-resistant K. pneumoniae at a hospital.