Emergence of a pandrug-resistant VIM-1-producing Providencia stuartii clonal strain causing an outbreak in a Greek intensive care unit

Evangelia Douka; Efstathia Perivolioti; Elena Kraniotaki; Kimon Fountoulis; Foteini Economidou; Athanassios Tsakris; Athanassios Skoutelis; Christina Routsi

doi:10.1016/j.ijantimicag.2014.12.030

Emergence of a pandrug-resistant VIM-1-producing Providencia stuartii clonal strain causing an outbreak in a Greek intensive care unit

Int J Antimicrob Agents. 2015 May;45(5):533-6. doi: 10.1016/j.ijantimicag.2014.12.030. Epub 2015 Feb 16.

Authors

Evangelia Douka¹, Efstathia Perivolioti², Elena Kraniotaki², Kimon Fountoulis², Foteini Economidou¹, Athanassios Tsakris³, Athanassios Skoutelis⁴, Christina Routsi⁵

Affiliations

¹ First Department of Critical Care, Medical School, University of Athens, Evangelismos Hospital, 45-47 Ipsilantou Street, Athens 106 76, Greece.
² Department of Clinical Microbiology, Evangelismos Hospital, Athens, Greece.
³ Department of Microbiology, Medical School, University of Athens, Athens, Greece.
⁴ Fifth Department of Internal Medicine, Evangelismos Hospital, Athens, Greece.
⁵ First Department of Critical Care, Medical School, University of Athens, Evangelismos Hospital, 45-47 Ipsilantou Street, Athens 106 76, Greece. Electronic address: chroutsi@hotmail.com.

PMID: 25749199
DOI: 10.1016/j.ijantimicag.2014.12.030

Abstract

Here we describe an outbreak caused by a pandrug-resistant Providencia stuartii strain involving 15 critically ill patients in a Greek intensive care unit (ICU) during September-November 2011. All isolates harboured the blaVIM-1 gene and a class 1 integron structure of 1913 bp as well as blaSHV-5 and blaTEM-1. Pulsed-field gel electrophoresis (PFGE) demonstrated that isolates from all 15 patients belonged to a single P. stuartii clonal type. As all of the infected patients were hospitalised during overlapping time periods, horizontal intra-ICU transmission was considered as the main route for the dissemination of the outbreak strain. The outbreak ended following reinforcement of infection control measures, including implementation of additional barrier precautions for infected patients.

Keywords: ICU; Outbreak; PFGE Pandrug-resistant; Providencia stuartii.

Publication types

Case Reports

MeSH terms

Adult
Aged
Aged, 80 and over
Critical Illness
Cross Infection / epidemiology
Cross Infection / microbiology
Cross Infection / transmission
DNA, Bacterial / genetics
Disease Outbreaks*
Disease Transmission, Infectious / prevention & control
Drug Resistance, Multiple, Bacterial*
Electrophoresis, Gel, Pulsed-Field
Enterobacteriaceae Infections / epidemiology*
Enterobacteriaceae Infections / microbiology
Enterobacteriaceae Infections / prevention & control
Enterobacteriaceae Infections / transmission
Female
Genotype*
Greece / epidemiology
Humans
Infection Control / methods
Integrons
Intensive Care Units
Male
Middle Aged
Molecular Typing
Providencia / classification
Providencia / enzymology*
Providencia / genetics
Providencia / isolation & purification
Young Adult
beta-Lactamases / genetics
beta-Lactamases / metabolism

Substances

DNA, Bacterial
VIM-1 metallo-beta-lactamase
beta-Lactamases