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Published on: June 5, 2012
Molecular epidemiology of a multiresistant Pseudomonas aeruginosa outbreak in a paediatric intensive care unit
Abstract:
After isolation of multiresistant (MR) Pseudomonas aeruginosa from 3 hospitalized patients in a paediatric intensive care unit (PICU), a prospective surveillance programme was established to detect infected and/or colonized patients in the hospital. Isolates were examined by means of outer membrane protein (OMP) profiles, serotyping and DNA genomic analysis using pulsed-field gel electrophoresis (PFGE). Fifty-five P. aeruginosa strains were isolated from 23 hospitalized patients during September and October 1997. The median hospital stay before isolation of P. aeruginosa was 8 d. PFGE demonstrated that the same clone infected 14 patients, 4 of whom were not hospitalized in the PICU. Susceptibility patterns and OMP profiles correlated with PFGE results in 37.8% and 36.4% of cases, respectively. Serotype O11 correlated with pattern A in 77% of cases and serotype O4 correlated with unrelated strains in 75% of cases but did not discriminate between outbreak and unrelated isolates. Extensive investigation of cultures failed to identify a reservoir of P. aeruginosa. PFGE was superior to OMP analysis and serotyping for discriminating between strains. The possible mode of acquisition for most of the patients infected with the same clone was cross-contamination.
Insights
Multiresistant Pseudomonas aeruginosa outbreaks in a pediatric intensive care unit were investigated. Pulsed-field gel electrophoresis (PFGE) identified a single clone responsible for most infections, suggesting cross-contamination as the primary transmission route.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Multiresistant (MR) Pseudomonas aeruginosa poses a significant threat in healthcare settings, particularly in pediatric intensive care units (PICUs).
- Early detection and characterization of bacterial clones are crucial for controlling hospital-acquired infections.
Purpose of the Study:
- To establish a surveillance program for detecting MR Pseudomonas aeruginosa infections and colonization in hospitalized patients.
- To investigate the genetic relatedness of P. aeruginosa isolates and identify potential transmission routes within the hospital.
Main Methods:
- Prospective surveillance for P. aeruginosa in a PICU.
- Molecular typing of isolates using pulsed-field gel electrophoresis (PFGE).
- Comparison of PFGE results with outer membrane protein (OMP) profiles and serotyping for strain discrimination.
Main Results:
- Fifty-five P. aeruginosa strains were isolated from 23 patients over two months.
- PFGE identified a single clone infecting 14 patients, with transmission extending beyond the PICU.
- PFGE demonstrated superior discriminatory power compared to OMP analysis and serotyping.
Conclusions:
- Cross-contamination was the likely mode of acquisition for the majority of patients infected with the dominant P. aeruginosa clone.
- PFGE is a highly effective tool for tracking the spread of P. aeruginosa within a hospital environment.
- The study highlights the importance of robust surveillance and infection control measures to prevent the dissemination of multiresistant pathogens.
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