1887

Abstract

Summary

Three consecutive isolates of were obtained from the blood cultures of a hospitalised patient who was receiving antibiotic therapy. The initial isolate possessed an inducible cephalosporinase and was susceptible to third-generation cephalo-sporins. After ceftazidime treatment, a second isolate resistant to this antibiotic and characterised by stable overproduction of the chromosomal -lactamase was obtained, and therapy was altered to a new combination which included imipenem. During this course of treatment, a strain of . was isolated that was resistant to virtually all -lactam agents including imipenem. Comparison of biotypes and ribotyping profiles indicated that the three isolates were probably derived from a single strain which had undergone several mutations during antibiotic exposure. Examination of outer-membrane protein (OMP) preparations and lipopolysaccharide (LPS) profiles showed that the imipenem-resistant isolate lacked a major OMP and high molecular mass LPS. Furthermore, this isolate displayed reduced permeability to cephaloridine compared with the initial isolate. The introduction of a plasmid carrying a wild-type allele prevented cephalosporinase production and restored -lactam susceptibility in the imipenem-resistant isolate. It was concluded that stable derepression of class-I -lactamase production and reduced permeability are both required for expression of imipenem resistance in . , and that previous exposure to cephalosporins may encourage the emergence of such strains.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/00222615-40-6-403
1994-06-01
2022-01-21
Loading full text...

Full text loading...

/deliver/fulltext/jmm/40/6/medmicro-40-6-403.html?itemId=/content/journal/jmm/10.1099/00222615-40-6-403&mimeType=html&fmt=ahah

References

  1. Wiedemann B. Genetic and biochemical basis of resistance of Enterobacteriaceae to β-lactam antibiotics. J Antimicrob Chemother 1986; 18:B31–38
    [Google Scholar]
  2. Yang Y, Livermore DM, Williams RJ. Chromosomal β-lactamase expression and antibiotic resistance in Entero-bacter cloacae . J Med Microbiol 1988; 25:227–233
    [Google Scholar]
  3. Hopkins JM, Towner KJ. Enhanced resistance to cefotaxime and imipenem associated with outer membrane protein alterations in Enterobacter aerogenes . J Antimicrob Chemother 1990; 25:49–55
    [Google Scholar]
  4. Chow JW, Shlaes DM. Imipenem resistance associated with the loss of a 40 kDa outer membrane protein in Enterobacter aerogenes . J Antimicrob Chemother 1991; 28:499–504
    [Google Scholar]
  5. Tzouvelekis LS, Tzelepi E, Mentis AF, Vatopoulos AC, Tsakris A. Imipenem resistance in Enterobacter aerogenes is associated with derepression of chromosomal cephalosporinases and impaired permeability. FEMS Microbiol Lett 1992; 95:195–200
    [Google Scholar]
  6. DeChamps C, Henquell C, Guelon D, Sirot D, Gazuy N, Sirot J. Clinical and bacteriological study of nosocomial infections due to Enterobacter aerogenes resistant to imipenem. J Clin Microbiol 1993; 31:123–127
    [Google Scholar]
  7. Honore N, Nicolas MH, Cole ST. Regulation of enterobacterial cephalosporinase production : the role of membrane-bound sensory transducer. Mol Microbiol 1989; 3:1121–1130
    [Google Scholar]
  8. Sambrook J, Fritsch EF, Maniatis T. Molecular cloning: a laboratory manual. , 2. Cold Spring Harbor, NY: Cold Spring Harbor Laboratory Press; 1989
    [Google Scholar]
  9. Garaizar J, Kaufmann ME, Pitt TL. Comparison of ribotyping with conventional methods for the type identification of Enterobacter cloacae . J Clin Microbiol 1991; 29:1303–1307
    [Google Scholar]
  10. Pitcher DG, Owen RJ, Dyal P, Beck A. Synthesis of a biotinylated DNA probe to detect ribosomal RNA cistrons in Providencia stuartii . FEMS Microbiol Lett 1987; 48:283–287
    [Google Scholar]
  11. National Committee for Clinical Laboratory Standards Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Approved Standard M7-A Villanova, PA, USA: NCCLS; 1985
    [Google Scholar]
  12. Tzelepi E, Tzouvelekis LS, Vatopoulos AC, Mentis AF, Tsakris A, Legakis NJ. High prevalence of stably derepressed class-I β-lactamase expression in multiresistant clinical isolates of Enterobacter cloacae from Greek hospitals. J Med Microbiol 1992; 37:91–95
    [Google Scholar]
  13. Matthew M, Harris AM, Marshall, Ross GW. The use of analytical isoelectric focusing for detection and identification of β-lactamases. J Gen Microbiol 1975; 88:169–178
    [Google Scholar]
  14. Filip C, Fletcher G, Wulff JL, Earhart CF. Solubilization of the cytoplasmic membrane of Escherichia coli by the ionic detergent sodium-lauryl sarcosinate. J Bacteriol 1973; 115:717–722
    [Google Scholar]
  15. Hitchcock PJ, Brown TM. Morphological heterogeneity among Salmonella lipopolysaccharide chemotypes in silver-stained polyacrylamide gels. J Bacteriol 1983; 154:269–277
    [Google Scholar]
  16. Nikaido H, Rosenberg EY, Foulds J. Porin channels in Escherichia coli studies with β-lactams in intact cells. J Bacteriol 1983; 153:232–240
    [Google Scholar]
  17. Biischer K-H, Cullmann W, Dick W, Opferkuch W. Imipenem resistance in Pseudomonas aeruginosa resulting from diminished expression of an outer membrane protein. Antimicrob Agents Chemother 1987; 31:703–708
    [Google Scholar]
  18. Trias J, Nikaido H. Outer membrane protein D2 catalyzes facilitated diffusion of carbapenems and penems through the outer membrane of Pseudomonas aeruginosa . Antimicrob Agents Chemother 1990; 34:52–57
    [Google Scholar]
  19. Livermore DM. Permeation of β-lactam antibiotics into Escherichia coli, Pseudomonas aeruginosa and other Gram-negative bacteria. Rev Infect Dis 1988; 10:691–698
    [Google Scholar]
  20. Nikaido H. Outer membrane barrier as a mechanism of antimicrobial resistance. Antimicrob Agents Chemother 1989; 33:1831–1836
    [Google Scholar]
  21. Lee EH, Nicolas MH, Kitzis MD, Pialoux G, Collatz E, Gutmann L. Association of two resistance mechanisms in a clinical isolate of Enterobacter cloacae with high-level resistance to imipenem. Antimicrob Agents Chemother 1991; 35:1093–1098
    [Google Scholar]
  22. Raimondi A, Traverso A, Nikaido H. Imipenem- and meropenem-resistant mutants of Enterobacter cloacae and Proteus rettgeri lack porins. Antimicrob Agents Chemother 1991; 35:1174–1180
    [Google Scholar]
  23. The Greek Society for Microbiology Antibiotic resistance among gram-negative bacilli in 19 Greek hospitals. J Hosp Infect 1989; 14:177–181
    [Google Scholar]
  24. Legakis NJ, Tzouvelekis LS, Tsakris A, Legakis JN, Vatopoulos AC. On the incidence of antibiotic resistance among aerobic gram-negative rods isolated in Greek hospitals. J Hosp Infect 1993; 24:233–237
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/00222615-40-6-403
Loading
/content/journal/jmm/10.1099/00222615-40-6-403
Loading

Data & Media loading...

Most cited this month Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error