Circulation of a multiresistant, conjugative, IncA/C plasmid within the nosocomial Providencia stuartii population in the Athens area.
The objective of the study is to report a multidrug-resistant outbreak of Providencia stuartii that occurred in inpatients in the Athens area in 2012 resulting from a very successful transmissible A/C multidrug-resistant plasmid. Thirteen multidrug-resistant P. stuartii clinical isolates from 5 hospitals were studied. Molecular typing was performed by pulsed-field gel electrophoresis. Antibiotic resistance genes and their genetic surround were detected by PCR and sequencing. Plasmid analysis included conjugation experiments using liquid cultures, sizing by S1 digestion, and incompatibility replicon typing by PCR. Isolates were grouped into 2 distinct clonal types A and B, exhibiting similarity less than 70%. Isolates of type A were recovered from patients hospitalized in 4 different hospitals with no obvious epidemiological linkage, while isolates of type B were recovered from patients treated in a single hospital. Both clonal types harbored a conjugative plasmid of 130 bp and IncA/C replicon type carrying 5 β-lactamase genes bla(SHV-5), bla(VEB-1), bla(VIM-1), bla(OXA-10), and bla(TEM-1) and aminoglycosides resistant determinants. All β-lactamase genes were included in stable structures as IS26, IS1999, and In-e541. The current plasmid seemed to have many common determinants with previously reported plasmids derived from P. stuartii and Proteus mirabilis clinical isolates and exhibited the ability to circulate in nosocomial bacterial populations.
Department of Microbiology, National School of Public Health, Athens, Greece. Electronic address: pgiakkoupi@esdy.edu.gr.
Panagiota
P
Giakkoupi
Hellenic Central Public Health Laboratory, Athens, Greece.
Kyriaki
K
Tryfinopoulou
Hellenic Central Public Health Laboratory, Athens, Greece.
Michalis
M
Polemis
Hellenic Central Public Health Laboratory, Athens, Greece.
Olga
O
Pappa
Department of Bacteriology, Hellenic Pasteur Institute, Athens, Greece.
Vivi
V
Miriagou
Department of Microbiology, National School of Public Health, Athens, Greece; Hellenic Central Public Health Laboratory, Athens, Greece.
Alkiviadis
A
Vatopoulos
D016000:Cluster Analysis; D003227:Conjugation, Genetic; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology*; D022761:Gene Transfer, Horizontal; D005838:Genotype; D006115:Greece / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D017720:Molecular Epidemiology; D058889:Molecular Typing; D010957:Plasmids / Q000032:analysis* / Q000145:classification; D016133:Polymerase Chain Reaction; D011532:Providencia / Q000145:classification / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification
Multidrug resistance; Providencia stuartii; SHV-5; VEB-1; VIM-1