Whirlpool-associated folliculitis caused by Pseudomonas aeruginosa: report of an outbreak and review

Ratnam, Samuel; Hogan, Kathleen A.; March, Sandra B.; Butler, R.W.

doi:10.1128/jcm.23.3.655-659.1986

Cited by 72 publications

(27 citation statements)

References 37 publications

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“…P. aeruginosa serotype O11 caused hospital outbreaks in the 1980s in the United States (8) and in 1994 and 1995 in Greece (50). P. aeruginosa O11 was implicated in folliculitis caused by the use of whirlpools and hot tubs in the 1970s and 1980s in the United States and Canada (40). More recently, hospital outbreaks caused by MDR P. aeruginosa serotype O11 occurred in Belgium (5) and in Japan (46).…”

Section: Discussionmentioning

confidence: 99%

Outbreaks of Multidrug-Resistant Pseudomonas aeruginosa in Community Hospitals in Japan

et al. 2007

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We previously reported an outbreak in a neurosurgery ward of catheter-associated urinary tract infection with multidrug-resistant (MDR) Pseudomonas aeruginosa strain IMCJ2.S1, carrying the 6-N-aminoglycoside acetyltransferase gene [aac(6)-Iae]. For further epidemiologic studies, 214 clinical isolates of MDR P. aeruginosa showing resistance to imipenem (MIC > 16 g/ml), amikacin (MIC > 64 g/ml), and ciprofloxacin (MIC > 4 g/ml) were collected from 13 hospitals in the same prefecture in Japan. We also collected 70 clinical isolates of P. aeruginosa that were sensitive to one or more of these antibiotics and compared their characteristics with those of the MDR P. aeruginosa isolates. Of the 214 MDR P. aeruginosa isolates, 212 (99%) were serotype O11. We developed a loop-mediated isothermal amplification (LAMP) assay and a slide agglutination test for detection of the aac(6)-Iae gene and the AAC(6)-Iae protein, respectively. Of the 212 MDR P. aeruginosa isolates, 212 (100%) and 207 (98%) were positive in the LAMP assay and in the agglutination test, respectively. Mutations of gyrA and parC genes resulting in amino acid substitutions were detected in 213 of the 214 MDR P. aeruginosa isolates (99%). Of the 214 MDR P. aeruginosa isolates, 212 showed pulsed-field gel electrophoresis patterns with >70% similarity to that of IMCJ2.S1 and 83 showed a pattern identical to that of IMCJ2.S1, indicating that clonal expansion of MDR P. aeruginosa occurred in community hospitals in this area. The methods developed in this study to detect aac(6)-Iae were rapid and effective in diagnosing infections caused by various MDR P. aeruginosa clones.Pseudomonas aeruginosa causes nosocomial infections as a result of its ubiquitous nature, ability to survive in moist environments, and resistance to many antibiotics and antiseptics. A serious problem is the emergence of multidrug-resistant (MDR) P. aeruginosa strains resistant to ␤-lactams, aminoglycosides, and quinolones (34,39,46 We previously reported a nosocomial outbreak of catheterassociated urinary tract infection involving new MDR P. aeruginosa strain IMCJ2.S1, which occurred in a neurosurgery ward of a hospital located in the Tohoku area of Japan (46). This strain showed broad-spectrum resistance to aminoglycosides, ␤-lactams, fluoroquinolones, tetracyclines, sulfonamide, and chlorhexidine. We found that IMCJ2.S1 harbored a novel class 1 integron, In113, containing an array of three gene cassettes of the metallo-␤-lactamase (MBL) bla IMP-1 gene, aminoglycoside 6Ј-acetyltransferase aac(6Ј)-Iae gene, and aminoglycoside 3Ј-adenylyltransferase aadA1 gene (46). This strain possessed mutations of the gyrA (83Thr3Ile) and parC (87Ser3Leu) genes involving amino acid substitutions, resulting in high-level resistance to fluoroquinolones.In the geographic area where the MDR P. aeruginosa outbreak occurred (46), hospitals and a commercial clinical laboratory were surveyed for similar organisms. Because 99% of the MDR P. aeruginosa isolates analyzed were found to harbor the aac(6Ј)-Iae gene, we d...

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Section: Discussionmentioning

confidence: 99%

Outbreaks of Multidrug-Resistant Pseudomonas aeruginosa in Community Hospitals in Japan

et al. 2007

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“…The increased popularity of whirlpool baths and spas has been associated with an increased incidence of folliculitis, principally caused by Pseudomonas aeruginosa serotype 0: 11 (8,13). Whirlpools are normally operated at 39 to 40°C.…”

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confidence: 99%

Incidence and persistence of Pseudomonas aeruginosa in whirlpools

Price

Ahearn

1988

J Clin Microbiol

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Pseudomonas aeruginosa was isolated from seven commercial and two residential whirlpools that were treated with halogens. None of the commercial whirlpools was constantly maintained at appropriate disinfection levels. Superchlorination or the draining, cleaning, disinfection, and refilling of whirlpools markedly reduced densities of P. aeruginosa in whirlpool water, but the bacterial populations were rapidly reestablished (less than 10(3) cells per ml) when disinfectant concentrations decreased below recommended levels (chlorine, 3.0 ppm [3.0 micrograms/ml]; bromine, 6.0 ppm). P. aeruginosa in the water was replenished from various sources, such as hoses used to fill the whirlpool and the biofilm in the filter and piping of the whirlpool systems. Daily monitoring and adjustment of chemical characteristics (regardless of bather load) were essential for controlling densities of P. aeruginosa.

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“…He and his partner required 6 weeks of oral ciprofloxacin. Widespread pseudomonas folliculitis acquired in spa baths is treated similarly, but is not as severe, nor does it result in scarring 8,9 . Identification of this organism and prompt treatment with appropriate antibiotics may result in less severe consequences.…”

Section: Discussionmentioning

confidence: 99%

A possible new cause of spa bath folliculitis: Aeromonas hydrophila

Mulholland

Yong‐Gee

2008

Aust J Dermatology

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A 34-year-old man presented with a pubic eruption of 4 weeks duration, affecting both himself and his partner. He had been treated unsuccessfully with intravenous and oral dicloxacillin. The eruption was a severely inflammatory folliculitis, with haemo-serous exudate and marked oedema. A clinical diagnosis of herpes simplex virus folliculitis was disproved when routine bacteriology isolated Aeromonas hydrophila and multiple viral polymerase chain reaction studies were negative. Histology demonstrated a chronic folliculitis with no organisms present. Both he and his partner were treated with oral ciprofloxacin 500 mg bd for 6 weeks with clinical clearance of infection, but both developed a scarring alopecia. Infection was attributed to possible contamination of a poorly maintained home spa bath with A. hydrophila.

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Whirlpool-associated folliculitis caused by Pseudomonas aeruginosa: report of an outbreak and review

Cited by 72 publications

References 37 publications

Outbreaks of Multidrug-Resistant Pseudomonas aeruginosa in Community Hospitals in Japan

Outbreaks of Multidrug-Resistant Pseudomonas aeruginosa in Community Hospitals in Japan

Incidence and persistence of Pseudomonas aeruginosa in whirlpools

A possible new cause of spa bath folliculitis: Aeromonas hydrophila

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