High-Level Expression of Chromosomally Encoded SHV-1 β-Lactamase and an Outer Membrane Protein Change Confer Resistance to Ceftazidime and Piperacillin- Tazobactam in a Clinical Isolate of Klebsiella pneumoniae

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Abstract
We describe Klebsiella pneumoniae 15571, a clinical isolate resistant to ceftazidime MIC = 32 μg/ml) and piperacillin-tazobactam (MICs = 1,024 and 128 μg/ml). K. pneumoniae 15571 expresses a single β-lactamase with a pI of 7.6. However, when cloned in a high-copy-number vector inEscherichia coli, this bla SHV-1gene did not confer resistance to ceftazidime, a spectrum consistent with the nucleotide sequence, which was nearly identical to those of previously described bla SHV-1 genes. Outer membrane protein (OMP) analysis of K. pneumoniae 15571 revealed a decrease in the quantity of a minor 45-kDa OMP in comparison to that in K. pneumoniae 44NR, a low-level ampicillin-resistant strain that also expresses a chromosomally determined bla SHV-1. Crude β-lactamase enzyme extracts from K. pneumoniae 15571 produced roughly 200-fold more β-lactamase activity than K. pneumoniae 44NR. Northern hybridization analysis revealed that this difference was explainable by quantifiable differences in transcription of thebla SHV-1 gene in the two strains. Primer extension analysis of bla SHV-1 mRNA fromK. pneumoniae 15571 and 44NR indicated that the transcriptional start sites were identical in the two strains. DNA sequencing of the promoter regions upstream of the ofbla SHV-1 open reading frames in the twoK. pneumoniae strains revealed an A→C change in the second position of the −10 region in K. pneumoniae 44NR compared to that in 15571. Site-directed mutagenesis of the clonedK. pneumoniae 15571 bla SHV-1, in which the A in the second position of the 15571 −10 region was changed to a C, resulted in a substantial lowering of the MIC of ampicillin. When the levels of β-lactamase enzyme expression inE. coli were compared, the bla SHV-1downstream of the altered −10 region produced 17-fold less β-lactamase enzyme. These results indicate that elevated levels of ceftazidime resistance can result from a combination of increased enzyme production and minor OMP changes and that levels of chromosomally encoded SHV-1 β-lactamase production can vary substantially with a single-base-pair change in promoter sequence.

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