Outbreaks of multidrug-resistant Pseudomonas aeruginosa in community hospitals in Japan.
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.
Sekiguchi
Jun-Ichiro
J
Department of Infectious Diseases, Research Institute, International Medical Center of Japan, 1-21-1 Toyama, Shinjuku, Tokyo 162-8655, Japan.
Asagi
Tsukasa
T
Miyoshi-Akiyama
Tohru
T
Kasai
Atsushi
A
Mizuguchi
Yukie
Y
Araake
Minako
M
Fujino
Tomoko
T
Kikuchi
Hideko
H
Sasaki
Satoru
S
Watari
Hajime
H
Kojima
Tadashi
T
Miki
Hiroshi
H
Kanemitsu
Keiji
K
Kunishima
Hiroyuki
H
Kikuchi
Yoshihiro
Y
Kaku
Mitsuo
M
Yoshikura
Hiroshi
H
Kuratsuji
Tadatoshi
T
Kirikae
Teruo
T
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
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D000123:Acetyltransferases; C019681:aminoglycoside acetyltransferase