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Journal of Clinical Microbiology, November 2009, p. 3524-3529, Vol. 47, No. 11
0095-1137/09/$08.00+0     doi:10.1128/JCM.01099-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

Large Dissemination of VIM-2-Metallo-β-Lactamase-Producing Pseudomonas aeruginosa Strains Causing Health Care-Associated Community-Onset Infections {triangledown}

Athanassios Tsakris,1* Aggeliki Poulou,2 Ioulia Kristo,3 Theodore Pittaras,1 Nicholas Spanakis,1 Spyros Pournaras,3 and Fani Markou2

Department of Microbiology, Medical School, University of Athens, Athens, Greece,1 Department of Microbiology, Serres General Hospital, Serres, Greece,2 Department of Microbiology, Medical School, University of Thessaly, Larissa, Greece3

Received 5 June 2009/ Returned for modification 8 June 2009/ Accepted 11 September 2009

During a 3-year period (May 2005 to April 2008), a series of 45 outpatients presented with community-onset urinary tract infections due to carbapenem-resistant Pseudomonas aeruginosa isolates. Forty of them had a history of previous hospitalization or exposure to healthcare facilities, while the remaining five had not been previously admitted to our healthcare facilities or elsewhere within the preceding 12 months. In 18 outpatients, the carbapenem-resistant organisms caused recurrent community-onset urinary tract infections, while in three outpatients the organisms were also implicated in bacteremic episodes. All 45 single-patient P. aeruginosa isolates harbored the blaVIM-2 metallo-β-lactamase (MBL) gene in a common class 1 integron structure. They belonged to one predominant pulsed-field gel electrophoresis type and three sporadically detected types; two of the sporadic clonal types were identified among outpatients without previous exposure to healthcare facilities, while the predominant clonal type was also identified to cause infections in hospitalized patients. This is the first study documenting that MBL-producing P. aeruginosa isolates cause community-onset infections that are related or not with exposure to healthcare facilities. Community-onset infections in our patients most likely resulted from the nosocomial acquisition of MBL producers, followed by a prolonged digestive carriage. The high rate of recurrent infections in the community underlies the difficulty of constraining infections caused by such microorganisms in the extrahospital setting.

* Corresponding author. Mailing address: Department of Microbiology, Medical School, University of Athens, 75 Mikras Asias Street, 11527 Athens, Greece. Phone: 30-210-746-2011. Fax: 30-210-746-2210. E-mail: atsakris{at}med.uoa.gr

{triangledown} Published ahead of print on 23 September 2009.

Journal of Clinical Microbiology, November 2009, p. 3524-3529, Vol. 47, No. 11
0095-1137/09/$08.00+0     doi:10.1128/JCM.01099-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.





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