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JAC Advance Access published online on October 20, 2005
Journal of Antimicrobial Chemotherapy, 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
Received March 20, 2005
Revised September 21, 2005
Accepted October 3, 2005

Brief report

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

Alexandre Prehn Zavascki 1*, Patrick Barcelos Gaspareto 2, Andreza Francisco Martins 2, Ana Lúcia Gonçalves 2, and Afonso Luís Barth 2

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

* To whom correspondence should be addressed.
Alexandre Prehn Zavascki, E-mail: apzavascki{at}terra.com.br


  Abstract

Objectives: To describe the first nosocomial outbreak of Pseudomonas aeruginosa producing SPM-1 metallo-{beta}-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; {beta}-lactamases; antibiotic resistance; carbapenems; nosocomial infections.
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