Genetic Diversity of Multidrug-Resistant Pseudomonas aeruginosa Isolates Carrying blaVIM–2 and blaKPC–2 Genes That Spread on Different Genetic Environment in Colombia

Pseudomonas aeruginosa is an opportunistic Gram-negative pathogen with an increase in the frequency of infections caused by multidrug resistant (MDR) and extensively drug resistant (XDR) strains, limiting the available therapeutic options. The most troublesome resistance is the acquisition and production of carbapenemases such as Verona integron-encoded metallo-β-lactamases (VIM), the most frequent and widespread, and the Klebsiella pneumoniae carbapenemases (KPC), which has continuously spread in the last decade. Its dissemination is linked to their location on mobile genetic elements (MGEs). In Colombia, VIM and KPC have been increasing in its frequency showing major successful dissemination. In this article, we molecularly characterized and analyzed the genetic context of blaVIM and blaKPC in carbapenem-resistant P. aeruginosa (CRPA) isolates from infected and colonized patients in two tertiary-care hospitals, one in Medellín and the other in a municipality close to Medellín, both areas with high carbapenemase endemicity in Colombia (2013–2015). Using whole-genome sequencing (WGS), we identified a remarkable variety of genetic backgrounds in these MDR P. aeruginosa isolates carrying blaKPC–2 and blaVIM–2. There were a diversity of class 1 integron and variations in the gene cassettes associated to blaVIM–2, as well as a possible event of spread of blaKPC–2 mediated by a plasmid that contained part of Tn4401b in one infection case. The dissemination of blaVIM–2 and blaKPC–2 in P. aeruginosa in this area in Colombia has been strongly influenced by successful international clones, carrying these genes and additional determinants of resistance on MGEs, accompanied by gene rearrangement under an antimicrobial selection pressure. These findings emphasize the need to implement control strategies based on rational antibiotic use.

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Metallo-β-Lactamase Gene blaIMP-15 in a Class 1 Integron, In95, from Pseudomonas aeruginosa Clinical Isolates from a Hospital in Mexico

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00679-07 ◽

2008 ◽

Vol 52 (8) ◽

pp. 2943-2946 ◽

Cited By ~ 38

Author(s):

U. Garza-Ramos ◽

R. Morfin-Otero ◽

H. S. Sader ◽

R. N. Jones ◽

E. Hernández ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Gene Cassette ◽

Clinical Isolates ◽

Care Hospital ◽

Class 1 Integron ◽

Carbapenem Resistant ◽

Class 1 ◽

Lactamase Gene

ABSTRACT During 2003, 40 carbapenem-resistant Pseudomonas aeruginosa clinical isolates collected in a Mexican tertiary-care hospital were screened for metallo-β-lactamase production. Thirteen isolates produced IMP-15, and 12 had a single pulsed-field gel electrophoresis pattern. The bla IMP-15 gene cassette was inserted in a plasmid-borne integron with a unique array of gene cassettes and was named In95.

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Prevalence and Risk Factors of Metallo β-lactamase Producing Pseudomonas aeruginosa and Acinetobacter species in Burns and Surgical Wards in a Tertiary Care Hospital

Journal of Laboratory Physicians ◽

10.4103/0974-2727.98670 ◽

2012 ◽

Vol 4 (01) ◽

pp. 039-042 ◽

Cited By ~ 12

Author(s):

Simit H Kumar ◽

Anuradha S De ◽

Sujata M Baveja ◽

Madhuri A Gore

Keyword(s):

Risk Factors ◽

Pseudomonas Aeruginosa ◽

Tertiary Care ◽

Significant Risk ◽

Antibiotic Use ◽

Multidrug Resistant ◽

Resistance Mechanisms ◽

Care Hospital ◽

Acinetobacter Species ◽

Carbapenem Resistant

ABSTRACT Introduction: The production of Metallo-β-lactamases (MBLs) is one of the resistance mechanisms of Pseudomonas aeruginosa and Acinetobacter species. There is not much Indian data on the prevalence of MBLs in burns and surgical wards. Materials and Methods: A total of 145 non-duplicate isolates of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter species, isolated from pus/wound swabs and endotracheal secretions from burns and surgical wards, were tested for MBL production by modified ethylene diamine tetra acetic acid (EDTA) disc synergy and double disc synergy tests. Results: Prevalence of MBLs was 26.9% by both the above tests. All MBL-positive isolates were multidrug resistant. Only 6.06% (2/33) P.aeruginosa and 16.67% (1/06) Acinetobacter species were susceptible to piperacillin-tazobactam and netilmycin, respectively. These patients had multiple risk factors like >8 days hospital stay, catheterization, IV lines, previous antibiotic use, mechanical ventilation, etc. Graft application and surgical intervention were significant risk factors in MBL-positive patients. Overall mortality in MBL-positive patients was 34.21%. Conclusion: Emergence of MBL-producing Pseudomonas aeruginosa and Acinetobacter species in this hospital is alarming, which reflect excessive use of carbapenems and at the same time, pose a therapeutic challenge to clinicians as well as to microbiologists. Therefore, a strict antibiotic policy and implementation of proper infection control practices will go a long way to prevent further spread of MBLs. Detection of MBLs should also become mandatory in all hospitals.

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Reduction in Fluoroquinolone Use following Introduction of Ertapenem into a Hospital Formulary Is Associated with Improvement in Susceptibility of Pseudomonas aeruginosa to Group 2 Carbapenems: a 10-Year Study

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00742-11 ◽

2011 ◽

Vol 55 (12) ◽

pp. 5597-5601 ◽

Cited By ~ 20

Author(s):

Paul P. Cook ◽

Michael Gooch ◽

Shemra Rizzo

Keyword(s):

Pseudomonas Aeruginosa ◽

Pearson Correlation ◽

Tertiary Care ◽

Carbapenem Resistance ◽

Antibiotic Use ◽

Care Hospital ◽

Hospital Formulary ◽

Content Type ◽

Carbapenem Resistant ◽

Group 2

ABSTRACTWe examined the effect of the addition of ertapenem to our hospital formulary on the resistance of nosocomialPseudomonas aeruginosato group 2 carbapenems (imipenem, meropenem, and doripenem). This was a retrospective, observational study conducted between 1 January 2000 and 31 January 2009 at a large, tertiary-care hospital. Autoregressive integrated moving average (ARIMA) regression models were used to evaluate the effect of ertapenem use on the susceptibility ofPseudomonas aeruginosato group 2 carbapenems as well as on the use of the group 2 carbapenems, ciprofloxacin, and other antipseudomonal drugs (i.e., tobramycin, cefepime, and piperacillin-tazobactam). Resistance was expressed as a percentage of total isolates as well as the number of carbapenem-resistant bacterial isolates per 10,000 patient days. Pearson correlation was used to assess the relationship between antibiotic use and carbapenem resistance. Following the addition of ertapenem to the formulary, there was a statistically significant decrease in the percentage ofPseudomonas aeruginosaisolates resistant to the group 2 carbapenems (P= 0.003). Group 2 carbapenem use and the number of carbapenem-resistantPseudomonas aeruginosaisolates per 10,000 patient days did not change significantly over the time period. There was a large decrease in the use of ciprofloxacin (P= 0.0033), and there was a correlation of ciprofloxacin use with the percentage of isolates resistant to the group 2 carbapenems (ρ = 0.47,P= 0.002). We suspect that the improvement in susceptibility ofPseudomonas aeruginosato group 2 carbapenems was related to a decrease in ciprofloxacin use.

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A Meta-Analysis of the Prevalence of Class 1 Integron and Correlation with Antibiotic Resistance in Pseudomonas aeruginosa Recovered from Iranian Burn Patients

Journal of Burn Care & Research ◽

10.1093/jbcr/irz135 ◽

2019 ◽

Vol 40 (6) ◽

pp. 972-978 ◽

Cited By ~ 2

Author(s):

Siamak Heidarzadeh ◽

Yasamin Enayati Kaliji ◽

Reza Pourpaknia ◽

Alireza Mohammadzadeh ◽

Mehran Ghazali-Bina ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Antibiotic Resistance ◽

Meta Analysis ◽

Multidrug Resistant ◽

Burn Patients ◽

Eligibility Criteria ◽

Class 1 Integron ◽

Cross Sectional ◽

Class 1 Integrons ◽

Class 1

Abstract The role of integrons has been highlighted in antibiotic resistance among Pseudomonas aeruginosa isolates. Therefore, we here reviewed the prevalence of class 1 integrons and their correlations with antibiotic resistance of P. aeruginosa isolated from Iranian burn patients. This review was conducted according to the guidelines of Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA). Cross-sectional and cohort studies published from January 1, 2000 until December 31, 2018 were enrolled. Meta-analysis was performed by Comprehensive Meta-Analysis (CMA) software using the random effects model, Cochran’s Q, and I2 tests. Publication bias was estimated by Funnel plot and Egger’s linear regression test. Nine out of 819 studies met the eligibility criteria. The overall combined prevalence of class 1 integrons in P. aeruginosa isolates was 69% (95% confidence interval [CI]: 50.5–83%). The highest combined resistance was reported against Cloxacillin (87.7%), followed by Carbenicillin (79.1%) and Ceftriaxone (77.3%). The combined prevalence of multidrug-resistant (MDR) isolates was 79.3% (95% CI: 31.1–97%). Also, a significant correlation was noted between the presence of class 1 integrons and antibiotic resistance in 55.5% of the included studies (P < .05). The results showed high prevalence of class 1 integrons, antibiotic resistance, and MDR strains in P. aeruginosa isolated from Iranian burn patients. Also, most of the included studies showed a significant correlation between the presence of class 1 integrons and antibiotic resistance.

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In169, A New Class 1 Integron that Encoded blaIMP-18 in a Multidrug-Resistant Pseudomonas aeruginosa Isolate from Mexico

Archives of Medical Research ◽

10.1016/j.arcmed.2010.05.006 ◽

2010 ◽

Vol 41 (4) ◽

pp. 235-239 ◽

Cited By ~ 8

Author(s):

Guillermina Sánchez-Martinez ◽

Ulises Jesús Garza-Ramos ◽

Fernando Luis Reyna-Flores ◽

Jesús Gaytán-Martínez ◽

Isaí Guillermo Lorenzo-Bautista ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Multidrug Resistant ◽

Class 1 Integron ◽

New Class ◽

Class 1

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First Occurrence of the OXA-198 Carbapenemase in Enterobacterales

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01471-19 ◽

2020 ◽

Vol 64 (4) ◽

Cited By ~ 2

Author(s):

Rémy A. Bonnin ◽

Agnès B. Jousset ◽

Lauraine Gauthier ◽

Cécile Emeraud ◽

Delphine Girlich ◽

...

Keyword(s):

Multidrug Resistant ◽

Routine Screening ◽

Conjugative Plasmid ◽

Resistant Bacteria ◽

Multidrug Resistant Bacteria ◽

Class 1 Integron ◽

Carbapenem Resistant ◽

Carbapenemase Gene ◽

Class 1 ◽

First Occurrence

ABSTRACT A carbapenem-resistant Citrobacter sp. was recovered from routine screening of multidrug-resistant bacteria. This isolate coproduced OXA-48 and OXA-198. OXA-48 was carried by the prototypical IncL plasmid, whereas OXA-198 was carried by a peculiar IncHI-type plasmid. This carbapenemase gene was inserted within a class 1 integron located on a conjugative plasmid. This report describes the first occurrence of OXA-198 in Enterobacterales.

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Infrequent Finding of Metallo-β-Lactamase VIM-2 in Carbapenem-Resistant Pseudomonas aeruginosa Strains from Croatia

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.05212-11 ◽

2012 ◽

Vol 56 (5) ◽

pp. 2746-2749 ◽

Cited By ~ 20

Author(s):

Sanda Sardelic ◽

Branka Bedenic ◽

Céline Colinon-Dupuich ◽

Stjepan Orhanovic ◽

Zrinka Bosnjak ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Coastal Region ◽

Large Hospital ◽

Class 1 Integron ◽

Content Type ◽

Variable Part ◽

Carbapenem Resistant ◽

Class 1 ◽

Sequence Types

ABSTRACTOne hundred sixty-nine nonreplicate imipenem-resistantPseudomonas aeruginosastrains isolated in a large hospital on the coastal region of Croatia were studied. The most active antibiotics were colistin and amikacin. Most of the isolates were multiresistant. The most prevalent serotype was O12, followed by O11. Six strains carried theblaVIM-2gene located in a novel class 1 integron composed in its variable part of theblaVIM-2-blaoxa-10-ΔqacF-aacA4genes. Metallo-β-lactamase-producing strains belonged to sequence types ST235 and ST111.

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Isolation of an Integron-Borne blaVIM-4 Type Metallo-β-Lactamase Gene from a Carbapenem-Resistant Pseudomonas aeruginosa Clinical Isolate in Hungary

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.48.9.3576-3578.2004 ◽

2004 ◽

Vol 48 (9) ◽

pp. 3576-3578 ◽

Cited By ~ 33

Author(s):

Balázs Libisch ◽

Mária Gacs ◽

Károly Csiszár ◽

Mónika Muzslay ◽

László Rókusz ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Clinical Isolate ◽

Structural Similarity ◽

Class 1 Integron ◽

Carbapenem Resistant ◽

High Structural Similarity ◽

Class 1 ◽

Lactamase Gene

ABSTRACT The first integron-borne metallo-β-lactamase gene was isolated in Hungary. The bla VIM-4 gene is located on a class 1 integron that also carries a novel bla OXA-like gene. The integron is harbored by a serotype O12 Pseudomonas aeruginosa strain and shows high structural similarity to integrons isolated in Greece and Poland.

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First Report ofblaIMP-14on a Plasmid Harboring Multiple Drug Resistance Genes in Escherichia coli Sequence Type 131

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00840-16 ◽

2016 ◽

Vol 60 (8) ◽

pp. 5068-5071 ◽

Cited By ~ 10

Author(s):

Nicole Stoesser ◽

Anna E. Sheppard ◽

Gisele Peirano ◽

Robert P. Sebra ◽

Tarah Lynch ◽

...

Keyword(s):

Escherichia Coli ◽

Pseudomonas Aeruginosa ◽

Multiple Drug Resistance ◽

Carbapenem Resistance ◽

Sequence Type ◽

Multiple Drug ◽

Class 1 Integron ◽

Content Type ◽

Carbapenem Resistant ◽

Class 1

ABSTRACTTheblaIMP-14carbapenem resistance gene has largely previously been observed inPseudomonas aeruginosaandAcinetobacterspp. As part of global surveillance and sequencing of carbapenem-resistantEscherichia coli, we identified a sequence type 131 strain harboringblaIMP-14within a class 1 integron, itself nested within an ∼54-kb multidrug resistance region on an epidemic IncA/C2plasmid. The emergence ofblaIMP-14in this context in the ST131 lineage is of potential clinical concern.

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