Risk factors for nosocomial infections due to Pseudomonas aeruginosa producing metallo- -lactamase in two tertiary-care teaching hospitals

Zavascki, Alexandre Prehn; Barth, Afonso Luís; Gaspareto, Patrick Barcelos; Gonçalves, Ana Lúcia Saraiva; Moro, Ana Laura Didonet; Fernandes, Juliana Fernandez; Goldani, Luciano Zubaran

doi:10.1093/jac/dkl327

Cited by 40 publications

(34 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The higher prevalence of resistance to cefepime, ceftazidime, ciprofl oxacin, meropenem, amikacin, gentamicin, and piperacillin/ tazobactam observed in the MPPa group is consistent with the results of Machado et al 5 and Zavascki et al 7 ; however, resistance in the NPPa group for our study was higher than the values reported by these authors. Normally, P. aeruginosa isolates are resistant to β-lactam antibiotics because of the hyperproduction of AmpC β-lactamase.…”

supporting

confidence: 92%

Phenotypic detection of metallo-β-lactamases in Pseudomonas aeruginosa and Acinetobacter baumannii isolated from hospitalized patients in São Luis, State of Maranhão, Brazil

Carvalho

Marques

Gonçalves

et al. 2013

Rev. Soc. Bras. Med. Trop.

View full text Add to dashboard Cite

Introduction: Acquired metallo-β-lactamases (MβL) are emerging determinants of resistance in Pseudomonas aeruginosa and Acinetobacter baumannii. The objectives of this study were to phenotypically detect MβL in imipenem-resistant P. aeruginosa and A. baumannii, to investigate the association between MβL-positive strains and hospitals, and to compare the resistance profi les of MβL-producing and non-MβL-producing strains. Methods: The approximation disk and combined disk assay methods were used in this study. Results: A total of 18 (38.3%) P. aeruginosa isolates and 1 (5.6%) A. baumannii isolate tested positive for the presence of MβL. Conclusions: These results demonstrate the need for strict surveillance and for the adoption of preventive measures to reduce the spread of infection and potential outbreaks of disease caused by MβL-producing microorganisms.

show abstract

supporting

confidence: 92%

Phenotypic detection of metallo-β-lactamases in Pseudomonas aeruginosa and Acinetobacter baumannii isolated from hospitalized patients in São Luis, State of Maranhão, Brazil

Carvalho

Marques

Gonçalves

et al. 2013

Rev. Soc. Bras. Med. Trop.

View full text Add to dashboard Cite

show abstract

“…To date, our understanding of the epidemiology of MBLproducing P. aeruginosa isolates is limited to outbreaks and infections reported from tertiary care medical centers (8,9,11,12,14,15,24,29). The occurrence of community-onset infections by MBL-producing P. aeruginosa has not been previously recognized, and the epidemiology of these infections outside hospitals has not been studied.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have identified the risk factors for MBL acquisition (8,14,29) as well as the outcome of P. aeruginosa infections caused by MBL producers (12,14). The increasing prevalence of nosocomial infections produced by MBL-possessing P. aeruginosa strains severely compromises the selection of appropriate treatments and is therefore associated with significant morbidity and mortality.…”

mentioning

confidence: 99%

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

et al. 2009

View full text Add to dashboard Cite

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.

show abstract

“…Risk factors associated with infections by MBL-producing P. aeruginosa isolates include recent use of ␤-lactams or fluoroquinolones, renal failure, indwelling urinary catheters, neurological disease, antineoplastic chemotherapy, corticosteroid therapy, and/or intensive care unit stay (14,47).…”

mentioning

confidence: 99%

Molecular Epidemiology of Metallo-β-Lactamase-Producing Pseudomonas aeruginosa Isolates from Norway and Sweden Shows Import of International Clones and Local Clonal Expansion

Samuelsen

Toleman

Sundsfjord

et al. 2010

Antimicrob Agents Chemother

153

120

View full text Add to dashboard Cite

Scandinavia is considered a region with a low prevalence of antimicrobial resistance. However, the number of multidrug-resistant (MDR) Gram-negative bacteria is increasing, including metallo-␤-lactamase (MBL)-producing Pseudomonas aeruginosa. In this study MBL-producing P. aeruginosa isolates identified in Norway (n ‫؍‬ 4) and Sweden (n ‫؍‬ 9) from 1999 to 2007 were characterized. Two international clonal complexes (CC), CC111 (n ‫؍‬ 8) and CC235 (n ‫؍‬ 2), previously associated with MBL-producing isolates, were dominant. CC111 isolates (ST111/229; serotype O12; bla VIM-2 ) included clonally related isolates identified in Skåne County, Sweden (n ‫؍‬ 6), and two isolates associated with importation from Greece and Denmark. In all CC111 isolates, bla VIM-2 was located in integron In59.2 or In59 variants. The two CC235 isolates (ST235/ST230; serotype O11; bla VIM-4 ) were imported from Greece and Cyprus, were possibly clonally related, and carried bla VIM-4 in two different integron structures. Three isolates imported from Ghana (ST233; serotype O6; bla VIM-2 ), Tunisia (ST654; serotype O11; bla VIM-2 ), and Thailand (ST260; serotype O6; bla IMP-14 ) were clonally unrelated. ST233 was part of a new CC (CC233) that included other MBL-producing isolates, while ST654 could also be part of a new CC associated with MBL producers. In the isolates imported from Ghana and Tunisia, bla VIM-2 was part of unusual integron structures lacking the 3 conserved segment and associated with transposons. The bla VIM gene was found to be located on the chromosome in all isolates. Known risk factors for acquisition of MBL were reported for all patients except one. The findings suggest that both import of successful international clones and local clonal expansion contribute to the emergence of MBL-producing P. aeruginosa in Scandinavia.

show abstract

Risk factors for nosocomial infections due to Pseudomonas aeruginosa producing metallo- -lactamase in two tertiary-care teaching hospitals

Abstract: beta-Lactam exposure is an important risk factor for MBL-PA infections even in a setting where patient-to-patient transmission plays a major role in the spread of the isolates. Other risk factors deserve further investigation, particularly exposure to fluoroquinolones.

Cited by 40 publications

References 14 publications

Phenotypic detection of metallo-β-lactamases in Pseudomonas aeruginosa and Acinetobacter baumannii isolated from hospitalized patients in São Luis, State of Maranhão, Brazil

Phenotypic detection of metallo-β-lactamases in Pseudomonas aeruginosa and Acinetobacter baumannii isolated from hospitalized patients in São Luis, State of Maranhão, Brazil

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

Molecular Epidemiology of Metallo-β-Lactamase-Producing Pseudomonas aeruginosa Isolates from Norway and Sweden Shows Import of International Clones and Local Clonal Expansion

Contact Info

Product

Resources

About