APHP, Laboratoire de Microbiologie, Hôpital Robert Debré, 48, Bld. Serurier, 75935 Paris, France.
Eur J Clin Microbiol Infect Dis. 2012 Oct;31(10):2827-34. doi: 10.1007/s10096-012-1636-4. Epub 2012 May 27.
Nosocomial outbreaks of extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae are an increasing concern in neonatal intensive care units (NICUs). We describe an outbreak of ESBL-producing K. pneumoniae that lasted 5 months and affected 23 neonates in our NICU. Proton pump inhibitor and extended-spectrum cephalosporin exposure were significantly associated with the risk of ESBL-producing K. pneumoniae colonisation and/or infection. Thirty isolates recovered from clinical, screening and environmental samples in the NICU were studied by means of Raman spectroscopy, pulsed-field gel electrophoresis and repetitive extragenic palindromic polymerase chain reaction (rep-PCR). The Raman clustering was in good agreement with the results of the other two molecular methods. Fourteen isolates belonged to the Raman clone 1 and 16 to the Raman clone 3. Molecular analysis showed that all the strains expressed SHV-1 chromosomal resistance, plasmid-encoded TEM-1 and CTX-M-15 β-lactamases. Incompatibility groups of plasmid content identified by PCR-based replicon typing indicated that resistance dissemination was due to the clonal spread of K. pneumoniae and horizontal CTX-M-15 gene transfer between the two clones.
产超广谱β-内酰胺酶（ESBL）的肺炎克雷伯菌在新生儿重症监护病房（NICU）的医院感染爆发日益受到关注。我们描述了一起在我们的 NICU 持续了 5 个月并影响了 23 名新生儿的产 ESBL 肺炎克雷伯菌爆发。质子泵抑制剂和广谱头孢菌素的暴露与产 ESBL 的肺炎克雷伯菌定植和/或感染的风险显著相关。对来自 NICU 临床、筛查和环境样本的 30 株分离株进行了拉曼光谱、脉冲场凝胶电泳和重复外回文聚合酶链反应（rep-PCR）研究。拉曼聚类与另外两种分子方法的结果非常吻合。14 株分离株属于拉曼克隆 1，16 株属于拉曼克隆 3。分子分析表明，所有菌株均表达染色体型 SHV-1 耐药性、质粒编码的 TEM-1 和 CTX-M-15 内酰胺酶。基于 PCR 的复制子分型鉴定的质粒含量不相容群表明，耐药性传播是由于肺炎克雷伯菌的克隆传播以及两个克隆之间 CTX-M-15 基因的水平转移。
