title: Dissemination of a Multidrug-Resistant VIM-1- and CMY-99-Producing Proteus mirabilis Clone in Bulgaria.
abstract: The aim of this study was to analyze the beta-lactamases and the molecular epidemiology of 19 clinically significant isolates of Proteus mirabilis with decreased susceptibility to imipenem, which have been collected from seven hospitals, located in different Bulgarian towns (Sofia, Varna, and Pleven). The isolates were obtained from blood, urine, tracheal and wound specimens. One additional isolate from hospital environment was included. Susceptibility testing, conjugation experiments, and plasmid replicon typing were carried out. Beta-lactamases were characterized by isoelectric focusing, PCR, and sequencing. Clonal relatedness was investigated by RAPD and PFGE. Integron mapping was performed by PCR and sequencing. All isolates showed a multidrug-resistance profile, but remained susceptible to piperacillin/tazobactam, cefepime, meropenem, and fosfomycin. They produced identical beta-lactamases, namely: TEM-1, VIM-1, and CMY-99. PCR mapping revealed that the blaVIM-1gene was part of a class 1 integron that additionally included the aac(6')-I, dhfrA1, and ant(3″)-Ia genes. In addition, 17 of the isolates carried the armA gene. Conjugation experiments and plasmid replicon typing were unsuccessful. The isolates were clonally related according to RAPD and PFGE typing. This study reveals the nationwide distribution of a multidrug-resistant P. mirabilis clone producing VIM-1 and CMY-99 along with the presence of different aminoglycoside resistance mechanisms.
authors.affiliation: 1 Department of Medical Microbiology, Medical Faculty, Medical University Sofia , Sofia, Bulgaria .
authors.forename: Rumyana
authors.initials: R
authors.lastname: Markovska
authors.affiliation: 2 MICOER Institute , Munich, Germany .
authors.forename: Ines
authors.initials: I
authors.lastname: Schneider
authors.affiliation: 3 Medical Institute , Ministry of the Interior, Sofia, Bulgaria .
authors.forename: Emma
authors.initials: E
authors.lastname: Keuleyan
authors.affiliation: 4 Second Multiprofile Active Treatment Hospital , Sofia, Bulgaria .
authors.forename: Dobrinka
authors.initials: D
authors.lastname: Ivanova
authors.affiliation: 5 Emergency Medical Institute "Pirogov ," Sofia, Bulgaria .
authors.forename: Magdalena
authors.initials: M
authors.lastname: Lesseva
authors.affiliation: 6 Varna University Hospital , Varna, Bulgaria .
authors.forename: Temenuga
authors.initials: T
authors.lastname: Stoeva
authors.affiliation: 7 Department of Microbiology, Medical University , Pleven, Bulgaria .
authors.forename: Mariya
authors.initials: M
authors.lastname: Sredkova
authors.affiliation: 2 MICOER Institute , Munich, Germany .
authors.forename: Adolf
authors.initials: A
authors.lastname: Bauernfeind
authors.affiliation: 1 Department of Medical Microbiology, Medical Faculty, Medical University Sofia , Sofia, Bulgaria .
authors.forename: Ivan
authors.initials: I
authors.lastname: Mitov
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics*; D002031:Bulgaria; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D006801:Humans; D032023:Integrons / Q000235:genetics; D008826:Microbial Sensitivity Tests / Q000379:methods; D010957:Plasmids / Q000235:genetics; D011513:Proteus mirabilis / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification*; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; C417264:VIM-1 metallo-beta-lactamase; D001618:beta-Lactamases
keywords: Bulgaria; CMY; Proteus mirabilis; VIM; class 1 integron; clone