Antibiotic susceptibility and molecular mechanisms of cephalosporins resistance in Klebsiella isolates from patients with hospital-acquired infections]

Antibiotic susceptibility of nosocomial Klebsiella isolates from inpatients of 30 medical centres in 15 various regions of Russia was studied. In total 212 strains were tested. The Klebsiella genus was represented by the following species: Klebsiella pmeumoniae ss. pneumoniae (182 isolates, 85.8%), Klebsiella pneumonia ss. ozaenae (1 isolate, 0.5%), Klebsiella oxytoca (29 isolates, 13.7%). The susceptibility was determined by the broth microdilution method. Carbapenems (imipenem and meropenem) remained to be the most active antibacterial agents. However, 1 imipenem resistant strain and 2 meropenem resistant strains were isolated. As for the 3rd generation cephalosporins, the lowest MICs were observed with the use of the inhibitor-protected agents, such as ceftazidime/clavulanic acid (MIC50 0.25 mcg/ml, MIC90 64 mcg/ml). 48.8%, 16.9%, 29.7% and only 10.5% of the isolates was susceptible to cefepime, cefotaxime, ceftazidime and cefoperazone respectively. Detecting of the beta-lactamase genes (TEM, SHV and CTX) was performed by PCR in 42 strains of Klebsiella pneumoniae ss. pneumoniae. Alone or in various combination the TEM type beta-lactamases were detected in 16 (38.1%) isolates. SHV and CTX were detected in 29 (69%) and 27 (64.3%) isolates respectively. Combinations of 2 and 3 different determinants of resistance to beta-lactams were revealed in 23.8% and 26.2% of the isolates respectively. No isolates producing class B MBL among the carbapenem resistant nosocomial Klebsiella strains were detected.     

急性脑卒中患者医院感染分析

目的为探明急性脑卒中患者医院感染的特点及危险因素,以便采取有效控制措施。方法对温州医学院附属第一医院1997年1月1日～2002年12月31日6年间收治的4730例急性脑卒中患者进行监测。结果医院感染率为1252%。女性高于男性(P<005),感染率随年龄增大而升高(P<001)。医院感染多发生在入院2周内,感染部位以呼吸道为主(4796%),其次为泌尿道(3481%)。病原菌以G-菌为主(4309%),其次为G+菌(3091%)和真菌(2600%)。耐药菌株不断增加。结论免疫功能低下、侵袭性操作、滥用抗生素和激素是急性脑卒中患者医院感染的主要危险因素。加强对细菌耐药性的监测,合理选用抗生素,是减少或延缓耐药菌株产生的关键措施。     

Antimicrobial susceptibility and molecular mechanisms of resistance to beta-lactams of gram-negative microorganisms--causative agents of nosocomial infections

Profiles and mechanisms of resistance to beta-lactam antibiotics of isolates of Gram-negative microorganisms, which are causative agents of infections in Intensive Care Unit of hospital surgery department, were studied. Two hundred and ten clinical isolates were studied: Pseudomonas aeruginosa--86 strains (40.9%), Acinetobacter baummanii--45 strains (21.4%), Klebsiella pneumoniae--52 strains (24.8%), Escherichia coli--23 strains (11%), Enterobacter spp.--4 strains (1.9%). Profiles of antibiotic resistance were studied by the method of serial microdilutions; detection of most widespread and clinically significant genes of beta-lactamases of Gram-negative bacteria was performed by polymerase chain reaction. Carbapenems and cefoperazone/sulbactam were the most active antibiotics. Local features of distribution of beta-lactamase coding genes (TEM, SHV, CTX) in K. pneumoniae and E. coli isolates were revealed. Eleven strains of P. aeruginosa resistant to carbapenems and possessing genetic determinants of VIM-group, which codes metallo-beta-lactamases, were isolated. Obtained data allows to assess the parameters of resistance to beta-lactam antibiotics and to reveal the main mechanisms of such resistance in etiologic agents of nosocomial infections, that, in its turn, allows to choose preparations for etiotropic therapy.     

Application of four variants of the diagnostic disc test (CD01, CD02, CD03, CD04) for detection of ESBL-positive strains of gram-negative rods

The aim of this study was to evaluate the usefulness of four variants of the diagnostic disc test (DD) to detect extended-spectrum beta-lactamases (ESBLs) in nosocomial strains of gram-negative rods. Also, the diagnostic disc test (DD) was compared with the double-disc synergy test (DDST) for the effectivity of ESBLs identification. A total number of 111 ESBL-positive (DDST-positive) strains of gram-negative rods isolated from hospitalized patients in 2004 was examined. Ninety nine strains belonged to enteric rods (89.2%) and twelve strains--to nonfermentative rods (10.8%). Two reference strains: E. coli ATCC 25922 (ESBL-negative one) and K. pneumoniae ATCC 700603 (ESBL-positive one) were included in the study. Four variants of the diagnostic disc test (DD, Oxoid Ltd, UK) were applied for ESBLs detection: CPD/CD01, CAZ/CD02, CTX/CD03 and CPO/CD04. All examined strains (111) were DDST-positive. Positive results in the DD test (Oxoid Ltd) were as follows: CPD/CD01--59 strains (53.2%), CAZ/CD02--80 strains (72.1%), CTX/CD03--92 strains (82.9%) and CPO/CD04--110 strains (99.1%). Discs containing cefpirome (CPO) and cefpirome with clavulanic acid (CD04) were the best set for detection of ESBLs in our collection of clinical gram-negative rods. Results of this variant of the DD test were the most consistent with the results of the DDST. Application of several disc diffusion methods to detect ESBL producers increases the probability of proper identification of these strains.     

Gram-negative bacillary community acquired meningitis is not a rare entity in last two decades

The aim of this short note is to assess gram-negative bacillary community acquired meningitis (CBM) and nosocomial meningitis (NM) within 17 years nationwide survey. All cases of gram-negative bacillary CBM within 1990-2007 were assessed in national database of 372 patients with bacterial meningitis: 69 of gram-negative cases were nosocomial and 24 of gram-negative meningitis cases were CBM. Those 24 cases were compared with all CBM (201 cases) for risk factors and outcome. Among nosocomial gram-negative pathogens, A. baumannii in 23 cases, Ps. aeruginosa in 15 cases and Enterobacteriaceae in 31 cases were isolated. Among CBM, in 13 cases Enterobacteriaceae (Escherichia coli 6, Klebsiella pneumoniae 3, Proteus mirabilis 2, Enterobacter cloacae 2), in 5 cases Ps. aeruginosa and in 6 cases Acinetobacter baumannii were isolated from cerebrospinal fluid (CSF). The only significant risk factor for CBM due to gram-negative bacilli was neonatal age (12.5% vs. 3.5%, p=0.04) as underlying disease. However, mortality among gram-negative bacillary meningitis was significantly higher (12.4% vs. 37.5%, p=0.001) in comparison to other meningitis.     

Frequency and susceptibility patterns of non-fermenting gram-negative rods isolated from patients hospitalised in intensive care units of a tertiary care hospital

The aim of the study was to assess frequency and susceptibility to antimicrobial agents of non-fermenting gram-negative rods isolated from clinical specimens obtained from patients requiring intensive care, with emphasis on profile of the unit. Identification of cultured isolates was done using automated VITEK and API systems (bioMerieux, France). Susceptibility to antimicrobial agents was tested by a disk-diffusion method according to the NCCLS recommendations. In total the analysis comprised 425 strains of non-fermenting gram-negative rods, constituting 58.9% of all isolates of gram-negative bacteria. In blood cultures predominated strains of A. baumannii (46.8%) and P. aeruginosa (40.4%), while in cultures of other clinical specimens these bacteria comprised 42.9% and 43.9% of isolates. Major differences were observed in frequency of these species on both ICU units. Strains of non-fermenting rods isolated from blood cultures comprised a lower percentage of strains susceptible to antimicrobials (particularly cefepime and carbapenems) than isolates cultured from other specimens. Strains of A. baumannii resistant to imipenem and meropenem were detected with a frequency of 12.5% and 26.7%, respectively. Resistance of P. aeruginosa strains to carbapenems was 62.2% and 44.3%, respectively. There was a relatively high percentage of strains susceptible to cefepime (82.0%), ceftazidime (78.9%), amikacin (77.8%) and piperacillin/tazobactam (69.7%). Conclusions: 1. There was a predominance (58.9%) of strains of gram-negative non-fermenting rods. 2. Isolates from blood cultures were characterised by a much higher percentage of resistant strains in comparison to other specimens. 3. Strains of A. baumannii resistant to carbapenems were recorded. 4. There were differences in frequency and antimicrobial susceptibility among the strains of P. aeruginosa and A. baumannii depending on the type of clinical specimen and ICU profile.     

Comparison of frequency and susceptibility to antimicrobials of bacterial strains of the family Enterobacteriaceae isolated from patients hospitalised in intensive care units

The aim of the study was estimation of frequency and susceptibility to antimicrobial agents of gram-negative rods isolated from clinical specimens obtained from patients requiring intensive care, with emphasis on profile of the unit. The analysis comprised strains of gram-negative rods isolated from patients of two intensive care units (ICUs) of a tertiary care hospital (1200 beds). Identification of cultured isolates was done using automated VITEK and API systems (bioMerieux, France). Susceptibility to antimicrobial agents was tested by a disk-diffusion method according to the NCCLS recommendations. In total the analysis comprised 722 strains of gram-negative rods. In blood cultures predominated strains of Enterobacter spp. (42.5%) and Klebsiella pneumoniae (37.5%). In cultures of clinical specimens other than blood 41.6% comprised strains of Klebsiella pneumoniae, 14.8% Escherichia coli and 14.4% Proteus mirabilis. Frequency of multi-drug resistant strains of bacteria of the family Enterobacteriaceae was much higher among blood isolates in comparison to strains cultured from other clinical specimens. There was a relatively high percentage of strains of Enterobacteriaceae susceptible to piperacillin and tazobactam (69.0%) and ceftazidime (54.6%). Conclusions: 1. All strains were susceptible to carbapenems. 2. There was a relatively high percentage of strains of gram-negative rods susceptible to piperacillin/tazobactam and ceftazidime. 3. Bacteria isolated from blood cultures were characterised by a much higher percentage of resistant strains in comparison to other specimens. 4. Longer stay in ICU promoted selection of strains resistant to antimicrobials.     

Analysis of the etiological structure and dynamics of antibiotic resistance in the causative agents of suppurative inflammatory diseases in the patients at a large general hospital

The structure of the causative agents isolated from patients with pyoinflammatory infections in 1980-1983 was analysed. It was shown that the surgical and urological infections were mainly caused by gram-negative bacteria. The other pyoinflammatory infections were mainly due to gram-positive cocci. A relatively high frequency of the strains of gram-negative bacteria, especially among Pseudomonas spp. and Enterobacter spp., resistant to aminoglycoside antibiotics, such as gentamicin, sisomycin and tobramycin with preserved sensitivity to amikacin and netilmicin in the majority of the strains was shown. Among the beta-lactam antibiotics cephotaxim and cephalotin were most active against gram-negative bacteria and staphylococci, respectively. The majority of the antibiotic resistant strains of gram-negative bacteria had analogous structures and levels of resistance to 7-12 antibiotics which might indicate the occurrence of 1-2 resistance plasmids among the clinical strains.     

体液病原菌分布及革兰氏阴性杆菌药敏结果分析

目的：分析2005-2006年我院内无菌体液病原菌流行状况及革兰氏阴性杆菌对常用抗生素的敏感性,以便更好地为临床治疗感染性疾病提供用药参考。方法：所有菌株用美国BD公司BBLCRYSTAL AUTOREADER仪器进行鉴定,药敏用K-B法,培养基和药敏纸片为BD公司的。结果：80株致病菌中,肠杆菌科占65%,非发酵菌占12.5%,革兰氏阳性葡萄球菌占17.5%,酵母样真菌占2.5%,厌氧菌占2.5%。大肠埃希菌感染占首位（50株）其次为铜绿假单胞菌（3株）。嗜麦芽窄食单胞菌（3株）。肺炎克雷伯菌（2株）。大肠埃希菌中ESBL阳性菌18%（9/50）ESBL阳性菌和阴性菌对不同抗菌药物的敏感性有显著差异,前者耐药明显高于后者。结论：临床应根据药敏结果合理使用抗生素,减少院内感染的发生。     

医院内感染的病原菌分布及其耐药谱的分析

本文统计了我院１９９２年８月—１９９４年７月两车间医院内感染病原菌的分离结果,分离出病原菌２５种７５８株,其中革兰氏阳性菌１６３株（占２１．５１％）,革兰氏阴性菌３７８株（占４９．８７％）,真菌２１７株（占２８．６２％）。院感病原菌依次为,白色念珠菌、绿脓假单胞菌表、葡菌、肺炎克雷伯氏菌、酵母菌及大肠艾希氏菌等,显示了真菌及表葡菌在院内感染中已经上升到不可忽略的地位。用１８种常用抗生素,对除真菌外的上述病原菌５４１株做耐药谱测定,并发现除了表葡菌及多数革兰氏阴性菌对喹谱酮类及少数头孢三代抗生素尚属敏感外,大部分均具有越来越广泛的耐药性。     

Occurrence of beta-lactamase type ESBL in rods of the Serratia species

Serratia spp. has been identified as an important opportunistic pathogen agent in nosocomial infections. The aim of the study was the determination of extended spectrum beta-lactamases (ESBL) occurrence among 78 of Serratia spp. strains isolated in 1996-1998 from clinical specimens obtained from patients of State Clinical Hospital in Bydgoszcz. Identification of Serratia spp. strains was performed in automatic ATB system with ID 32GN strips (bioMérieux). The strains with ESBL activity were detected by double-disc method according to Jarlier et al. (10) with small modifications. Clavulanic acid, tazobactam and sulbactam were used as the inhibitors of ESBLs. Drug-susceptibility was determined by disc-diffusion method according to NCCLS standards. Forty-five (57.7%) of the strains were ESBL (+). All of them belonged to S. marcescens species. The majority--91.1% of strains was derived from urine, 3 from wound and 1 from blood. The obtained results indicate the necessity of monitoring of ESBL-producing strains among gram-negative rods from clinical specimen. The aims of such a procedure are to control and to prevent their dissemination within hospital, as well as to avoid therapeutic failures.     

血液病患者院内感染危险因素分析与对策

目的：探讨血液病患者院内感染危险因素,为制定控制措施提供理论依据。方法：回顾性调查我院血液科2009年3月．2011年3月间685例血液病患者发生院内感染的情况,并对引起院内感染的危险因素进行分析。结果：685例患者中有91例发生院内感染,感染部位以呼吸系统、皮肤和口腔为主。分离病原菌88株,革兰阴性杆菌53株（60．22％）,革兰阳性菌28株（31．81％）,真菌7株（7．95％）。白细胞下降、化疗、激素和广谱抗生素的使用是院内感染的主要因素。结论：为减少医院感染发生率,必须对白细胞〈2×10^9／L的病人进行保护性隔离,并合理使用抗生素治疗感染性疾病。     

Susceptibility of antibiotic-resistant gram-negative bacteria to biocides: a perspective from the study of catheter biofilms

Bacteria resistant to both the agents deployed to prevent infections and those used to treat infections would be formidable nosocomial pathogens. The aim of this paper is to review the evidence that gram-negative bacteria resistant to antibiotics and biocides have emerged and been responsible for catheter-associated urinary tract infection. A study of patients undergoing intermittent bladder catheterization revealed that the frequent application of the antiseptic chlorhexidine to the perineal skin prior to the insertion of the catheter was effective against the normal gram-positive skin flora but not against the gram-negative organisms that subsequently colonized this site. Organisms such as Providencia stuartii, Pseudomonas aeruginosa and Proteus mirabilis were repeatedly isolated from the skin of these patients and inevitably went on to cause urinary infections. The minimum inhibitory concentration (MIC) of chlorhexidine for many of these strains proved to be 200-800 microg ml(-1) compared with the 10-50 microg ml(-1) recorded for reference strains of gram-negative species. A subsequent survey of over 800 gram-negative isolates from urinary tract infections in patients from both hospitals and the community revealed that chlorhexidine resistance was not a widespread phenomenon, but was restricted to these species and to units where the care of catheterized patients involved the extensive use of chlorhexidine. Analysis of the antibiotic resistance patterns revealed that the chlorhexidine-resistant strains were also multidrug resistant. Other clinical studies also reported catheter-associated infections with chlorhexidine- and multidrug-resistant strains of Pr. mirabilis when chlorhexidine was being used extensively. This species poses particular problems to the catheterized patient. Chlorhexidine thus proved counterproductive in the care of catheters and its use in this context has been largely abandoned. Suggestions of reintroducing this agent in the form of biocide-impregnated catheters should be resisted.     

革兰阴性杆菌ESBLs和AmpC酶的检测及耐药分析

目的检测引起医院感染的革兰阴性杆菌携带产ESBLs和去阻遏AmpC酶状况,探讨各菌对临床常用抗生素的主要耐药机制及耐药性,为临床制定合理使用抗生素策略提供依据。方法采用全自动微生物分析仪（VITEK-32）做细菌鉴定和药敏试验,用纸片扩散确证法检测超广谱β-内酰胺酶（ESBLs）,用三维法检测高水平表达染色体编码的AmpC酶。结果158株革兰阴性杆菌ESBLs检出率为26．6％,主要菌为大肠埃希菌（45．2％）、肺炎克雷伯菌（42．9％）、阴沟肠杆菌（11．9％）。AmpC酶检出率为10．1％,主要为鲍曼不动杆菌（43．8％）、阴沟肠杆菌（25％）;上述产酶细菌均对青霉素和一、二、三代头孢菌素、磺胺类、喹诺酮类、氨基糖苷类耐药,对亚胺培南敏感。结论革兰阴性杆菌耐药机制主要是产超广谱β-内酰胺酶和AmpC酶,这些产酶菌株均出现多重耐药。     

普外科切口感染病原菌及细菌耐药性分析

目的探讨普外科切口感染菌分布及耐药性,指导临床用药及预防控制措施。方法总结分析本院2003年1月至2005年5月普外科124例切口感染住院患者的病原菌资料。结果124例切口感染标本中共分离出感染菌127株,病原菌依次为:大肠埃希菌占47.24%、肠球菌占18.90%、金黄色葡萄球菌占12.60%、肠杆菌属占7.87%、真菌占7.09%、克雷伯菌属占6.30%。以革兰阴性菌为主占61.41%,革兰阳性菌占31.50%,真菌占7.09%。大肠埃希菌与克雷伯菌的耐药性相仿,对哌拉西林/他唑巴坦、头孢西丁、头孢吡肟、亚胺硫霉素、阿米卡星的耐药率较低,肠杆菌属仅对亚胺硫霉素和阿米卡星的耐药率低,肠球菌仅对万古霉素的耐药率低,金黄色葡萄球菌MRSA检出率为25%,除对青霉素和氨苄青霉素的耐药率较高外,对其它抗菌药物的耐药率尚处于低水平。结论细菌耐药性是引起术后感染、治愈困难的重要原因之一,加强细菌耐药性监测,采用合理预防控制措施,能减低术后切口感染的发生。     

呼吸机相关性肺炎的常见病原菌耐药性分析

目的:探讨呼吸机相关性肺炎(VAP)的常见病原菌并分析其耐药性,为临床治疗提供依据。方法:选取我院收治的135例VAP患者的临床资料,分析其病原菌分布以及抗菌药物的耐药性。结果:135例患者中共分离出183株病原菌,其中革兰氏阴性菌135株(占73.77%),革兰氏阳性细菌33株(占18.03%),真菌15株(占8.20%)。革兰氏阴性菌主要为鲍曼不动杆菌,占35.52%,革兰氏阳性细菌主要为金黄色葡萄球菌,占9.84%,革兰阳性菌无一对万古霉素耐药,除了米诺环素总耐药率为42.42%外,其余病原菌对于常用的药物总耐药率均大于60.0%,革兰阴性菌普遍存在多药耐药现象。结论:引起VAP患者感染的主要致病菌为革兰阴性菌群,且存在严重的多重耐药现象,在临床上应加强对VAP疾病的预防和控制,合理应用抗菌药物。     

ICU机械通气并发下呼吸道医院感染病原菌的调查分析

目的：分析ICU机械通气并发下呼吸道医院感染病原学构成及耐药情况。为临床防治提供依据。方法：对我院1996年6月-1999年6月3间ICU收住的98例机械通气合并下呼吸道医院感染患者的致病菌及药敏结果进行回顾性调查。结果：共检出致病毒128株,其中革兰阴性细菌（G^-菌）占66.4%（85株）,革兰阳性细菌（G^ 菌）占25.8%(33株）,真菌占7.8%(10株）;前四位致病菌分别为铜绿假单胞菌（24株）,革兰阳性细菌（G^ 菌）占25.8%(33株）,真菌占7.8%(10株）;前四位致病菌分别为铜绿假单胞菌（24株）,金黄色葡萄球菌（22株）,不动杆菌属（21株）,肠杆菌属（18株）,药敏结果显示这类菌株多重耐药现象严重。结论：ICU机械通气并发下呼吸道医院感染病原体构成以G^-菌为主,其药敏试验呈多重耐药,临床应重视病原学检查,开展细菌耐药性监测,合理使用抗菌药物。     

Frequency,epidemiology, risk factors,clinical and bacteriological features of enterococcal disease in patients with HIV infection in a decade survey

In order to assess the frequency and clinical significance of Enterococcus spp. infection during HIV disease, the epidemiological features, risk factors, microbiological issues, and therapeutic perspectives of all the 148 consecutive episodes observed in the past decade were analyzed. The overall frequency of these complications (which involved the genito-urinary tract in over 75% of cases) regarded 5.3% of all admission for HIV disease, with a clear prevalence of Enterococcus faecalis as the causative agent (86.5% of episodes), and a proportionally elevated frequency of polymicrobial infection (45.9% of cases). Among the 148 cultured bacterial strains, a complete susceptibility to glycopeptide antibiotics was documented, together with favorable sensitivity levels against semisynthetic penicillins, followed by chloramphenicol, macrolides, and clindamycin. An advanced underlying HIV disease characterized by a concurrent, severe immunodeficiency, concomitant, prolonged neurological complications, hospitalization itself (with prevalence of nosocomial infection), recourse to invasive diagnostic and/or therapeutic procedures, and prior administration of broad spectrum antimicrobial agents, all seem to support HIV-associated enterococcal disease (mostly involving the genito-urinary tract). The adjunct of neutropenia, a very low CD4+ lymphocyte count, and severe AIDS-defining illnesses represented significant risk factors for hematogenous dissemination of this bacterial infection with potentially life-threatening consequences (16.1% of lethal cases among our septic patients).     

2015-2017年某综合医院医院感染现患率调查分析

摘要 目的：了解与掌握医院感染现状及抗菌药物的使用,为有效预防与控制医院感染提供科学依据。方法：采用横断面调查方法,对医院2015年9月12日、2016年9月7日、2017年8月23日住院患者医院感染横断面调查,并对调查的所有资料进行分析。结果：应调查4160例,实查4125例,实查率99.16%,实查率符合现患率调查要求。2015-2017年医院感染现患率分别为6.12%、4.58%、4.12%,三年调查现患率比较,差异有统计学意义（x²=6.537,P=0.038）。调查科室中综合ICU医院感染现患率最高,为30.30%,例次感染率为36.36%。2015-2017年医院感染部位均以下呼吸道最高,其次为泌尿道,血管相关最低。2015-2017年现患率调查统计病原菌共172株,以革兰阴性菌为主。2015-2017年调查抗菌药物使用率分别为27.54%、24.09%、23.32%,合计为24.99%,三年调查日的使用率比较,差异有统计学意义（x²=7.452,P=0.024）。病原学送检673例,送检率79.83%。结论：医院感染现患率调查有助于掌握医院感染现状,根据调查存在的问题,采取相应干预措施,可有效预防与控制医院感染。     

Adhesive properties and antibiotic resistance of Klebsiella strains isolated from gastrointestinal tracts of children hospitalised in Wroclaw nad Opole

Gram negative Klebsiella bacilli present many pathogenic properties, which determine their ability to survive and rapid spreading in hospital environment. There are many factors responsible for the pathogenicity of Klebsiella strains: capsule, fimbriae, nonfimbrial adhesins, lipopolysaccharide of the cell wall and extracellular secreted exotoxins. Klebsiella strains are etiological agents of different nosocomial infections but also colonized gastrointestinal and respiratory tracts. The aim of our work were adhesive properties and antibiotic resistance of Klebsiella strains isolated from stool of hospitalized children, according to source of potential nosocomial infections--100 Klebsiella strains from Wroclaw and 76 strains from Opole, isolated in cases of diarrhea. The resistance of this strains to different group of antibiotics, the expression of ESBL enzymes, the activity in hemagglutination and their ability to adherence to different cell lines were tested. The highest resistance of all strains to aminopenicillins was observed. The production of ESBL was highest in strains from Opole (51% strains) then in Wroclaw (9%). In both hospital units, ESBL+ strains were resistant to aminoglicosides and cotrimoxazol but sensitive to ciprofloxacine. Using hemagglutination method the types of fimbriae were defined. Above 90% investigated Klebsiella strains showed the presence of fimbriae (in Wroc?aw more strains simultaneously expressed fimbriae type 1 and 3, in Opole mainly fimbriae type 3). Over 70% strains demonstrated the high level of adherence to cell lines. Only several strains showed the low level or the lack of adhesion. These results suggested that among Klebsiella strains in gastrointestinal tract were presented multiresistant strains with high ability to adherence, which may be potential source of nosocomial infections.