Skip to main content
Epidemiology and Infection logoLink to Epidemiology and Infection
. 1995 Aug;115(1):61–70. doi: 10.1017/s095026880005812x

Control of infection with multiple antibiotic resistant bacteria in a hospital renal unit: the value of plasmid characterization.

C S Reed 1, S P Barrett 1, E J Threlfall 1, T Cheasty 1
PMCID: PMC2271566  PMID: 7641839

Abstract

An outbreak of infections due to multiple antibiotic-resistant bacteria took place over a period of approximately 18 months in a renal unit. Strains of Escherichia coli, Enterobacter aerogenes, Klebsiella pneumoniae, Citrobacter spp. and Pseudomonas spp. were involved, and a variety of antibiotic resistances was encountered. Closely related plasmids encoding resistance to aztreonam, ceftazidime and piperacillin, possibly derived from an archetypal plasmid of 105 kb were found in the majority of isolates examined. After limiting the use of aztreonam the incidence of new patient isolates of multiple-resistant organisms was greatly reduced. This study demonstrated how molecular studies can contribute to the control of an outbreak situation in a hospital unit by providing an impetus to reduce the use of specific antibiotics.

Full text

PDF
61

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brun-Buisson C., Legrand P., Rauss A., Richard C., Montravers F., Besbes M., Meakins J. L., Soussy C. J., Lemaire F. Intestinal decontamination for control of nosocomial multiresistant gram-negative bacilli. Study of an outbreak in an intensive care unit. Ann Intern Med. 1989 Jun 1;110(11):873–881. doi: 10.7326/0003-4819-110-11-873. [DOI] [PubMed] [Google Scholar]
  2. Grindley N. D., Grindley J. N., Anderson E. S. R factor compatibility groups. Mol Gen Genet. 1972;119(4):287–297. doi: 10.1007/BF00272087. [DOI] [PubMed] [Google Scholar]
  3. Hammami A., Arlet G., Ben Redjeb S., Grimont F., Ben Hassen A., Rekik A., Philippon A. Nosocomial outbreak of acute gastroenteritis in a neonatal intensive care unit in Tunisia caused by multiply drug resistant Salmonella wien producing SHV-2 beta-lactamase. Eur J Clin Microbiol Infect Dis. 1991 Aug;10(8):641–646. doi: 10.1007/BF01975816. [DOI] [PubMed] [Google Scholar]
  4. Handwerger S., Raucher B., Altarac D., Monka J., Marchione S., Singh K. V., Murray B. E., Wolff J., Walters B. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin. Clin Infect Dis. 1993 Jun;16(6):750–755. doi: 10.1093/clind/16.6.750. [DOI] [PubMed] [Google Scholar]
  5. Henderson D. K., Baptiste R., Parrillo J., Gill V. J. Indolent epidemic of Pseudomonas cepacia bacteremia and pseudobacteremia in an intensive care unit traced to a contaminated blood gas analyzer. Am J Med. 1988 Jan;84(1):75–81. doi: 10.1016/0002-9343(88)90011-3. [DOI] [PubMed] [Google Scholar]
  6. John J. F., Jr, Twitty J. A. Plasmids as epidemiologic markers in nosocomial gram-negative bacilli: experience at a university and review of the literature. Rev Infect Dis. 1986 Sep-Oct;8(5):693–704. doi: 10.1093/clinids/8.5.693. [DOI] [PubMed] [Google Scholar]
  7. Kado C. I., Liu S. T. Rapid procedure for detection and isolation of large and small plasmids. J Bacteriol. 1981 Mar;145(3):1365–1373. doi: 10.1128/jb.145.3.1365-1373.1981. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. McAllister T. A., Lucas C. E., Mocan H., Liddell R. H., Gibson B. E., Hann I. M., Platt D. J. Serratia marcescens outbreak in a paediatric oncology unit traced to contaminated chlorhexidine. Scott Med J. 1989 Oct;34(5):525–528. doi: 10.1177/003693308903400506. [DOI] [PubMed] [Google Scholar]
  9. Orskov F., Orskov I. Escherichia coli O:H serotypes isolated from human blood. Prevalence of the K1 antigen with technical details of O and H antigenic determination. Acta Pathol Microbiol Scand Suppl. 1975 Dec;83(6):595–600. [PubMed] [Google Scholar]
  10. Price D. J., Sleigh J. D. Control of infection due to Klebsiella aerogenes in a neurosurgical unit by withdrawal of all antibiotics. Lancet. 1970 Dec 12;2(7685):1213–1215. doi: 10.1016/s0140-6736(70)92179-3. [DOI] [PubMed] [Google Scholar]
  11. Rice L. B., Willey S. H., Papanicolaou G. A., Medeiros A. A., Eliopoulos G. M., Moellering R. C., Jr, Jacoby G. A. Outbreak of ceftazidime resistance caused by extended-spectrum beta-lactamases at a Massachusetts chronic-care facility. Antimicrob Agents Chemother. 1990 Nov;34(11):2193–2199. doi: 10.1128/aac.34.11.2193. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Ritter E., Bauernfeind A., Becker-Boost E., Fiehn A., Stöcker H., Wirsing von König C. H., Finger H. Ausbruch einer nosokomialen Infektion durch SHV2-Betalaktamase-bildende Klebsiella-pneumoniae-Stämme in einer operativen Intensivstation. Immun Infekt. 1992 Feb;20(1):3–6. [PubMed] [Google Scholar]
  13. Rubens C. E., Farrar W. E., Jr, McGee Z. A., Schaffner W. Evolution of a plasmid mediating resistance to multiple antimicrobial agents during a prolonged epidemic of nosocomial infections. J Infect Dis. 1981 Feb;143(2):170–181. doi: 10.1093/infdis/143.2.170. [DOI] [PubMed] [Google Scholar]
  14. Rutala W. A., Kennedy V. A., Loflin H. B., Sarubbi F. A., Jr Serratia marcescens nosocomial infections of the urinary tract associated with urine measuring containers and urinometers. Am J Med. 1981 Mar;70(3):659–663. doi: 10.1016/0002-9343(81)90592-1. [DOI] [PubMed] [Google Scholar]
  15. Threlfall E. J., Rowe B., Ferguson J. L., Ward L. R. Characterization of plasmids conferring resistance to gentamicin and apramycin in strains of Salmonella typhimurium phage type 204c isolated in Britain. J Hyg (Lond) 1986 Dec;97(3):419–426. doi: 10.1017/s0022172400063609. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Threlfall E. J., Rowe B., Ward L. R. Subdivision of Salmonella enteritidis phage types by plasmid profile typing. Epidemiol Infect. 1989 Jun;102(3):459–465. doi: 10.1017/s095026880003017x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Vandenbroucke-Grauls C. M., Kerver A. J., Rommes J. H., Jansen R., den Dekker C., Verhoef J. Endemic Acinetobacter anitratus in a surgical intensive care unit: mechanical ventilators as reservoir. Eur J Clin Microbiol Infect Dis. 1988 Aug;7(4):485–489. doi: 10.1007/BF01962597. [DOI] [PubMed] [Google Scholar]
  18. Ward L. R., Threlfall E. J., Rowe B. Multiple drug resistance in salmonellae in England and Wales: a comparison between 1981 and 1988. J Clin Pathol. 1990 Jul;43(7):563–566. doi: 10.1136/jcp.43.7.563. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Epidemiology and Infection are provided here courtesy of Cambridge University Press

RESOURCES