Molecular epidemiology of extended-spectrum β-lactamase-producing, fluoroquinolone-resistant isolates of Klebsiella pneumoniae in Taiwan

W. L. Yu, R. N. Jones, R. J. Hollis, S. A. Messer, D. J. Biedenbach, L. M. Deshpande, Michael A. Pfaller

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Strains of extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) have emerged worldwide. Concomitant ciprofloxacin resistance with ESBL production in K. pneumoniae isolates would severely restrict treatment options. Among 39 (18.5%) of 211 ESBL-KP isolates resistant to ciprofloxacin (MIC, ≥4 μg/ml), 37 (95%) were high level resistant (MIC, ≥16 μg/ml). These isolates were also cross resistant to the newer fluoroquinolones, including levofloxacin, gatifloxacin, gemifloxacin, and garenoxacin (BMS 284756). Sitafloxacin was most active against these ciprofloxacin-resistant ESBL-KP isolates with MICs for 67% of the isolates being ≤2 μg/ml. The molecular epidemiology of these multiresistant isolates was investigated by automated ribotyping and pulsed-field gel electrophoresis (PFGE). Ribotyping identified 18 different strains among the 39 ciprofloxacin-resistant ESBL-KP isolates. The majority (67%) of these isolates were contained in six ribogroups which were further confirmed by PFGE. The distribution of the six major strains of ciprofloxacinresistant ESBL-KP within Taiwan included one (ribogroup 255.3-PFGE type E) with a nationwide distribution and several institution-specific strains. Interhospital cooperation appears necessary, with strict infection control practices coupled with restriction of fluoroquinolone and extended-spectrum β-lactam use to control both the major epidemic strain and the more diverse strains observed within individual institutions.

Original languageEnglish
Pages (from-to)4666-4669
Number of pages4
JournalJournal of Clinical Microbiology
Issue number12
Publication statusPublished - Dec 1 2002
Externally publishedYes


ASJC Scopus subject areas

  • Microbiology (medical)
  • Microbiology

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