JAC Advance Access originally published online on March 10, 2008
Journal of Antimicrobial Chemotherapy 2008 61(6):1392-1393; doi:10.1093/jac/dkn091
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Research letters |
Multidrug-resistant Providencia stuartii expressing extended-spectrum β-lactamase PER-1, originating in Kosovo
1 Service de Bactériologie-Virologie, INSERM U914 ‘Emerging Resistance to Antibiotics’, Assistance Publique/Hôpitaux de Paris, Faculté de Médecine et Université Paris-Sud, Hôpital de Bicêtre, 94275 K.-Bicêtre, France 2 Microbiology Laboratory, University Hospital Basel, 4031 Basel, Switzerland 3 Division Unit of Infectious Diseases, Basel University Medical Clinic, 4410 Liestal, Switzerland
* Corresponding author. E-mail: nordmann.patrice{at}bct.aphp.fr
Keywords: P. stuartii , ESBLs , β-lactamases
The current emergence and dissemination of clavulanic acid-inhibited, extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae represent a global threat, as they are difficult to trace and eradicate, and cause both nosocomial and community-acquired infections.1 Although the unexplained worldwide escalation of CTX-M-type enzymes is of major concern, other types of ESBLs may be prevalent in more restricted geographical areas. The ESBL PER-1 has been identified in several Gram-negative species including Salmonella typhimurium, Pseudomonas aeruginosa and Acinetobacter baumannii.2 This ESBL determinant has been identified in several countries such as France, Italy, Poland and South Korea and is particularly widespread in Turkey.2
We report here a multidrug-resistant Providencia stuartii isolate, which was recovered in 2004 from a 60-year-old patient who had a femur head prosthesis implantation at the University Hospital Pristina, Kosovo. He subsequently developed a chronic infection, fistulations occurred and he was transferred to the University Medical Clinic of Orthopaedic Surgery, Liestal, Switzerland, where his femur head was removed. Cultures made from intra-operative biopsies yielded oxacillin-susceptible Staphylococcus aureus, Enterococcus faecium and P. stuartii isolates; the latter isolate was identified with the API32GN system (bioMérieux, Marcy l'Étoile, France). Disc diffusion and broth microdilution methods were used to determine its antibiotic susceptibility and results were interpreted according to CLSI criteria. P. stuartii isolate 166 was resistant to multiple antibiotics including oxyimino-cephalosporins, fluoroquinolones, chloramphenicol, tetracycline, trimethoprim, aminoglycosides (except amikacin) and colistin, but it remained susceptible to cephamycins and carbapenems. Synergy tests performed with discs containing ticarcillin/clavulanic acid and either ceftazidime or cefepime indicated production of an ESBL. PCR with primers specific for known ESBL genes2 identified blaPER-1, and PCR mapping showed this to be part of a Tn1213 composite transposon.3 Plasmid-mediated Qnr-type determinants have been associated with ESBL genes, but isolate 166 lacked known Qnr-encoding genes.4 Conjugation studies, with ceftazidime selection and Escherichia coli J53 (azide-resistant) as the recipient, showed that the blaPER-1 gene was located on a 150 kb plasmid, which also conferred resistance to chloramphenicol, trimethoprim, aminoglycosides (except amikacin) and sulphonamides.
The patient was treated for 6 weeks in Switzerland with imipenem and vancomycin and recovered, but further follow-up was not possible because the patient returned to Kosovo.
There are no epidemiological data regarding ESBLs available for Kosovo. A survey recently performed in Bosnia and Herzegovina identified SHV-5 producers among ESBL-positive enterobacterial isolates.5 PER-1 ESBL has been identified in A. baumannii and P. aeruginosa in Turkey and Romania, and in P. stuartii in Italy.6 This report of PER-1 in an enterobacterial isolate from Kosovo may indicate that the blaPER-1 gene has spread in South Eastern Europe.
 |
Funding |
|---|
 Top Funding Transparency declarationsReferences |
|---|
This work was partially funded by a grant from the Ministère de l'Education Nationale et de la Recherche (UPRES-EA3539), Université Paris XI, France and mostly by a grant from the European Community (LSHM-CT-2005-018705).
|
Transparency declarations |
|---|
|
TopFundingTransparency declarationsReferences |
|---|
None to declare.
|
References |
|---|
|
TopFundingTransparency declarationsReferences |
|---|
1 Paterson DL, Bonomo RA. Extended-spectrum β-lactamases: a clinical update. Clin Microbiol Rev (2005) 18:657–86.
2 Naas T, Poirel L, Nordmann P. Minor extended-spectrum β-lactamases. Clin Microbiol Infect (2008) 14(Suppl 1):42–52.[CrossRef][Web of Science][Medline]
3
Poirel L, Cabanne L, Vahaboglü H, et al. Genetic environment and expression of the extended-spectrum β-lactamase blaPER-1 gene in Gram-negative bacteria. Antimicrob Agents Chemother (2005) 49:1708–13.
4
Cattoir V, Poirel L, Rotimi V, et al. Multiplex PCR for detection of plasmid-mediated quinolone resistance qnr genes in ESBL-producing enterobacterial isolates. J Antimicrob Chemother (2007) 60:394–7.
5 Uzunovic-Kamberovic S, Bedenic B, Vranes J. Predominance of SHV-5 β-lactamase in enteric bacteria causing community-acquired urinary tract infections in Bosnia and Herzegovina. Clin Microbiol Infect (2007) 13:820–3.[CrossRef][Web of Science][Medline]
6
Perilli M, De Santis F, Mugnaioli C, et al. Spread of Enterobacteriaceae carrying the PER-1 extended-spectrum β-lactamase gene as a chromosomal insert: a report from Italy. J Antimicrob Chemother (2007) 59:323–4.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  H. Iabadene, C. Dallenne, Y. Messai, D. Geneste, R. Bakour, and G. Arlet Emergence of Extended-Spectrum {beta}-Lactamase PER-1 in Proteus vulgaris and Providencia stuartii Isolates from Algiers, Algeria Antimicrob. Agents Chemother., September 1, 2009; 53(9): 4043 - 4044. [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||