High mortality of bloodstream infection outbreak caused by carbapenem-resistant P. aeruginosa producing SPM-1 in a bone marrow transplant unit
| Autor: | Lucas Chaves, Gleice Cristina Leite, Roberta Ruedas Martins, Thais Guimarães, Marjorie Vieira Batista, Anna S. Levin, Matias Chiarastelli Salomão, Ulysses Amigo, Jessica Fernandes Ramos, Silvia Figueiredo Costa, Lisia Gomes Martins de Moura Tomich, Camila Rizek, Patrícia R. Neves |
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| Rok vydání: | 2017 |
| Předmět: |
Adult
Male 0301 basic medicine Microbiology (medical) Carbapenem 030106 microbiology Virulence Bacteremia Biology Neutropenia medicine.disease_cause Microbiology Bacterial Adhesion beta-Lactamases Virulence factor Disease Outbreaks 03 medical and health sciences Bacterial Proteins Risk Factors Drug Resistance Multiple Bacterial medicine Humans Pseudomonas Infections Risk factor Bone Marrow Transplantation Pseudomonas aeruginosa Mortality rate Outbreak General Medicine Length of Stay Middle Aged bacterial infections and mycoses medicine.disease Virology Anti-Bacterial Agents Carbapenems Biofilms Case-Control Studies Female Brazil Genome-Wide Association Study medicine.drug |
| Zdroj: | Journal of Medical Microbiology. 66:1722-1729 |
| ISSN: | 1473-5644 0022-2615 |
| Popis: | Purpose. Carbapenem resistance in P. aeruginosa is increasing worldwide. In Brazil, SPM-1 is the main P. aeruginosa carbapenemase identified. Little is known about the virulence factor in SPM-1 clones. Methodolgy. We describe a carbapenem-resistant P. aeruginosa bloodstream infection (CRPa-BSI) outbreak in a bone marrow transplant Unit (BMT). Twenty-nine CRPa-BSI cases were compared to 58 controls. Microbiological characteristics of isolates, such as sensitivity, carbapenemase gene PCR for P. aeruginosa, and PFGE are described, as well as the whole-genome sequence (WGS) of three strains. Results/Key findings. The cultures from environmental and healthcare workers were negative. Some isolates harboured KPC and SPM. The WGS showed that the 03 strains belonged to ST277, presented the same mutations in outer membrane protein, efflux pump, and virulence genes such as those involved in adhesion, biofilm, quorum-sensing and the type III secretion system, but differ regarding the carbapenemase profile. A predominant clone-producing SPM harbouring Tn 4371 was identified and showed cross-transmission; no common source was found. Overall mortality rate among cases was 79 %. The first multivariate analysis model showed that neutropenia (P=0.018), GVHD prophylaxis (P=0.016) and prior use of carbapenems (P=0.0089) were associated with CRPa-BSI. However, when MASCC>21 points and platelets were added in the final multivariate analysis, only prior use of carbapenems remained as an independent risk factor for CRPa-BSI (P=0.043). Conclusions. The predominant clone belonging to ST277 showed high mortality. Carbapenem use was the only risk factor associated with CRPa-BSI. This finding is a wake-up call for the need to improve management in BMT units. |
| Databáze: | OpenAIRE |
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