Emergence of multidrug-resistant Providencia rettgeri isolates co-producing NDM-1 carbapenemase and PER-1 extended-spectrum β-lactamase causing a first outbreak in Korea

Ann Clin Microbiol Antimicrob. 2018 May 5;17(1):20. doi: 10.1186/s12941-018-0272-y.

Abstract

Background: Nosocomial outbreak due to carbapenem-resistant Enterobacteriaceae has become serious challenge to patient treatment and infection control. We describe an outbreak due to a multidrug-resistant Providencia rettgeri from January 2016 to January 2017 at a University Hospital in Seoul, Korea.

Methods: A total of eight non-duplicate P. rettgeri isolates were discovered from urine samples from eight patients having a urinary catheter and admitted in a surgical intensive care unit. The β-lactamase genes were identified using polymerase chain reaction and direct sequencing, and strain typing was done with pulsed-field gel electrophoresis (PFGE).

Results: All isolates showed high-level resistance to extended-spectrum cephalosporins, aztreonam, meropenem, ertapenem, ciprofloxacin, and amikacin. They harbored the blaNDM-1 carbapenemase and the blaPER-1 type extended-spectrum β-lactamases genes. PFGE revealed that all isolates from eight patients were closely related strains.

Conclusions: The 13-month outbreak ended following reinforcement of infection control measures, including contact isolation precautions and environmental disinfection. This is the first report of an outbreak of a P. rettgeri clinical isolates co-producing NDM-1 and PER-1 β-lactamase.

Keywords: NDM-1; Outbreak; PER-1; Providencia rettgeri; Urinary tract infection.

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Bacterial Proteins / genetics
  • Disease Outbreaks*
  • Drug Resistance, Multiple, Bacterial / drug effects
  • Drug Resistance, Multiple, Bacterial / genetics*
  • Electrophoresis, Gel, Pulsed-Field / methods
  • Enterobacteriaceae Infections / epidemiology*
  • Enterobacteriaceae Infections / microbiology*
  • Female
  • Genes, Bacterial / genetics
  • Humans
  • Intensive Care Units
  • Male
  • Microbial Sensitivity Tests
  • Providencia / drug effects
  • Providencia / genetics*
  • Providencia / isolation & purification*
  • Providencia / pathogenicity*
  • Republic of Korea / epidemiology
  • Urinary Catheters / microbiology
  • Urinary Tract Infections / epidemiology
  • Urinary Tract Infections / microbiology
  • Urine / microbiology
  • beta-Lactamases / genetics

Substances

  • Anti-Bacterial Agents
  • Bacterial Proteins
  • beta-lactamase PER-1
  • beta-Lactamases
  • beta-lactamase NDM-1
  • carbapenemase