title: Investigation of a nosocomial outbreak of Acinetobacter baumannii producing PER-1 extended-spectrum beta-lactamase in an intensive care unit.
abstract: We investigated an outbreak of Acinetobacter baumannii in an adult intensive care unit of Kosin University Gospel Hospital in Busan, Republic of Korea. The outbreak involved 10 cases of infection by A. baumannii producing PER-1 extended-spectrum beta-lactamase over a seven-month period, and was caused by a single pulsed-field gel electrophoresis clone. The epidemic isolates were characterized by slight synergy between clavulanic acid and cefepime. Isoelectric focusing of crude bacterial extracts detected two nitrocefin-positive bands with pI values of 8.0 and 5.3. Polymerase chain reaction amplification and characterization of the amplicons by restriction analysis and direct sequencing indicated that the epidemic isolates carried a bla(PER-1) determinant. The epidemic isolates were characterized by a multidrug-resistant phenotype that remained unchanged over the outbreak, including penicillins, beta-lactam/beta-lactamase inhibitor, extended-spectrum cephalosporins and monobactams. 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.
authors.affiliation: Department of Laboratory Medicine and Graduate School of Public Health, Kosin University College of Medicine, Busan, Republic of Korea.
authors.forename: S H
authors.initials: SH
authors.lastname: Jeong
authors.forename: I K
authors.initials: IK
authors.lastname: Bae
authors.forename: S B
authors.initials: SB
authors.lastname: Kwon
authors.forename: K
authors.initials: K
authors.lastname: Lee
authors.forename: D
authors.initials: D
authors.lastname: Yong
authors.forename: G J
authors.initials: GJ
authors.lastname: Woo
authors.forename: J H
authors.initials: JH
authors.lastname: Lee
authors.forename: H I
authors.initials: HI
authors.lastname: Jung
authors.forename: S J
authors.initials: SJ
authors.lastname: Jang
authors.forename: K H
authors.initials: KH
authors.lastname: Sung
authors.forename: S H
authors.initials: SH
authors.lastname: Lee
mesh_terms: D000151:Acinetobacter Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification* / Q000378:metabolism; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology; D017931:DNA Primers; D004269:DNA, Bacterial / Q000032:analysis; D004196:Disease Outbreaks; D018432:Drug Resistance, Multiple; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007723:Korea / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D017931:DNA Primers; D004269:DNA, Bacterial; D001618:beta-Lactamases