An Outbreak of Multidrug-Resistant<i>Pseudomonas Aeruginosa</i>Associated with Increased Risk of Patient Death in an Intensive Care Unit

Bukholm, Geir; Tannæs, Tone; Kjelsberg, Anne Britt Bye; Smith-Erichsen, N

doi:10.1086/502082

Cited by 119 publications

(81 citation statements)

References 28 publications

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“…Any variant was indicated by a numerical suffix (e.g., A1). For AFLP, we classified a type designated by a capital letter and patterns showing Ն90% Pearson similarity as previously proposed (1).…”

Section: Methodsmentioning

confidence: 99%

“…aeruginosa exhibits intrinsic resistance to several ␤-lactams and may acquire additional resistance mechanisms, including decreased outer membrane permeability, penicillin binding protein modifications, production of extended-spectrum ␤-lactamases, acquisition of metallo-␤-lactamases or other enzymes, increased expression of efflux pump systems, and decreased porin expression (5,8,(16)(17)(18)(19). These multipleantibiotic-resistant P. aeruginosa strains caused sporadic nosocomial outbreaks (1,8,24), but several drug-resistant P. aeruginosa clones are now spreading among vulnerable patients, such as those with cystic fibrosis, as recently described (20).…”

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confidence: 99%

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Molecular Characterization of an Epidemic Clone of Panantibiotic-Resistant Pseudomonas aeruginosa

Deplano¹,

Denis²,

Poirel

et al. 2005

J Clin Microbiol

135

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We describe the molecular characterization of a multiresistant Pseudomonas aeruginosa clone causing an outbreak in the intensive care unit (ICU) of a tertiary-care university hospital. Analysis included antimicrobial susceptibility profile, O-serotyping, pulsed-field gel electrophoresis, and amplified fragment length polymorphism. Resistance mechanisms were characterized, including production of naturally occurring and acquired ␤-lactamases, porin expression, and efflux pump systems. Eighteen patients were colonized or infected with multiresistant P. aeruginosa. Multiresistant P. aeruginosa was panresistant to penicillins, cephalosporins, carbapenems, aminoglycosides, and fluoroquinolones and remained susceptible only to colistin. Sixteen isolates (89%) belonged to serotype O:11, pulsed-field gel electrophoresis type A1, and amplified fragment length polymorphism type A. Resistance characterization of this epidemic clone showed an overexpression of the chromosomal cephalosporinase AmpC combined with decreased expression of porin OprD and the absence of metallo-␤-lactamase or extended-spectrum beta-lactamase. An upregulation of the MexXY efflux system due to an agrZ mutation in the mexZ repressor was detected. This epidemic clone was restricted to the ICU and was not found elsewhere in hospital. Contamination of the ICU environment and the hands of an ICU nurse with this clone suggests possible hand-borne transmission. Implementation of contact precautions effectively controlled transmission of the epidemic clone. This study illustrates the ability of multiresistant P. aeruginosa to cause an outbreak with significant morbidity and mortality and underscores the need to identify clonal outbreaks, which require targeted infection control measures.Pseudomonas aeruginosa is an opportunistic pathogen that is able to cause severe invasive diseases in critically ill and immunocompromised patients. Because of its ubiquitous nature, ability to survive in moist environments, and innate resistance to many antibiotics and antiseptics, P. aeruginosa is a common pathogen in hospitals and particularly in intensive care units (ICUs). A European survey on the prevalence of nosocomial infection in ICU patients showed that P. aeruginosa was one of the most frequent pathogens, isolated from 29% of ICU-acquired infections (27,28). A multicentric study conducted in Belgium placed P. aeruginosa as the first gram-negative pathogen recovered in the ICU (6). Furthermore, the high frequency of multiple resistance among P. aeruginosa strains makes its eradication difficult (6, 27, 28), and mortality associated with P. aeruginosa infection is high compared to other bacteria.P. aeruginosa exhibits intrinsic resistance to several ␤-lactams and may acquire additional resistance mechanisms, including decreased outer membrane permeability, penicillin binding protein modifications, production of extended-spectrum ␤-lactamases, acquisition of metallo-␤-lactamases or other enzymes, increased expression of efflux pump systems, and decreased porin expr...

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Molecular Characterization of an Epidemic Clone of Panantibiotic-Resistant Pseudomonas aeruginosa

Deplano¹,

Denis²,

Poirel

et al. 2005

J Clin Microbiol

135

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“…[1][2][3] Person-to-person transmission is a well-established mechanism of P. aeruginosa spreading; more recently, several studies stress the importance of environmental contamination. [4][5][6] Different typing systems have been applied to studying P. aeruginosa outbreaks.…”

Section: Introductionmentioning

confidence: 99%

Molecular epidemiological investigation of an outbreak of Pseudomonas aeruginosa infection in an SCT unit

Fanci

Bartolozzi

Sergi

et al. 2008

Bone Marrow Transplant

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“…Several factors have contributed to this, such as the presence of critically ill patients who need invasive devices, extensive use of antibiotics, and limited number of health care providers [9][10][11][12]. In our study, all carbapenemresistant P. aeruginosa isolates, except two, were collected from patients hospitalized in the ICU.…”

Section: Discussionmentioning

confidence: 99%

Carbapenem-resistant Pseudomonas aeruginosa outbreak in an intensive care unit of a teaching hospital

Gales¹,

Torres

Vilarinho³

et al. 2004

Braz J Infect Dis

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The genetic similarity of carbapenem-resistant Pseudomonas aeruginosa strains isolated in the Hospital Universitário São Francisco, Bragança Paulista, São Paulo, Brasil, was evaluated by pulsed field gel electrophoresis (PFGE). A unique clone was detected among 5 of 7 isolates, suggesting that cross-contamination might have played a role in the spread of carbapenemresistant P. aeruginosa strains. Interestingly, a similar PFGE pattern was encountered in a P. aeruginosa strain isolated from Hospital São Paulo that was used as a PFGE control.

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An Outbreak of Multidrug-ResistantPseudomonas AeruginosaAssociated with Increased Risk of Patient Death in an Intensive Care Unit

Abstract: Complete elimination of the outbreak was achieved after weekly pasteurization of the water taps of the ICU and use of sterile water as a solvent in the gastric tubes.

Cited by 119 publications

References 28 publications

Molecular Characterization of an Epidemic Clone of Panantibiotic-Resistant Pseudomonas aeruginosa

Molecular Characterization of an Epidemic Clone of Panantibiotic-Resistant Pseudomonas aeruginosa

Molecular epidemiological investigation of an outbreak of Pseudomonas aeruginosa infection in an SCT unit

Carbapenem-resistant Pseudomonas aeruginosa outbreak in an intensive care unit of a teaching hospital

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