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J Hosp Infect ; 87(4): 234-40, 2014 Aug.
Article in English | MEDLINE | ID: mdl-25027563

ABSTRACT

BACKGROUND: Metallo-ß-lactamases (MBLs) have emerged as one of the most important bacterial resistance mechanisms because of their ability to hydrolyse virtually all ß-lactam agents. MBL-producing Pseudomonas aeruginosa (MBL-PA) are an important cause of nosocomial infections, particularly in intensive care units (ICUs), where they are associated with serious infections and present a significant clinical risk. AIM: To assess the molecular epidemiology, risk factors and outcomes of nosocomial infections caused by MBL-PA in a teaching hospital in Southern Brazil. METHODS: From January 2001 to December 2008, 142 carbapenem-resistant P. aeruginosa strains were isolated from distinct clinical samples from hospitalized patients. These isolates were screened for MBLs, and underwent polymerase chain reaction, sequencing and pulsed-field gel electrophoresis (PFGE). Patients infected with carbapenem-resistant MBL-PA were considered as cases, and patients infected with non-MBL-PA were considered as controls. FINDINGS: Eighty-four of 142 patients with positive carbapenem-resistant P. aeruginosa cultures met the criteria of the Centers for Disease Control and Prevention for infection. Fifty-eight patients were infected with MBL-PA (69%) and 26 patients were infected with non-MBL-PA (31%). Multi-variate analysis revealed that ICU stay [P = 0.003, odds ratio (OR) 4.01, 95% confidence interval (CI) 1.15-14.01] and urinary tract infection (P = 0.001, OR 9.67, 95% CI 1.72-54.48) were important risk factors for MBL-PA infection. Patients infected with MBL-PA showed faster onset of infection (P = 0.002) and faster progression to death (P = 0.04). CONCLUSIONS: These results showed the severity of MBL-PA infections, and demonstrated the urgent need for strategies to improve infection control measures to prevent an increase in these nosocomial infections.


Subject(s)
Bacterial Proteins/metabolism , Cross Infection/epidemiology , Cross Infection/pathology , Pseudomonas Infections/epidemiology , Pseudomonas Infections/pathology , Pseudomonas aeruginosa/enzymology , beta-Lactamases/metabolism , Adolescent , Adult , Aged , Aged, 80 and over , Brazil/epidemiology , Case-Control Studies , Child , Cross Infection/microbiology , Cross Infection/prevention & control , DNA, Bacterial/chemistry , DNA, Bacterial/genetics , Electrophoresis, Gel, Pulsed-Field , Female , Hospitals, Teaching , Humans , Infection Control/methods , Male , Middle Aged , Polymerase Chain Reaction , Pseudomonas Infections/microbiology , Pseudomonas Infections/prevention & control , Pseudomonas aeruginosa/classification , Pseudomonas aeruginosa/genetics , Pseudomonas aeruginosa/isolation & purification , Retrospective Studies , Risk Factors , Sequence Analysis, DNA , Survival Analysis , Treatment Outcome , Young Adult
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