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19. Dynamics of a Nosocomial Outbreak of Multidrug-Resistant Pseudomonas aeruginosaProducing the PER-1 Extended-Spectrum ß-Lactamase

Author

Luzzaro, Francesco, Mantengoli, Elisabetta, Perilli, Mariagrazia, Lombardi, Gianluigi, Orlandi, Viviana, Orsatti, Alessandra, Amicosante, Gianfranco, Rossolini, Gian Maria, and Toniolo, Antonio

Abstract

ABSTRACTFrom November 1998 to August 1999, a large outbreak occurred in the general intensive care unit of the Ospedale di Circolo in Varese (Italy), caused by Pseudomonas aeruginosaproducing the PER-1 extended-spectrum ß-lactamase. A total of 108 clinical isolates of P. aeruginosaresistant to broad-spectrum cephalosporins were recovered from 18 patients. Epidemic isolates were characterized by synergy between clavulanic acid and ceftazidime, cefepime, and aztreonam. Isoelectric focusing of crude bacterial extracts detected two nitrocefin-positive bands with pI values of 8.0 and 5.3. PCR amplification and characterization of the amplicons by restriction analysis and direct sequencing indicated that the epidemic isolates carried a blaPER-1determinant. The outbreak was of clonal origin as shown by pulsed-field gel electrophoresis analysis. This technique also indicated that the epidemic strain was not related to three other PER-1-positive isolates obtained at the same hospital in 1997. Typing by enterobacterial repetitive intergenic consensus-PCR showed that minor genetic variations occurred during the outbreak. The epidemic strain was characterized by a multiple-drug-resistance phenotype that remained unchanged over the outbreak, including extended-spectrum cephalosporins, monobactams, aminoglycosides, and fluoroquinolones. Isolation of infected patients and appropriate carbapenem therapy were successful in ending the outbreak. Our report indicates that theblaPER-1resistance determinant may become an emerging therapeutic problem in Europe.

Published
2001
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