{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T10:56:05Z","timestamp":1777373765346,"version":"3.51.4"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"5","license":[{"start":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T00:00:00Z","timestamp":1620086400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001871","name":"Funda\u00e7\u00e3o para a Ci\u00eancia e a Tecnologia","doi-asserted-by":"publisher","award":["SFRH\/BD\/133266\/2017"],"award-info":[{"award-number":["SFRH\/BD\/133266\/2017"]}],"id":[{"id":"10.13039\/501100001871","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100006111","name":"MCTES","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006111","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100004895","name":"Fundo Social Europeu","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100004895","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Agencia Estatal de Investigation (AEI) of Spain and FEDER of EU","award":["SAF2016-76571-R"],"award-info":[{"award-number":["SAF2016-76571-R"]}]},{"name":"Algerian Ministry of Higher Education and Scientific Research"},{"name":"Funda\u00e7\u00e3o para a Ci\u00eancia e Tecnologia\u201d","award":["SFRH\/BD\/137947\/2018"],"award-info":[{"award-number":["SFRH\/BD\/137947\/2018"]}]},{"name":"FCT\/MCTES","award":["UIDB\/50006\/2020 and UIDP\/50006\/2020"],"award-info":[{"award-number":["UIDB\/50006\/2020 and UIDP\/50006\/2020"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p><jats:italic>Klebsiella pneumoniae<\/jats:italic> is a major pathogen implicated in nosocomial infections. Extended-spectrum \u03b2-lactamase (ESBL)-producing <jats:italic>K<\/jats:italic>. <jats:italic>pneumoniae<\/jats:italic> isolates are a public health concern. We aim to characterize the type of \u03b2-lactamases and the associated resistance mechanisms in ESBL-producing <jats:italic>K<\/jats:italic>. <jats:italic>pneumoniae<\/jats:italic> isolates obtained from blood cultures in a Portuguese hospital, as well as to determine the circulating clones. Twenty-two cefotaxime\/ceftazidime-resistant (CTX\/CAZ<jats:sup>R<\/jats:sup>) <jats:italic>K<\/jats:italic>. <jats:italic>pneumoniae<\/jats:italic> isolates were included in the study. Identification was performed by MALDI-TOF MS and the antimicrobial susceptibility testing by disk-diffusion. The screening test for ESBL-production was performed and ESBL-producer isolates were further characterized. The presence of different beta-lactamase genes (<jats:italic>bla<\/jats:italic><jats:sub>CTX-M<\/jats:sub>, <jats:italic>bla<\/jats:italic><jats:sub>SHV<\/jats:sub>, <jats:italic>bla<\/jats:italic><jats:sub>TEM<\/jats:sub>, <jats:italic>bla<\/jats:italic><jats:sub>KPC<\/jats:sub>, <jats:italic>bla<\/jats:italic><jats:sub>NDM,<\/jats:sub> <jats:italic>bla<\/jats:italic><jats:sub>VIM,<\/jats:sub> <jats:italic>bla<\/jats:italic><jats:sub>OXA-48,<\/jats:sub> <jats:italic>bla<\/jats:italic><jats:sub><jats:italic>CMY-2<\/jats:italic><\/jats:sub>, <jats:italic>bla<\/jats:italic><jats:sub>DHA-1,<\/jats:sub> <jats:italic>bla<\/jats:italic><jats:sub>FOX,<\/jats:sub> <jats:italic>bla<\/jats:italic><jats:sub>MOX,<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>ACC<\/jats:sub>) was analyzed by PCR\/sequencing in ESBL-producer isolates, as well as the presence of other resistance genes (<jats:italic>aac(6\u2019)-Ib-cr<\/jats:italic>, <jats:italic>tet<\/jats:italic>A\/B, <jats:italic>dfrA<\/jats:italic>, <jats:italic>qnr<\/jats:italic>A\/B\/S, <jats:italic>sul<\/jats:italic>1\/2\/3) or integron-related genes (<jats:italic>int<\/jats:italic>1\/2\/3). Multilocus-sequence-typing (MLST) was performed for selected isolates. ESBL activity was detected in 12 of the 22 CTX\/CAZ<jats:sup>R<\/jats:sup> <jats:italic>K<\/jats:italic>. <jats:italic>pneumoniae<\/jats:italic> isolates and 11 of them carried the <jats:italic>bla<\/jats:italic><jats:sub>CTX-M-15<\/jats:sub> gene (together with <jats:italic>bla<\/jats:italic><jats:sub>TEM<\/jats:sub>)<jats:sub>,<\/jats:sub> and the remaining isolate carried the <jats:italic>bla<\/jats:italic><jats:sub>SHV-106<\/jats:sub> gene. All the <jats:italic>bla<\/jats:italic><jats:sub>CTX-M-15<\/jats:sub> harboring isolates also contained a <jats:italic>bla<\/jats:italic><jats:sub>SHV<\/jats:sub> gene (<jats:italic>bla<\/jats:italic><jats:sub>SHV-1<\/jats:sub>, <jats:italic>bla<\/jats:italic><jats:sub>SHV-11<\/jats:sub> or <jats:italic>bla<\/jats:italic><jats:sub>SHV-27<\/jats:sub> variants). Both <jats:italic>bla<\/jats:italic><jats:sub>SHV-27<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>SHV-106<\/jats:sub> genes correspond to ESBL-variants. Two of the CTX-M-15 producing isolates carried a carbapenemase gene (<jats:italic>bla<\/jats:italic><jats:sub>KPC2\/3<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>OXA-48<\/jats:sub>) and showed imipenem resistance. The majority of the ESBL-producing isolates carried the <jats:italic>int<\/jats:italic>1 gene, as well as sulphonamide-resistance genes (<jats:italic>sul<\/jats:italic>2 and\/or <jats:italic>sul<\/jats:italic>3); the <jats:italic>tetA<\/jats:italic> gene was detected in all eight tetracycline-resistant isolates. Three different genetic lineages were found in selected isolates: ST348 (one CTX-M-15\/TEM\/SHV-27\/KPC-2\/3-producer isolate), ST11 (two CTX-M-15\/TEM\/SHV-1- and CTX-M-15-TEM-SHV-11-OXA-48-producer isolates) and ST15 (one SHV-106\/TEM-producer isolate). ESBL enzymes of CTX-M-15 or SHV-type are detected among blood <jats:italic>K<\/jats:italic>. <jats:italic>pneumoniae<\/jats:italic> isolates, in some cases in association with carbapenemases of KPC or OXA-48 type.<\/jats:p>","DOI":"10.1371\/journal.pone.0250525","type":"journal-article","created":{"date-parts":[[2021,5,4]],"date-time":"2021-05-04T19:39:45Z","timestamp":1620157185000},"page":"e0250525","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":44,"title":["Multidrug-resistant Klebsiella pneumoniae harboring extended spectrum \u03b2-lactamase encoding genes isolated from human septicemias"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1762-412X","authenticated-orcid":true,"given":"Isabel","family":"Carvalho","sequence":"first","affiliation":[]},{"given":"Nadia Safia","family":"Chenouf","sequence":"additional","affiliation":[]},{"given":"Jos\u00e9 Ant\u00f3nio","family":"Carvalho","sequence":"additional","affiliation":[]},{"given":"Ana Paula","family":"Castro","sequence":"additional","affiliation":[]},{"given":"Vanessa","family":"Silva","sequence":"additional","affiliation":[]},{"given":"Rosa","family":"Capita","sequence":"additional","affiliation":[]},{"given":"Carlos","family":"Alonso-Calleja","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2146-5627","authenticated-orcid":true,"given":"Maria de Lurdes Nunes","family":"Enes Dapkevicius","sequence":"additional","affiliation":[]},{"given":"Gilberto","family":"Igrejas","sequence":"additional","affiliation":[]},{"given":"Carmen","family":"Torres","sequence":"additional","affiliation":[]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0925-689X","authenticated-orcid":true,"given":"Patr\u00edcia","family":"Poeta","sequence":"additional","affiliation":[]}],"member":"340","published-online":{"date-parts":[[2021,5,4]]},"reference":[{"key":"pone.0250525.ref001","doi-asserted-by":"crossref","first-page":"1919","DOI":"10.1038\/s41564-019-0492-8","article-title":"Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is driven by nosocomial spread","volume":"4","author":"S David","year":"2019","journal-title":"Nat. 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