Investigation of a nosocomial outbreak of Acinetobacter baumannii producing PER-1 extended-spectrum β-lactamase in an intensive care unit

Jeong, Seok Hoon; Bae, Ii Kwon; Kwon, Su Bong; Lee, K.; Yong, Dongeun; Woo, Gun Jo; Lee, J. H.; Jung, Ho Sang; Jang, Sook-Jin; Sung, Kwang Hoon; Lee, Sangeun

doi:10.1016/j.jhin.2004.09.025

Cited by 25 publications

(15 citation statements)

References 19 publications

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“…Molecular typing revealed two clones among the outbreak isolates, with one of these, ST244 (PFGE type A), being greatly predominant. The clonal dissemination of Acinetobacter baumannii, P. aeruginosa, or Proteus mirabilis strains with PER-1 in hospitals in Korea, Turkey, Italy, and Belgium has been reported previously, but the corresponding outbreaks were limited and restricted to ICUs (6,23,30,39,51). The concurrent presence of two or more unrelated clones of A. baumannii or P. aeruginosa with the PER-1 enzyme in some Korean, Turkish, and Italian centers has been reported previously (1,38,55).…”

Section: Discussionmentioning

confidence: 53%

Outbreak of Pseudomonas aeruginosa Infections with PER-1 Extended-Spectrum β-Lactamase in Warsaw, Poland: Further Evidence for an International Clonal Complex

et al. 2007

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Forty-one Pseudomonas aeruginosa isolates with extended-spectrum ␤-lactamases (ESBLs) from a hospital in Warsaw, Poland, were analyzed. Thirty-seven isolates from several wards were collected over 9 months in 2003 and 2004. The isolates were recovered from patients with multiple types of infections, mostly respiratory tract and postoperative wound infections. All 41 isolates produced the PER-1 ESBL, originally observed in Turkey but recently also identified in several countries in Europe and the Far East. The bla PER-1 gene resided within the Tn1213 composite transposon, which was chromosomally located. Pulsed-field gel electrophoresis and multilocus sequence typing (MLST) revealed the presence of three separate clones among the isolates. Two of these, corresponding to sequence types (STs) ST244 and ST235, were responsible for parallel outbreaks. Apart from PER-1, all the isolates produced OXA-2 oxacillinase. ST235 isolates additionally expressed a novel enzyme, OXA-74, differing by one amino acid from the OXA-17 ESBL identified originally in PER-1-and OXA-2-positive P. aeruginosa isolates from Ankara, Turkey, in 1992. These earlier Ankara isolates with PER-1, OXA-2, and OXA-17 were also classified into ST235, which is a single-locus variant of two other STs, ST227 and ST230. ST227, ST230, and ST235 all correspond to the recently described clonal complex BG11, which seems to be internationally distributed, having spread in Turkey, Greece, Italy, Hungary, Poland, Sweden, and much of Russia. It is associated with various ␤-lactamases, including PER-1 and VIM metalloenzymes. This work further demonstrates the value of MLST of P. aeruginosa.

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Section: Discussionmentioning

confidence: 53%

Outbreak of Pseudomonas aeruginosa Infections with PER-1 Extended-Spectrum β-Lactamase in Warsaw, Poland: Further Evidence for an International Clonal Complex

et al. 2007

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“…PCR amplification of class A ␤-lactamase genes revealed that 40% (30/75) of the isolates contained bla TEM , only one isolate contained bla SHV , and two isolates contained bla PER (24,34). This is also the first description of bla PER in the United States.…”

Section: Resultsmentioning

confidence: 69%

Analysis of Antibiotic Resistance Genes in Multidrug-Resistant Acinetobacter sp. Isolates from Military and Civilian Patients Treated at the Walter Reed Army Medical Center

Hujer

Hulten³

et al. 2006

Antimicrob Agents Chemother

444

319

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Military medical facilities treating patients injured in Iraq and Afghanistan have identified a large number of multidrug-resistant (MDR)Acinetobacter baumannii isolates. In order to anticipate the impact of these pathogens on patient care, we analyzed the antibiotic resistance genes responsible for the MDR phenotype in Acinetobacter sp. isolates collected from patients at the Walter Reed Army Medical Center (WRAMC). Susceptibility testing, PCR amplification of the genetic determinants of resistance, and clonality were determined. Seventy-five unique patient isolates were included in this study: 53% were from bloodstream infections, 89% were resistant to at least three classes of antibiotics, and 15% were resistant to all nine antibiotics tested. Thirty-seven percent of the isolates were recovered from patients nosocomially infected or colonized at the WRAMC. Sixteen unique resistance genes or gene families and four mobile genetic elements were detected. In addition, this is the first report of bla OXA-58 -like and bla PER -like genes in the U.S. MDR A. baumannii isolates with at least eight identified resistance determinants were recovered from 49 of the 75 patients. Molecular typing revealed multiple clones, with eight major clonal types being nosocomially acquired and with more than 60% of the isolates being related to three pan-European types. This report gives a "snapshot" of the complex genetic background responsible for antimicrobial resistance in Acinetobacter spp. from the WRAMC. Identifying genes associated with the MDR phenotype and defining patterns of transmission serve as a starting point for devising strategies to limit the clinical impact of these serious infections.

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“…Among the members of the PER family, PER-1 (first identified in 1991) (16) has been responsible for the ESBL profiles in clinically important enterobacteria and nonfermenter gramnegative bacilli isolated in different locations around the world: France (Pseudomonas aeruginosa, Acinetobacter baumannii, and Providencia stuartii) (12,16,22,23), Italy (P. aeruginosa, Alcaligenes faecalis, and P. mirabilis) (17,18,20), Turkey (Salmonella enterica serovar Typhimurium, A. baumanii, and P. aeruginosa) (34)(35)(36)(37), Belgium (P. aeruginosa) (7), and Korea (A. baumannii) (10,39).…”

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confidence: 99%

Biochemical Characterization of PER-2 and Genetic Environment of bla _PER-2

Power

Conza

Rodríguez

et al. 2007

Antimicrob Agents Chemother

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PER-2 was the first detected and the second most prevalent extended-spectrum ␤-lactamase in clinical pathogens isolated in Argentina and was also reported only in other South American countries. Citrobacter freundii 33587 was isolated in 1999 in Buenos Aires and was resistant to all tested ␤-lactams except cephamycins and carbapenems. The strain produced both plasmid-borne TEM-1 and PER-2 (pI 5.4), which could be transferred by conjugation. By PCR screening, thermal asymmetric interlaced PCR, and DNA sequencing, we detected an ISPa12/IS1387a insertion sequence upstream of bla PER-2 , previously reported as also being associated with bla PER-1 . The presence of similar structures upstream of bla PER-1 and bla PER-2 suggests a common origin and mobilization. Compared to bla PER-1 genes, an additional putative promoter for bla PER-2 was found. PER-2 kinetic analysis showed its high hydrolysis efficiencies toward both CTX and CAZ (k cat /K m , 0.76 and 0.43 M ؊1 ⅐ s ؊1 , respectively).

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Investigation of a nosocomial outbreak of Acinetobacter baumannii producing PER-1 extended-spectrum β-lactamase in an intensive care unit

Cited by 25 publications

References 19 publications

Outbreak of Pseudomonas aeruginosa Infections with PER-1 Extended-Spectrum β-Lactamase in Warsaw, Poland: Further Evidence for an International Clonal Complex

Outbreak of Pseudomonas aeruginosa Infections with PER-1 Extended-Spectrum β-Lactamase in Warsaw, Poland: Further Evidence for an International Clonal Complex

Analysis of Antibiotic Resistance Genes in Multidrug-Resistant Acinetobacter sp. Isolates from Military and Civilian Patients Treated at the Walter Reed Army Medical Center

Biochemical Characterization of PER-2 and Genetic Environment of bla _PER-2

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Investigation of a nosocomial outbreak of Acinetobacter baumannii producing PER-1 extended-spectrum β-lactamase in an intensive care unit

Cited by 25 publications

References 19 publications

Outbreak of Pseudomonas aeruginosa Infections with PER-1 Extended-Spectrum β-Lactamase in Warsaw, Poland: Further Evidence for an International Clonal Complex

Outbreak of Pseudomonas aeruginosa Infections with PER-1 Extended-Spectrum β-Lactamase in Warsaw, Poland: Further Evidence for an International Clonal Complex

Analysis of Antibiotic Resistance Genes in Multidrug-Resistant Acinetobacter sp. Isolates from Military and Civilian Patients Treated at the Walter Reed Army Medical Center

Biochemical Characterization of PER-2 and Genetic Environment of bla PER-2

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Biochemical Characterization of PER-2 and Genetic Environment of bla _PER-2