Characterization of an epidemic carbapenem-resistant Pseudomonas aeruginosa producing SPM-1 metallo-beta-lactamase in a hospital located in Rio de Janeiro, Brazil

Metallo-beta-lactamase production is emerging worldwide as an important mechanism of carbapenem resistance among nonfermentative Gram-negative isolates, and this mechanism is becoming frequently observed in Brazil. This study documents the occurrence and characteristics of an epidemic SPM-1-producing Pseudomonas aeruginosa strain in a teaching hospital located in Rio de Janeiro City, Brazil. The bla (SPM-1) gene and a class 1 integron were detected in 13 isolates, representing 20% of the 65 imipenem-resistant P. aeruginosa isolates obtained from January, 2000, to August, 2001. DNA sequencing revealed that this integron carries three gene cassettes that confer resistance to antimicrobials, aacA4, bla (OXA-56), and aadA7, and an orf1 encoding a putative transposase. All 13 SPM-producing P. aeruginosa isolates had closely related pulsed-field gel electrophoresis (PFGE) profiles, designated as clonal group A, suggesting nosocomial spread of the strain. This clonal group was the same as that observed in other SPM-1-producing P. aeruginosa isolates from distinct Brazilian states. The dissemination of this clone throughout Brazil could not be explained by transfer of infected patients and/or sharing of common health-care staff. It is likely that the spread of these strains occurred indirectly via the community.