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

Saeam Shin; Seok Hoon Jeong; Hyukmin Lee; Jun Sung Hong; Min‑Jeong Park; Wonkeun Song

doi:10.1186/s12941-018-0272-y

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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

Authors: Saeam Shin ; Seok Hoon Jeong ; Hyukmin Lee ; Jun Sung Hong ; Min‑Jeong Park ; Wonkeun Song

Citation: ANNALS OF CLINICAL MICROBIOLOGY AND ANTIMICROBIALS, Vol.17 : 20, 2018

Journal Title: ANNALS OF CLINICAL MICROBIOLOGY AND ANTIMICROBIALS

Issue Date: 2018

MeSH: 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

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

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.