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A hospital outbreak caused by a chlorhexidine and antibiotic-resistant Proteus mirabilis
D A Dance1, A D Pearson, D V Seal
1Public Health Laboratory, General Hospital, Southampton.
Abstract:
An outbreak of urinary-tract infection involving a strain of Proteus mirabilis resistant to gentamicin and several other antibiotics affected 90 patients in Southampton between July 1980 and May 1985. The outbreak strain was also resistant to chlorhexidine and this, in combination with the antibiogram and Dienes' test, permitted differentiation from other P. mirabilis strains. The outbreak had features in common with other Enterobacteriaceae outbreaks, although certain aspects of the population involved have made it particularly difficult to control. The outbreak commenced shortly after the introduction of a catheter care policy which involved the use of chlorhexidine, and although the majority of the cases were colonized before this policy was enforced, chlorhexidine had been used extensively for other procedures within the district. Preliminary evidence suggests that there is no genetic linkage between the chlorhexidine and multiple antibiotic resistance.
Insights
A Proteus mirabilis outbreak caused urinary-tract infections in 90 patients due to multi-drug resistance. The strain
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- An outbreak of urinary-tract infection (UTI) caused by a multi-drug resistant strain of Proteus mirabilis occurred in Southampton.
- The outbreak strain exhibited resistance to gentamicin and other antibiotics, complicating treatment options.
- Notably, the strain was also resistant to chlorhexidine, a disinfectant, which aided in its identification.
Purpose of the Study:
- To investigate an outbreak of Proteus mirabilis resistant to multiple antibiotics and chlorhexidine.
- To differentiate the outbreak strain from other Proteus mirabilis strains using antibiogram and Dienes' test.
- To explore potential links between the outbreak and a new catheter care policy involving chlorhexidine.
Main Methods:
- Characterization of the outbreak strain using antibiogram and Dienes' test.
- Epidemiological investigation of patient data and healthcare practices.
- Analysis of potential genetic linkage between chlorhexidine and antibiotic resistance.
Main Results:
- Ninety patients were affected by the resistant Proteus mirabilis strain between July 1980 and May 1985.
- The outbreak strain's resistance to chlorhexidine, alongside its antibiogram, facilitated differentiation from other strains.
- Preliminary findings indicated no genetic linkage between chlorhexidine resistance and multiple antibiotic resistance.
Conclusions:
- The Proteus mirabilis outbreak presented challenges in control due to strain characteristics and patient population.
- The introduction of a chlorhexidine-based catheter care policy may have coincided with the outbreak's emergence.
- Further investigation is needed to understand the mechanisms and control strategies for such resistant strains.