The role of interventional molecular epidemiology in controlling clonal clusters of multidrug resistant Pseudomonas aeruginosa in critically ill cancer patients

• Published in: American journal of infection control 2009-08, Vol.37 (6), p.442-446
• Main Authors: Adachi, Javier A., MD, Perego, Cheryl, MPH, Graviss, Linda, MT, Dvorak, Tanya, BS, Hachem, Ray, MD, Chemaly, Roy F., MD, Raad, Issam I., MD
• Format: Article
• Language: English
• Subjects: Anti-Bacterial Agents - pharmacology; Bacteria; Bacterial Typing Techniques - methods; Cluster Analysis; Critical care; Critical Illness; Cross Infection - epidemiology; Cross Infection - microbiology; Disease control; Disease Outbreaks; DNA Fingerprinting - methods; DNA, Bacterial - genetics; Drug resistance; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field - methods; Epidemiology; Genotype; Humans; Infection Control; Infection Control - methods; Infectious Disease; Microbial Sensitivity Tests; Molecular Epidemiology; Neoplasms - complications; Nosocomial infections; Pseudomonas aeruginosa - classification; Pseudomonas aeruginosa - drug effects; Pseudomonas aeruginosa - genetics; Pseudomonas aeruginosa - isolation & purification; Pseudomonas Infections - epidemiology; Pseudomonas Infections - microbiology
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2008.09.012

Background Pseudomonas aeruginosa is one of the leading causes of hospital-acquired infections in intensive care units (ICUs). The objective was to evaluate the impact of molecular identification of clonal multidrug-resistant (MDR) P aeruginosa strains and the implementation of infection control measures. Methods One hundred seventy-seven strains from ICU patients infected or colonized with MDR P aeruginosa from May 2001 to April 2006 were collected. In vitro susceptibility to 16 antibiotics was done. Pulsed-field gel electrophoresis was performed to identify clonal strains. Nosocomial outbreak was defined as the presence of ≥3 MDR P aeruginosa over ≤3 consecutive months. Results During the 5 years of the study, 25 infected and 14 colonized patients with a clonal strain of MDR P aeruginosa were distributed among 5 episodic clusters. These strains were only susceptible to ceftazidime and colistin. Molecular biology identification, diligent monitoring, and multidisciplinary infection control interventions were implemented to suppress this clonal strain after each cluster. Even more, after the last outbreak (June-August 2005), the infection control measures were able to reduce the MDR P aeruginosa to zero during the last 8 months of this study. Conclusion Interventional molecular epidemiology combined with early identification, monitoring, and implementation of multidisciplinary infection control measures can control temporarily the transmission of MDR P aeruginosa infection in ICUs.