title: Outbreaks of multidrug-resistant Pseudomonas aeruginosa in community hospitals in Japan.
abstract: We previously reported an outbreak in a neurosurgery ward of catheter-associated urinary tract infection with multidrug-resistant (MDR) Pseudomonas aeruginosa strain IMCJ2.S1, carrying the 6'-N-aminoglycoside acetyltransferase gene [aac(6')-Iae]. For further epidemiologic studies, 214 clinical isolates of MDR P. aeruginosa showing resistance to imipenem (MIC >or= 16 microg/ml), amikacin (MIC >or= 64 microg/ml), and ciprofloxacin (MIC >or= 4 microg/ml) were collected from 13 hospitals in the same prefecture in Japan. We also collected 70 clinical isolates of P. aeruginosa that were sensitive to one or more of these antibiotics and compared their characteristics with those of the MDR P. aeruginosa isolates. Of the 214 MDR P. aeruginosa isolates, 212 (99%) were serotype O11. We developed a loop-mediated isothermal amplification (LAMP) assay and a slide agglutination test for detection of the aac(6')-Iae gene and the AAC(6')-Iae protein, respectively. Of the 212 MDR P. aeruginosa isolates, 212 (100%) and 207 (98%) were positive in the LAMP assay and in the agglutination test, respectively. Mutations of gyrA and parC genes resulting in amino acid substitutions were detected in 213 of the 214 MDR P. aeruginosa isolates (99%). Of the 214 MDR P. aeruginosa isolates, 212 showed pulsed-field gel electrophoresis patterns with >or=70% similarity to that of IMCJ2.S1 and 83 showed a pattern identical to that of IMCJ2.S1, indicating that clonal expansion of MDR P. aeruginosa occurred in community hospitals in this area. The methods developed in this study to detect aac(6')-Iae were rapid and effective in diagnosing infections caused by various MDR P. aeruginosa clones.
authors.affiliation: Department of Infectious Diseases, Research Institute, International Medical Center of Japan, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan.
authors.forename: Jun-Ichiro
authors.initials: J
authors.lastname: Sekiguchi
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Asagi
authors.forename: Tohru
authors.initials: T
authors.lastname: Miyoshi-Akiyama
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kasai
authors.forename: Yukie
authors.initials: Y
authors.lastname: Mizuguchi
authors.forename: Minako
authors.initials: M
authors.lastname: Araake
authors.forename: Tomoko
authors.initials: T
authors.lastname: Fujino
authors.forename: Hideko
authors.initials: H
authors.lastname: Kikuchi
authors.forename: Satoru
authors.initials: S
authors.lastname: Sasaki
authors.forename: Hajime
authors.initials: H
authors.lastname: Watari
authors.forename: Tadashi
authors.initials: T
authors.lastname: Kojima
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Miki
authors.forename: Keiji
authors.initials: K
authors.lastname: Kanemitsu
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kunishima
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kikuchi
authors.forename: Mitsuo
authors.initials: M
authors.lastname: Kaku
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yoshikura
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Kuratsuji
authors.forename: Teruo
authors.initials: T
authors.lastname: Kirikae
mesh_terms: D000123:Acetyltransferases / Q000235:genetics*; D000372:Agglutination Tests / Q000379:methods; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D004269:DNA, Bacterial / Q000032:analysis; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D005838:Genotype; D006764:Hospitals, Community; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D021141:Nucleic Acid Amplification Techniques / Q000379:methods; D011552:Pseudomonas Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D012703:Serotyping
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D000123:Acetyltransferases; C019681:aminoglycoside acetyltransferase