title: Outbreak of Citrobacter freundii carrying VIM-1 in an Italian Hospital, identified during the carbapenemases screening actions, June 2012.
abstract: OBJECTIVE
  The identification of patients colonized or infected with carbapenemase-producing Enterobacteriaceae (CPE), in order to control and prevent the global spread of multidrug-resistant (MDR) pathogens.
  
  
  METHODS
  From June 1 to June 15, 2012, eight Citrobacter freundii strains with reduced susceptibility to carbapenems were isolated from rectal swabs of hospitalized patients during active screening following the detection of a Klebsiella pneumoniae carbapenemase (KPC) -positive patient on the ward. All isolates were analyzed phenotypically and molecularly by PCR and sequencing. Genotype clustering was performed by multilocus sequence typing (MLST) analysis.
  
  
  RESULTS
  The isolates showed high rates of multidrug resistance profile. A phenotypic assay for carbapenemase production suggested the presence of metallo-β-lactamase (MBL). The blaVIM-1 gene was detected in all imipenem-resistant C. freundii isolates. MLST showed that the C. freundii isolates shared the same sequence type (ST). Phylogenetic analysis revealed a strict relationship with an ST5C. freundii isolate from a diarrhea patient in China.
  
  
  CONCLUSIONS
  Our findings showed that the active surveillance program for CPE was useful, not only for the detection of KPC-producers, but also to identify and control the spread of other MDR pathogens that could expand the spectrum of circulating MDR pathogens.
authors.affiliation: Operative Unit of Clinical Microbiology, St. Orsola-Malpighi University Hospital, Regional Reference Centre for Microbiological Emergencies, 9 via G. Massarenti, 40138 Bologna, Italy. paolo.gaibani@unibo.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Gaibani
authors.forename: Simone
authors.initials: S
authors.lastname: Ambretti
authors.forename: Patrizia
authors.initials: P
authors.lastname: Farruggia
authors.forename: Gloria
authors.initials: G
authors.lastname: Bua
authors.forename: Andrea
authors.initials: A
authors.lastname: Berlingeri
authors.forename: Maria Vittoria
authors.initials: MV
authors.lastname: Tamburini
authors.forename: Miriam
authors.initials: M
authors.lastname: Cordovana
authors.forename: Luca
authors.initials: L
authors.lastname: Guerra
authors.forename: Magda
authors.initials: M
authors.lastname: Mazzetti
authors.forename: Greta
authors.initials: G
authors.lastname: Roncarati
authors.forename: Ciro
authors.initials: C
authors.lastname: Tenace
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Moro
authors.forename: Carlo
authors.initials: C
authors.lastname: Gagliotti
authors.forename: Maria Paola
authors.initials: MP
authors.lastname: Landini
authors.forename: Vittorio
authors.initials: V
authors.lastname: Sambri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016971:Citrobacter freundii / Q000145:classification / Q000187:drug effects / Q000235:genetics*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006761:Hospitals; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D058885:Multilocus Sequence Typing; D010802:Phylogeny; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; C417264:VIM-1 metallo-beta-lactamase; D001618:beta-Lactamases
keywords: Citrobacter freundii; Italy; MLST; VIM-1