Archives of Clinical Infectious Diseases

Published by: Kowsar

Prevalence of Extended-Spectrum β-Lactamases Among Klebsiella pneumoniae Isolated from Intensive Care Unit Patients in a Tertiary Hospital

Shahin Najar-Peerayeh 1 , Safoura Derakhshan 2 , * , Fatemeh Fallah 3 , Bita Bakhshi 1 and Masoud Alebouyeh 4 , 5
Authors Information
1 Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
2 Liver and Digestive Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
3 Pediatric Infections Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
4 Foodborne and Waterborne Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 Pediatric Infections Research Center (PIRC), Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Article information
  • Archives of Clinical Infectious Diseases: 14 (1); e69199
  • Published Online: February 27, 2019
  • Article Type: Research Article
  • Received: April 8, 2018
  • Revised: October 7, 2018
  • Accepted: November 5, 2018
  • DOI: 10.5812/archcid.69199

To Cite: Najar-Peerayeh S, Derakhshan S, Fallah F, Bakhshi B, Alebouyeh M. Prevalence of Extended-Spectrum β-Lactamases Among Klebsiella pneumoniae Isolated from Intensive Care Unit Patients in a Tertiary Hospital, Arch Clin Infect Dis. Online ahead of Print ; 14(1):e69199. doi: 10.5812/archcid.69199.

Copyright © 2019, Archives of Clinical Infectious Diseases. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
1. Background
2. Objectives
3. Methods
4. Results
5. Discussion
  • 1. Paterson DL, Bonomo RA. Extended-spectrum beta-lactamases: A clinical update. Clin Microbiol Rev. 2005;18(4):657-86. doi: 10.1128/CMR.18.4.657-686.2005. [PubMed: 16223952]. [PubMed Central: PMC1265908].
  • 2. Asensio A, Oliver A, Gonzalez-Diego P, Baquero F, Perez-Diaz JC, Ros P, et al. Outbreak of a multiresistant Klebsiella pneumoniae strain in an intensive care unit: Antibiotic use as risk factor for colonization and infection. Clin Infect Dis. 2000;30(1):55-60. doi: 10.1086/313590. [PubMed: 10619733].
  • 3. Da Silva GJ, Mendonca N. Association between antimicrobial resistance and virulence in Escherichia coli. Virulence. 2012;3(1):18-28. doi: 10.4161/viru.3.1.18382. [PubMed: 22286707].
  • 4. Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: Epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev. 1998;11(4):589-603. [PubMed: 9767057]. [PubMed Central: PMC88898].
  • 5. Cheng HY, Chen YS, Wu CY, Chang HY, Lai YC, Peng HL. RmpA regulation of capsular polysaccharide biosynthesis in Klebsiella pneumoniae CG43. J Bacteriol. 2010;192(12):3144-58. doi: 10.1128/JB.00031-10. [PubMed: 20382770]. [PubMed Central: PMC2901686].
  • 6. Shu HY, Fung CP, Liu YM, Wu KM, Chen YT, Li LH, et al. Genetic diversity of capsular polysaccharide biosynthesis in Klebsiella pneumoniae clinical isolates. Microbiology. 2009;155(Pt 12):4170-83. doi: 10.1099/mic.0.029017-0. [PubMed: 19744990].
  • 7. Messai Y, Iabadene H, Benhassine T, Alouache S, Tazir M, Gautier V, et al. Prevalence and characterization of extended-spectrum beta-lactamases in Klebsiella pneumoniae in Algiers hospitals (Algeria). Pathol Biol (Paris). 2008;56(5):319-25. doi: 10.1016/j.patbio.2008.05.008. [PubMed: 18585867].
  • 8. Mena A, Plasencia V, Garcia L, Hidalgo O, Ayestaran JI, Alberti S, et al. Characterization of a large outbreak by CTX-M-1-producing Klebsiella pneumoniae and mechanisms leading to in vivo carbapenem resistance development. J Clin Microbiol. 2006;44(8):2831-7. doi: 10.1128/JCM.00418-06. [PubMed: 16891499]. [PubMed Central: PMC1594597].
  • 9. Lytsy B, Sandegren L, Tano E, Torell E, Andersson DI, Melhus A. The first major extended-spectrum beta-lactamase outbreak in Scandinavia was caused by clonal spread of a multiresistant Klebsiella pneumoniae producing CTX-M-15. APMIS. 2008;116(4):302-8. doi: 10.1111/j.1600-0463.2008.00922.x. [PubMed: 18397465].
  • 10. Sekse C, Sunde M, Lindstedt BA, Hopp P, Bruheim T, Cudjoe KS, et al. Potentially human-pathogenic Escherichia coli O26 in Norwegian sheep flocks. Appl Environ Microbiol. 2011;77(14):4949-58. doi: 10.1128/AEM.00189-11. [PubMed: 21642413]. [PubMed Central: PMC3147382].
  • 11. Dumpis U, Iversen A, Balode A, Saule M, Miklasevics E, Giske CG. Outbreak of CTX-M-15-producing Klebsiella pneumoniae of sequence type 199 in a Latvian teaching hospital. APMIS. 2010;118(9):713-6. doi: 10.1111/j.1600-0463.2010.02640.x. [PubMed: 20718724].
  • 12. Gierczynski R, Golubov A, Neubauer H, Pham JN, Rakin A. Development of multiple-locus variable-number tandem-repeat analysis for Yersinia enterocolitica subsp. palearctica and its application to bioserogroup 4/O3 subtyping. J Clin Microbiol. 2007;45(8):2508-15. doi: 10.1128/JCM.02252-06. [PubMed: 17553973]. [PubMed Central: PMC1951228].
  • 13. Dyet KH, Robertson I, Turbitt E, Carter PE. Characterization of Escherichia coli O157:H7 in New Zealand using multiple-locus variable-number tandem-repeat analysis. Epidemiol Infect. 2011;139(3):464-71. doi: 10.1017/S0950268810001068. [PubMed: 20478087].
  • 14. Turton JF, Perry C, Elgohari S, Hampton CV. PCR characterization and typing of Klebsiella pneumoniae using capsular type-specific, variable number tandem repeat and virulence gene targets. J Med Microbiol. 2010;59(Pt 5):541-7. doi: 10.1099/jmm.0.015198-0. [PubMed: 20110386].
  • 15. Morris D, Boyle F, Morris C, Condon I, Delannoy-Vieillard AS, Power L, et al. Inter-hospital outbreak of Klebsiella pneumoniae producing KPC-2 carbapenemase in Ireland. J Antimicrob Chemother. 2012;67(10):2367-72. doi: 10.1093/jac/dks239. [PubMed: 22744760].
  • 16. Drew RJ, Turton JF, Hill RL, Livermore DM, Woodford N, Paulus S, et al. Emergence of carbapenem-resistant Enterobacteriaceae in a UK paediatric hospital. J Hosp Infect. 2013;84(4):300-4. doi: 10.1016/j.jhin.2013.05.003. [PubMed: 23831281].
  • 17. Jain A, Hopkins KL, Turton J, Doumith M, Hill R, Loy R, et al. NDM carbapenemases in the United Kingdom: An analysis of the first 250 cases. J Antimicrob Chemother. 2014;69(7):1777-84. doi: 10.1093/jac/dku084. [PubMed: 24769387].
  • 18. Ranjbar R, Memariani H, Sorouri R, Memariani M. Distribution of virulence genes and genotyping of CTX-M-15-producing Klebsiella pneumoniae isolated from patients with community-acquired urinary tract infection (CA-UTI). Microb Pathog. 2016;100:244-9. doi: 10.1016/j.micpath.2016.10.002. [PubMed: 27725280].
  • 19. Forbes BA, Sahm DF, Weissfeld AS. Bailey and Scott's diagnostic microbiology. 12th ed. Elsevier Publishing Company; 2007.
  • 20. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. 26th ed. CLSI; 2016.
  • 21. Nadasy KA, Domiati-Saad R, Tribble MA. Invasive Klebsiella pneumoniae syndrome in North America. Clin Infect Dis. 2007;45(3):e25-8. doi: 10.1086/519424. [PubMed: 17599300].
  • 22. Vu-Thien H, Corbineau G, Hormigos K, Fauroux B, Corvol H, Clement A, et al. Multiple-locus variable-number tandem-repeat analysis for longitudinal survey of sources of Pseudomonas aeruginosa infection in cystic fibrosis patients. J Clin Microbiol. 2007;45(10):3175-83. doi: 10.1128/JCM.00702-07. [PubMed: 17699654]. [PubMed Central: PMC2045346].
  • 23. Ghasemi Y, Archin T, Kargar M, Mohkam M. A simple multiplex PCR for assessing prevalence of extended-spectrum beta-lactamases producing Klebsiella pneumoniae in intensive care units of a referral hospital in Shiraz, Iran. Asian Pac J Trop Med. 2013;6(9):703-8. doi: 10.1016/S1995-7645(13)60122-4. [PubMed: 23827147].
  • 24. Sekowska A, Gospodarek E, Kusza K. The prevalence of infections and colonisation with Klebsiella pneumoniae strains isolated in ICU patients. Anaesthesiol Intensive Ther. 2014;46(4):280-3. doi: 10.5603/AIT.2014.0045. [PubMed: 25293479].
  • 25. Gharrah MM, Mostafa El-Mahdy A, Barwa RF. Association between virulence factors and extended spectrum beta-lactamase producing klebsiella pneumoniae compared to nonproducing isolates. Interdiscip Perspect Infect Dis. 2017;2017:7279830. doi: 10.1155/2017/7279830. [PubMed: 28684959]. [PubMed Central: PMC5480045].
  • 26. Hertz FB, Nielsen JB, Schonning K, Littauer P, Knudsen JD, Lobner-Olesen A, et al. Population structure of drug-susceptible,-resistant and ESBL-producing Escherichia coli from community-acquired urinary tract. BMC Microbiol. 2016;16:63. doi: 10.1186/s12866-016-0681-z. [PubMed: 27067536]. [PubMed Central: PMC4827192].
  • 27. Heffernan H, Dyet KH, Woodhouse R, Williamson D. Antimicrobial susceptibility and molecular epidemiology of extended-spectrum β-lactamase producing Enterobacteriaceae in New Zealand, 2013. 2014.
  • 28. Cookson BD, Robinson DA, Monk AB, Murchan S, Deplano A, de Ryck R, et al. Evaluation of molecular typing methods in characterizing a European collection of epidemic methicillin-resistant Staphylococcus aureus strains: The HARMONY collection. J Clin Microbiol. 2007;45(6):1830-7. doi: 10.1128/JCM.02402-06. [PubMed: 17428929]. [PubMed Central: PMC1933060].
  • 29. Schouls LM, Spalburg EC, van Luit M, Huijsdens XW, Pluister GN, van Santen-Verheuvel MG, et al. Multiple-locus variable number tandem repeat analysis of Staphylococcus aureus: Comparison with pulsed-field gel electrophoresis and spa-typing. PLoS One. 2009;4(4). e5082. doi: 10.1371/journal.pone.0005082. [PubMed: 19343175]. [PubMed Central: PMC2661140].
  • 30. Akbari Dehbalaei M, Najar-Peerayeh S, Taherikalani M, Behmanesh M. Clinical isolates of acinetobacter baumannii from Tehran hospitals: Pulsed-field gel electrophoresis characterization, clonal lineages, antibiotic susceptibility, and biofilm-forming ability. Jundishapur J Microbiol. 2017;10(7). e13790. doi: 10.5812/jjm.13790.
  • 31. Skally M, Duffy F, Burns K, Doyle D, Foley S, Thomas T, et al. What may be lurking in the hospital undergrowth? Inapparent cross-transmission of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. J Hosp Infect. 2014;88(3):156-61. doi: 10.1016/j.jhin.2014.07.011. [PubMed: 25280879].
  • 32. Hall JM, Corea E, Sanjeewani HD, Inglis TJ. Molecular mechanisms of beta-lactam resistance in carbapenemase-producing Klebsiella pneumoniae from Sri Lanka. J Med Microbiol. 2014;63(Pt 8):1087-92. doi: 10.1099/jmm.0.076760-0. [PubMed: 24855071].
  • 33. Aqel AA, Meunier D, Alzoubi HM, Masalha IM, Woodford N. Detection of CTX-M-type extended-spectrum beta-lactamases among Jordanian clinical isolates of Enterobacteriaceae. Scand J Infect Dis. 2014;46(2):155-7. doi: 10.3109/00365548.2013.835069. [PubMed: 24069912].

Featured Image:

Creative Commons License Except where otherwise noted, this work is licensed under Creative Commons Attribution Non Commercial 4.0 International License .

Search Relations:



Create Citiation Alert
via Google Reader

Readers' Comments