A type of drug-resistant Pseudomonas aeruginosa discovered in an Ohio long-term care facility has killed one person and infected six others, according to clinician researchers. A dangerous genetic element of this pathogen might already have been spreading, and “surveillance is urgently needed,” the investigators announced.
The infection initially was found in the foot wound of a 69-year-old diabetic long-term care resident in 2012, the clinicians reported in a scholarly article on their research into the pathogen. Throughout 2012 and 2013, the other cases were discovered. Their “epidemiological link” appears to be admission to a community hospital and long-term care facility in northeastern Ohio, with the exception of one outlier case of a person brought to the area for care from Qatar.
“Patients who were affected had multiple comorbidities, endured prolonged colonization, required long-term care and, in one instance, had a lethal outcome from a bloodstream infection,” the study authors wrote.
The pathogen was highly resistant to antibiotics — including “last resort” colistin — due in large part to the presence of a drug-resistant enzyme that is common in some countries but rare in the United States, the investigators determined. The enzyme was found in a genetic element known as an integron, which can “jump” between different types of bacteria.
Genomic sequencing also found that a “recombination event” had occurred between Salmonella and P. aeruginosa, giving the latter even more resistance genes and creating the possibility of “enhanced virulence,” the investigators discovered. This is the first time this type of genetic exchange has been described, they noted.
No infections have been detected in the year since the last case, the authors stated. Their full findings appear online and will be forthcoming in the journal Antimicrobial Agents and Chemotherapy.
The threat of multi-drug resistant pathogens has grown more dire in recent years, putting pressure on long-term care facilities and other facilities to boost infection control and antibiotic stewardship efforts.
