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Journal of Clinical Microbiology, May 1998, p. 1347-1351, Vol. 36, No. 5
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.

Persistence of a Multidrug-Resistant Pseudomonas aeruginosa Clone in an Intensive Care Burn Unit

Po-Ren Hsueh,1,2 Lee-Jene Teng,2,3 Pan-Chyr Yang,2 Yu-Chi Chen,1 Shen-Wu Ho,2,3 and Kwen-Tay Luh1,2,*

Departments of Laboratory Medicine1 and Internal Medicine,2 National Taiwan University Hospital, and Department of Medical Technology,3 National Taiwan University College of Medicine, Taipei, Taiwan

Received 27 October 1997/Returned for modification 9 January 1998/Accepted 10 February 1998

Long-term colonization of various body sites with a multidrug-resistant Pseudomonas aeruginosa clone (resistant to piperacillin, cefoperazone, ceftazidime, aztreonam, imipenem, cefepime, cefpirome, ofloxacin, ciprofloxacin, minocycline, and aminoglycosides) with subsequent severe infections in burn patients has not been reported previously. Thirty-nine isolates of multidrug-resistant P. aeruginosa (resistant to ceftazidime and at least three of the agents listed above) recovered from various clinical samples from three patients in an intensive care burn unit from April 1997 to May 1997 and seven preserved isolates recovered from six patients in other medical wards at National Taiwan University Hospital from April 1996 to May 1997 were studied for their epidemiological relatedness. The epidemic could be attributed to a multidrug-resistant P. aeruginosa clone belonging to serogroup O:F (serogroup O:4) by means of antimicrobial susceptibility testing, O serogrouping, and analysis of the randomly amplified polymorphic DNA patterns generated by arbitrarily primed PCR of the isolates. The epidemic strain persisted in the three patients for weeks to months; in the meantime, these patients had received multiple antimicrobial agents for the management of intervening episodes of invasive infections (bacteremia, ventilator-associated pneumonia, and/or catheter-related sepsis) caused by this strain, as well as concomitant infections due to other organisms. The strain had been isolated only once previously, from a burn patient who was on the unit in December 1996. The present report, describing a small outbreak due to P. aeruginosa, documents the fact that a single clone of multidrug-resistant P. aeruginosa can cause long-term persistence in different body sites of burn patients and that the colonization can subsequently result in various severe infections.

* Corresponding author. Mailing address: Department of Laboratory Medicine, National Taiwan University Hospital, No. 7, Chung-Shan South Rd., Taipei, Taiwan. Phone: 886-2-3562150. Fax: 886-2-3224263. E-mail: luhkt{at}ha.mc.ntu.edu.tw.

Journal of Clinical Microbiology, May 1998, p. 1347-1351, Vol. 36, No. 5
0095-1137/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.


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