An outbreak of extremely drug-resistant Pseudomonas aeruginosa in a tertiary care pediatric hospital in Italy

BMC Infect Dis. 2014 Sep 10:14:494. doi: 10.1186/1471-2334-14-494.

Abstract

Background: Extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) isolates are susceptible to only one or two classes of antibiotics. In 2011-2012, we investigated an outbreak of XDR-PA affecting children with onco-hematological diseases.

Methods: Outbreak investigation included ascertainment of cases, tracing of intestinal carriers and environmental surveillance. Contact precautions were adopted for patients with infection or colonization. Isolates were tested for antimicrobial susceptibility; phenotypic confirmation of carbapenemase production was performed, and carbapenemase genes were tested by multiplex polymerase-chain-reaction (PCR). Genotypes were determined by pulsed-field gel electrophoresis (PFGE).

Results: XDR-PA was isolated from 27 patients; 12 had bacteremia, 6 other infections and 9 were colonized. Severe neutropenia was significantly associated with bacteremia. Bloodstream-infection mortality rate was 67%. All isolates were resistant to carbapenems, cephalosporins and penicillins + β-lactamase inhibitors. Isolates were susceptible only to colistin in 22 patients, to colistin and amikacin in 4, and to ciprofloxacin and colistin in 1. PFGE results identified 6 subtypes of a single genotype, associated with clusters of cases, and 4 sporadic genotypes. Two sporadic isolates were metallo-β-lactamase producers, negative to PCR. All other isolates were metallo-β-lactamase producers due to the presence of a VIM carbapenemase. Incidence of XDR-PA infections decreased from 0.72 cases/1,000 inpatient-days in March 2011-March 2012, to 0.34/1,000 in April-December 2012, after implementation of active finding of intestinal carriers on all onco-hematological inpatients.

Conclusions: Control measures targeting intestinal carriers are crucial in limiting in-hospital transmission of XDR-PA polyclonal strains, protecting more vulnerable patients, such as severely neutropenic children, from developing clinical infections.

MeSH terms

  • Adolescent
  • Adult
  • Anti-Bacterial Agents / pharmacology*
  • Carbapenems / pharmacology
  • Child
  • Child, Preschool
  • Cross Infection / drug therapy
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology*
  • Disease Outbreaks
  • Drug Resistance, Bacterial*
  • Electrophoresis, Gel, Pulsed-Field
  • Female
  • Hospitals, Pediatric / statistics & numerical data
  • Humans
  • Infant
  • Italy / epidemiology
  • Male
  • Pseudomonas Infections / drug therapy
  • Pseudomonas Infections / epidemiology*
  • Pseudomonas Infections / microbiology*
  • Pseudomonas aeruginosa / drug effects*
  • Pseudomonas aeruginosa / genetics
  • Pseudomonas aeruginosa / isolation & purification
  • Pseudomonas aeruginosa / physiology
  • Tertiary Healthcare / statistics & numerical data
  • Young Adult

Substances

  • Anti-Bacterial Agents
  • Carbapenems