NOSOCOMIAL OUTBREAK OF KLEBSIELLA-PNEUMONIAE PRODUCING SHV-5 EXTENDED-SPECTRUM BETA-LACTAMASE, ORIGINATING FROM A CONTAMINATED ULTRASONOGRAPHY COUPLING GEL

Klebsiella pneumoniae resistant to ceftazidime was isolated from six a dult women and two neonates hospitalized between July and November 199 3 in the Department of Obstetrics and Gynecology of Boucicaut Hospital (Paris, France). The epidemiological investigation revealed a notably short delay (less than 48 h) between admission and contamination of t he six adults and peripartum transmission to the neonates. The only en vironmental source of ceftazidime-resistant K. pneumoniae was the ultr asonography coupling gel used in the emergency room. Phenotypic (bioty ping and antibiotyping) and genotypic (plasmid profile and pulsed-fiel d gel electrophoresis) analysis of all the clinical isolates indicated the spread of a single strain. It produced SHV-5 and TEM-1 beta-lacta mases, as demonstrated by isoelectric focusing and gene sequencing. Th e risk of cross-contamination in ultrasonography procedures is usually low and had not been associated so far with bacteria producing an ext ended-spectrum beta-lactamase (ESBL), Furthermore, this is the first t ime an epidemic of an SHV-5 ESBL-producing member of the family Entero bacteriaceae has been reported from a French hospital.