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Rameshkumar G, Dhandapani R, Lalitha P, Rajapandian SGK, Palanivel V, Thangavelu S, Alyousef AA, Albalawi T, Alam P, Zubair M, Saleh FM, Alatawi FA, Husain FM. Prevalence and Molecular Characterization of Metallo β-Lactamase Producing Gram-Negative Pathogens Causing Eye Infections. Front Public Health 2022; 10:870354. [PMID: 35774580 PMCID: PMC9237426 DOI: 10.3389/fpubh.2022.870354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose:Metallo β-lactamases (MβL) production is a worldwide problem, particularly in gram-negative bacteria. As scanty data is available on the prevalence of MBL, the present study is being undertaken to determine the prevalence, antibacterial sensitivity patterns, and molecular characterization of MβL associated resistant genes in gram-negative bacteria isolated from ocular infections.Material and MethodsAt a tertiary eye care center in south India, 359 gram-negative pathogens, 200 isolates from eye infections, and 159 isolates from normal flora of the eye were studied. A gold standard microbiology method was used to identify the isolates. An antibiotic double disc synergy test and a combination disc test were used to detect MβL production. Multiplex PCR was used to investigate the molecular characteristics of the MβL encoding genes blaVIM, blaIMP, and blaNDM.ResultsOf the 359 gram-negative bacterial pathogens, Pseudomonas aeruginosa 108 (30.1%) and Enterobacter agglomerans 46 (12.8%) were commonly isolated. High prevalence of P. aeruginosa 81% (17 strains) was detected as an MβL producer and it shows 100% resistance to 2nd and 3rd generation cephalosporins and meropenem. Multiplex PCR detected only the blaVIM gene in 56 (28%) of various eye infections and 27 (17%) of normal flora of the gram-negative bacteria (GNB). The blaVIM gene is detected predominantly in 51.8% of keratitis and 21.4% of postoperative endophthalmitis. High prevalence of the gene was detected in P. aeruginosa 42.9% (24 of 56) and Alcaligens denitrificans 10.7% (6 of 56) from eye infections. Whereas, in the control group, P. aeruginosa and E. coli each had 14.8% (4 of 27) that were shown positive.ConclusionThe emerging MβLs mediated resistance among P. aeruginosa is a challenging task for ophthalmologists, especially in patients with endophthalmitis and bacterial keratitis. This local knowledge will aid in advising appropriate antibiotic use and avoiding unnecessary antibiotic prescriptions, which are highly warranted.
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Affiliation(s)
- Gunasekaran Rameshkumar
- Medical Microbiology Laboratory, Department of Microbiology, Alagappa University, Karaikudi, India
- Department of Ocular Microbiology, Aravind Eye Hospital, Madurai, India
| | - Ranjithkumar Dhandapani
- Medical Microbiology Laboratory, Department of Microbiology, Alagappa University, Karaikudi, India
| | - Prajna Lalitha
- Department of Ocular Microbiology, Aravind Eye Hospital, Madurai, India
| | | | - Velmurugan Palanivel
- Centre for Material Engineering and Regenerative Medicine Bharath Institute of Higher Education, Chennai, India
| | - Sathiamoorthi Thangavelu
- Medical Microbiology Laboratory, Department of Microbiology, Alagappa University, Karaikudi, India
| | - Abdullah A. Alyousef
- Clinical Laboratory Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Thamer Albalawi
- Department of Biology, College of Sciences and Humanities, Prince Sattam Bin Andulaziz University, Alkharj, Saudi Arabia
| | - Pravej Alam
- Department of Biology, College of Sciences and Humanities, Prince Sattam Bin Andulaziz University, Alkharj, Saudi Arabia
| | - Mohammad Zubair
- Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
- *Correspondence: Mohammad Zubair
| | - Fayez M. Saleh
- Department of Medical Microbiology, Faculty of Medicine, University of Tabuk, Tabuk, Saudi Arabia
| | | | - Fohad M. Husain
- Department of Food Science and Nutrition, King Saud University, Riyadh, Saudi Arabia
- Fohad M. Husain
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Detection of blaOXA-10 and blaOXA-48 Genes in Pseudomonas aeruginosa Clinical Isolates by Multiplex PCR. JOURNAL OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASES 2021. [DOI: 10.52547/jommid.9.3.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Antibiotic Resistance Pattern and Evaluation of Metallo-Beta Lactamase Genes Including bla- IMP and bla- VIM Types in Pseudomonas aeruginosa Isolated from Patients in Tehran Hospitals. ISRN MICROBIOLOGY 2014; 2014:941507. [PMID: 24944839 PMCID: PMC4040202 DOI: 10.1155/2014/941507] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 03/02/2014] [Indexed: 11/17/2022]
Abstract
Beta-lactamase producing strains of Pseudomonas aeruginosa are important etiological agents of hospital infections. Carbapenems are among the most effective antibiotics used against Pseudomonas infections, but they can be rendered infective by group B β-lactamase, commonly called metallo-beta lactamase. In this study, the antimicrobial sensitivity patterns of P. aeruginosa strains isolated from 9 different hospitals in Tehran, Iran, as well as the prevalence of MBLs genes (bla-VIM and bla-IMP) were determined. A total of 212 strains of P. aeruginosa recovered from patients in hospitals in Tehran were confirmed by both biochemical methods and PCR. Their antimicrobial sensitivity patterns were determined by Kirby-Bauer disk diffusion method. Following MIC determination, imipenem resistant strains were selected by DDST method which was followed by PCR tests for determination of MBLs genes: bla-IMP and bla-VIM. The results indicated that, in the DDST phenotypic method, among the 100 imipenem resistant isolates, 75 strains were MBLs positive. The PCR test indicated that 70 strains (33%) carried bla-VIM gene and 20 strains (9%) harbored bla-IMP. The results indicated that the extent of antibiotic resistance among Pseudomonas aeruginosa is on the rise. This may be due to production of MBLs enzymes. Therefore, determination of antibiotic sensitivity patterns and MBLs production by these bacteria, can be important in control of clinical Pseudomonas infection.
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Najar Peerayeh S, Pirhajati Mahabadi R, Pakbaten Toupkanlou S, Siadat SD. Diversity of β-lactamases produced by imipenem resistant, Pseudomonas aeruginosa isolates from the bloodstream. Burns 2014; 40:1360-4. [PMID: 24513132 DOI: 10.1016/j.burns.2014.01.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 01/14/2014] [Accepted: 01/15/2014] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The emergence of imipenem non-susceptible Pseudomonas aeruginosa isolates is a matter of great concern because these isolates can become resistant to all available antibiotics. This study conducted to characterize β-lactamase genes in imipenem resistant P. aeruginosa isolates from bloodstream. METHODS 56 non-duplicate clinical isolates of P. aeruginosa were collected in Tehran hospitals. Antibacterial susceptibility was determined by disk diffusion and MIC methods. ESBL and MBL production was confirmed by combined disk. β-Lactamase classes A, B and D genes were identified by PCR. RESULTS Seventeen (30.3%) isolates were imipenem resistant for which 16 isolates simultaneously were resistant to all tested antibiotics. While among 39 imipenem susceptible isolates, only two isolates were resistant to all tested antibiotics. In imipenem resistant isolates, blaTEM, blaSHV and blaOXA-10 were found in 41.1% of isolates and blaVIM, blaIMP and blaPER were identified in 47%, 11.7% and 5.8% of isolates respectively, while in imipenem susceptible isolates, blaTEM, blaSHV and blaOXA-10 were determined in 2.5%, 7.6% and 33.3% of isolates, respectively. The imipenem resistant isolates had been recovered mostly (67.7%) from patients in the Burn hospital. CONCLUSION The result of this study indicated the emergence of multidrug resistant MBL and non-MBL producing P. aeruginosa, particularly in the Burn hospital and blaVIM was dominant β-lactamase genes in imipenem resistant isolates. The isolation of carrier patients may lead to prevent a further dissemination.
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Affiliation(s)
- Shahin Najar Peerayeh
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | - Rahim Pirhajati Mahabadi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
| | | | - Seyed Davar Siadat
- Department of Hepatitis and AIDS, Pasteur Institute of Iran, Tehran, Iran.
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Grossi P, Dalla Gasperina D. Treatment ofPseudomonas aeruginosainfection in critically ill patients. Expert Rev Anti Infect Ther 2014; 4:639-62. [PMID: 17009943 DOI: 10.1586/14787210.4.4.639] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Critically ill patients are on the increase in the present clinical setting. Aging of our population and increasingly aggressive medical and therapeutic interventions, including implanted foreign bodies, organ transplantation and advances in the chemotherapy of malignant diseases, have created a cohort of particularly vulnerable patients. Pseudomonas aeruginosa is one of the leading gram-negative organisms associated with nosocomial infections. This organism is frequently feared because it causes severe hospital-acquired infections, especially in immunocompromised hosts, and is often antibiotic resistant, complicating the choice of therapy. The epidemiology, microbiology, mechanisms of resistance and currently available and future treatment options for the most relevant infections caused by P. aeruginosa are reviewed.
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Affiliation(s)
- Paolo Grossi
- University of Insubria, Infectious Diseases Department, viale Borri 57, 21100 Varese, Italy.
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Deshmukh DG, Damle AS, Bajaj JK, Bhakre JB, Patwardhan NS. Metallo-β-lactamase-producing clinical isolates from patients of a tertiary care hospital. J Lab Physicians 2012; 3:93-7. [PMID: 22219562 PMCID: PMC3249725 DOI: 10.4103/0974-2727.86841] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background: The growing increase in the rates of antibiotic resistance is a major cause for concern in both non-fermenting bacilli and isolates of the Enterobacteriaceae family. β-lactams have been the mainstay of treatment for serious infections, and the most active of these are the carbapenems. Acquired metallo-β-lactamases (MBL) have recently emerged as one of the most worrisome resistance mechanisms owing to their capacity to hydrolyze all β-lactams, including carbapenems. We have undertaken this investigation to ascertain the prevalence of MBL-producing non-fermenting bacilli and Enterobacteriaceae. Materials and Methods: The study was conducted over a period of 4 months in a 1200-bedded teaching hospital. Isolates included in the study were screened for imipenem resistance both by conventional methods and mini analytical profile index (miniAPI). The isolates that showed imipenem resistance were tested for MBL production by imipenem (IMP)-ethylenediaminetetraacetic acid combined disc test. Imipenem-resistant non-MBL isolates also tested for Modified Hodge test and AmpC β-lactamases production to detect other mechanisms of carbapenem resistance. Results: Of 638 gram negative bacilli isolates and 3.39% showed imipenem resistance, 2.9% showed MBL production, of which 1.7% were non-fermenters and 1.25% were Enterobacteriaceae, 0.3% showing non-MBL KPC carbapenemas. Most isolates were from the intensive care unit and from post-operative patients. Our findings show that there are significant numbers of isolates having MBL production along with multidrug resistance. There is a need for active surveillance to detect MBL producers.
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First countrywide survey of acquired metallo-beta-lactamases in gram-negative pathogens in Italy. Antimicrob Agents Chemother 2008; 52:4023-9. [PMID: 18809945 DOI: 10.1128/aac.00707-08] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Metallo-beta-lactamases (MBLs) can confer resistance to most beta-lactams, including carbapenems. Their emergence in gram-negative pathogens is a matter of major concern. Italy was the first European country to report the presence of acquired MBLs in gram-negative pathogens and is one of the countries where MBL producers have been detected repeatedly. Here, we present the results of the first Italian nationwide survey of acquired MBLs in gram-negative pathogens. Of 14,812 consecutive nonreplicate clinical isolates (12,245 Enterobacteriaceae isolates and 2,567 gram-negative nonfermenters) screened for reduced carbapenem susceptibility during a 4-month period (September to December 2004), 30 isolates (28 Pseudomonas aeruginosa isolates, 1 Pseudomonas putida isolate, and 1 Enterobacter cloacae isolate) carried acquired MBL determinants. MBL producers were detected in 10 of 12 cities, with a predominance of VIM-type enzymes over IMP-type enzymes (4:1). Although having an overall low prevalence (1.3%) and significant geographical differences, MBL-producing P. aeruginosa strains appeared to be widespread in Italy, with a notable diversity of clones, enzymes, and integrons carrying MBL gene cassettes.
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Characterization of multidrug-resistant and metallo-beta-lactamase-producing Pseudomonas aeruginosa isolates from a paediatric clinic in China. Chin Med J (Engl) 2008. [DOI: 10.1097/00029330-200809010-00003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Pena A, Donato AM, Alves AF, Leitão R, Cardoso OM. Detection of Pseudomonas aeruginosa producing metallo-β-lactamase VIM-2 in a central hospital from Portugal. Eur J Clin Microbiol Infect Dis 2008; 27:1269-71. [DOI: 10.1007/s10096-008-0579-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 06/06/2008] [Indexed: 10/21/2022]
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Abstract
Carbapenemases are beta-lactamases with versatile hydrolytic capacities. They have the ability to hydrolyze penicillins, cephalosporins, monobactams, and carbapenems. Bacteria producing these beta-lactamases may cause serious infections in which the carbapenemase activity renders many beta-lactams ineffective. Carbapenemases are members of the molecular class A, B, and D beta-lactamases. Class A and D enzymes have a serine-based hydrolytic mechanism, while class B enzymes are metallo-beta-lactamases that contain zinc in the active site. The class A carbapenemase group includes members of the SME, IMI, NMC, GES, and KPC families. Of these, the KPC carbapenemases are the most prevalent, found mostly on plasmids in Klebsiella pneumoniae. The class D carbapenemases consist of OXA-type beta-lactamases frequently detected in Acinetobacter baumannii. The metallo-beta-lactamases belong to the IMP, VIM, SPM, GIM, and SIM families and have been detected primarily in Pseudomonas aeruginosa; however, there are increasing numbers of reports worldwide of this group of beta-lactamases in the Enterobacteriaceae. This review updates the characteristics, epidemiology, and detection of the carbapenemases found in pathogenic bacteria.
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Affiliation(s)
- Anne Marie Queenan
- Johnson & Johnson Pharmaceutical Research & Development, L.L.C., Raritan, NJ 08869, USA.
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Yazdi HR, Nejad GB, Peerayeh SN, Mostafaei M. Prevalence and detection of metallo-β-lactamase (MBL)-producingPseudomonas aeruginosa strains from clinical isolates in Iran. ANN MICROBIOL 2007. [DOI: 10.1007/bf03175223] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Cornaglia G, Akova M, Amicosante G, Cantón R, Cauda R, Docquier JD, Edelstein M, Frère JM, Fuzi M, Galleni M, Giamarellou H, Gniadkowski M, Koncan R, Libisch B, Luzzaro F, Miriagou V, Navarro F, Nordmann P, Pagani L, Peixe L, Poirel L, Souli M, Tacconelli E, Vatopoulos A, Rossolini GM. Metallo-beta-lactamases as emerging resistance determinants in Gram-negative pathogens: open issues. Int J Antimicrob Agents 2007; 29:380-8. [PMID: 17223319 DOI: 10.1016/j.ijantimicag.2006.10.008] [Citation(s) in RCA: 111] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Accepted: 10/29/2006] [Indexed: 01/14/2023]
Abstract
The rapid spread of acquired metallo-beta-lactamases (MBLs) among major Gram-negative pathogens is a matter of particular concern worldwide and primarily in Europe, one of first continents where the emergence of acquired MBLs has been reported and possibly the geographical area where the increasing diversity of these enzymes and the number of bacterial species affected are most impressive. This spread has not been paralleled by accuracy/standardisation of detection methods, completeness of epidemiological knowledge or a clear understanding of what MBL production entails in terms of clinical impact, hospital infection control and antimicrobial chemotherapy. A number of European experts in the field met to review the current knowledge on this phenomenon, to point out open issues and to reinforce and relate to one another the existing activities set forth by research institutes, scientific societies and European Union-driven networks.
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Aboufaycal H, Sader HS, Rolston K, Deshpande LM, Toleman M, Bodey G, Raad I, Jones RN. blaVIM-2 and blaVIM-7 carbapenemase-producing Pseudomonas aeruginosa isolates detected in a tertiary care medical center in the United States: report from the MYSTIC program. J Clin Microbiol 2006; 45:614-5. [PMID: 17151207 PMCID: PMC1829048 DOI: 10.1128/jcm.01351-06] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Two Pseudomonas aeruginosa strains resistant to beta-lactams, fluoroquinolones, aminoglycosides, tetracyclines, and carbapenems and susceptible only to polymyxin B (MIC <or= 2 microg/ml) were identified as part of the Meropenem Yearly Susceptibility Test Information Collection program. Metallo-beta-lactamase screening tests were positive, PCR yielded products with blaVIM primers, and sequence analysis revealed blaVIM-7 and blaVIM-2. The isolates had distinct ribotype and pulsed-field gel electorphoresis patterns and appeared independently, remote in time and location, at the same cancer center.
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Affiliation(s)
- H Aboufaycal
- The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA
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Ait El Kadi M, Aghrouch M, Seffar M, El harti J, Bouklouze A, Cherrah Y, Souly K, Zouhdi M. Prévalence des souches d'Acinetobacter baumannii et de Pseudomonas aeruginosa résistantes à l'imipénème par production de métallo-β-lactamases. Med Mal Infect 2006; 36:386-9. [PMID: 16842953 DOI: 10.1016/j.medmal.2006.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Accepted: 05/15/2006] [Indexed: 11/23/2022]
Abstract
UNLABELLED Metallo-beta-lactamases (MBL) are enzymes produced by Gram-negative bacilli such as Pseudomonas aeruginosa and Acinetobacter baumannii. These enzymes make these isolates resistant to imipenem. AIM The aim of this study was to determine the prevalence of this resistance mechanism in Pseudomonas aeruginosa and Acinetobacter baumannii strains identified in the bacteriology laboratory of the Rabat Ibn Sina teaching hospital, Morocco. MATERIALS AND METHOD Screening for MBL was systematic in all resistant strains and/or strains with decreased sensitivity to imipenem, according to Dongeun Yong et al.'s method, using a sterilized solution of EDTA 0.5 M pH 8. RESULTS Eighty-five bacterial strains (48 P. aeruginosa and 37 A. baumannii) were identified 23% (11) and 57% (21) of which were respectively resistant to the imipenem. The prevalence of MbetaL producing strains was 27% for P. aeruginosa and 38% for A. baumannii. CONCLUSION These results show that the frequency of these strains is increases in our hospital and that their emergence represents a serious therapeutic and epidemiological problem. This means that we need to implement the supervision of hospital microbial environment and strictly apply hygiene measures.
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Affiliation(s)
- M Ait El Kadi
- Service de microbiologie, hôpital des spécialités, CHU Ibn-Sina, Rabat, Maroc.
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Toniolo A, Endimiani A, Luzzaro F. Microbiology of Postoperative Infections. Surg Infect (Larchmt) 2006; 7 Suppl 2:S13-6. [PMID: 16895495 DOI: 10.1089/sur.2006.7.s2-13] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Surgical infections, accounting for approximately one quarter of all nosocomial infections, contribute to longer hospital stays and higher medical costs. Clinical failure of antibiotic treatment often is associated with increasing drug resistance. METHODS Non-duplicated microbial isolates obtained at our institution from surgical patients were identified and tested for antimicrobial susceptibility using the Sceptor system in 2001-2002 and the Phoenix system in 2003-2005. Epidemiologic data were extracted using Epicenter and Powerlab. During selected periods, genetic and biochemical characterization was performed by pulsed-field gel electrophoresis, colony blot hybridization, gene amplification and sequencing, isoelectric focusing, and enzyme kinetics. RESULTS The specimens were most commonly isolated from infections at surgical sites (24.0%), the urinary tract (19.0%), and blood stream (10.6%). Isolates of Escherichia coli showed an increasing prevalence of resistance to penicillins, third-generation cephalosporins, ciprofloxacin, and gentamicin, whereas the prevalence of resistant Staphylococcus aureus generally declined. Highly aggressive multi-drug-resistant (MDR) Pseudomonas aeruginosa strains were widespread, although colistin remained effective in 100% of cases. A significant increase was seen in infections attributable to S. epidermidis and Candida albicans. The overall number of Enterobacteriaceae carrying extended-spectrum beta-lactamases increased continuously, and new resistance traits emerged. It appeared that the TEM-92 determinant moved from Enterobacteriaceae to nonfermenting gram-negative rods such as Acinetobacter baumannii. CONCLUSION The number and type of antimicrobial-resistance determinants are increasing.
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Affiliation(s)
- Antonio Toniolo
- Laboratory of Microbiology and Virology, University of Insubria and Ospedale di Circolo e Fondazione Macchi, Varese, Italy.
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Pagani L, Colinon C, Migliavacca R, Labonia M, Docquier JD, Nucleo E, Spalla M, Li Bergoli M, Rossolini GM. Nosocomial outbreak caused by multidrug-resistant Pseudomonas aeruginosa producing IMP-13 metallo-beta-lactamase. J Clin Microbiol 2005; 43:3824-8. [PMID: 16081918 PMCID: PMC1233900 DOI: 10.1128/jcm.43.8.3824-3828.2005] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
An outbreak of Pseudomonas aeruginosa showing a multidrug-resistant (MDR) phenotype (including carbapenems, ceftazidime, cefepime, gentamicin, tobramycin, and fluoroquinolones) was observed, during a 5-month period, in a general intensive care unit of a large tertiary care and clinical research hospital in southern Italy. The outbreak involved 15 patients, with a total of 87 isolates, mostly from lower respiratory tract specimens. Analysis of isolates involved in the outbreak revealed production of metallo-beta-lactamase (MBL) activity, and genotyping by pulsed-field gel electrophoresis of genomic DNA digested by SpeI revealed clonal relatedness among isolates. Molecular analysis of the MBL determinant showed the presence of a bla(IMP-13) gene carried on a gene cassette inserted in a class 1 integron which also contained an aacA4 aminoglycoside resistance cassette encoding an AAC(6')-Ib enzyme. The bla(IMP-13)-containing integron and its genetic environment appeared to be similar to those found in P. aeruginosa isolates producing IMP-13 from a hospital in Rome. The bla(IMP-13) gene was not transferable by conjugation and was apparently carried on the chromosome. The outbreak was coincidental with a shortage of nursing personnel, and resolution was apparently associated with reinstatement of nursing personnel and reinforcement of general infection control practices within the intensive care unit. To our best knowledge this is the first description of a nosocomial outbreak of relatively large size caused by an IMP-producing gram-negative pathogen in Europe.
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Affiliation(s)
- Laura Pagani
- Dipartimento di Scienze Morfologiche, Eidologiche e Cliniche, Sezione di Microbiologia, Università di Pavia, Servizio di Analisi Microbiologiche IRCCS S. Matteo, Pavia, Dipartimento di Biologia Molecolare, Laboratorio di Fisiologia e Biotecnologia dei Microrganismi, Università di Siena, Siena, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy, Centre d'Ingénierie des Protéines, Institut de Chimie, Université de Liège, B-4000 Liège, Belgium
| | - Céline Colinon
- Dipartimento di Scienze Morfologiche, Eidologiche e Cliniche, Sezione di Microbiologia, Università di Pavia, Servizio di Analisi Microbiologiche IRCCS S. Matteo, Pavia, Dipartimento di Biologia Molecolare, Laboratorio di Fisiologia e Biotecnologia dei Microrganismi, Università di Siena, Siena, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy, Centre d'Ingénierie des Protéines, Institut de Chimie, Université de Liège, B-4000 Liège, Belgium
| | - Roberta Migliavacca
- Dipartimento di Scienze Morfologiche, Eidologiche e Cliniche, Sezione di Microbiologia, Università di Pavia, Servizio di Analisi Microbiologiche IRCCS S. Matteo, Pavia, Dipartimento di Biologia Molecolare, Laboratorio di Fisiologia e Biotecnologia dei Microrganismi, Università di Siena, Siena, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy, Centre d'Ingénierie des Protéines, Institut de Chimie, Université de Liège, B-4000 Liège, Belgium
| | - Maria Labonia
- Dipartimento di Scienze Morfologiche, Eidologiche e Cliniche, Sezione di Microbiologia, Università di Pavia, Servizio di Analisi Microbiologiche IRCCS S. Matteo, Pavia, Dipartimento di Biologia Molecolare, Laboratorio di Fisiologia e Biotecnologia dei Microrganismi, Università di Siena, Siena, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy, Centre d'Ingénierie des Protéines, Institut de Chimie, Université de Liège, B-4000 Liège, Belgium
| | - Jean-Denis Docquier
- Dipartimento di Scienze Morfologiche, Eidologiche e Cliniche, Sezione di Microbiologia, Università di Pavia, Servizio di Analisi Microbiologiche IRCCS S. Matteo, Pavia, Dipartimento di Biologia Molecolare, Laboratorio di Fisiologia e Biotecnologia dei Microrganismi, Università di Siena, Siena, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy, Centre d'Ingénierie des Protéines, Institut de Chimie, Université de Liège, B-4000 Liège, Belgium
| | - Elisabetta Nucleo
- Dipartimento di Scienze Morfologiche, Eidologiche e Cliniche, Sezione di Microbiologia, Università di Pavia, Servizio di Analisi Microbiologiche IRCCS S. Matteo, Pavia, Dipartimento di Biologia Molecolare, Laboratorio di Fisiologia e Biotecnologia dei Microrganismi, Università di Siena, Siena, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy, Centre d'Ingénierie des Protéines, Institut de Chimie, Université de Liège, B-4000 Liège, Belgium
| | - Melissa Spalla
- Dipartimento di Scienze Morfologiche, Eidologiche e Cliniche, Sezione di Microbiologia, Università di Pavia, Servizio di Analisi Microbiologiche IRCCS S. Matteo, Pavia, Dipartimento di Biologia Molecolare, Laboratorio di Fisiologia e Biotecnologia dei Microrganismi, Università di Siena, Siena, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy, Centre d'Ingénierie des Protéines, Institut de Chimie, Université de Liège, B-4000 Liège, Belgium
| | - Michele Li Bergoli
- Dipartimento di Scienze Morfologiche, Eidologiche e Cliniche, Sezione di Microbiologia, Università di Pavia, Servizio di Analisi Microbiologiche IRCCS S. Matteo, Pavia, Dipartimento di Biologia Molecolare, Laboratorio di Fisiologia e Biotecnologia dei Microrganismi, Università di Siena, Siena, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy, Centre d'Ingénierie des Protéines, Institut de Chimie, Université de Liège, B-4000 Liège, Belgium
| | - Gian Maria Rossolini
- Dipartimento di Scienze Morfologiche, Eidologiche e Cliniche, Sezione di Microbiologia, Università di Pavia, Servizio di Analisi Microbiologiche IRCCS S. Matteo, Pavia, Dipartimento di Biologia Molecolare, Laboratorio di Fisiologia e Biotecnologia dei Microrganismi, Università di Siena, Siena, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy, Centre d'Ingénierie des Protéines, Institut de Chimie, Université de Liège, B-4000 Liège, Belgium
- Corresponding author. Mailing address: Dipartimento di Biologia Molecolare, Università di Siena, Policlinico Santa Maria alle Scotte, I-53100 Siena, Italy. Phone: 39-0577-233455. Fax: 39-0577-233334. E-mail:
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Aubron C, Poirel L, Fortineau N, Nicolas P, Collet L, Nordmann P. Nosocomial Spread ofPseudomonas aeruginosaIsolates Expressing the Metallo-β-Lactamase VIM-2 in a Hematology Unit of a French Hospital. Microb Drug Resist 2005; 11:254-9. [PMID: 16201928 DOI: 10.1089/mdr.2005.11.254] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Dissemination of metallo-beta-lactamases (carbapenemases) was investigated retrospectively among ceftazidimeand imipenem-resistant Pseudomonas aeruginosa isolates in a hematology unit in Marseilles, France, from September, 1995, to March, 1999. Sixteen clinical isolates and 23 environmental strains were identified, with a same bla (VIM-2) gene that encoded a carbapenemase identified in Southern Europe and South Korea. Five different genotypes were identified among clinical and environmental P. aeruginosa isolates all harboring an approximately 45-kb plasmid with bla (VIM-2)-positive class 1 integrons varying in structures. This study identified a hidden reservoir of carbapenemase producers.
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Affiliation(s)
- Cécile Aubron
- Service de Bactériologie-Virologie, Hôpital de Bicêtre, Assistance Publique/Hôpitaux de Paris, Faculté de Médecine Paris-Sud, 94275 Le Kremlin-Bicêtre cedex, France
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Altoparlak U, Aktas F, Celebi D, Ozkurt Z, Akcay MN. Prevalence of metallo-β-lactamase among Pseudomonas aeruginosa and Acinetobacter baumannii isolated from burn wounds and in vitro activities of antibiotic combinations against these isolates. Burns 2005; 31:707-10. [PMID: 16129224 DOI: 10.1016/j.burns.2005.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2004] [Accepted: 02/10/2005] [Indexed: 10/25/2022]
Abstract
The prevalence of metallo-beta-lactamases (MBLs) produced by isolates of Pseudomonas aeruginosa and Acinetobacter baumannii and the activities of various antmicrobial combinations against MBL producer strains were investigated. During the period from June 2003 till July 2004, 120 P. aeruginosa and 9 A. baumannii nonduplicate isolates were obtained from burn wounds. Forty strains (37 P. aeruginosa, 3 A. baumannii) were selected because of resistance to carbapenems. Screening for MBL production was performed in the latter isolates by the combined disk method which depends on comparing the zones given by disks containing imipenem with and without ethylenediaminetetraacetic acid (EDTA). Of imipenem resistant P. aeruginosa strains, 21 and 1 of A. baumannii were found metallo-beta-lactamase producers. Disk approximation studies were then performed to test for in vitro activities of various antimicrobial combinations. For a total of 21 P. aeruginosa strains, synergy was demonstrated predominantly by ciprofloxacin in combination with ceftazidime and imipenem, by ofloxacin in combination with astreonam. Against MBL producer A. baumannii strain, synergy was detected only with imipenem-ofloxacin combination. None of the combinations were antagonistic. These results suggest that MBL producing P. aeruginosa and A. baumanni strains have been introduced into burn centers, and to prevent the further spread of MBL producers, it is essential for carbapenem resistant isolates to be screened for MBLs.
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Affiliation(s)
- Ulku Altoparlak
- Department of Microbiology and Clinical Microbiology, Ataturk University, Tip Fakultesi, Aziziye Hastanesi, Mikrobiyoloji ve Klinik Mikrobiyoloji Anabilim Dali, School of Medicine, Erzurum 25100, Turkey.
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Riccio ML, Pallecchi L, Docquier JD, Cresti S, Catania MR, Pagani L, Lagatolla C, Cornaglia G, Fontana R, Rossolini GM. Clonal relatedness and conserved integron structures in epidemiologically unrelated Pseudomonas aeruginosa strains producing the VIM-1 metallo-{beta}-lactamase from different Italian hospitals. Antimicrob Agents Chemother 2005; 49:104-10. [PMID: 15616282 PMCID: PMC538861 DOI: 10.1128/aac.49.1.104-110.2005] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Three epidemiologically independent Pseudomonas aeruginosa isolates, representative of the first VIM-1 metallo-beta-lactamase producers detected at three different hospitals in northern Italy, were investigated to determine their genomic relatedness and to compare the structures of the genetic supports for the VIM-1 determinants. The three isolates, all of serotype O11, appeared to be clonally related according to the results of genotyping by macrorestriction analysis of genomic DNA by pulsed-field gel electrophoresis and random amplification of polymorphic DNA. Investigation of the genetic support for the bla(VIM-1) determinant revealed that it was carried on identical or almost identical integrons (named In70.2 and In70.3) located within a conserved genomic context. The integrons were structurally related to In70 and In110, two plasmid-borne bla(VIM-1)-containing integrons from Achromobacter xylosoxidans and Pseudomonas putida isolates, respectively, from the same geographic area (northern Italy) and were found to be inserted close to the res site of a Tn5051-like transposon, different from any of those described previously, that was apparently carried on the bacterial chromosome. The present findings suggest that the three VIM-1-producing isolates are members of the same clonal complex which have been spreading in hospitals in northern Italy since the late 1990s and point to a common ancestry of their bla(VIM-1)-containing integrons.
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Affiliation(s)
- Maria Letizia Riccio
- Dipartimento di Biologia Molecolare, Sezione di Microbiologia, Università di Siena, Policlinico "Le Scotte", 53100 Siena, Italy
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Luzzaro F, Docquier JD, Colinon C, Endimiani A, Lombardi G, Amicosante G, Rossolini GM, Toniolo A. Emergence in Klebsiella pneumoniae and Enterobacter cloacae clinical isolates of the VIM-4 metallo-beta-lactamase encoded by a conjugative plasmid. Antimicrob Agents Chemother 2004; 48:648-50. [PMID: 14742229 PMCID: PMC321512 DOI: 10.1128/aac.48.2.648-650.2004] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Resistance to carbapenems is an emerging problem among gram-negative hospital pathogens. A transferable plasmid encoding the VIM-4 metallo-beta-lactamase was detected in isolates of Klebsiella pneumoniae and Enterobacter cloacae obtained from a single patient under carbapenem therapy. Thus, enterobacteria appear to increasingly contribute to the spread of VIM-type enzymes.
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Affiliation(s)
- Francesco Luzzaro
- Laboratorio di Microbiologia, Ospedale di Circolo, and Università dell'Insubria, I-21100 Varese, Italy
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