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2011, vol. 42, br. 2, str. 75-79
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Epidemija infekcije u hirurškoj jedinici intenzivne nege izazvane bakterijom Proteus mirabilis koja stvara metalo-beta-laktamazu
An outbreak of infection due to metallo-ß-lactamase-producing Proteus mirabilis in the surgical intensive care unit
aKlinički centar Srbije, Beograd, Srbija bUniverzitet u Beogradu, Medicinski fakultet, Srbija cVojnomedicinska akademija, Beograd, Srbija
e-adresa: ve.mir@sbb.rs
Sažetak
Uvod. U radu je opisana epidemija infekcije u hirurškoj jedinici intenzivne nege (JIN) izazvane izolatima P. mirabilis koji stvaraju metalo-beta-laktamaze (MBL). Metode. Ovo je opservaciona retrospektivna studija. Podaci o bolesnicima, od kojih su poticali izolati P. mirabilis koji stvaraju MBL, prikupljeni su i analizirani retrospektivno. Svi izolati enterobakterija u posmatranom periodu su ispitani na stvaranje MBL. Izolati iz kliničkih uzoraka koji stvaraju MBL (samo jedan izolat od jednog bolesnika) ispitani su primenom multiplex lančane reakcije polimeraze kojom su detektovane i diferencirane familije gena za stvaranje MBL: IPM, VIM, SPM, GIM i SIM. Jula i novembra 2008. godine u ovoj jedinici intenzivne nege, uzeti su brisevi rektuma od svih bolesnika i ispitani na prisustvo izolata P. mirabilis koji stvaraju MBL. Rezultati. U periodu juni - novembar 2008. godine, ukupno devet pacijenata je bilo inficirano sa P. mirabilis koji stvara MBL. Epidemijski izolati prvi put su otkriveni u junu te godine i brzo su se proširili na odeljenju pa je sledećeg meseca, u studiji preseka, kod 10 od ukupno 12 pacijenata (83,3%) nađena kolonizacija rektuma sa P. mirabilis koji stvara MBL. Sa druge strane, posle primene epidemioloških mera kontrole i nadzora, novembra 2008. godine, u posmatranoj jedinici intenzivne nege nije bilo bolesnika s kolonizacijom rektuma ili infekcijom bakterijama P. mirabilis koje stvaraju MBL. Utvrđeno je sedam slučajeva bakterijemije uključujući tri slučaja povezana sa primenom intravenskog katetera, jedna infekcija rane hirurškog mesta i jedna infekcija urinarnog trakta. Šest od devet MBL pozitivnih izolata P. mirabilis pripadalo je IPM familiji, dok su ostala tri pripadala VIM familiji. Stopa smrtnosti inficiranih pacijenata iznosila je 56%, ali se nije mogla utvrditi smrtnost koja bi se mogla pripisati samoj infekciji. Zaključak. Pojava P. mirabilis koji stvara MBL u našoj bolnici predstavlja važan izazov za kliničke lekare, mikrobiologe i bolničke epidemiologe jer uz postojeću visoku učestalost rezistencije ograničava se mogućnost efikasne antibiotske terapije. Epidemiološke mere kontrole i nadzora nad ovom epidemijom bile su uspešne.
Abstract
Background. We described an emerging outbreak of infection caused by metallo-ß-lactamase (MBL)-producing Proteus mirabilis that occurred in the surgical ICU of a Serbian university hospital, and assessed this outbreak in a retrospective observational study. Methods. Records from patients in this ICU who had MBL-producing P. mirabilis isolates were reviewed retrospectively. All enterobacterial isolates from clinical specimens (one per patient) were tested for MBL production. We used a multiplex PCR assay to detect and differentiate each of the MBL gene families: IPM, VIM, SPM, GIM and SIM. In July and in November 2008, we conducted a point prevalence survey of rectal colonization with MBL-producing P. mirabilis. Results. From June through November, 2008, nine patients in the surgical ICU were infected by MBL-producing P. mirabilis. These isolates exhibited multi-drug resistance. The outbreak was discovered in June and expanded rapidly; ten of twelve (83%) patients in ICU were colonized with outbreak strains in July. Seven cases of bacteremia, including 3 intravascular catheter related, one surgical site infection, and one urinary tract infection were identified. Six of nine MBL-positive P. mirabilis strains belonged to the IPM family, and three others belonged to the VIM family. Actual mortality was 56%, but we could not determine mortality indirectly attributable to the infection. Conclusion. The rapid emergence of MBL-producing P. mirabilis within a Serbian hospital created a challenge for clinicians, microbiologists, and epidemiologists. This resistant infection added further to the established cases of antimicrobial resistance within the hospital.
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Reference
|
|
  
|
Daikos, G.L., Petrikkos, P., Psichogiou, M., Kosmidis, C., Vryonis, E., Skoutelis, A., Georgousi, K., Tzouvelekis, L.S., Tassios, P.T., Bamia, C., Petrikkos, G. (2009) Prospective observational study of the impact of VIM-1 metallo-β-lactamase on the outcome of patients with Klebsiella pneumoniae bloodstream infections. Antimicrobial Agents and Chemotherapy, 53(5): 1868-1873
|
|
|
Drieux, L., Brossier, F., Sougakoff, W., Jarlier, V. (2008) Phenotypic detection of extended-spectrum β-lactamase production in Enterobacteriaceae: Review and bench guide. Clinical Microbiology and Infection, 14 suppl. 1: 90-103
|
|
|
Ellington, M.J., Kistler, J., Livermore, D.M., Woodford, N. (2007) Multiplex PCR for rapid detection of genes encoding acquired metallo-β-lactamases. Journal of Antimicrobial Chemotherapy, 59(2): 321-322
|
|
|
Giakkoupi, P., Tzouvelekis, L.S., Daikos, G.L., Miriagou, V., Petrikkos, G., Legakis, N.J., Vatopoulos, A.C. (2005) Discrepancies and interpretation problems in susceptibility testing of VIM-1-producing klebsiella pneumoniae isolates. Journal of Clinical Microbiology, 43(1): 494-496
|
|
|
Jones, R.N., Biedenbach, D.J., Sader, H.S., Fritsche, T.R., Toleman, M.A., Walsh, T.R. (2005) Emerging epidemic of metallo-β-lactamase-mediated resistances. Diagnostic Microbiology and Infectious Disease, 51(2): 77-84
|
|
|
Miriagou, V., Papagiannitsis, C.C., Tzelepi, E., Casals, J.B., Legakis, N.J., Tzouvelekis, L.S. (2010) Detecting VIM-1 production in Proteus mirabilis by an imipenem-dipicolinic acid double disk synergy test. Journal of Clinical Microbiology, 48(2): 667-668
|
|
 
|
Paterson, D.L., Bonomo, R.A. (2005) Extended-spectrum β-lactamases: A clinical update. Clinical Microbiology Reviews, 18(4): 657-686
|
|
|
Queenan, A.M., Bush, K. (2007) Carbapenemases: The versatile β-lactamases. Clinical Microbiology Reviews, 20(3): 440-458, table of contents
|
|
|
Souli, M., Kontopidou, F.V., Papadomichelakis, E., Galani, I., Armaganidis, A., Giamarellou, H. (2008) Clinical experience of serious infections caused by Enterobacteriaceae producing VIM-1 metallo-β-lactamase in a Greek university hospital. Clinical Infectious Diseases, 46(6): 847-854
|
|
|
Struelens, M.J., Monnet, D.L., Magiorakos, A.P., o'Connor Santos, F., Giesecke, J., Štefkoviková, M., The, E.N.S.P. (2010) New Delhi metallo-beta-lactamase 1-producing Enterobacteriaceae: Emergence and response in Europe. Eurosurveillance, 15(46), http://www.eu-rosurveillance.org/ViewArticle.aspx?Articleld=19716, accessed August 19, 2011
|
|
|
Tsakris, A., Ikonomidis, A.A., Poulou, A., Spanakis, N., Pournaras, S., Markou, F. (2007) Transmission in the community of clonal Proteus mirabilis carrying VIM-1 metallo-β-lactamase. Journal of Antimicrobial Chemotherapy, 60(1): 136-139
|
|
|
Walsh, T.R., Toleman, M.A., Poirel, L., Nordmann, P. (2005) Metallo-β-lactamases: The quiet before the storm?. Clinical Microbiology Reviews, 18(2): 306-325
|
|
|
|
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