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A large outbreak of multiresistant Pseudomonas aeruginosa strains in north-eastern Germany
B Panzig1, G Schröder, F A Pitten
1Institute of Medical Microbiology, University of Greifswald, Germany.
Abstract:
Multiply-resistant Pseudomonas aeruginosa were first detected in north-eastern Germany at the end of 1996; since then they have been isolated predominantly from patients in intensive care units. Colonization/infection, especially of the respiratory tract, has been demonstrated in 80 patients, with strains resistant to beta-lactams, carbapenems, aminoglycosides and quinolones. Amikacin showed in-vitro synergy with cefepime, ceftazidime or piperacillin/tazobactam. Horizontal transfer of strains was followed by PFGE and identical strains were detected in the environment, but the source of infection was not established. Rigorous infection control and restricted clinical use of carbapenems limited further dissemination of this outbreak.
Insights
Multiply-resistant Pseudomonas aeruginosa strains emerged in German intensive care units, showing resistance to multiple antibiotics. Infection control measures and reduced carbapenem use helped limit the outbreak
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Public Health
Background:
- Detection of multiply-resistant Pseudomonas aeruginosa in north-eastern Germany starting in 1996.
- Predominant isolation from intensive care unit (ICU) patients.
- Significant colonization/infection, particularly of the respiratory tract, in 80 patients.
Purpose of the Study:
- To characterize the multiply-resistant Pseudomonas aeruginosa strains.
- To investigate the antibiotic resistance patterns and potential treatment synergies.
- To understand the transmission dynamics and environmental presence of the strains.
Main Methods:
- Phenotypic characterization of antibiotic resistance (beta-lactams, carbapenems, aminoglycosides, quinolones).
- In-vitro synergy testing of amikacin with cefepime, ceftazidime, and piperacillin/tazobactam.
- Pulsed-field gel electrophoresis (PFGE) for strain typing and tracking horizontal transfer.
Main Results:
- Strains exhibited resistance to multiple antibiotic classes, including beta-lactams, carbapenems, aminoglycosides, and quinolones.
- In-vitro synergy observed between amikacin and cefepime, ceftazidime, or piperacillin/tazobactam.
- Identical strains were detected in both patients and the environment, indicating potential environmental reservoirs.
Conclusions:
- Rigorous infection control protocols and judicious use of carbapenems were crucial in curbing the dissemination of this multidrug-resistant organism (MDRO) outbreak.
- The findings highlight the importance of comprehensive infection control strategies in ICUs to manage resistant bacterial strains.
- Further investigation is needed to identify the precise environmental source of infection.