title: Intrahospital spread of carbapenem-resistant Pseudomonas aeruginosa in a University Hospital in Florianópolis, Santa Catarina, Brazil.
abstract: BACKGROUND
  Carbapenem-resistant Pseudomonas aeruginosa (CRPA) has been isolated with increasing frequency in Brazilian hospitals. Since June 2003, its detection in a teaching hospital in the city of Florianópolis, Brazil, has increased. This study aimed to investigate the minimal inhibitory concentration (MIC), presence of Metallo-beta-lactamase (MbetaL) and a possible clonal relationship among the isolates.
  
  
  METHODS
  The study included 29 CRPA and seven isolates with reduced susceptibility. The MIC was determined by agar-dilution. Detection of MbetaL was performed by Double Disk Sinergism (DDS) and Combined Disk (CD). The MbetaL gene was verified by PCR and nucleotide sequence analysis. Epidemiological typing was performed by pulsed-field gel electrophoresis.
  
  
  RESULTS
  Among the 29 carbapenem-resistant isolates, polymyxin B presented 100% susceptibility and piperacillin/tazobactam 96.7%. Seventeen (62%) strains were verified as clonal (A clone) and among these, six isolates indicated phenotypically positive tests for MbetaL and harbored the blaSPM-1 gene. The first CRPA isolates were unrelated to clone A, harbored blaIMP-16 and were phenotypically positive only by CD.
  
  
  CONCLUSIONS
  The spread of a high-level of resistance clone suggests cross transmission as an important dissemination mechanism and has contributed to the increased rate of resistance to carbapenems. This study emphasizes the need for continuous surveillance and improved strategies.
authors.affiliation: University Hospital, Federal University of Santa Catarina, Florianópolis, SC, Brazil.
authors.forename: Mara Cristina
authors.initials: MC
authors.lastname: Scheffer
authors.forename: Maria Luiza
authors.initials: ML
authors.lastname: Bazzo
authors.forename: Mario
authors.initials: M
authors.lastname: Steindel
authors.forename: Ana Lucia
authors.initials: AL
authors.lastname: Darini
authors.forename: Eduardo
authors.initials: E
authors.lastname: Clímaco
authors.forename: Libera Maria
authors.initials: LM
authors.lastname: Dalla-Costa
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001938:Brazil; D015780:Carbapenems / Q000494:pharmacology*; D016521:Electrophoresis, Gel, Pulsed-Field; D005838:Genotype; D006785:Hospitals, University; D006801:Humans; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D011552:Pseudomonas Infections / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics; D018440:beta-Lactam Resistance / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems