Ertapenem Resistance among Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae Isolates
Ertapenem resistance in Klebsiella pneumoniae is rare. We report on an ertapenem-nonsusceptible phenotype among 25 out of 663 (3.77%) extended-spectrum-β-lactamase (ESBL)-producing K. pneumoniae isolates in a multicenter Israeli study. These isolates originated from six different hospitals and were...
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| Veröffentlicht in: | Journal of Clinical Microbiology 2009-04, Vol.47 (4), p.969-974 |
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| creator | Leavitt, Azita Chmelnitsky, Inna Colodner, Raul Ofek, Itzhak Carmeli, Yehuda Navon-Venezia, Shiri |
| description | Ertapenem resistance in Klebsiella pneumoniae is rare. We report on an ertapenem-nonsusceptible phenotype among 25 out of 663 (3.77%) extended-spectrum-β-lactamase (ESBL)-producing K. pneumoniae isolates in a multicenter Israeli study. These isolates originated from six different hospitals and were multiclonal, belonging to 12 different genetic clones. Repeat testing using Etest and agar dilution confirmed ertapenem nonsusceptibility in only 15/663 (2.3%) of the isolates. The molecular mechanisms of ertapenem resistance in seven single-clone resistant isolates was due to the presence of ESBL genes (CTX-M-2 in four isolates, CTX-M-10 and OXA-4 in one isolate, SHV-12 in one isolate, and SHV-28 in one isolate) combined with the absence of OMPK36. Seven of 10 isolates initially reported as ertapenem nonsusceptible and subsequently classified as susceptible showed an inoculum effect with ertapenem but not with imipenem or meropenem. Population analysis detected the presence of an ertapenem-resistant subpopulation at a frequency of 10⁻⁶. These rare resistant subpopulations carried multiple ESBL genes, including TEM-30, SHV-44, CTX-M-2, and CTX-M-10, and they lacked OMPK36. The clinical and diagnostic significance of the results should be further studied. |
| doi_str_mv | 10.1128/JCM.00651-08 |
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We report on an ertapenem-nonsusceptible phenotype among 25 out of 663 (3.77%) extended-spectrum-β-lactamase (ESBL)-producing K. pneumoniae isolates in a multicenter Israeli study. These isolates originated from six different hospitals and were multiclonal, belonging to 12 different genetic clones. Repeat testing using Etest and agar dilution confirmed ertapenem nonsusceptibility in only 15/663 (2.3%) of the isolates. The molecular mechanisms of ertapenem resistance in seven single-clone resistant isolates was due to the presence of ESBL genes (CTX-M-2 in four isolates, CTX-M-10 and OXA-4 in one isolate, SHV-12 in one isolate, and SHV-28 in one isolate) combined with the absence of OMPK36. Seven of 10 isolates initially reported as ertapenem nonsusceptible and subsequently classified as susceptible showed an inoculum effect with ertapenem but not with imipenem or meropenem. Population analysis detected the presence of an ertapenem-resistant subpopulation at a frequency of 10⁻⁶. These rare resistant subpopulations carried multiple ESBL genes, including TEM-30, SHV-44, CTX-M-2, and CTX-M-10, and they lacked OMPK36. The clinical and diagnostic significance of the results should be further studied.</description><identifier>ISSN: 0095-1137</identifier><identifier>EISSN: 1098-660X</identifier><identifier>DOI: 10.1128/JCM.00651-08</identifier><identifier>PMID: 19213695</identifier><language>eng</language><publisher>United States: American Society for Microbiology</publisher><subject>Anti-Bacterial Agents - pharmacology ; Bacterial Outer Membrane Proteins - analysis ; Bacterial Proteins - biosynthesis ; Bacterial Proteins - genetics ; Bacterial Typing Techniques ; Bacteriology ; beta-Lactam Resistance ; beta-Lactamases - biosynthesis ; beta-Lactamases - genetics ; beta-Lactams - pharmacology ; Electrophoresis, Polyacrylamide Gel ; Genotype ; Hospitals ; Humans ; Israel ; Klebsiella Infections - microbiology ; Klebsiella pneumoniae - classification ; Klebsiella pneumoniae - drug effects ; Klebsiella pneumoniae - enzymology ; Klebsiella pneumoniae - genetics ; Microbial Sensitivity Tests</subject><ispartof>Journal of Clinical Microbiology, 2009-04, Vol.47 (4), p.969-974</ispartof><rights>Copyright © 2009, American Society for Microbiology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c431t-dc29f84d0238ca7afbaa80fd7d990043d7219a5ef8c310ec4ab901408d1daa3e3</citedby><cites>FETCH-LOGICAL-c431t-dc29f84d0238ca7afbaa80fd7d990043d7219a5ef8c310ec4ab901408d1daa3e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2668359/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2668359/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,3188,3189,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/19213695$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Leavitt, Azita</creatorcontrib><creatorcontrib>Chmelnitsky, Inna</creatorcontrib><creatorcontrib>Colodner, Raul</creatorcontrib><creatorcontrib>Ofek, Itzhak</creatorcontrib><creatorcontrib>Carmeli, Yehuda</creatorcontrib><creatorcontrib>Navon-Venezia, Shiri</creatorcontrib><title>Ertapenem Resistance among Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae Isolates</title><title>Journal of Clinical Microbiology</title><addtitle>J Clin Microbiol</addtitle><description>Ertapenem resistance in Klebsiella pneumoniae is rare. We report on an ertapenem-nonsusceptible phenotype among 25 out of 663 (3.77%) extended-spectrum-β-lactamase (ESBL)-producing K. pneumoniae isolates in a multicenter Israeli study. These isolates originated from six different hospitals and were multiclonal, belonging to 12 different genetic clones. Repeat testing using Etest and agar dilution confirmed ertapenem nonsusceptibility in only 15/663 (2.3%) of the isolates. The molecular mechanisms of ertapenem resistance in seven single-clone resistant isolates was due to the presence of ESBL genes (CTX-M-2 in four isolates, CTX-M-10 and OXA-4 in one isolate, SHV-12 in one isolate, and SHV-28 in one isolate) combined with the absence of OMPK36. Seven of 10 isolates initially reported as ertapenem nonsusceptible and subsequently classified as susceptible showed an inoculum effect with ertapenem but not with imipenem or meropenem. Population analysis detected the presence of an ertapenem-resistant subpopulation at a frequency of 10⁻⁶. These rare resistant subpopulations carried multiple ESBL genes, including TEM-30, SHV-44, CTX-M-2, and CTX-M-10, and they lacked OMPK36. The clinical and diagnostic significance of the results should be further studied.</description><subject>Anti-Bacterial Agents - pharmacology</subject><subject>Bacterial Outer Membrane Proteins - analysis</subject><subject>Bacterial Proteins - biosynthesis</subject><subject>Bacterial Proteins - genetics</subject><subject>Bacterial Typing Techniques</subject><subject>Bacteriology</subject><subject>beta-Lactam Resistance</subject><subject>beta-Lactamases - biosynthesis</subject><subject>beta-Lactamases - genetics</subject><subject>beta-Lactams - pharmacology</subject><subject>Electrophoresis, Polyacrylamide Gel</subject><subject>Genotype</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Israel</subject><subject>Klebsiella Infections - microbiology</subject><subject>Klebsiella pneumoniae - classification</subject><subject>Klebsiella pneumoniae - drug effects</subject><subject>Klebsiella pneumoniae - enzymology</subject><subject>Klebsiella pneumoniae - genetics</subject><subject>Microbial Sensitivity Tests</subject><issn>0095-1137</issn><issn>1098-660X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkctuFDEQRVsIRCaBHWvoFas4VLX7YW-QotEAgUEgQiR2Vo1dPeOoX9jdPH6LD-Gb6GFGPFa1qFO37tVNkkcIF4iZevZ6-fYCoCxQgLqTLBC0EmUJn-4mCwBdCERZnSSnMd4CYJ4Xxf3kBHWGstTFItmswkgDd9ymHzj6OFJnOaW277bp6tvInWMnrge2Y5ha8fOHWJMdqaXI4n3o3WT9DL5peBM9Nw2lQ8fTfOyJ06vYNzRyfJDcq6mJ_PA4z5KbF6uPy1di_e7l1fJyLWwucRTOZrpWuYNMKksV1RsiBbWrnNYAuXRVhpoKrpWVCGxz2ug5ECiHjkiyPEueH3SHadOys9yNgRozBN9S-G568ub_Ted3Ztt_MVlZKlnoWeDpUSD0nyeOo2l9tPtYHfdTNGWFIHNVzOD5AbShjzFw_ecJgtmXYuZSzO9SDKgZf_yvsb_wsYUZSA_Azm93X31gQ7E1t7Y1eWVyo8u9tycHpKbe0Db4aG6uM0AJWKLUWMlfgkCfpQ</recordid><startdate>20090401</startdate><enddate>20090401</enddate><creator>Leavitt, Azita</creator><creator>Chmelnitsky, Inna</creator><creator>Colodner, Raul</creator><creator>Ofek, Itzhak</creator><creator>Carmeli, Yehuda</creator><creator>Navon-Venezia, Shiri</creator><general>American Society for Microbiology</general><general>American Society for Microbiology (ASM)</general><scope>FBQ</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20090401</creationdate><title>Ertapenem Resistance among Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae Isolates</title><author>Leavitt, Azita ; Chmelnitsky, Inna ; Colodner, Raul ; Ofek, Itzhak ; Carmeli, Yehuda ; Navon-Venezia, Shiri</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c431t-dc29f84d0238ca7afbaa80fd7d990043d7219a5ef8c310ec4ab901408d1daa3e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Anti-Bacterial Agents - pharmacology</topic><topic>Bacterial Outer Membrane Proteins - analysis</topic><topic>Bacterial Proteins - biosynthesis</topic><topic>Bacterial Proteins - genetics</topic><topic>Bacterial Typing Techniques</topic><topic>Bacteriology</topic><topic>beta-Lactam Resistance</topic><topic>beta-Lactamases - biosynthesis</topic><topic>beta-Lactamases - genetics</topic><topic>beta-Lactams - pharmacology</topic><topic>Electrophoresis, Polyacrylamide Gel</topic><topic>Genotype</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Israel</topic><topic>Klebsiella Infections - microbiology</topic><topic>Klebsiella pneumoniae - classification</topic><topic>Klebsiella pneumoniae - drug effects</topic><topic>Klebsiella pneumoniae - enzymology</topic><topic>Klebsiella pneumoniae - genetics</topic><topic>Microbial Sensitivity Tests</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Leavitt, Azita</creatorcontrib><creatorcontrib>Chmelnitsky, Inna</creatorcontrib><creatorcontrib>Colodner, Raul</creatorcontrib><creatorcontrib>Ofek, Itzhak</creatorcontrib><creatorcontrib>Carmeli, Yehuda</creatorcontrib><creatorcontrib>Navon-Venezia, Shiri</creatorcontrib><collection>AGRIS</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of Clinical Microbiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Leavitt, Azita</au><au>Chmelnitsky, Inna</au><au>Colodner, Raul</au><au>Ofek, Itzhak</au><au>Carmeli, Yehuda</au><au>Navon-Venezia, Shiri</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Ertapenem Resistance among Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae Isolates</atitle><jtitle>Journal of Clinical Microbiology</jtitle><addtitle>J Clin Microbiol</addtitle><date>2009-04-01</date><risdate>2009</risdate><volume>47</volume><issue>4</issue><spage>969</spage><epage>974</epage><pages>969-974</pages><issn>0095-1137</issn><eissn>1098-660X</eissn><abstract>Ertapenem resistance in Klebsiella pneumoniae is rare. We report on an ertapenem-nonsusceptible phenotype among 25 out of 663 (3.77%) extended-spectrum-β-lactamase (ESBL)-producing K. pneumoniae isolates in a multicenter Israeli study. These isolates originated from six different hospitals and were multiclonal, belonging to 12 different genetic clones. Repeat testing using Etest and agar dilution confirmed ertapenem nonsusceptibility in only 15/663 (2.3%) of the isolates. The molecular mechanisms of ertapenem resistance in seven single-clone resistant isolates was due to the presence of ESBL genes (CTX-M-2 in four isolates, CTX-M-10 and OXA-4 in one isolate, SHV-12 in one isolate, and SHV-28 in one isolate) combined with the absence of OMPK36. Seven of 10 isolates initially reported as ertapenem nonsusceptible and subsequently classified as susceptible showed an inoculum effect with ertapenem but not with imipenem or meropenem. Population analysis detected the presence of an ertapenem-resistant subpopulation at a frequency of 10⁻⁶. 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| source | American Society for Microbiology; MEDLINE; EZB-FREE-00999 freely available EZB journals; PubMed Central |
| subjects | Anti-Bacterial Agents - pharmacology Bacterial Outer Membrane Proteins - analysis Bacterial Proteins - biosynthesis Bacterial Proteins - genetics Bacterial Typing Techniques Bacteriology beta-Lactam Resistance beta-Lactamases - biosynthesis beta-Lactamases - genetics beta-Lactams - pharmacology Electrophoresis, Polyacrylamide Gel Genotype Hospitals Humans Israel Klebsiella Infections - microbiology Klebsiella pneumoniae - classification Klebsiella pneumoniae - drug effects Klebsiella pneumoniae - enzymology Klebsiella pneumoniae - genetics Microbial Sensitivity Tests |
| title | Ertapenem Resistance among Extended-Spectrum-β-Lactamase-Producing Klebsiella pneumoniae Isolates |
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