The role of interventional molecular epidemiology in controlling clonal clusters of multidrug resistant Pseudomonas aeruginosa in critically ill cancer patients.
BACKGROUND
Pseudomonas aeruginosa is one of the leading causes of hospital-acquired infections in intensive care units (ICUs). The objective was to evaluate the impact of molecular identification of clonal multidrug-resistant (MDR) P aeruginosa strains and the implementation of infection control measures.


METHODS
One hundred seventy-seven strains from ICU patients infected or colonized with MDR P aeruginosa from May 2001 to April 2006 were collected. In vitro susceptibility to 16 antibiotics was done. Pulsed-field gel electrophoresis was performed to identify clonal strains. Nosocomial outbreak was defined as the presence of > or =3 MDR P aeruginosa over < or =3 consecutive months.


RESULTS
During the 5 years of the study, 25 infected and 14 colonized patients with a clonal strain of MDR P aeruginosa were distributed among 5 episodic clusters. These strains were only susceptible to ceftazidime and colistin. Molecular biology identification, diligent monitoring, and multidisciplinary infection control interventions were implemented to suppress this clonal strain after each cluster. Even more, after the last outbreak (June-August 2005), the infection control measures were able to reduce the MDR P aeruginosa to zero during the last 8 months of this study.


CONCLUSIONS
Interventional molecular epidemiology combined with early identification, monitoring, and implementation of multidisciplinary infection control measures can control temporarily the transmission of MDR P aeruginosa infection in ICUs.
Adachi
Javier A
JA
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA. jaadachi@mdanderson.org
Perego
Cheryl
C
Graviss
Linda
L
Dvorak
Tanya
T
Hachem
Ray
R
Chemaly
Roy F
RF
Raad
Issam I
II
D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015373:Bacterial Typing Techniques / Q000379:methods; D016000:Cluster Analysis; D016638:Critical Illness; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D016172:DNA Fingerprinting / Q000379:methods; D004269:DNA, Bacterial / Q000235:genetics; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field / Q000379:methods; D005838:Genotype; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D009369:Neoplasms / Q000150:complications*; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000145:classification* / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification
D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial