Large Dissemination of VIM-2-Metallo-β-Lactamase-Producing Pseudomonas aeruginosa Strains Causing Health Care-Associated Community-Onset Infections

Abstract

a series of 45 outpatients presented with community-onset urinary tract infections due to carbapenem-resistant Pseudomonas aeruginosa isolates. Forty of them had a history of previous hospitalization or exposure to healthcare facilities, while the remaining five had not been previously admitted to our healthcare facilities or elsewhere within the preceding 12 months. In 18 outpatients, the carbapenem-resistant organisms caused recurrent community-onset urinary tract infections, while in three outpatients the organisms were also implicated in bacteremic episodes. All 45 single-patient P. aeruginosa isolates harbored the bla VIM-2 metallo-␤-lactamase (MBL) gene in a common class 1 integron structure. They belonged to one predominant pulsed-field gel electrophoresis type and three sporadically detected types; two of the sporadic clonal types were identified among outpatients without previous exposure to healthcare facilities, while the predominant clonal type was also identified to cause infections in hospitalized patients. This is the first study documenting that MBL-producing P. aeruginosa isolates cause community-onset infections that are related or not with exposure to healthcare facilities. Community-onset infections in our patients most likely resulted from the nosocomial acquisition of MBL producers, followed by a prolonged digestive carriage. The high rate of recurrent infections in the community underlies the difficulty of constraining infections caused by such microorganisms in the extrahospital setting.

Dissemination of Clinical Isolates of Klebsiella oxytoca Harboring CMY-31, VIM-1, and a New OXY-2-Type Variant in the Community

“…Supporting evidence for this hypothesis is that despite the presence of factors adverse to antimicrobial effectiveness, such as renal lithiasis and papillary transitional carcinoma of urinary bladder, all outpatients were treated successfully with antimicrobial regimens. In contrast, previous studies have shown that MBL-producing Pseudomonas aeruginosa and Klebsiella pneumoniae strains are frequently associated with recurrent community-onset infections (19,24).…”

Dissemination of Pseudomonas aeruginosa Producing blaIMP1, blaVIM2, blaSIM1, blaSPM1 in Shiraz, Iran

“…Based on the results, 31 P. aeruginosa and 3 A. baumannii isolates were found to carry MBL genes including blaIMP1 and blaVIM2 (19). In Greece during 3 years, large dissemination of P. aeruginosa producing blaVIM2 was studied (24).…”

“…The researchers reported that the major cause of (urinary tract) infections in nosocomial acquisition samples was P. aeruginosa producing MBL (24). In an Australian paper (25) published in 2010, dissemination and genetic variants of MBLs producing P. aeruginosa isolates recovered from four countries including Korea, India, Taiwan, and Philippines were examined.…”

The Accessory Genome of Pseudomonas aeruginosa

“…Such integrons have the potential to dramatically enhance the fitness of the host bacterium in the health care setting (39,135,175). Integron-associated antibiotic resistance genes have been identified in several outbreaks of strains producing metallo-␤-lactamases (MBLs) (74,111,163,172,215). Like KPC ␤-lactamases, MBLs hydrolyze most ␤-lactam antibiotics, including carbapenems (31,134,223).…”