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Antimicrobial Agents and Chemotherapy, September 2004, p. 3477-3482, Vol. 48, No. 9
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.9.3477-3482.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Increased Serum Resistance in Klebsiella pneumoniae Strains Producing Extended-Spectrum ß-Lactamases{dagger}

H. Sahly,1* H. Aucken,2 V. J. Benedí,3 C. Forestier,4 V. Fussing,5 D. S. Hansen,5 I. Ofek,6 R. Podschun,1 D. Sirot,4 J. M. Tomás,7 D. Sandvang,5 and U. Ullmann1

Department of Medical Microbiology and Virology, University of Kiel, Kiel, Germany,1 Central Public Health Laboratory, London, United Kingdom,2 Area de Microbiologia, Departmento de Biologia, Universidad de las Islas Baleares, Palma de Mallorca,3 Departmento de Microbiologia, Facultad de Biologia, Universidad de Barcelona, Barcelona, Spain,7 Laboratoire de Bactériologie, Facultés de Médecine-Pharmacie, Clermont-Ferrand, France,4 Department of Gastrointestinal Infections, Statens Serum Institut, Copenhagen, Denmark,5 Department of Human Microbiology, University of Tel Aviv, Tel Aviv, Israel6

Received 27 October 2003/ Returned for modification 28 January 2004/ Accepted 30 April 2004

The aim of this study was to determine whether there is an association between serum resistance, O serotypes, and the production of extended-spectrum ß-lactamases (ESBLs) in Klebsiella pneumoniae. Ninety ESBL-producing and 178 non-ESBL-producing K. pneumoniae isolates gathered in five European countries were O serotyped and tested for sensitivity to the serum's bactericidal effect. The frequency of serum-resistant isolates was higher among ESBL-producing strains (30%; 27/90 isolates) than among non-ESBL-producing strains (17.9%; 32/178 isolates) (P = 0.037; odds ratio [OR] = 1.96; 95% confidence interval [95% CI] = 1.08 to 3.53). Although O1 was the most common O serotype in both Klebsiella groups, its frequency among ESBL-producing strains was significantly higher (59%; 53/90 isolates) than among non-ESBL producers (36%; 64/178 isolates) (P = 0.0006; OR = 2.5; 95% CI = 1.52 to 4.29). Furthermore, the prevalence of the O1 serotype was higher among serum-resistant strains of both ESBL-producing (74%; 20/27isolates) and non-ESBL producers (75%; 24/32 isolates) than among serum-sensitive ESBL producers (52.4%; 33/63 isolates) and non-ESBL producers (27.4%; 40/146 isolates). Serum resistance among ESBL-producing strains (36%; 17/47 isolates) versus non-ESBL-producing strains (16%; 27/166 isolates) was also significantly higher after the exclusion of clonal strains (P = 0.0056; OR = 2.9; 95% CI = 1.41 to 6.01). Sixteen ESBL types were detected, among which the frequency of serum resistance was significantly lower among the SHV-producing strains (9/48 isolates) than among the TEM producers (16/35 isolates) (P = 0.016; OR = 3.65; CI = 1.3 to 9.7). Curing ESBL-coding plasmids did not influence the serum resistance of the bacteria; all six plasmid-cured derivatives maintained serum resistance. The present findings suggest that ESBL-producing strains have a greater pathogenic potential than non-ESBL-producing strains, but the linkage between O serotypes, serum resistance, and ESBL production remains unclear at this stage.

* Corresponding author. Mailing address: Department of Medical Microbiology and Virology, University of Kiel, Brunswiker Str. 4, 24105 Kiel, Germany. Phone: 494315973316. Fax: 494315973296. E-mail: sahly{at}medmicrobio.uni-kiel.de.

{dagger} This study was submitted in memory of Vicente Javier Benedí, who died prior to submission of the manuscript.

Antimicrobial Agents and Chemotherapy, September 2004, p. 3477-3482, Vol. 48, No. 9
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.9.3477-3482.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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