Emergence of a pandrug-resistant VIM-1-producing Providencia stuartii clonal strain causing an outbreak in a Greek...

Area of Science:

• Infectious Diseases
• Microbiology
• Public Health

Background:

• Intensive care units (ICUs) are vulnerable settings for the emergence and spread of multidrug-resistant organisms (MDROs).
• Providencia stuartii is an opportunistic pathogen that can cause severe infections, particularly in immunocompromised patients.

Observation:

• An outbreak of pandrug-resistant Providencia stuartii occurred in a Greek ICU between September and November 2011, affecting 15 critically ill patients.
• All isolates exhibited resistance to all available antibiotics and carried specific resistance genes (blaVIM-1, blaSHV-5, blaTEM-1) and a class 1 integron.
• Pulsed-field gel electrophoresis confirmed that all patient isolates were clonally identical, indicating a single source or strain.

Findings:

• Horizontal transmission within the ICU was identified as the primary route for the dissemination of the outbreak strain.
• The genetic analysis revealed the presence of multiple antibiotic resistance genes, contributing to the pandrug-resistant phenotype.
• The outbreak strain belonged to a single clonal type, suggesting efficient transmission dynamics.

Implications:

• This outbreak highlights the critical need for stringent infection control measures in ICUs to prevent the spread of pandrug-resistant bacteria.
• Effective implementation of barrier precautions and enhanced surveillance is crucial for controlling nosocomial infections caused by MDROs.
• The findings underscore the importance of molecular typing and genetic analysis in understanding and managing outbreaks of resistant pathogens.