Clonal spread of Klebsiella pneumoniae producing CMY-2 AmpC-type β-lactamase in surgical intensive care units

Hsin Chun Lee, Jing Jou Yan, Jiunn Jong Wu, Chai Ming Chang, Chi Jung Wu, Nan Yao Lee, Po Ling Chen, Ching Chi Lee, Wen Chien Ko

Research output: Contribution to journalArticle

Abstract

Background and purpose: CMY-2, an AmpC-type β-lactamase, has become more prevalent in Klebsiella pneumoniae isolates at the National Cheng Kung University Hospital, Tainan, Taiwan. This retrospective study investigated the epidemiological characteristics of CMY-2-producing strains of K. pneumoniae. Methods: Molecular experiments were performed to describe the blaCMY-2 gene carriage rate and the trend of K. pneumoniae isolates with resistance to cefoxitin between January 2001 and June 2003. The epidemiological correlation between patients with blaCMY-2-positive K. pneumoniae was further analyzed and compared by chart review and pulsed-field gel electrophoresis (PFGE). Results: Of 285 cefoxitin-resistant K. pneumoniae isolates, 69 (24.2%) carried a blaCMY-2 sequence. The first blaCMY-2-positive isolate of each patient was genotyped by PFGE; 49 (89.1%) of 55 were genetically related. Forty five isolates (91.8%) were noted between January and September 2002. Eighteen isolates were from patients in 2 surgical intensive care units (SICUs), and 23 were from patients with prior SICU stays. Compared with patients with non-epidemic CMY-2-producing isolates, patients with the epidemic clone had a shorter duration of hospital stay (p = 0.007) and SICU stay (p = 0.01) before isolation. Recent surgery was independently associated with acquisition of epidemic CMY-2-producing K. pneumoniae. Conclusions: An unrecognized clonal spread of K. pneumoniae producing CMY-2 AmpC-type β-lactamase in SICUs was found. Cross-transmission of the epidemic clone, suggested by a shorter hospital stay before isolation of the bacterium and the association with recent surgery, highlights the importance of surveillance to recognize an epidemic and initiate control measures.

Original languageEnglish
Pages (from-to)479-487
Number of pages9
JournalJournal of Microbiology, Immunology and Infection
Volume42
Issue number6
Publication statusPublished - 2009 Dec 1

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Klebsiella pneumoniae
Critical Care
Intensive Care Units
Cefoxitin
Pulsed Field Gel Electrophoresis
Length of Stay
Clone Cells
Taiwan
Retrospective Studies
Bacteria
Genes

All Science Journal Classification (ASJC) codes

  • Immunology and Allergy
  • Immunology and Microbiology(all)
  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{c8f2b1f8cbcc40f08bf9bd1df1aa0a24,
title = "Clonal spread of Klebsiella pneumoniae producing CMY-2 AmpC-type β-lactamase in surgical intensive care units",
abstract = "Background and purpose: CMY-2, an AmpC-type β-lactamase, has become more prevalent in Klebsiella pneumoniae isolates at the National Cheng Kung University Hospital, Tainan, Taiwan. This retrospective study investigated the epidemiological characteristics of CMY-2-producing strains of K. pneumoniae. Methods: Molecular experiments were performed to describe the blaCMY-2 gene carriage rate and the trend of K. pneumoniae isolates with resistance to cefoxitin between January 2001 and June 2003. The epidemiological correlation between patients with blaCMY-2-positive K. pneumoniae was further analyzed and compared by chart review and pulsed-field gel electrophoresis (PFGE). Results: Of 285 cefoxitin-resistant K. pneumoniae isolates, 69 (24.2{\%}) carried a blaCMY-2 sequence. The first blaCMY-2-positive isolate of each patient was genotyped by PFGE; 49 (89.1{\%}) of 55 were genetically related. Forty five isolates (91.8{\%}) were noted between January and September 2002. Eighteen isolates were from patients in 2 surgical intensive care units (SICUs), and 23 were from patients with prior SICU stays. Compared with patients with non-epidemic CMY-2-producing isolates, patients with the epidemic clone had a shorter duration of hospital stay (p = 0.007) and SICU stay (p = 0.01) before isolation. Recent surgery was independently associated with acquisition of epidemic CMY-2-producing K. pneumoniae. Conclusions: An unrecognized clonal spread of K. pneumoniae producing CMY-2 AmpC-type β-lactamase in SICUs was found. Cross-transmission of the epidemic clone, suggested by a shorter hospital stay before isolation of the bacterium and the association with recent surgery, highlights the importance of surveillance to recognize an epidemic and initiate control measures.",
author = "Lee, {Hsin Chun} and Yan, {Jing Jou} and Wu, {Jiunn Jong} and Chang, {Chai Ming} and Wu, {Chi Jung} and Lee, {Nan Yao} and Chen, {Po Ling} and Lee, {Ching Chi} and Ko, {Wen Chien}",
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Clonal spread of Klebsiella pneumoniae producing CMY-2 AmpC-type β-lactamase in surgical intensive care units. / Lee, Hsin Chun; Yan, Jing Jou; Wu, Jiunn Jong; Chang, Chai Ming; Wu, Chi Jung; Lee, Nan Yao; Chen, Po Ling; Lee, Ching Chi; Ko, Wen Chien.

In: Journal of Microbiology, Immunology and Infection, Vol. 42, No. 6, 01.12.2009, p. 479-487.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Clonal spread of Klebsiella pneumoniae producing CMY-2 AmpC-type β-lactamase in surgical intensive care units

AU - Lee, Hsin Chun

AU - Yan, Jing Jou

AU - Wu, Jiunn Jong

AU - Chang, Chai Ming

AU - Wu, Chi Jung

AU - Lee, Nan Yao

AU - Chen, Po Ling

AU - Lee, Ching Chi

AU - Ko, Wen Chien

PY - 2009/12/1

Y1 - 2009/12/1

N2 - Background and purpose: CMY-2, an AmpC-type β-lactamase, has become more prevalent in Klebsiella pneumoniae isolates at the National Cheng Kung University Hospital, Tainan, Taiwan. This retrospective study investigated the epidemiological characteristics of CMY-2-producing strains of K. pneumoniae. Methods: Molecular experiments were performed to describe the blaCMY-2 gene carriage rate and the trend of K. pneumoniae isolates with resistance to cefoxitin between January 2001 and June 2003. The epidemiological correlation between patients with blaCMY-2-positive K. pneumoniae was further analyzed and compared by chart review and pulsed-field gel electrophoresis (PFGE). Results: Of 285 cefoxitin-resistant K. pneumoniae isolates, 69 (24.2%) carried a blaCMY-2 sequence. The first blaCMY-2-positive isolate of each patient was genotyped by PFGE; 49 (89.1%) of 55 were genetically related. Forty five isolates (91.8%) were noted between January and September 2002. Eighteen isolates were from patients in 2 surgical intensive care units (SICUs), and 23 were from patients with prior SICU stays. Compared with patients with non-epidemic CMY-2-producing isolates, patients with the epidemic clone had a shorter duration of hospital stay (p = 0.007) and SICU stay (p = 0.01) before isolation. Recent surgery was independently associated with acquisition of epidemic CMY-2-producing K. pneumoniae. Conclusions: An unrecognized clonal spread of K. pneumoniae producing CMY-2 AmpC-type β-lactamase in SICUs was found. Cross-transmission of the epidemic clone, suggested by a shorter hospital stay before isolation of the bacterium and the association with recent surgery, highlights the importance of surveillance to recognize an epidemic and initiate control measures.

AB - Background and purpose: CMY-2, an AmpC-type β-lactamase, has become more prevalent in Klebsiella pneumoniae isolates at the National Cheng Kung University Hospital, Tainan, Taiwan. This retrospective study investigated the epidemiological characteristics of CMY-2-producing strains of K. pneumoniae. Methods: Molecular experiments were performed to describe the blaCMY-2 gene carriage rate and the trend of K. pneumoniae isolates with resistance to cefoxitin between January 2001 and June 2003. The epidemiological correlation between patients with blaCMY-2-positive K. pneumoniae was further analyzed and compared by chart review and pulsed-field gel electrophoresis (PFGE). Results: Of 285 cefoxitin-resistant K. pneumoniae isolates, 69 (24.2%) carried a blaCMY-2 sequence. The first blaCMY-2-positive isolate of each patient was genotyped by PFGE; 49 (89.1%) of 55 were genetically related. Forty five isolates (91.8%) were noted between January and September 2002. Eighteen isolates were from patients in 2 surgical intensive care units (SICUs), and 23 were from patients with prior SICU stays. Compared with patients with non-epidemic CMY-2-producing isolates, patients with the epidemic clone had a shorter duration of hospital stay (p = 0.007) and SICU stay (p = 0.01) before isolation. Recent surgery was independently associated with acquisition of epidemic CMY-2-producing K. pneumoniae. Conclusions: An unrecognized clonal spread of K. pneumoniae producing CMY-2 AmpC-type β-lactamase in SICUs was found. Cross-transmission of the epidemic clone, suggested by a shorter hospital stay before isolation of the bacterium and the association with recent surgery, highlights the importance of surveillance to recognize an epidemic and initiate control measures.

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