{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:07:15Z","timestamp":1791158835821,"version":"4.1.0"},"reference-count":39,"publisher":"American Society for Microbiology","issue":"8","license":[{"start":{"date-parts":[[2006,8,1]],"date-time":"2006-08-01T00:00:00Z","timestamp":1154390400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["J Clin Microbiol"],"published-print":{"date-parts":[[2006,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            All extended-spectrum \u03b2-lactamase (ESBL)-producing\n            <jats:italic>Enterobacteriaceae<\/jats:italic>\n            isolates from patients admitted to and adult intensive care unit were prospectively documented from 2002 to 2005, when a large outbreak (51 patients affected) of multiresistant ESBL-producing\n            <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n            infection was detected. The involvement of a single\n            <jats:italic>K. pneumoniae<\/jats:italic>\n            clone was demonstrated by pulsed-field gel electrophoresis. In addition to the ESBL-mediated resistance, the epidemic strain uniformly showed cross-resistance to ciprofloxacin, gentamicin, tobramycin, trimethoprim-sulfamethoxazole, and tetracycline, whereas resistance to the \u03b2-lactam-\u03b2-lactamase inhibitor combinations was variable. The ESBL involved was CTX-M-1, as demonstrated by isoelectric focusing, PCR amplification, and sequencing. CTX-M-1 as well as the aminoglycoside resistance determinants were encoded in a 50-kb plasmid that could be transferred to\n            <jats:italic>Escherichia coli<\/jats:italic>\n            only by transformation. In two of the infected patients, carbapenem resistance development (MICs of 8 to 12, 16, and &gt;32 \u03bcg\/ml for imipenem, meropenem, and ertapenem, respectively) was documented, both in clinical samples and in intestinal colonization studies. The analysis of the outer membrane proteins of the carbapenem-susceptible and -resistant isolates revealed that the former expressed only one of the two major porins, OmpK36, whereas the latter did not express either of them. In one of the cases, the lack of expression of OmpK36 was demonstrated to be mediated by the interruption of the coding sequence by the insertion sequence IS\n            <jats:italic>26<\/jats:italic>\n            . This is the first report of a large outbreak of CTX-M-1-producing\n            <jats:italic>Enterobacteriaceae<\/jats:italic>\n            and, curiously, the first documented description in the literature of CTX-M-1 in\n            <jats:italic>K. pneumoniae<\/jats:italic>\n            , despite the fact that this enzyme has been found in multiple species. Furthermore, we document and characterize for the first time carbapenem resistance development in CTX-M-1-producing\n            <jats:italic>Enterobacteriaceae<\/jats:italic>\n            .\n          <\/jats:p>","DOI":"10.1128\/jcm.00418-06","type":"journal-article","created":{"date-parts":[[2006,8,5]],"date-time":"2006-08-05T01:54:18Z","timestamp":1154742858000},"page":"2831-2837","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":125,"title":["Characterization of a Large Outbreak by CTX-M-1-Producing\n            <i>Klebsiella pneumoniae<\/i>\n            and Mechanisms Leading to In Vivo Carbapenem Resistance Development"],"prefix":"10.1128","volume":"44","author":[{"given":"Ana","family":"Mena","sequence":"first","affiliation":[{"name":"Servicio de Microbiologi\u0301a, Hospital Son Dureta and Instituto Universitario de Investigacio\u0301n en Ciencias de la Salud"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Plasencia","sequence":"additional","affiliation":[{"name":"Servicio de Microbiologi\u0301a, Hospital Son Dureta and Instituto Universitario de Investigacio\u0301n en Ciencias de la Salud"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Garci\u0301a","sequence":"additional","affiliation":[{"name":"A\u0301rea de Microbiologi\u0301a and Instituto Universitario de Investigacio\u0301n en Ciencias de la Salud, Universidad de las Islas Baleares"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Hidalgo","sequence":"additional","affiliation":[{"name":"Servicio de Medicina Preventiva, Hospital Son Dureta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose\u0301 Ignacio","family":"Ayestara\u0301n","sequence":"additional","affiliation":[{"name":"Servicio de Medicina Intensiva, Hospital Son Dureta, Palma de Mallorca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastia\u0301n","family":"Alberti","sequence":"additional","affiliation":[{"name":"A\u0301rea de Microbiologi\u0301a and Instituto Universitario de Investigacio\u0301n en Ciencias de la Salud, Universidad de las Islas Baleares"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nuria","family":"Borrell","sequence":"additional","affiliation":[{"name":"Servicio de Microbiologi\u0301a, Hospital Son Dureta and Instituto Universitario de Investigacio\u0301n en Ciencias de la Salud"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose\u0301 L.","family":"Pe\u0301rez","sequence":"additional","affiliation":[{"name":"Servicio de Microbiologi\u0301a, Hospital Son Dureta and Instituto Universitario de Investigacio\u0301n en Ciencias de la Salud"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Oliver","sequence":"additional","affiliation":[{"name":"Servicio de Microbiologi\u0301a, Hospital Son Dureta and Instituto Universitario de Investigacio\u0301n en Ciencias de la Salud"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/iai.63.3.903-910.1995"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF01647010"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.48.1.1-14.2004"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.38.3.1048-1052.2000"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.14.4.933-951.2001"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.3.1262-1264.2005"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.39.6.1211"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.38.4.1339-1346.2000"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/46.6.895"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.2.500-510.2002"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.11.3679-3682.2002"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1128\/aem.46.3.565-572.1983"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.47.10.3332-3335.2003"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.46.2.534-537.2002"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1128\/jb.115.3.717-722.1973"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.5.2122-2125.2005"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.43.4.937"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/46.2.273"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.48.8.3203-3206.2004"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1093\/clinids\/10.4.867"},{"key":"e_1_3_2_22_2","first-page":"17","volume":"15","year":"1998","unstructured":"Kaufmann, M. E. 1998. Pulsed-field gel electrophoresis. Methods Mol. Med.15:17-31.","journal-title":"Methods Mol. Med."},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.28.2.302"},{"key":"e_1_3_2_24_2","first-page":"94","volume":"7","year":"2000","unstructured":"Komatsu, M., N. Ikeda, M. Aihara, Y. Nakamachi, S. Kinoshita, K. Yamasaki, and K. Shimakawa. 2000. Hospital outbreak of MEN-1-derived extended spectrum beta-lactamase-producing Klebsiella pneumoniae. J. Infect. Chemother.7:94-101.","journal-title":"J. Infect. Chemother."},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1038\/227680a0"},{"key":"e_1_3_2_26_2","first-page":"557","volume":"8","year":"1997","unstructured":"Livermore, D. M. 1997. \u03b2-Lactamases in laboratory and clinical resistance. Clin. Microbiol. Rev.8:557-584.","journal-title":"Clin. Microbiol. Rev."},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.40.2.342"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.43.7.1669"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.43.8.4183-4185.2005"},{"key":"e_1_3_2_30_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1469-0691.2002.00401.x"},{"key":"e_1_3_2_31_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.49.4.1567-1571.2005"},{"key":"e_1_3_2_32_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.41.9.4264-4269.2003"},{"key":"e_1_3_2_33_2","doi-asserted-by":"publisher","DOI":"10.1086\/313719"},{"key":"e_1_3_2_34_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.42.1.53"},{"key":"e_1_3_2_35_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.48.1.15-22.2004"},{"key":"e_1_3_2_36_2","doi-asserted-by":"publisher","DOI":"10.1086\/342577"},{"key":"e_1_3_2_37_2","doi-asserted-by":"publisher","DOI":"10.1086\/317474"},{"key":"e_1_3_2_38_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.33.9.2233-2239.1995"},{"key":"e_1_3_2_39_2","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.76.9.4350"},{"key":"e_1_3_2_40_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.45.4.1151-1161.2001"}],"container-title":["Journal of Clinical Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/JCM.00418-06","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.asm.org\/doi\/pdf\/10.1128\/JCM.00418-06","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,5]],"date-time":"2022-03-05T05:17:48Z","timestamp":1646457468000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.asm.org\/doi\/10.1128\/JCM.00418-06"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2006,8]]},"references-count":39,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2006,8]]}},"alternative-id":["10.1128\/JCM.00418-06"],"URL":"https:\/\/doi.org\/10.1128\/jcm.00418-06","relation":{},"ISSN":["0095-1137","1098-660X"],"issn-type":[{"value":"0095-1137","type":"print"},{"value":"1098-660X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2006,8]]},"assertion":[{"value":"2006-02-26","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2006-06-02","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2006-08-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}