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Antimicrobial Agents and Chemotherapy, November 2003, p. 3554-3560, Vol. 47, No. 11
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.11.3554-3560.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.

Extended-Spectrum ß-Lactamases in Klebsiella pneumoniae Bloodstream Isolates from Seven Countries: Dominance and Widespread Prevalence of SHV- and CTX-M-Type ß-Lactamases

David L. Paterson,1 Kristine M. Hujer,2 Andrea M. Hujer,2 Bethany Yeiser,2 Michael D. Bonomo,2 Louis B. Rice,2 Robert A. Bonomo,2* and the International Klebsiella Study Group{dagger},1

Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania 15213,1 Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland Ohio 441062

Received 13 March 2003/ Returned for modification 28 April 2003/ Accepted 22 August 2003

A huge variety of extended-spectrum ß-lactamases (ESBLs) have been detected during the last 20 years. The majority of these have been of the TEM or SHV lineage. We have assessed ESBLs occurring among a collection of 455 bloodstream isolates of Klebsiella pneumoniae, collected from 12 hospitals in seven countries. Multiple ß-lactamases were produced by isolates with phenotypic evidence of ESBL production (mean of 2.7 ß-lactamases per isolate; range, 1 to 5). SHV-type ESBLs were the most common ESBL, occurring in 67.1% (49 of 73) of isolates with phenotypic evidence of ESBL production. In contrast, TEM-type ESBLs (TEM-10 type, -12 type, -26 type, and -63 type) were found in just 16.4% (12 of 73) of isolates. The finding of TEM-10 type and TEM-12 type represents the first detection of a TEM-type ESBL in South America. PER (for Pseudomonas extended resistance)-type ß-lactamases were detected in five of the nine isolates from Turkey and were found with SHV-2-type and SHV-5-type ESBLs in two of the isolates. CTX-M-type ESBLs (blaCTX-M-2 type and blaCTX-M-3 type) were found in 23.3% (17 of 73) of isolates and were found in all study countries except for the United States. We also detected CTX-M-type ESBLs in four countries where they have previously not been described—Australia, Belgium, Turkey, and South Africa. The widespread emergence and proliferation of CTX-M-type ESBLs is particularly noteworthy and may have important implications for clinical microbiology laboratories and for physicians treating patients with serious K. pneumoniae infections.

* Corresponding author. Mailing address: Section of Infectious Diseases, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH 44106. Phone: (216) 791-3800, ext. 4399. E-mail: Robert.bonomo{at}med.va.gov.

{dagger} Members of the International Klebsiella Study Group are listed in Acknowledgments.

Antimicrobial Agents and Chemotherapy, November 2003, p. 3554-3560, Vol. 47, No. 11
0066-4804/03/$08.00+0     DOI: 10.1128/AAC.47.11.3554-3560.2003
Copyright © 2003, American Society for Microbiology. All Rights Reserved.



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