ESBL-producing multidrug-resistant Providencia stuartii infections in a university hospital.
OBJECTIVE
To investigate the epidemiological and clinical findings of extended-spectrum beta-lactamase (ESBL)-producing Providencia stuartii infections in a large Italian university hospital.


METHODS
All consecutive episodes of P. stuartii infection that occurred during 1999-2002 were included in the study. For each patient, we recorded the area of hospitalization and drug susceptibility of the P. stuartii strains. Patients with ESBL-producing P. stuartii infection were considered cases and those with non-ESBL-producing P. stuartii infection were used as controls.


RESULTS
One hundred and sixteen (52%) out of 223 P. stuartii strains collected during the study period were found to be ESBL-producing. On the basis of PCR and DNA sequencing experiments, TEM-52 was identified in 87% of isolates and TEM-72 in 13%. All ESBL-producing P. stuartii infections were nosocomially acquired. The prevalence increased from 31% of P. stuartii infections in 1999 to 62% in 2002 (P = 0.04). All 116 strains were classified as ESBL-producing multidrug-resistant P. stuartii, since 88% of the isolates were cross-resistant to ciprofloxacin and amikacin and the other 12% were cross-resistant to ciprofloxacin and gentamicin. At logistic regression analysis, advanced age (P < 0.001), previous hospitalization (P < 0.01), neoplastic disease (P < 0.001) and previous antibiotic therapy (P < 0.001) were independent risk factors for the development of ESBL-producing infections.


CONCLUSIONS
This 4 year surveillance of Providencia complaints clearly indicates that infections caused by ESBL-producing multidrug-resistant P. stuartii are an emerging problem.
Tumbarello
Mario
M
Departments of Infectious Diseases and Microbiology, Università Cattolica, Largo A. Gemelli 8, 00168 Roma, Italy. tumbarello@rm.unicatt.it
Citton
Rita
R
Spanu
Teresa
T
Sanguinetti
Maurizio
M
Romano
Lucio
L
Fadda
Giovanni
G
Cauda
Roberto
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D004357:Drug Synergism; D004756:Enterobacteriaceae Infections / Q000382:microbiology*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007558:Italy; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D011532:Providencia / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction; D018570:Risk Assessment; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics
D001618:beta-Lactamases