Email updates

Keep up to date with the latest news and content from Antimicrobial Resistance and Infection Control and BioMed Central.

Open Access Short report

Difficult-to-detect carbapenem-resistant IMP13-producing P. aeruginosa: experience feedback concerning a cluster of urinary tract infections at a surgical clinic in France

Odile Milan1, Laurent Debroize2, Xavier Bertrand34, Patrick Plesiat5, Anne-Sophie Valentin6, Roland Quentin6 and Nathalie Van der Mee-Marquet67*

Author Affiliations

1 Clinique Notre dame de Bon Secours, Chartres, France

2 Laboratoire d’Analyses Médicales, Luisant, France

3 Service d’Hygiène, Centre Hospitalier Universitaire, Besançon, France

4 UMR 6249 Chrono-environnement, Université de Franche-Comté, Besançon, France

5 Centre National de référence, Centre Hospitalier Universitaire, Université de Franche-Comté, Besançon, France

6 Service de Bactériologie et Hygiène, Tours, France

7 Réseau des Hygiénistes du Centre, Hôpital Trousseau, Centre Hospitalier Universitaire, Tours, France

For all author emails, please log on.

Antimicrobial Resistance and Infection Control 2013, 2:12  doi:10.1186/2047-2994-2-12

Published: 4 April 2013

Abstract

Background

We report a carbapenem-resistant P. aeruginosa clone responsible for a cluster of urinary tract infections in elderly surgery patients, diagnosed during a three-month period in a 59-bed surgical clinic.

Findings

The clonal nature of the cluster was established by molecular study of the P. aeruginosa isolates (PFGE and MLST). Despite an MIC of imipenem in the susceptibility range for two isolates, all were metallo-β-lactamase-producers (IMP13-type, clone ST621). We conducted a review of the medical and surgical procedures. We tested water delivered into the clinic and urological devices for the presence of the epidemic strain. The hygiene nurse observed hygiene practices. A week after the implementation of barrier precautions around the fourth infected patient, we studied the extent to which the patients hospitalised were colonised to assess whether the spread of the epidemic strain had been controlled.

Conclusions

1/ Our findings indicate the difficulties in the detection of the metallo-β-lactamase in this clone, that resulted in the alert being delayed. 2/ Unlike most investigations of UTI outbreaks described in urology wards, we did not detect any contaminated urological devices or water colonisation. 3/ Consistent with outbreaks involving the IMP-13 clone in critical care units, the observation of inadequate application of standard precautions argued for patient-to-patient transmission during urinary management of the urology patients. 4/ The implementation of barrier precautions around infected patients resulted in control of the spread of the epidemic clone. This report serves as an alert concerning a difficult-to-detect multidrug-resistant P. aeruginosa clone in elderly urology patients.