RESUMEN
During a 2-year period (April 2005-March 2007), 31 intensive care unit (ICU) patients in a Greek hospital were infected or colonised with imipenem-resistant isolates of Acinetobacter baumannii. Twelve patients died, with imipenem-resistant A. baumannii infection contributing to the death of seven patients. The 31 representative A. baumannii isolates were multidrug-resistant and clustered in four distinct clones, each of which contained different carbapenemase genes: clone I was predominant and contained bla(VIM-1), bla(OXA-58) and the intrinsic bla(OXA-66) gene; clone II contained bla(VIM-4), bla(OXA-58) and the intrinsic bla(OXA-69) gene; clone III contained bla(OXA-58) and the intrinsic bla(OXA-69) gene; and clone IV contained only the intrinsic bla(OXA-66) gene. ISAba1 was not associated with the intrinsic bla(OXA-51-like) alleles, whereas ISAba3 was found upstream and downstream of bla(OXA-58) in isolates of clone I, and upstream of bla(OXA-58) in isolates of clone III, but was not detected in isolates of clone II. PCR, curing and hybridisation experiments indicated that the bla(VIM) alleles were chromosomally located, whereas the bla(OXA-58) alleles were plasmid-located. This study provides the first description of the clonal spread of multidrug-resistant A. baumannii isolates carrying bla(VIM-1) and bla(VIM-4) metallo-beta-lactamase genes, and revealed that distinct carbapenem-resistant A. baumannii clusters bearing different carbapenemase genes may emerge and cause severe infections, even in a well-defined regional hospital setting.
Asunto(s)
Infecciones por Acinetobacter/epidemiología , Acinetobacter baumannii/genética , Proteínas Bacterianas/genética , Farmacorresistencia Bacteriana Múltiple/genética , Imipenem/farmacología , Unidades de Cuidados Intensivos , beta-Lactamasas/genética , Acinetobacter baumannii/enzimología , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Análisis por Conglomerados , Infección Hospitalaria/epidemiología , ADN Bacteriano/análisis , Brotes de Enfermedades , Femenino , Genes Bacterianos , Grecia/epidemiología , Hospitales Generales , Humanos , Incidencia , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Infecciones Oportunistas/epidemiología , Vigilancia de Guardia , Análisis de Secuencia de ADNRESUMEN
We report a case of fulminant massive hemolysis due to Clostridium perfringens septicemia in an elderly patient with non-systematic or local predisposing disorder. The patient presented with atypical symptoms but the progress of the disease was extremely rapid and he died almost 3h after his hospital admission. A focal infection or a possible portal of bacterial access was not found.
