Brun-Buisson C, Legrand P, Philippon A, Montravers F, Ansquer M, Duval J
Lancet. 1987 Aug 8;2(8554):302-6. doi: 10.1016/s0140-6736(87)90891-9.
Klebsiella pneumoniae strains that were resistant to third-generation cephalosporins and amikacin were recovered from 62 of 395 patients (15.7%) during 1986. 25 isolates (40%) caused urinary tract infections. The outbreak involved three intensive care units (54 isolates), and spread from one unit to another and then to four wards (8 isolates). K pneumoniae of various serotypes and strains of different Enterobacteriaceae demonstrating the same antibiotic resistance pattern were isolated, which suggests dissemination of an R-factor. The isolates had low-level resistance to third-generation cephalosporins (mode minimum inhibitory concentration of cefotaxime, 2 mg/l) but remained sensitive to cephamycins. Cefotaxime was effective in cases of uncomplicated urinary tract infection, but failed in major infections at other sites. 1-5 mg/l of the beta-lactamase inhibitors clavulanic acid or sulbactam restored normal activity to cefotaxime against the multiresistant strains. Resistance to third-generation cephalosporins was mediated by a new broad-spectrum enzyme of isoelectric point 6.3. Resistance to beta-lactams and aminoglycosides was transferable to Escherichia coli. The emergence of transferable enzymatic resistance to newer beta-lactams in K pneumoniae strains indicates a major risk of spread of such resistance to otherwise sensitive strains.
1986年，从395名患者中的62名（15.7%）身上分离出了对第三代头孢菌素和阿米卡星耐药的肺炎克雷伯菌菌株。25株分离菌（40%）引起了尿路感染。此次暴发涉及三个重症监护病房（54株分离菌），并从一个病房传播到另一个病房，然后传播到四个普通病房（8株分离菌）。分离出了不同血清型的肺炎克雷伯菌以及不同肠杆菌科菌株，它们表现出相同的抗生素耐药模式，这表明存在R因子的传播。这些分离菌对第三代头孢菌素有低水平耐药（头孢噻肟的最低抑菌浓度中位数为2 mg/l），但对头孢霉素仍敏感。头孢噻肟对单纯性尿路感染有效，但对其他部位的严重感染无效。1 - 5 mg/l的β-内酰胺酶抑制剂克拉维酸或舒巴坦可恢复头孢噻肟对多重耐药菌株的正常活性。对第三代头孢菌素的耐药性由一种新的等电点为6.3的广谱酶介导。对β-内酰胺类和氨基糖苷类的耐药性可转移至大肠杆菌。肺炎克雷伯菌菌株中出现对新型β-内酰胺类的可转移酶耐药性，表明这种耐药性向其他敏感菌株传播的重大风险。
