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Mortality related to Verona Integron-encoded Metallo-?-lactamase-positive Pseudomonas aeruginosa: assessment by a novel clinical tool.

ABSTRACT: Background:Verona Integron-encoded Metallo-?-lactamase-positive Pseudomonas aeruginosa (VIM-PA) can cause nosocomial infections and may be responsible for increased mortality. Multidrug resistance in VIM-PA complicates treatment. We aimed to assess the contribution of VIM-PA to mortality in patients in a large tertiary care hospital in the Netherlands. Methods:A focus group of five members created a scheme to define related mortality based on clinical and diagnostic findings. Contribution to mortality was categorized as "definitely", "probably", "possibly", or "not" related to infection with VIM-PA, or as "unknown". Patients were included when infected with or carrier of VIM-PA between January 2008 and January 2016. Patient-related data and specific data on VIM-PA cultures were retrieved from the electronic laboratory information system. For patients who died in our hospital, medical records were independently reviewed and thereafter discussed by three physicians. Results:A total of 198 patients with any positive culture with VIM-PA were identified, of whom 95 (48.0%) died. Sixty-seven patients died in our hospital and could be included in the analysis. The death of 15 patients (22.4%) was judged by all reviewers to be definitely related to infection with VIM-PA. In 17 additional patients (25.4%), death was probably or possibly related to an infection with VIM-PA. The level of agreement was 65.7% after the first evaluation, and 98.5% after one session of discussion. Conclusion:Using our assessment tool, infections with VIM-PA were shown to have an important influence on mortality in our complex and severely ill patients. The tool may be used for other (resistant) bacteria as well but this needs further exploration.

SUBMITTER: Persoon MC

PROVIDER: S-EPMC6582487 | biostudies-literature | 2019

REPOSITORIES: biostudies-literature

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Mortality related to Verona Integron-encoded Metallo-β-lactamase-positive <i>Pseudomonas aeruginosa</i>: assessment by a novel clinical tool.

Persoon Marjolein C MC Voor In 't Holt Anne F AF van Meer Maurits P A MPA Bokhoven Karen C KC Gommers Diederik D Vos Margreet C MC Severin Juliëtte A JA

Antimicrobial resistance and infection control 20190619

<h4>Background</h4>Verona Integron-encoded Metallo-β-lactamase-positive <i>Pseudomonas aeruginosa</i> (VIM-PA) can cause nosocomial infections and may be responsible for increased mortality. Multidrug resistance in VIM-PA complicates treatment. We aimed to assess the contribution of VIM-PA to mortality in patients in a large tertiary care hospital in the Netherlands.<h4>Methods</h4>A focus group of five members created a scheme to define related mortality based on clinical and diagnostic finding ...[more]

PMID: 31244998

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Project description:BackgroundAntibiotic resistance is often spread through bacterial populations via conjugative plasmids. However, plasmid transfer is not well recognized in clinical settings because of technical limitations, and health care-associated infections are usually caused by clonal transmission of a single pathogen. In 2015, multiple species of carbapenem-resistant Enterobacteriaceae (CRE), all producing a rare carbapenemase, were identified among patients in an intensive care unit. This observation suggested a large, previously unrecognized plasmid transmission chain and prompted our investigation.MethodsElectronic medical record reviews, infection control observations, and environmental sampling completed the epidemiologic outbreak investigation. A laboratory analysis, conducted on patient and environmental isolates, included long-read whole-genome sequencing to fully elucidate plasmid DNA structures. Bioinformatics analyses were applied to infer plasmid transmission chains and results were subsequently confirmed using plasmid conjugation experiments.ResultsWe identified 14 Verona integron-encoded metallo-ß-lactamase (VIM)-producing CRE in 12 patients, and 1 additional isolate was obtained from a patient room sink drain. Whole-genome sequencing identified the horizontal transfer of blaVIM-1, a rare carbapenem resistance mechanism in the United States, via a promiscuous incompatibility group A/C2 plasmid that spread among 5 bacterial species isolated from patients and the environment.ConclusionsThis investigation represents the largest known outbreak of VIM-producing CRE in the United States to date, which comprises numerous bacterial species and strains. We present evidence of in-hospital plasmid transmission, as well as environmental contamination. Our findings demonstrate the potential for 2 types of hospital-acquired infection outbreaks: those due to clonal expansion and those due to the spread of conjugative plasmids encoding antibiotic resistance across species.

Dataset Information

Mortality related to Verona Integron-encoded Metallo-?-lactamase-positive Pseudomonas aeruginosa: assessment by a novel clinical tool.

Publications

Mortality related to Verona Integron-encoded Metallo-β-lactamase-positive <i>Pseudomonas aeruginosa</i>: assessment by a novel clinical tool.

Similar Datasets

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