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Nosocomial outbreak caused by multidrug-resistant Pseudomonas aeruginosa producing IMP-13 metallo-beta-lactamase

Laura Pagani1, Céline Colinon, Roberta Migliavacca

  • 1Dipartimento di Scienze Morfologiche, Eidologiche e Cliniche, Sezione di Microbiologia, Università di Pavia, Italy.

Journal of Clinical Microbiology
|August 6, 2005
PubMed

Insights

A multidrug-resistant Pseudomonas aeruginosa outbreak in an Italian ICU involved 15 patients. The outbreak was linked to the bla(IMP-13) gene and resolved with improved infection control.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Hospital Epidemiology

Background:

  • Nosocomial outbreaks of multidrug-resistant (MDR) Pseudomonas aeruginosa pose significant challenges in intensive care units (ICUs).
  • The emergence of metallo-beta-lactamase (MBL) producing pathogens is a growing global health concern.

Purpose of the Study:

  • To investigate a 5-month outbreak of MDR Pseudomonas aeruginosa in a general ICU.
  • To characterize the molecular mechanisms and genetic elements responsible for the observed multidrug resistance.

Main Methods:

  • Analysis of 87 P. aeruginosa isolates from 15 patients using phenotypic resistance testing, metallo-beta-lactamase activity assays, and pulsed-field gel electrophoresis (PFGE) for genotyping.
  • Molecular analysis of resistance genes, including sequencing of the MBL determinant and associated genetic elements.

Main Results:

  • The outbreak involved 15 patients and was caused by a clonal strain of P. aeruginosa exhibiting resistance to carbapenems, ceftazidime, cefepime, gentamicin, tobramycin, and fluoroquinolones.
  • Isolates produced metallo-beta-lactamase (MBL) activity due to the bla(IMP-13) gene located on a class 1 integron, alongside an aminoglycoside resistance cassette.
  • The bla(IMP-13) gene was chromosomally located and not transferable by conjugation; its genetic environment resembled previously reported IMP-13 isolates from Rome.

Conclusions:

  • This study reports the first significant nosocomial outbreak in Europe caused by an IMP-13 producing P. aeruginosa.
  • The outbreak coincided with nursing staff shortages and was resolved by reinforcing infection control measures and reinstating nursing personnel.
  • Effective infection control practices and adequate staffing are crucial for managing MDR pathogen outbreaks in ICUs.

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