title: Emergence and prevention measures for multidrug resistant Pseudomonas aeruginosa in catheter-associated urinary tract infection in spinal cord injury patients.
abstract: OBJECTIVE
  To evaluate measures for preventing multidrug resistant Pseudomonas aeruginosa (MDRP) in catheter-associated urinary tract infection (CAUTI) in spinal cord injury patients.
  
  
  METHODS
  Spinal Cord Injury Unit of Hyogo Prefectural Hyogo Prefectural Rehabilitation Center, Kobe, Japan.
  
  
  METHODS
  We defined MDRP as resistance to amikacin, imipenem and levofloxacin. We had eight cases of MDRP-causing CAUTI in hospitalized neurogenic bladder patients caused by spinal cord injury in 2 months. Pulse-field gel electrophoresis (PFGE) was performed for epidemiological studies. We assessed prevention measures against MDRP emergence from the 2nd month, such as surveillance of CAUTI and infection control, and evaluated the outcomes of these measures over a total of 8 months.
  
  
  RESULTS
  Our PFGE results showed that these eight MDRP isolates could be considered as closely related strains. We concluded that this was an MDRP outbreak that was causing CAUTI. The isolated ratio of MDRP began to decrease over 4 months of surveillance and significantly decreased in the 4th quarter (7th and 8th months) compared with the 1st quarter (1st and 2nd months) (P=0.021) even though urinary tract device usage significantly increased over the same period (P<0.001).
  
  
  CONCLUSIONS
  We experienced an outbreak of emergent MDRP causing CAUTI in neurogenic bladder patients with spinal cord injury. Our preventive measures for isolating the outbreak, including surveillance, may have led to the decrease we observed in the ratio of MDRP isolated.
authors.affiliation: 1] Division of Urology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan [2] Infection Control Team, Kobe University Hospital, Kobe, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Shigemura
authors.affiliation: Infection Control Team, Hyogo Prefectural Rehabilitation Center, Kobe, Japan.
authors.forename: R
authors.initials: R
authors.lastname: Takase
authors.affiliation: Infection Control Team, Kobe University Hospital, Kobe, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Osawa
authors.affiliation: Infection Control Team, Hyogo Prefectural Rehabilitation Center, Kobe, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Takaba
authors.affiliation: Infection Control Team, Hyogo Prefectural Rehabilitation Center, Kobe, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Nomi
authors.affiliation: Division of Urology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Fujisawa
authors.affiliation: 1] Division of Urology, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan [2] Infection Control Team, Kobe University Hospital, Kobe, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Arakawa
mesh_terms: D055499:Catheter-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D006801:Humans; D011552:Pseudomonas Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D011550:Pseudomonas aeruginosa / Q000235:genetics / Q000302:isolation & purification; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000628:therapy; D013997:Time Factors