Nosocomial outbreak by imipenem-resistant metallo-β-lactamase-producing Pseudomonas aeruginosa in an adult intensive care unit in a Brazilian teaching hospital

Cezário, Renata Cristina; Morais, Lea Duarte De; Ferreira, Joseane Cristina; Costa-Pinto, Rogério M.; Darini, Ana Lúcia da Costa; Gontijo-Filho, Paulo Pinto

doi:10.1016/j.eimc.2008.09.009

Cited by 43 publications

(31 citation statements)

References 24 publications

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“…As infecções por BGNNF aumentaram no grau de importância em instituições hospitalares a partir da década de 1970, tendo como principais representantes Pseudomonas aeruginosa, Acinetobacter spp., Stenotrophomonas maltophilia e Burkholderia cepacia (3,11,5) . Além disso, esses não fermentadores vêm apresentando sensibilidade diminuída a um grande número de fármacos (34) .…”

Section: Introductionunclassified

Prevalência de bacilos Gram-negativos não fermentadores de pacientes internados em Porto Alegre-RS

Deliberali¹,

Myiamoto²,

Neto³

et al. 2011

J. Bras. Patol. Med. Lab.

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Section: Introductionunclassified

Prevalência de bacilos Gram-negativos não fermentadores de pacientes internados em Porto Alegre-RS

Deliberali¹,

Myiamoto²,

Neto³

et al. 2011

J. Bras. Patol. Med. Lab.

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“…Doripenem was the most active drug against these resistant isolates (12). The presence of carbapenem-nonsusceptible P. aeruginosa isolates has been described worldwide, particularly in relation to outbreaks (1,5,6,17,18,25,28,30,31,37). Most of these studies focused on clinical isolates, and genetic relatedness was established using molecular typing tools based on macrorestriction-fragment analysis or PCR of repetitive DNA sequences on the chromosome.…”

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confidence: 99%

Wide Dispersion of ST175 Clone despite High Genetic Diversity of Carbapenem-Nonsusceptible Pseudomonas aeruginosa Clinical Strains in 16 Spanish Hospitals

et al. 2011

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During the COMParative Activity of Carbapenems Testing (COMPACT) surveillance study, 448 Pseudomonas aeruginosa clinical isolates were obtained from 16 Spanish hospitals. Nonsusceptibility (EUCAST breakpoints) to imipenem (35%), meropenem (33%), and/or doripenem (33%) was observed with 175 isolates (39%). Simultaneous resistance to these three drugs was observed with 126 of the 175 isolates (72%). Except for colistin, high resistance rates were observed among noncarbapenem antibiotics. Clonal relatedness was investigated by pulsed-field gel electrophoresis (PFGE) with SpeI, discriminating 68 patterns. Multilocus sequence typing (MLST) was performed on 84 isolates representing different PFGE types and all participating hospitals. Thirty-nine sequence types (STs) could be distinguished, and of these, ST175 (48 isolates, 10 hospitals), ST646 (16 isolates, 4 hospitals), ST532 (13 isolates, 3 hospitals), and ST111 (13 isolates, 7 hospitals) were the most frequently encountered. Minimum-spanning tree analysis confirmed a wide dissemination of different clones among participant hospitals, particularly ST175. PFGE pattern comparison within the four most frequent STs revealed that ST175 isolates were relatively uniform, while ST646, ST532, and ST111 isolates were highly diverse, with almost every isolate belonging to a unique pulsotype, even when originating from the same center. The population of carbapenem-nonsusceptible P. aeruginosa isolates from 16 hospitals is highly diverse, with one ST (ST175) representing a highly conserved clone disseminated in 10 of the 16 participant hospitals. This ST175 clone should be added to the list of P. aeruginosa clones at high risk for epidemic spread, such as the Liverpool, Manchester, and Melbourne clones previously found in cystic fibrosis patients and ST235 in the nosocomial setting.Antibiotic surveillance studies are necessary not only for the better understanding of bacterial epidemiology, but also for the design of control strategies for preventing bacterial resistance and establishing therapeutic guidelines. In this context, the COMParative Activity of Carbapenems Testing (COMPACT) multicenter study was performed in 16 European countries, including Spain (23). The main objectives of this surveillance study were to test the activity of currently used carbapenems against Pseudomonas aeruginosa clinical isolates and to detect carbapenem nonsusceptible isolates (12).In this multicenter study, Spanish authors concluded that percentages of carbapenem resistance among P. aeruginosa clinical isolates in their country (range of 21.4% to 32.6%) are very similar to those previously reported in other European countries. Doripenem was the most active drug against these resistant isolates (12). The presence of carbapenem-nonsusceptible P. aeruginosa isolates has been described worldwide, particularly in relation to outbreaks (1,5,6,17,18,25,28,30,31,37). Most of these studies focused on clinical isolates, and genetic relatedness was established using molecular typing tools based on macror...

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“…23 Patients with MR-PA colonization and/or infections frequently have contamination of their hands, clothes, and/ or immediate surroundings, which raises the possibility of transmission to other patients either directly or via contact with hospital staff or contaminated equipment. 1,2,6,27 During the first outbreak, four patients were undergoing hemodialysis performed by the same technician. We controlled this epidemic after we reviewed this technician's work and assigned different technicians for each patient.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8] These infections are usually associated with high mortality rates. [1][2][3][4][5][6] Also, in patients with human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS), authors have described persistent and recurrent infections caused by non-MR-PA strains. 9,10 Pulsed-field gel electrophoresis (PFGE) is the recommended technique for determining the genotypes of nosocomial pathogens.…”

Section: Introductionmentioning

confidence: 99%

Outbreaks, persistence, and high mortality rates of multiresistant Pseudomonas aeruginosa infections in a hospital with AIDS-predominant admissions

Gomes¹,

Machado²,

Conceição³

et al. 2011

Braz J Infect Dis

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Introduction: Authors have reported increased incidence of multiresistant Pseudomonas aeruginosa (MR-PA) infections worldwide over the last decade. Researchers have proposed multifaceted approaches to control MR-PA infections, but none have been reported in the acquired immunodeficiency syndrome (AIDS) setting. Objective and Methods: Herein we report the impact of a multifaceted intervention for controlling MR-PA over five years in a hospital with AIDS-predominant admissions and describe the clinical characteristics of MR-PA infection in our patient population. The clinical outcomes of infected patients and molecular characteristics of the isolated strains were used as tools for controlling MR-PA infection rates. Results: Significant temporary decrease of new infections was achieved after intervention, although a high level of diagnostic suspicion of nosocomial infection was maintained. We obtained 35 P. aeruginosa isolates with multiresistant profiles from 13 infected and 3 colonized patients and 2 environmental samples. Most of the patients (94%) were immunocompromised with AIDS (n = 10) or HTLV-1 infections (n = 5). Of the followed patients, 67% had persistent and/or recurrent infections, and 92% died. We observed differences in the antibiotic-resistance pattern of MR-PA infection/colonization during two outbreaks, although the genetic profiles of the tested strains were identical. Conclusions: Therefore, we concluded that early multidisciplinary interventions are essential for reducing the burden caused by this microorganism in patients with AIDS. Prolonged or suppressive antibiotic-based therapy should be considered for MR-PA infections in patients with AIDS because of the persistence characteristic of MR-PA in these patients.

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Nosocomial outbreak by imipenem-resistant metallo-β-lactamase-producing Pseudomonas aeruginosa in an adult intensive care unit in a Brazilian teaching hospital

Cited by 43 publications

References 24 publications

Prevalência de bacilos Gram-negativos não fermentadores de pacientes internados em Porto Alegre-RS

Prevalência de bacilos Gram-negativos não fermentadores de pacientes internados em Porto Alegre-RS

Wide Dispersion of ST175 Clone despite High Genetic Diversity of Carbapenem-Nonsusceptible Pseudomonas aeruginosa Clinical Strains in 16 Spanish Hospitals

Outbreaks, persistence, and high mortality rates of multiresistant Pseudomonas aeruginosa infections in a hospital with AIDS-predominant admissions

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