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JAC Advance Access originally published online on October 20, 2005
Journal of Antimicrobial Chemotherapy 2005 56(6):1148-1151; doi:10.1093/jac/dki390
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© The Author 2005. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Outbreak of carbapenem-resistant Pseudomonas aeruginosa producing SPM-1 metallo-ß-lactamase in a teaching hospital in southern Brazil

Alexandre Prehn Zavascki1,*, Patrick Barcelos Gaspareto2, Andreza Francisco Martins2, Ana Lúcia Gonçalves2 and Afonso Luís Barth2

1 Infectious Diseases Service, Hospital São Lucas da Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil; 2 Microbiolgy Unit, Clinical Pathology Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil

Received 20 March 2005; returned 15 September 2005; revised 21 September 2005; accepted 3 October 2005

* Corresponding author. Tel/Fax: +55-(51)-3362-1850; E-mail: apzavascki{at}terra.com.br

Objectives: To describe the first nosocomial outbreak of Pseudomonas aeruginosa producing SPM-1 metallo-ß-lactamase (MBL) in southern Brazil.

Patients and methods: From January to October 2004, carbapenem-resistant P. aeruginosa (CRPA) were recovered from hospitalized patients. Mortality, site of infection/colonization, patient location and susceptibility profiles were analysed. A sample of CRPA was screened for MBL production, evaluated for the presence of blaSPM-1, blaIMP-1 and blaVIM-2 genes by PCR and submitted for molecular typing by DNA macrorestriction.

Results: A total of 135 CRPA (one isolate per patient) were recovered. Two major antibiotic susceptibility profiles comprised 63.7% of the isolates (susceptibility to polymyxin B and aztreonam, and susceptibility only to polymyxin B). Thirty-five CRPA were screened for MBL production (10 isolates from April, June and July, and 25 from September and October) and 27 (77.1%) proved to be positive for MBL production. Twenty-one of the 24 CRPA tested carried the blaSPM-1 gene. The mortality of patients with CRPA was 48.1% and no variable was associated with death. Molecular typing revealed the presence of a clone with four related subtypes among the blaSPM-1-positive CRPA.

Conclusions: The prevalence of MBL production by CRPA is high and horizontal transmission is a major determinant for the spread of SPM-1 CRPA among patients in this institution. As infection control measures failed to control the spread of CRPA, continuous surveillance for MBL production is warranted.

Keywords: P. aeruginosa , ß-lactamases , antibiotic resistance , carbapenems , nosocomial infections


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