RESUMEN
OBJECTIVES: To elucidate the epidemiology of widespread ciprofloxacin resistance in our Veterans Affairs medical center using whole cell DNA analysis. DESIGN: In vitro study of ciprofloxacin resistant and susceptible Enterobacteriaceae isolated during the course of a clinical epidemiologic study of quinolone resistance. SETTING: Veterans Affairs Medical Center with acute care and long-term care divisions. RESULTS: We examined 40 ciprofloxacin-resistant strains of Serratia marcescens, Proteus mirabilis, and Providencia stuartii using restriction endonuclease analysis of whole cell DNA and compared them with concomitantly isolated ciprofloxacin sensitive strains. We sought to determine whether resistant strains were identical to susceptible strains, indicating in vivo emergence of resistant strains from susceptible strains, and whether resistant strains were shared among patients. All 26 ciprofloxacin-resistant S marcescens isolates shared a single ecoRI restriction pattern. Multiple patterns were seen in the ciprofloxacin-susceptible S marcescens isolates; however, several isolates had a pattern matching that of the resistant isolates. Similar results were seen among the P mirabilis isolates. Three different ecoRI patterns were found among the ciprofloxacin-resistant P stuartii isolates; none matched those found among the susceptible isolates. The frequency of spontaneous emergence of ciprofloxacin resistance in susceptible S marcescens strains with restriction pattern matching that of the resistant strains was significantly higher than that of nonmatching strains. CONCLUSIONS: Ciprofloxacin-resistant strains of Enterobacteriaceae became widespread within a short period of time. Resistant strains of S marcescens and P mirabilis arose from endemic susceptible strains. The resistant strain of S marcescens appeared to arise from a susceptible strain with a relatively high frequency of spontaneous ciprofloxacin resistance.
Asunto(s)
Ciprofloxacina/farmacología , ADN Bacteriano/genética , Enterobacteriaceae/efectos de los fármacos , Estudios de Casos y Controles , Enzimas de Restricción del ADN/genética , Farmacorresistencia Microbiana , Enterobacteriaceae/genética , Hospitales de Veteranos , Humanos , Pruebas de Sensibilidad Microbiana , Serratia marcescens/efectos de los fármacos , Serratia marcescens/genéticaRESUMEN
Although cases of community-acquired Legionnaires' disease have been epidemiologically linked to residential water supplies, the risk of acquiring Legionnaires' disease from exposure to Legionella pneumophila in residential water systems is uncertain. The residential water supplies of 218 members of the American Legion in six different geographical areas in Pittsburgh were cultured for L. pneumophila. Residents of the homes provided a recent medical history and a blood sample for detection of antibodies to legionella. A urine sample for legionella urinary antigen testing was also requested from individuals residing in legionella-positive homes and individuals with a positive antibody test. Six percent (14/218) of the homes yielded L. pneumophila (range within six areas 0-22%). Lower hot water tank temperature was significantly associated with legionella positivity (P less than 0.01). Analysis of water samples for mineral content showed no association between legionella positivity and concentrations of calcium and magnesium. Water samples from the area where 22% of the homes surveyed were positive for legionella had a higher iron content than water samples from the other areas tested. None of the individuals residing in legionella-positive homes showed elevated antibody titres to legionella or the presence of legionella antigen in urine. For the immunocompetent hosts, the risk of contracting Legionnaires' disease from exposure to contaminated household water supplies in the Pittsburgh area appears to be low.
Asunto(s)
Legionella pneumophila/aislamiento & purificación , Enfermedad de los Legionarios/epidemiología , Microbiología del Agua , Abastecimiento de Agua , Adulto , Anciano , Anciano de 80 o más Años , Anticuerpos Antibacterianos/sangre , Antígenos Bacterianos/orina , Calor , Humanos , Legionella pneumophila/inmunología , Persona de Mediana Edad , Minerales/análisis , Análisis Multivariante , Prevalencia , Abastecimiento de Agua/análisisRESUMEN
Legionnaires' disease is a severe pneumonia caused by the bacterium Legionella pneumophila. Outbreaks of Legionnaire's disease have occurred in hotels, hospitals, and homes but had not been reported yet in the work environment. The authors report the occurrence of Legionnaires' disease in three employees of two industrial plants. The potable water in the two plants contained high numbers of Legionella pneumophila. Monoclonal antibody subtyping of environmental and patient isolates of L. pneumophila implicated one of the plants as the source for the disease. L. pneumophila was eradicated from this plant using acidic and caustic scale removers, calcium hypochlorite, and a biocide. A systematic approach to Legionnaires' disease in the work environment, a problem which can be expected to be recognized with increasing frequency, is presented.