title: First outbreak of VIM-2 metallo-β-lactamase-producing Pseudomonas aeruginosa in The Netherlands: microbiology, epidemiology and clinical outcomes.
abstract: This study was designed to investigate the prevalence and characteristics of metallo-β-lactamase (MBL)-producing Pseudomonas aeruginosa in a tertiary care centre in The Netherlands, a country that is considered to have a low prevalence of antibiotic-resistant bacteria. Imipenem-resistant P. aeruginosa isolates cultured from clinical specimens during 2008-2009 were analysed phenotypically and molecularly by polymerase chain reaction (PCR) with sequencing. Genotyping was performed by multiple-locus variable-number tandem repeat (VNTR) analysis (MLVA). Clinical information was obtained by electronic chart review for all patients infected or colonised with an imipenem-resistant P. aeruginosa isolate that was included in the study. In total, 106 imipenem-resistant P. aeruginosa isolates were included. The bla(VIM-2) gene was detected in 35/106 isolates (33%) and was associated with integrons. Compared with non-MBL-producing imipenem-resistant P. aeruginosa, VIM-2 MBL-producing isolates showed higher rates of multidrug resistance. Patients with VIM-2 MBL-producing isolates were more likely to be admitted to the Intensive Care Unit (ICU) and had a higher risk of invasive infection, including development of bacteraemia. MLVA identified two separate VIM-2 MBL-producing clones, responsible for outbreaks in the ICU but also affecting 10 other departments. This is the first reported outbreak of VIM-2 MBL-producing P. aeruginosa in The Netherlands. Once introduced, VIM-2 MBL-producing P. aeruginosa cause significant infections and are easily spread within the hospital setting.
authors.affiliation: Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands. a.vanderbij@erasmusmc.nl
authors.forename: A K
authors.initials: AK
authors.lastname: Van der Bij
authors.forename: R
authors.initials: R
authors.lastname: Van Mansfeld
authors.forename: G
authors.initials: G
authors.lastname: Peirano
authors.forename: W H F
authors.initials: WH
authors.lastname: Goessens
authors.forename: J A
authors.initials: JA
authors.lastname: Severin
authors.forename: J D D
authors.initials: JD
authors.lastname: Pitout
authors.forename: R
authors.initials: R
authors.lastname: Willems
authors.forename: M
authors.initials: M
authors.lastname: Van Westreenen
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015373:Bacterial Typing Techniques; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005838:Genotype; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D008297:Male; D008875:Middle Aged; D018598:Minisatellite Repeats; D058889:Molecular Typing; D009426:Netherlands / Q000453:epidemiology; D016133:Polymerase Chain Reaction; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D017422:Sequence Analysis, DNA; D016896:Treatment Outcome; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D015378:Imipenem; C425108:beta-lactamase bla(vim-2); D001618:beta-Lactamases