title: Detection and termination of an extended low-frequency hospital outbreak of GIM-1-producing Pseudomonas aeruginosa ST111 in Germany.
abstract: BACKGROUND
  Metallo-β-lactamase German imipenemase-1 (GIM-1)-mediated carbapenem resistance is emerging in Germany but has not spread beyond a very localized region. The aim of this study was to describe the first outbreak of an extensively drug-resistant GIM-1-carrying Pseudomonas aeruginosa strain affecting 29 patients in a tertiary care hospital from 2002-2013.
  
  
  METHODS
  The outbreak was studied retrospectively and prospectively by a combination of molecular methods (carbapenemase polymerase chain reaction [PCR]), genotyping (DiversiLab, pulsed field gel electrophoresis and multi-locus sequence typing, bioMérieux, Marcy l'Etoile, France), descriptive epidemiology, and extensive environmental investigations using swabs with liquid transport medium, blaGIM-1 PCR, directly from the medium and culture.
  
  
  RESULTS
  Of the 29 affected patients, 24 had been admitted to a surgical intensive care unit at some point, where environmental sampling revealed a high burden of blaGIM-1 in the wastewater system. The outbreak strain was found in several sinks and on a reusable hair washbasin. Initially, general infection control measures were applied; thereafter, specific measures were implemented, including the restriction of washbasin use. Continued surveillance over a period of 2 years has revealed no further case of GIM-1-carrying Pseudomonas aeruginosa.
  
  
  CONCLUSIONS
  This long-term outbreak highlights the potential of molecular methods in surveillance for multidrug-resistant pathogens and in environmental sampling and the successful containment by application of specific control measures targeting biofilms within sink drains as potential environmental reservoirs for P aeruginosa.
authors: Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
authors: Andreas F
authors: AF
authors: Wendel
authors: Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
authors: Susanne
authors: S
authors: Kolbe-Busch
authors: Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
authors: Sofija
authors: S
authors: Ressina
authors: Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
authors: Roland
authors: R
authors: Schulze-Röbbecke
authors: Department of Anaesthesiology, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
authors: Detlef
authors: D
authors: Kindgen-Milles
authors: Department of Anaesthesiology, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
authors: Christel
authors: C
authors: Lorenz
authors: Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany.
authors: Klaus
authors: K
authors: Pfeffer
authors: Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University, Düsseldorf, Germany. Electronic address: colin.mackenzie@uni-duesseldorf.de.
authors: Colin R
authors: CR
authors: MacKenzie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015780:Carbapenems / Q000494:pharmacology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D004784:Environmental Monitoring / Q000379:methods; D004866:Equipment Contamination; D005260:Female; D005838:Genotype; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D001618:beta-Lactamases / Q000187:drug effects / Q000302:isolation & purification*
chemical_list: D015780:Carbapenems; D001618:beta-Lactamases; C495217:beta-lactamase GIM-1, Pseudomonas aeruginosa
keywords: Environmental sampling; German imipenemase-1; Metallo-β-lactamase; Multidrug resistance; Outbreak; Pseudomonas aeruginosa