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Journal of Clinical Microbiology, May 2001, p. 1865-1870, Vol. 39, No. 5
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.5.1865-1870.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.

Dynamics of a Nosocomial Outbreak of Multidrug-Resistant Pseudomonas aeruginosa Producing the PER-1 Extended-Spectrum beta -Lactamase

Francesco Luzzaro,1 Elisabetta Mantengoli,2 Mariagrazia Perilli,3 Gianluigi Lombardi,1 Viviana Orlandi,1 Alessandra Orsatti,1 Gianfranco Amicosante,3 Gian Maria Rossolini,2 and Antonio Toniolo1,*

Laboratory of Microbiology, Ospedale di Circolo and University of Insubria, Varese,1 Department of Molecular Biology, Section of Microbiology, University of Siena, Siena,2 and Department of Sciences and Biomedical Technology, University of L'Aquila, L'Aquila,3 Italy

Received 25 October 2000/Returned for modification 4 January 2001/Accepted 5 March 2001

From November 1998 to August 1999, a large outbreak occurred in the general intensive care unit of the Ospedale di Circolo in Varese (Italy), caused by Pseudomonas aeruginosa producing the PER-1 extended-spectrum beta -lactamase. A total of 108 clinical isolates of P. aeruginosa resistant to broad-spectrum cephalosporins were recovered from 18 patients. Epidemic isolates were characterized by synergy between clavulanic acid and ceftazidime, cefepime, and aztreonam. Isoelectric focusing of crude bacterial extracts detected two nitrocefin-positive bands with pI values of 8.0 and 5.3. PCR amplification and characterization of the amplicons by restriction analysis and direct sequencing indicated that the epidemic isolates carried a blaPER-1 determinant. The outbreak was of clonal origin as shown by pulsed-field gel electrophoresis analysis. This technique also indicated that the epidemic strain was not related to three other PER-1-positive isolates obtained at the same hospital in 1997. Typing by enterobacterial repetitive intergenic consensus-PCR showed that minor genetic variations occurred during the outbreak. The epidemic strain was characterized by a multiple-drug-resistance phenotype that remained unchanged over the outbreak, including extended-spectrum cephalosporins, monobactams, aminoglycosides, and fluoroquinolones. Isolation of infected patients and appropriate carbapenem therapy were successful in ending the outbreak. Our report indicates that the blaPER-1 resistance determinant may become an emerging therapeutic problem in Europe.

* Corresponding author. Mailing address: Laboratory of Microbiology, Ospedale di Circolo and University of Insubria, Viale Borri 57, 21100, Varese, Italy. Phone: 39-0332-278.309. Fax: 39-0332-260.820. E-mail: antonio.toniolo{at}uninsubria.it.

Journal of Clinical Microbiology, May 2001, p. 1865-1870, Vol. 39, No. 5
0095-1137/01/$04.00+0   DOI: 10.1128/JCM.39.5.1865-1870.2001
Copyright © 2001, American Society for Microbiology. All rights reserved.


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