Pseudomonas aeruginosa carbapenem resistance mechanisms in Spain: impact on the activity of imipenem, meropenem and doripenem

Abstract PURPOSE: Pseudomonas aeruginosa causes a wide spectrum of infections including bacteremia, pneumonia, urinary tract infection, etc., Metallo-beta-lactamase (MBL) producing P. aeruginosa is an emerging threat and cause of concern as they have emerged as one of the most feared resistance mechanisms. This study was designed to know the prevalence of MBL production in P. aeruginosa and to evaluate the four phenotypic tests for detection of MBL production in imipenem-resistant clinical isolates of P. aeruginosa. METHODS: Totally, 800 isolates of P. aeruginosa isolated from various clinical samples were evaluated for carbapenem resistance and MBL production. All imipenem-resistant strains were tested for carabapenemase production by modified Hodge test. Screening for MBL production was done by double-disc synergy test and combined disc test (CDT). Confirmation of MBL production was done by the E-test (Ab BioDisk, Solna, Sweden). RESULTS: Out of the 800 isolates of P. aeruginosa, 250 isolates were found resistant to imipenem. Based on the results of E-test, 147 (18.37%) isolates of P. aeruginosa were positive for MBL production. The CDT has the highest sensitivity and specificity for the detection of MBL production as compared to other tests. CONCLUSION: The results of this study are indicative that MBL production is an important mechanism of carbapenem resistance among P. aeruginosa. Use of simple screening test like CDT will be crucial step toward large-scale monitoring of these emerging resistant determinants. Phenotypic test for MBL production has to be standardized, and all the isolates should be routinely screened for MBL production.

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Distribution of carbapenem resistance mechanisms in Pseudomonas aeruginosa isolates among hospitalised children in Poland: Characterisation of two novel insertion sequences disrupting the oprD gene

Journal of Global Antimicrobial Resistance ◽

10.1016/j.jgar.2016.08.007 ◽

2016 ◽

Vol 7 ◽

pp. 119-125 ◽

Cited By ~ 8

Author(s):

Tomasz Wołkowicz ◽

Jan Andrzej Patzer ◽

Wanda Kamińska ◽

Rafał Gierczyński ◽

Danuta Dzierżanowska

Keyword(s):

Pseudomonas Aeruginosa ◽

Carbapenem Resistance ◽

Resistance Mechanisms ◽

Insertion Sequences

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Distribution of carbapenem resistance mechanisms in clinical isolates of XDR Pseudomonas aeruginosa

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-019-03585-0 ◽

2019 ◽

Vol 38 (8) ◽

pp. 1547-1552 ◽

Cited By ~ 6

Author(s):

Annalisa De Rosa ◽

Nico T. Mutters ◽

Claudio M. Mastroianni ◽

Stefan J. Kaiser ◽

Frank Günther

Keyword(s):

Pseudomonas Aeruginosa ◽

Carbapenem Resistance ◽

Resistance Mechanisms ◽

Clinical Isolates

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Problematic clinical isolates of Pseudomonas aeruginosa from the university hospitals in Sofia, Bulgaria: current status of antimicrobial resistance and prevailing resistance mechanisms

Journal of Medical Microbiology ◽

10.1099/jmm.0.46986-0 ◽

2007 ◽

Vol 56 (7) ◽

pp. 956-963 ◽

Cited By ~ 17

Author(s):

Tanya Strateva ◽

Vessela Ouzounova-Raykova ◽

Boyka Markova ◽

Albena Todorova ◽

Yulia Marteva-Proevska ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Antimicrobial Agents ◽

Carbapenem Resistance ◽

Multidrug Resistant ◽

Resistance Mechanisms ◽

Clinical Isolates ◽

Current Status ◽

University Hospitals ◽

Active Efflux ◽

Genes Encoding

A total of 203 clinical isolates of Pseudomonas aeruginosa was collected during 2001–2006 from five university hospitals in Sofia, Bulgaria, to assess the current levels of antimicrobial susceptibility and to evaluate resistance mechanisms to antipseudomonal antimicrobial agents. The antibiotic resistance rates against the following antimicrobials were: carbenicillin 93.1 %, azlocillin 91.6 %, piperacillin 86.2 %, piperacillin/tazobactam 56.8 %, ceftazidime 45.8 %, cefepime 48.9 %, cefpirome 58.2 %, aztreonam 49.8 %, imipenem 42.3 %, meropenem 45.5 %, amikacin 59.1 %, gentamicin 79.7 %, tobramycin 89.6 %, netilmicin 69.6 % and ciprofloxacin 80.3 %. A total of 101 of the studied P. aeruginosa isolates (49.8 %) were multidrug resistant. Structural genes encoding class A and class D β-lactamases showed the following frequencies: bla VEB-1 33.1 %, bla PSE-1 22.5 %, bla PER-1 0 %, bla OXA-groupI 41.3 % and bla OXA-groupII 8.8 %. IMP- and VIM-type carbapenemases were not detected. In conclusion, the studied clinical strains of P. aeruginosa were problematic nosocomial pathogens. VEB-1 extended-spectrum β-lactamases appear to have a significant presence among clinical P. aeruginosa isolates from Sofia. Carbapenem resistance was related to non-enzymic mechanisms such as a deficiency of OprD proteins and active efflux.

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Epidemiology and carbapenem resistance mechanisms in Pseudomonas aeruginosa : Role of high-risk clones in multidrug resistance

Enfermedades infecciosas y microbiologia clinica (English ed ) ◽

10.1016/j.eimce.2017.02.006 ◽

2017 ◽

Vol 35 (3) ◽

pp. 137-138

Author(s):

Antonio Oliver

Keyword(s):

Pseudomonas Aeruginosa ◽

Multidrug Resistance ◽

High Risk ◽

Carbapenem Resistance ◽

Resistance Mechanisms

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Epidemiology and carbapenem resistance mechanisms of carbapenem-non-susceptible Pseudomonas aeruginosa collected during 2009-11 in 14 European and Mediterranean countries

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dku048 ◽

2014 ◽

Vol 69 (7) ◽

pp. 1804-1814 ◽

Cited By ~ 116

Author(s):

M. Castanheira ◽

L. M. Deshpande ◽

A. Costello ◽

T. A. Davies ◽

R. N. Jones

Keyword(s):

Pseudomonas Aeruginosa ◽

Carbapenem Resistance ◽

Resistance Mechanisms ◽

Mediterranean Countries

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Molecular Epidemiology and Mechanisms of Carbapenem Resistance in Pseudomonas aeruginosa

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00574-09 ◽

2009 ◽

Vol 53 (11) ◽

pp. 4783-4788 ◽

Cited By ~ 169

Author(s):

José-Manuel Rodríguez-Martínez ◽

Laurent Poirel ◽

Patrice Nordmann

Keyword(s):

Pseudomonas Aeruginosa ◽

Membrane Protein ◽

Molecular Epidemiology ◽

Outer Membrane ◽

Outer Membrane Protein ◽

Carbapenem Resistance ◽

Resistance Mechanisms ◽

Mechanisms Of Resistance ◽

Genes Encoding ◽

Imipenem Resistance

ABSTRACT The contributions of different mechanisms of resistance to carbapenems among a collection of imipenem- and meropenem-nonsusceptible Pseudomonas aeruginosa isolates were investigated. This screening included the recently reported extended-spectrum cephalosporinases (ESACs) weakly hydrolyzing carbapenems. Eighty-seven percent of the studied isolates were resistant to imipenem. Genes encoding metallo-β-lactamases or carbapenem-hydrolyzing oxacillinases were not identified. The main mechanism associated with imipenem resistance was the loss of outer membrane protein OprD. Identification of overexpressed ESACs and loss of OprD were observed for 65% of the isolates, all being fully resistant to imipenem. Resistance to meropenem was observed in 78% of the isolates, with all but one also being resistant to imipenem. Overexpression of the MexAB-OprM, MexXY-OprM, or MexCD-OprJ efflux systems was observed in 60% of the isolates, suggesting the contribution of efflux mechanisms in resistance to meropenem. The loss of porin OprD and the overproduction of ESACs were observed in 100% and 92% of the meropenem-resistant isolates, respectively. P. aeruginosa can very often accumulate different resistance mechanisms, including ESAC production, leading to carbapenem resistance.

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