title: Dynamics of a nosocomial outbreak of multidrug-resistant Pseudomonas aeruginosa producing the PER-1 extended-spectrum beta-lactamase.
abstract: From 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 aeruginosa producing the PER-1 extended-spectrum beta-lactamase. A total of 108 clinical isolates of P. aeruginosa resistant 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 bla(PER-1) determinant. 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 the bla(PER-1) resistance determinant may become an emerging therapeutic problem in Europe.
authors.affiliation: Laboratory of Microbiology, Ospedale di Circolo and University of Insubria, Viale Borri 57, 21100, Varese, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Luzzaro
authors.forename: E
authors.initials: E
authors.lastname: Mantengoli
authors.forename: M
authors.initials: M
authors.lastname: Perilli
authors.forename: G
authors.initials: G
authors.lastname: Lombardi
authors.forename: V
authors.initials: V
authors.lastname: Orlandi
authors.forename: A
authors.initials: A
authors.lastname: Orsatti
authors.forename: G
authors.initials: G
authors.lastname: Amicosante
authors.forename: G M
authors.initials: GM
authors.lastname: Rossolini
authors.forename: A
authors.initials: A
authors.lastname: Toniolo
mesh_terms: D002511:Cephalosporins / Q000494:pharmacology*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D004352:Drug Resistance, Microbial / Q000235:genetics; D018432:Drug Resistance, Multiple / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D005798:Genes, Bacterial; D006801:Humans; D007362:Intensive Care Units; D016133:Polymerase Chain Reaction / Q000379:methods; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000145:classification / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D002511:Cephalosporins; C108863:beta-lactamase PER-1; D001618:beta-Lactamases