Prevalence of a transferable SHV-5 type beta-lactamase in clinical isolates of Klebsiella pneumoniae and Escherichia coli in Greece.

Analysis with a double-disc synergy test (DDST) of clinical isolates of Klebsiella pneumoniae and Escherichia coli during the period October 1988-September 1989 revealed that 24% of the former and 4% of the latter, mainly isolated from urine, possessed an extended-spectrum beta-lactamase. During this period no DDST was positive for isolates of other enterobacterial species. Transfer of ceftazidime resistance was demonstrated from six K. pneumoniae and two E. coli isolates resistant to third generation cephalosporins and aztreonam. Apart from one strain of K. pneumoniae, these strains harboured self-transferable multiresistance plasmids (c. 91 kb) with closely related EcoRI, HindIII, AvaII and PstI restriction patterns. These plasmids encoded an extended-spectrum beta-lactamase that conferred an unusually high level of resistance to ceftazidime and aztreonam (MIC greater than or equal to 64 mg/l). This enzyme had a pI of 8.2 and a substrate profile similar to that of the SHV-5 enzyme isolated initially in Chile, and later in France (CAZ-4). The remaining K. pneumoniae isolate harboured a transmissible multiresistance plasmid (c. 182 kb) that encoded the widely distributed SHV-2 enzyme. The resistance to cefoxitin that was observed in some of these strains was associated with outer membrane protein alterations.