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Zurita J, Sevillano G, Solís MB, Paz Y Miño A, Alves BR, Changuan J, González P. Pseudomonas aeruginosa epidemic high-risk clones and their association with multidrug-resistant. J Glob Antimicrob Resist 2024; 38:332-338. [PMID: 39019398 DOI: 10.1016/j.jgar.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 07/01/2024] [Accepted: 07/06/2024] [Indexed: 07/19/2024] Open
Abstract
OBJECTIVE In Ecuador, data on molecular epidemiology, as well as circulating clones, are limited. Therefore, this study aims to know the population structure of Pseudomonas aeruginosa by identifying clones in clinical samples in Quito-Ecuador. METHODS A significant set (45) clinical P. aeruginosa isolates were selected, including multidrug and non-multidrug resistant isolates, which were assigned to sequence types (STs) and compared with their antibiotic susceptibility profile. The genetic diversity was assessed by applying the multilocus sequence typing (MLST) scheme and the genetic relationships between different STs were corroborated by phylogenetic networks. RESULTS The MLST analysis identified 24 different STs and the most prevalent STs were ST-3750 and ST-253. The majority of the multidrug-resistance (MDR) isolates were included in ST-3750 and ST-253, also 3 singleton STs were identified as MDR isolates. The 21 different STs were found in non-multidrug resistance (non-MDR) isolates, and only 3 STs were found in more the one isolate. CONCLUSIONS The population structure of clinical P. aeruginosa present in these isolates indicates a significant association between MDR isolates and the clonal types: all ST-3750 and ST-253 isolates were MDR. ST-3750 is a closely related strain to the clonal complex ST111 (CC111). ST-253 and ST111 are a group of successful high-risk clones widely distributed worldwide. The multiresistant isolates studied are grouped in the most prevalent STs found, and the susceptible isolates correspond mainly with singleton STs. Therefore, these high-risk clones and their association with MDR phenotypes are contributing to the spread of MDR in Quito, Ecuador.
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Affiliation(s)
- Jeannete Zurita
- Unidad de Investigaciones en Biomedicina. Zurita & Zurita Laboratorios, Quito, Ecuador; Facultad de Medicina. Pontificia Universidad Católica del Ecuador, Quito, Ecuador.
| | - Gabriela Sevillano
- Unidad de Investigaciones en Biomedicina. Zurita & Zurita Laboratorios, Quito, Ecuador
| | - María Belén Solís
- Unidad de Investigaciones en Biomedicina. Zurita & Zurita Laboratorios, Quito, Ecuador
| | - Ariane Paz Y Miño
- Unidad de Investigaciones en Biomedicina. Zurita & Zurita Laboratorios, Quito, Ecuador; Mass General Brigham Salem Hospital, Salem, MA, USA
| | | | - Jessica Changuan
- Unidad de Investigaciones en Biomedicina. Zurita & Zurita Laboratorios, Quito, Ecuador
| | - Pablo González
- Unidad de Investigaciones en Biomedicina. Zurita & Zurita Laboratorios, Quito, Ecuador
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Arfaoui A, Rojo-Bezares B, Fethi M, López M, Toledano P, Sayem N, Ben Khelifa Melki S, Ouzari HI, Klibi N, Sáenz Y. Molecular characterization of Pseudomonas aeruginosa from diabetic foot infections in Tunisia. J Med Microbiol 2024; 73. [PMID: 38963417 DOI: 10.1099/jmm.0.001851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/05/2024] Open
Abstract
Background. Pseudomonas aeruginosa is an invasive organism that frequently causes severe tissue damage in diabetic foot ulcers.Gap statement. The characterisation of P. aeruginosa strains isolated from diabetic foot infections has not been carried out in Tunisia.Purpose. The aim was to determine the prevalence of P. aeruginosa isolated from patients with diabetic foot infections (DFIs) in Tunisia and to characterize their resistance, virulence and molecular typing.Methods. Patients with DFIs admitted to the diabetes department of the International Hospital Centre of Tunisia, from September 2019 to April 2021, were included in this prospective study. P. aeruginosa were obtained from the wound swabs, aspiration and soft tissue biopsies during routine clinical care and were confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Antimicrobial susceptibility testing, serotyping, integron and OprD characterization, virulence, biofilm production, pigment quantification, elastase activity and molecular typing were analysed in all recovered P. aeruginosa isolates by phenotypic tests, specific PCRs, sequencing, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing.Results. Sixteen P. aeruginosa isolates (16.3 %) were recovered from 98 samples of 78 diabetic patients and were classified into 6 serotypes (O:11 the most frequent), 11 different PFGE patterns and 10 sequence types (three of them new ones). The high-risk clone ST235 was found in two isolates. The highest resistance percentages were observed to netilmicin (69 %) and cefepime (43.8 %). Four multidrug-resistant (MDR) isolates (25 %) were detected, three of them being carbapenem-resistant. The ST235-MDR strain harboured the In51 class 1 integron (intI1 +aadA6+orfD+qacED1-sul1). According to the detection of 14 genes involved in virulence or quorum sensing, 5 virulotypes were observed, including 5 exoU-positive, 9 exoS-positive and 2 exoU/exoS-positive strains. The lasR gene was truncated by ISPpu21 insertion sequence in one isolate, and a deletion of 64 bp in the rhlR gene was detected in the ST235-MDR strain. Low biofilm, pyoverdine and elastase production were detected in all P. aeruginosa; however, the lasR-truncated strain showed a chronic infection phenotype characterized by loss of serotype-specific antigenicity, high production of phenazines and high biofilm formation.Conclusions. Our study demonstrated for the first time the prevalence and the molecular characterization of P. aeruginosa strains from DFIs in Tunisia, showing a high genetic diversity, moderate antimicrobial resistance, but a high number of virulence-related traits, highlighting their pathological importance.
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Affiliation(s)
- Ameni Arfaoui
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Beatriz Rojo-Bezares
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Meha Fethi
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Maria López
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Paula Toledano
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
| | - Noureddine Sayem
- Service of Biology, Carthagene International Hospital of Tunisia, Tunis, Tunisia
| | | | - Hadda-Imene Ouzari
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Naouel Klibi
- Laboratory of Microorganisms and Active Biomolecules, Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Yolanda Sáenz
- Área de Microbiología Molecular, Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, Spain
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Dos Santos PAS, Rodrigues YC, Marcon DJ, Lobato ARF, Cazuza TB, Gouveia MIM, Silva MJA, Souza AB, Lima LNGC, Quaresma AJPG, Brasiliense DM, Lima KVB. Endemic High-Risk Clone ST277 Is Related to the Spread of SPM-1-Producing Pseudomonas aeruginosa during the COVID-19 Pandemic Period in Northern Brazil. Microorganisms 2023; 11:2069. [PMID: 37630629 PMCID: PMC10457858 DOI: 10.3390/microorganisms11082069] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 08/27/2023] Open
Abstract
Pseudomonas aeruginosa is a high-priority bacterial agent that causes healthcare-acquired infections (HAIs), which often leads to serious infections and poor prognosis in vulnerable patients. Its increasing resistance to antimicrobials, associated with SPM production, is a case of public health concern. Therefore, this study aims to determine the antimicrobial resistance, virulence, and genotyping features of P. aeruginosa strains producing SPM-1 in the Northern region of Brazil. To determine the presence of virulence and resistance genes, the PCR technique was used. For the susceptibility profile of antimicrobials, the Kirby-Bauer disk diffusion method was performed on Mueller-Hinton agar. The MLST technique was used to define the ST of the isolates. The exoS+/exoU- virulotype was standard for all strains, with the aprA, lasA, toxA, exoS, exoT, and exoY genes as the most prevalent. All the isolates showed an MDR or XDR profile against the six classes of antimicrobials tested. HRC ST277 played a major role in spreading the SPM-1-producing P. aeruginosa strains.
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Affiliation(s)
- Pabllo Antonny Silva Dos Santos
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Tv. Perebebuí, 2623-Marco, Belém 66087-662, PA, Brazil; (P.A.S.D.S.); (D.J.M.); (L.N.G.C.L.); (D.M.B.)
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.R.F.L.); (T.B.C.); (M.I.M.G.); (M.J.A.S.); (A.B.S.); (A.J.P.G.Q.)
| | - Yan Corrêa Rodrigues
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.R.F.L.); (T.B.C.); (M.I.M.G.); (M.J.A.S.); (A.B.S.); (A.J.P.G.Q.)
- Program in Epidemiology and Health Surveillance (PPGEVS), Evandro Chagas Institute (IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil
- Department of Natural Science, State University of Pará (DCNA/UEPA), Belém 66050-540, PA, Brazil
| | - Davi Josué Marcon
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Tv. Perebebuí, 2623-Marco, Belém 66087-662, PA, Brazil; (P.A.S.D.S.); (D.J.M.); (L.N.G.C.L.); (D.M.B.)
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.R.F.L.); (T.B.C.); (M.I.M.G.); (M.J.A.S.); (A.B.S.); (A.J.P.G.Q.)
| | - Amália Raiana Fonseca Lobato
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.R.F.L.); (T.B.C.); (M.I.M.G.); (M.J.A.S.); (A.B.S.); (A.J.P.G.Q.)
| | - Thalyta Braga Cazuza
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.R.F.L.); (T.B.C.); (M.I.M.G.); (M.J.A.S.); (A.B.S.); (A.J.P.G.Q.)
| | - Maria Isabel Montoril Gouveia
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.R.F.L.); (T.B.C.); (M.I.M.G.); (M.J.A.S.); (A.B.S.); (A.J.P.G.Q.)
| | - Marcos Jessé Abrahão Silva
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.R.F.L.); (T.B.C.); (M.I.M.G.); (M.J.A.S.); (A.B.S.); (A.J.P.G.Q.)
- Program in Epidemiology and Health Surveillance (PPGEVS), Evandro Chagas Institute (IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil
| | - Alex Brito Souza
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.R.F.L.); (T.B.C.); (M.I.M.G.); (M.J.A.S.); (A.B.S.); (A.J.P.G.Q.)
| | - Luana Nepomuceno Gondim Costa Lima
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Tv. Perebebuí, 2623-Marco, Belém 66087-662, PA, Brazil; (P.A.S.D.S.); (D.J.M.); (L.N.G.C.L.); (D.M.B.)
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.R.F.L.); (T.B.C.); (M.I.M.G.); (M.J.A.S.); (A.B.S.); (A.J.P.G.Q.)
- Program in Epidemiology and Health Surveillance (PPGEVS), Evandro Chagas Institute (IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil
| | - Ana Judith Pires Garcia Quaresma
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.R.F.L.); (T.B.C.); (M.I.M.G.); (M.J.A.S.); (A.B.S.); (A.J.P.G.Q.)
| | - Danielle Murici Brasiliense
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Tv. Perebebuí, 2623-Marco, Belém 66087-662, PA, Brazil; (P.A.S.D.S.); (D.J.M.); (L.N.G.C.L.); (D.M.B.)
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.R.F.L.); (T.B.C.); (M.I.M.G.); (M.J.A.S.); (A.B.S.); (A.J.P.G.Q.)
- Program in Epidemiology and Health Surveillance (PPGEVS), Evandro Chagas Institute (IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil
| | - Karla Valéria Batista Lima
- Program in Parasitic Biology in the Amazon Region (PPGBPA), State University of Pará (UEPA), Tv. Perebebuí, 2623-Marco, Belém 66087-662, PA, Brazil; (P.A.S.D.S.); (D.J.M.); (L.N.G.C.L.); (D.M.B.)
- Bacteriology and Mycology Section, Evandro Chagas Institute (SABMI/IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil; (A.R.F.L.); (T.B.C.); (M.I.M.G.); (M.J.A.S.); (A.B.S.); (A.J.P.G.Q.)
- Program in Epidemiology and Health Surveillance (PPGEVS), Evandro Chagas Institute (IEC), Ministry of Health, Ananindeua 67030-000, PA, Brazil
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Camargo CH, Yamada AY, Souza ARD, Lima MDJDC, Cunha MPV, Ferraro PSP, Sacchi CT, Santos MBND, Campos KR, Tiba-Casas MR, Freire MP, Barretti P. Genomics and Antimicrobial Susceptibility of Clinical Pseudomonas aeruginosa Isolates from Hospitals in Brazil. Pathogens 2023; 12:918. [PMID: 37513765 PMCID: PMC10384983 DOI: 10.3390/pathogens12070918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Pseudomonas aeruginosa, an opportunistic pathogen causing infections in immunocompromised patients, usually shows pronounced antimicrobial resistance. In recent years, the frequency of carbapenemases in P. aeruginosa has decreased, which allows use of new beta-lactams/combinations in antimicrobial therapy. Therefore, the in vitro evaluation of these drugs in contemporary isolates is warranted. We evaluated the antimicrobial susceptibility and genomic aspects of 119 clinical P. aeruginosa isolates from 24 different hospitals in Brazil in 2021-2022. Identification was performed via MALDI-TOF-MS, and antimicrobial susceptibility was identified through broth microdilution, gradient tests, or disk diffusion. Whole-genome sequencing was carried out using NextSeq equipment. The most active drug was cefiderocol (100%), followed by ceftazidime-avibactam (94.1%), ceftolozane-tazobactam (92.4%), and imipenem-relebactam (81.5%). Imipenem susceptibility was detected in 59 isolates (49.6%), and the most active aminoglycoside was tobramycin, to which 99 (83.2%) isolates were susceptible. Seventy-one different sequence types (STs) were detected, including twelve new STs described herein. The acquired resistance genes blaCTX-M-2 and blaKPC-2 were identified in ten (8.4%) and two (1.7%) isolates, respectively. Several virulence genes (exoSTUY, toxA, aprA, lasA/B, plcH) were also identified. We found that new antimicrobials are effective against the diverse P. aeruginosa population that has been circulating in Brazilian hospitals in recent years.
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Affiliation(s)
- Carlos Henrique Camargo
- Centro de Bacteriologia, Instituto Adolfo Lutz, Sao Paulo 01246-902, SP, Brazil
- Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 01246-902, SP, Brazil
| | - Amanda Yaeko Yamada
- Centro de Bacteriologia, Instituto Adolfo Lutz, Sao Paulo 01246-902, SP, Brazil
- Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 01246-902, SP, Brazil
| | | | | | | | | | | | | | | | | | | | - Pasqual Barretti
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Botucatu 18618-686, SP, Brazil
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Hussain MA, Mohamed MS, Altayb HN, Mohamed AO, Ashour A, Osman W, Sherif AE, Ghazawi KF, Miski SF, Ibrahim SRM, Mohamed GA, Sindi IA, Alshamrani AA, Elgaml A. Comparative Genomic Analysis of Multi-Drug Resistant Pseudomonas aeruginosa Sequence Type 235 Isolated from Sudan. Microorganisms 2023; 11:1432. [PMID: 37374934 DOI: 10.3390/microorganisms11061432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/20/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023] Open
Abstract
Pseudomonas aeruginosa (P. aeruginosa) is known to be associated with resistance to practically all known antibiotics. This is a cross-sectional, descriptive, laboratory-based analytical study in which 200 P. aeruginosa clinical isolates were involved. The DNA of the most resistant isolate was extracted and its whole genome was sequenced, assembled, annotated, and announced, strain typing was ascribed, and it was subjected to comparative genomic analysis with two susceptible strains. The rate of resistance was 77.89%, 25.13%, 21.61%, 18.09%, 5.53%, and 4.52% for piperacillin, gentamicin, ciprofloxacin, ceftazidime, meropenem, and polymyxin B, respectively. Eighteen percent (36) of the tested isolates exhibited a MDR phenotype. The most MDR strain belonged to epidemic sequence type 235. Comparative genomic analysis of the MDR strain (GenBank: MVDK00000000) with two susceptible strains revealed that the core genes were shared by the three genomes but there were accessory genes that were strain-specific, and this MDR genome had a low CG% (64.6%) content. A prophage sequence and one plasmid were detected in the MDR genome, but amazingly, it contained no resistant genes for drugs with antipseudomonal activity and there was no resistant island. In addition, 67 resistant genes were detected, 19 of them were found only in the MDR genome and 48 genes were efflux pumps, and a novel deleterious point mutation (D87G) was detected in the gyrA gene. The novel deleterious mutation in the gyrA gene (D87G) is a known position behind quinolone resistance. Our findings emphasize the importance of adoption of infection control strategies to prevent dissemination of MDR isolates.
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Affiliation(s)
- Mohamed A Hussain
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, International University of Africa, Khartoum P.O. Box 2469, Sudan
| | - Malik Suliman Mohamed
- Department of Pharmaceutics, College of Pharmacy, Jouf University, Sakaka 72388, Saudi Arabia
- Department of Pharmaceutics, Faculty of Pharmacy, University of Khartoum, Khartoum 11111, Sudan
| | - Hisham N Altayb
- Department of Biochemistry, Faculty of Sciences, King Abdulaziz University, Jeddah 23589, Saudi Arabia
| | - Ahmed Osman Mohamed
- Department of Pharmaceutical Microbiology, Faculty of Pharmacy, International University of Africa, Khartoum P.O. Box 2469, Sudan
| | - Ahmed Ashour
- Department of Pharmacognosy, Faculty of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
- Department of Pharmacognosy, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Wadah Osman
- Department of Pharmacognosy, Faculty of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
- Department of Pharmacognosy, Faculty of Pharmacy, University of Khartoum, Khartoum 11115, Sudan
| | - Asmaa E Sherif
- Department of Pharmacognosy, Faculty of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
- Department of Pharmacognosy, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Kholoud F Ghazawi
- Clinical Pharmacy Department, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia
| | - Samar F Miski
- Department of Pharmacology and Toxicology, College of Pharmacy, Taibah University, Al-Madinah Al-Munawwarah 30078, Saudi Arabia
| | - Sabrin R M Ibrahim
- Department of Chemistry, Preparatory Year Program, Batterjee Medical College, Jeddah 21442, Saudi Arabia
- Department of Pharmacognosy, Faculty of Pharmacy, Assiut University, Assiut 71526, Egypt
| | - Gamal A Mohamed
- Department of Natural Products and Alternative Medicine, Faculty of Pharmacy, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ikhlas A Sindi
- Department of Biology, Faculty of Science, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Ahmad A Alshamrani
- Pharmaceutical Care Department, Ministry of National Guard-Health Affairs, Jeddah 22384, Saudi Arabia
| | - Abdelaziz Elgaml
- Microbiology and Immunology Department, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
- Microbiology and Immunology Department, Faculty of Pharmacy, Horus University, New Damietta 34511, Egypt
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Nakayama R, Inoue-Tsuda M, Matsui H, Ito T, Hanaki H. Classification of the metallo β-lactamase subtype produced by the carbapenem-resistant Pseudomonas aeruginosa isolates in Japan. J Infect Chemother 2021; 28:170-175. [PMID: 34863648 DOI: 10.1016/j.jiac.2021.04.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/08/2021] [Accepted: 04/04/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Multidrug resistant microorganisms are a serious threat to human health. Under the circumstances, a front line of antimicrobials in clinical setting may be carbapenem β-lactams (CRBP). However, emergence of CRBP resistant (CRBP-r) Gram-negative bacteria are the most alarming. CRBP-r is mainly caused to the production of β-lactamase, down and up expression of the diffusion channel and the efflux pump genes, respectively. Among them, production of metallo-β-lactamase (MBL) is a major cause of high-level of CRBP-r. METHOD We analyzed the MBL subtypes by PCR and DNA sequencing in CRBP-r Psudomonas aeruginosa in the collection of the joint program by the Japanese Association for Infectious Diseases, Japan Society for Clinical Microbiology and Japanese Society of Chemotherapy (2006-2015 in Japan). RESULTS Among 275 strains out of a total 1716 isolates, 23 (8.3%) were MBL-positive exhibiting resistant to meropenem (MEPM), imipenem, ceftazidime, cefepime, ciprofloxacin and levofloxacin without exception and the MIC of MEPM appeared over 128 μg/mL. Their MBL subtype analysis revealed that 16, 2, and 2 isolates were IMP-1, IMP-7 and VIM-2 positive, respectively, and one isolate each expressed either IMP-10, IMP-34 or IMP-41. CONCLUSIONS This study revealed that all the MBL-positive CRBP-r isolates were highly resistant to carbapenems dominating IMP-1 production.
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Affiliation(s)
- Ryo Nakayama
- Research Center for Infection Control, Ōmura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan; External Innovation, Drug Research Division, Sumitomo Dainippon Pharma Co., Ltd, Japan
| | - Megumi Inoue-Tsuda
- Research Center for Infection Control, Ōmura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| | - Hidehito Matsui
- Research Center for Infection Control, Ōmura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| | - Tamaki Ito
- Research Center for Infection Control, Ōmura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan
| | - Hideaki Hanaki
- Research Center for Infection Control, Ōmura Satoshi Memorial Institute, Kitasato University, Tokyo, Japan.
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Ramos JF, Leite G, Martins RCR, Rizek C, Al Sanabani SS, Rossi F, Guimarães T, Levin AS, Rocha V, Costa SF. Clinical outcome from hematopoietic cell transplant patients with bloodstream infection caused by carbapenem-resistant P. aeruginosa and the impact of antimicrobial combination in vitro. Eur J Clin Microbiol Infect Dis 2021; 41:313-317. [PMID: 34651217 DOI: 10.1007/s10096-021-04361-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/01/2021] [Indexed: 11/25/2022]
Abstract
Bloodstream infection (BSI) caused by carbapenem-resistant P. aeruginosa (CRPA) has high mortality in hematopoietic stem cell transplant (HSCT) recipients. We performed MIC, checkerboard, time-kill assay, PFGE, PCR, and whole genome sequence and described the clinical outcome through Epi Info comparing the antimicrobial combination in vitro. Mortality was higher in BSI caused by CRPA carrying the lasB virulence gene. The isolates were 97% resistant to meropenem displaying synergistic effect to 57% in combination with colistin. Seventy-three percent of the isolates harbored blaSPM-1 and Tn4371 and belonged to ST277. The synergistic effect in vitro with meropenem with colistin appeared to be a better therapeutic option.
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Affiliation(s)
- Jessica Fernandes Ramos
- Department of Infectious Diseases of Faculdade de Medicina, University of Sao Paulo, São Paulo, Brazil
- Department of Haematology, Hemotherapy and Cellular Therapy of Faculdade de Medicina, University of Sao Paulo, São Paulo, Brazil
| | - Gleice Leite
- Laboratory of Medical Investigation - LIM 49 - Medical Tropical Institute, University of Sao Paulo, São Paulo, Brazil.
| | | | - Camila Rizek
- Laboratory of Medical Investigation - LIM 49 - Medical Tropical Institute, University of Sao Paulo, São Paulo, Brazil
| | - Sabri Saeed Al Sanabani
- Laboratory of Medical Investigation - LIM 52 - Medical Tropical Institute, University of Sao Paulo, São Paulo, Brazil
| | - Flavia Rossi
- Laboratory of Clinical Microbiology of Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, São Paulo, Brazil
| | - Thais Guimarães
- Department of Infectious Diseases of Faculdade de Medicina, University of Sao Paulo, São Paulo, Brazil
- Laboratory of Medical Investigation - LIM 49 - Medical Tropical Institute, University of Sao Paulo, São Paulo, Brazil
| | - Anna Sara Levin
- Department of Infectious Diseases of Faculdade de Medicina, University of Sao Paulo, São Paulo, Brazil
- Laboratory of Medical Investigation - LIM 49 - Medical Tropical Institute, University of Sao Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Department of Haematology, Hemotherapy and Cellular Therapy of Faculdade de Medicina, University of Sao Paulo, São Paulo, Brazil
- Haematology Department, NHS BT, Oxford University, Oxford, UK
| | - Silvia Figueiredo Costa
- Department of Infectious Diseases of Faculdade de Medicina, University of Sao Paulo, São Paulo, Brazil
- Laboratory of Medical Investigation - LIM 49 - Medical Tropical Institute, University of Sao Paulo, São Paulo, Brazil
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8
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Bahr G, González LJ, Vila AJ. Metallo-β-lactamases in the Age of Multidrug Resistance: From Structure and Mechanism to Evolution, Dissemination, and Inhibitor Design. Chem Rev 2021; 121:7957-8094. [PMID: 34129337 PMCID: PMC9062786 DOI: 10.1021/acs.chemrev.1c00138] [Citation(s) in RCA: 106] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Antimicrobial resistance is one of the major problems in current practical medicine. The spread of genes coding for resistance determinants among bacteria challenges the use of approved antibiotics, narrowing the options for treatment. Resistance to carbapenems, last resort antibiotics, is a major concern. Metallo-β-lactamases (MBLs) hydrolyze carbapenems, penicillins, and cephalosporins, becoming central to this problem. These enzymes diverge with respect to serine-β-lactamases by exhibiting a different fold, active site, and catalytic features. Elucidating their catalytic mechanism has been a big challenge in the field that has limited the development of useful inhibitors. This review covers exhaustively the details of the active-site chemistries, the diversity of MBL alleles, the catalytic mechanism against different substrates, and how this information has helped developing inhibitors. We also discuss here different aspects critical to understand the success of MBLs in conferring resistance: the molecular determinants of their dissemination, their cell physiology, from the biogenesis to the processing involved in the transit to the periplasm, and the uptake of the Zn(II) ions upon metal starvation conditions, such as those encountered during an infection. In this regard, the chemical, biochemical and microbiological aspects provide an integrative view of the current knowledge of MBLs.
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Affiliation(s)
- Guillermo Bahr
- Instituto de Biología Molecular y Celular de Rosario (IBR), CONICET, Universidad Nacional de Rosario, Ocampo y Esmeralda S/N, 2000 Rosario, Argentina
- Area Biofísica, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Suipacha 531, 2000 Rosario, Argentina
| | - Lisandro J. González
- Instituto de Biología Molecular y Celular de Rosario (IBR), CONICET, Universidad Nacional de Rosario, Ocampo y Esmeralda S/N, 2000 Rosario, Argentina
- Area Biofísica, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Suipacha 531, 2000 Rosario, Argentina
| | - Alejandro J. Vila
- Instituto de Biología Molecular y Celular de Rosario (IBR), CONICET, Universidad Nacional de Rosario, Ocampo y Esmeralda S/N, 2000 Rosario, Argentina
- Area Biofísica, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Suipacha 531, 2000 Rosario, Argentina
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9
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Diversity and Distribution of Resistance Markers in Pseudomonas aeruginosa International High-Risk Clones. Microorganisms 2021; 9:microorganisms9020359. [PMID: 33673029 PMCID: PMC7918723 DOI: 10.3390/microorganisms9020359] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 12/12/2022] Open
Abstract
Pseudomonas aeruginosa high-risk clones are disseminated worldwide and they are common causative agents of hospital-acquired infections. In this review, we will summarize available data of high-risk P. aeruginosa clones from confirmed outbreaks and based on whole-genome sequence data. Common feature of high-risk clones is the production of beta-lactamases and among metallo-beta-lactamases NDM, VIM and IMP types are widely disseminated in different sequence types (STs), by contrast FIM type has been reported in ST235 in Italy, whereas GIM type in ST111 in Germany. In the case of ST277, it is most frequently detected in Brazil and it carries a resistome linked to blaSPM. Colistin resistance develops among P. aeruginosa clones in a lesser extent compared to other resistance mechanisms, as ST235 strains remain mainly susceptible to colistin however, some reports described mcr positive P. aeurigonsa ST235. Transferable quinolone resistance determinants are detected in P. aeruginosa high-risk clones and aac(6′)-Ib-cr variant is the most frequently reported as this determinant is incorporated in integrons. Additionally, qnrVC1 was recently detected in ST773 in Hungary and in ST175 in Spain. Continuous monitoring and surveillance programs are mandatory to track high-risk clones and to analyze emergence of novel clones as well as novel resistance determinants.
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10
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Rocha-Santos G, Cuba GT, Cayô R, Streling AP, Nodari CS, Gales AC, Pignatari ACC, Nicolau DP, Kiffer CRV. In vitro synergy of ticarcillin/clavulanate in combination with aztreonam and ceftolozane/tazobactam against SPM-1-producing Pseudomonas aeruginosa strains. Diagn Microbiol Infect Dis 2021; 100:115343. [PMID: 33652305 DOI: 10.1016/j.diagmicrobio.2021.115343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/28/2021] [Accepted: 02/05/2021] [Indexed: 10/22/2022]
Abstract
Minimal inhibitory concentrations (MICs) of ticarcillin/clavulanic acid (TLc), ceftolozane/tazobactam (C/T), and aztreonam (AT) were determined for 6 SPM-1-producing Pseudomonas aeruginosa (PSA) using Etest® strips and the synergistic effect of such antimicrobials against was evaluated by gradient diffusion strip crossing (GDSC) test. The fraction inhibitory concentration indexes (FICI) were calculated and showed a synergistic (n = 3) and additive (n = 2) effects of TLc + AT against SPM-1 producers, while TLc + C/T combination caused no effect. Average MIC reduction of TLc and AT by GDSC was 3-fold and 2-fold dilutions, respectively. Thus, TLc + AT might be a candidate as a combination therapy to treat SPM-1-producing PSA infections.
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Affiliation(s)
- Gerlan Rocha-Santos
- Universidade Federal de São Paulo (UNIFESP), Laboratório Especial de Microbiologia Clínica (LEMC), Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, Brazil
| | - Gabriel T Cuba
- Universidade Federal de São Paulo (UNIFESP), Laboratório Especial de Microbiologia Clínica (LEMC), Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, Brazil.
| | - Rodrigo Cayô
- Universidade Federal de São Paulo (UNIFESP), Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, Brazil; Universidade Federal de São Paulo (UNIFESP), Laboratório de Imunologia e Bacteriologia (LIB), Setor de Biologia Molecular, Microbiologia e Imunologia, Departamento de Ciências Biológicas (DCB), Instituto de Ciências Ambientais, Químicas e Farmacêuticas (ICAQF), Diadema, Brazil
| | - Ana Paula Streling
- Universidade Federal de São Paulo (UNIFESP), Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, Brazil
| | - Carolina S Nodari
- Universidade Federal de São Paulo (UNIFESP), Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, Brazil
| | - Ana C Gales
- Universidade Federal de São Paulo (UNIFESP), Laboratório Especial de Microbiologia Clínica (LEMC), Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, Brazil; Universidade Federal de São Paulo (UNIFESP), Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, Brazil
| | - Antonio C C Pignatari
- Universidade Federal de São Paulo (UNIFESP), Laboratório Especial de Microbiologia Clínica (LEMC), Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, Brazil; Universidade Federal de São Paulo (UNIFESP), Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, Brazil
| | - David P Nicolau
- Center for Anti-infective Research and Development, Hartford Hospital, Hartford, CT, USA; Division of Infectious Diseases, Hartford Hospital, Hartford, CT, USA
| | - Carlos R V Kiffer
- Universidade Federal de São Paulo (UNIFESP), Laboratório Especial de Microbiologia Clínica (LEMC), Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina (EPM), São Paulo, Brazil
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11
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Gaudereto JJ, Neto LVP, Leite GC, Espinoza EPS, Martins RCR, Villas Boa Prado G, Rossi F, Guimarães T, Levin AS, Costa SF. Comparison of methods for the detection of in vitro synergy in multidrug-resistant gram-negative bacteria. BMC Microbiol 2020; 20:97. [PMID: 32299353 PMCID: PMC7161189 DOI: 10.1186/s12866-020-01756-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 03/20/2020] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The use of combined antibiotic therapy has become an option for infections caused by multidrug-resistant (MDR) bacteria. The time-kill (TK) assay is considered the gold standard method for the evaluation of in vitro synergy, but it is a time-consuming and expensive method. The purpose of this study was to evaluate two methods for testing in vitro antimicrobial combinations: the disk diffusion method through disk approximation (DA) and the agar gradient diffusion method via the MIC:MIC ratio. The TK assay was included as the gold standard. MDR Gram-negative clinical isolates (n = 62; 28 Pseudomonas aeruginosa, 20 Acinetobacter baumannii, and 14 Serratia marcescens) were submitted to TK, DA, and MIC:MIC ratio synergy methods. RESULTS Overall, the agreement between the DA and TK assays ranged from 20 to 93%. The isolates of A. baumannii showed variable results of synergism according to TK, and the calculated agreement was statistically significant in this species against fosfomycin with meropenem including colistin-resistant isolates. The MIC:MIC ratiometric agreed from 35 to 71% with TK assays. The kappa test showed good agreement for the combination of colistin with amikacin (K = 0.58; P = 0.04) among the colistin-resistant A. baumannii isolates. CONCLUSIONS The DA and MIC:MIC ratiometric methods are easier to perform and might be a more viable tool for clinical microbiology laboratories.
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Affiliation(s)
- Juliana Januario Gaudereto
- Laboratório de Investigação Médica 49 - LIM-49, Instituto de Medicina Tropical, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Enéas de Carvalho Aguiar, 470, São Paulo, SP, 05403-000, Brazil
| | - Lauro Vieira Perdigão Neto
- Laboratório de Investigação Médica 49 - LIM-49, Instituto de Medicina Tropical, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Enéas de Carvalho Aguiar, 470, São Paulo, SP, 05403-000, Brazil
| | - Gleice Cristina Leite
- Laboratório de Investigação Médica 49 - LIM-49, Instituto de Medicina Tropical, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Enéas de Carvalho Aguiar, 470, São Paulo, SP, 05403-000, Brazil
| | - Evelyn Patricia Sanchez Espinoza
- Laboratório de Investigação Médica 49 - LIM-49, Instituto de Medicina Tropical, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Enéas de Carvalho Aguiar, 470, São Paulo, SP, 05403-000, Brazil
| | - Roberta Cristina Ruedas Martins
- Laboratório de Investigação Médica 49 - LIM-49, Instituto de Medicina Tropical, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Enéas de Carvalho Aguiar, 470, São Paulo, SP, 05403-000, Brazil
| | - Gladys Villas Boa Prado
- Laboratório de Investigação Médica 49 - LIM-49, Instituto de Medicina Tropical, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Enéas de Carvalho Aguiar, 470, São Paulo, SP, 05403-000, Brazil
| | - Flavia Rossi
- Divisão de Laboratório Central - Serviço de Microbiologia Clínica, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Thais Guimarães
- Laboratório de Investigação Médica 49 - LIM-49, Instituto de Medicina Tropical, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Enéas de Carvalho Aguiar, 470, São Paulo, SP, 05403-000, Brazil
| | - Anna Sara Levin
- Laboratório de Investigação Médica 49 - LIM-49, Instituto de Medicina Tropical, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Enéas de Carvalho Aguiar, 470, São Paulo, SP, 05403-000, Brazil
| | - Silvia Figueiredo Costa
- Laboratório de Investigação Médica 49 - LIM-49, Instituto de Medicina Tropical, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, Avenida Doutor Enéas de Carvalho Aguiar, 470, São Paulo, SP, 05403-000, Brazil.
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12
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Silveira MC, Rocha-de-Souza CM, Albano RM, de Oliveira Santos IC, Carvalho-Assef APD. Exploring the success of Brazilian endemic clone Pseudomonas aeruginosa ST277 and its association with the CRISPR-Cas system type I-C. BMC Genomics 2020; 21:255. [PMID: 32293244 PMCID: PMC7092672 DOI: 10.1186/s12864-020-6650-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/04/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The Brazilian endemic clone Pseudomonas aeruginosa ST277 carries important antibiotic resistance determinants, highlighting the gene coding for SPM-1 carbapenemase. However, the resistance and persistence of this clone is apparently restricted to the Brazilian territory. To understand the differences between Brazilian strains from those isolated in other countries, we performed a phylogenetic analysis of 47 P. aeruginosa ST277 genomes as well as analyzed the virulence and resistance gene profiles. Furthermore, we evaluated the distribution of genomic islands and assessed in detail the characteristics of the CRISPR-Cas immunity system in these isolates. RESULTS The Brazilian genomes presented a typical set of resistance and virulence determinants, genomic islands and a high frequency of the CRISPR-Cas system type I-C. Even though the ST277 genomes are closely related, the phylogenetic analysis showed that the Brazilian strains share a great number of exclusively SNPs when compared to other ST277 genomes. We also observed a standard CRISPR spacers content for P. aeruginosa ST277, confirming a strong link between sequence type and spacer acquisition. Most CRISPR spacer targets were phage sequences. CONCLUSIONS Based on our findings, P. aeruginosa ST277 strains circulating in Brazil characteristically acquired In163 and PAGI-25, which can distinguish them from strains that do not accumulate resistance mechanisms and can be found on the Asian, European and North American continents. The distinctive genetic elements accumulated in Brazilian samples can contribute to the resistance, pathogenicity and transmission success that characterize the ST277 in this country.
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Affiliation(s)
- Melise Chaves Silveira
- Laboratório de Pesquisa em Infecção Hospitalar, Oswaldo Cruz Institute, Fiocruz, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21040-360, Brazil
| | - Cláudio Marcos Rocha-de-Souza
- Laboratório de Pesquisa em Infecção Hospitalar, Oswaldo Cruz Institute, Fiocruz, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21040-360, Brazil
| | - Rodolpho Mattos Albano
- Departamento de Bioquímica, Universidade do Estado do Rio de Janeiro, Boulevard Vinte e Oito de Setembro, 87, fundos, andar 4, Vila Isabel, Rio de Janeiro, Rio de Janeiro, 20551-030, Brazil
| | - Ivson Cassiano de Oliveira Santos
- Laboratório de Pesquisa em Infecção Hospitalar, Oswaldo Cruz Institute, Fiocruz, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21040-360, Brazil
| | - Ana Paula D'Alincourt Carvalho-Assef
- Laboratório de Pesquisa em Infecção Hospitalar, Oswaldo Cruz Institute, Fiocruz, Avenida Brasil 4365, Manguinhos, Rio de Janeiro, Rio de Janeiro, 21040-360, Brazil.
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13
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Kocsis B, Toth A, Gulyas D, Ligeti B, Katona K, Rokusz L, Szabo D. Acquired qnrVC1 and blaNDM-1 resistance markers in an international high-risk Pseudomonas aeruginosa ST773 clone. J Med Microbiol 2019; 68:336-338. [PMID: 30667355 DOI: 10.1099/jmm.0.000927] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
A multidrug-resistant Pseudomonas aeruginosa PS1 isolated from urine clinical sample was investigated in this study. The strain exhibited resistance to piperacillin/tazobactam, ciprofloxacin, imipenem, ceftazidime but it was susceptible to colistin. Analysis of whole-genome sequencing data by ResFinder detected various resistance determinants including qnrVC1 and blaNDM-1. The multiresistant P. aeruginosa isolate belonged to ST773 high-risk clone. The qnrVC1 and blaNDM-1 determinants were incorporated into different integrons. Expression of blaNDM-1 was fourfold and qnrVC1 was twofold increased, compared to that of rpsL housekeeping gene. Mutations in gyrA Thr83Leu and parC Ser87Leu were detected and additionally qnrVC1 expression indicates protective effect of QnrVC1 pentapeptid protein on gyrase and topoisomerase. High-risk P. aeruginosa clones integrate various carbapenemase and other resistance determinants into their genomes that facilitates further dissemination of multiresistance among clinical isolates. We report blaNDM-1 and qnrVC1 genes in P. aeruginosa ST773 international high-risk clone.
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Affiliation(s)
- Bela Kocsis
- 1 Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary
| | - Akos Toth
- 2 National Public Health Institute, Budapest, Hungary
| | - Daniel Gulyas
- 1 Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary
| | - Balazs Ligeti
- 1 Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary.,3 Faculty of Information Technology and Bionics, Pázmány Péter Catholic University, Budapest, Hungary
| | - Katalin Katona
- 4 Department of Microbiology, State Health Center, Budapest, Hungary
| | - Laszlo Rokusz
- 5 First Department of Medicine, State Health Center, Budapest, Hungary
| | - Dora Szabo
- 1 Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary
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14
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Neves PR, Perdigão Neto LV, Ruedas Martins RC, Ramos JF, Leite G, Rossi F, Sanabani SS, Rocha V, Batista MV, Guimaraes T, Levin AS, Costa SF. Carbapenem-resistant Pseudomonas aeruginosa carrying bla VIM-36 assigned to ST308: Indicated non-virulence in a Galleria mellonella model. J Glob Antimicrob Resist 2018; 16:92-97. [PMID: 30244038 DOI: 10.1016/j.jgar.2018.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/23/2018] [Accepted: 09/06/2018] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVES Based on pulsed-field gel electrophoresis (PFGE) profile, whole-genome sequencing (WGS) of eight carbapenem-resistant Pseudomonas aeruginosa isolates from a bone marrow transplant unit in São Paulo, Brazil, was performed to investigate the presence of resistance and virulence genes as well as to determine the sequence type (ST) by multilocus sequence typing (MLST). METHODS The initial phenotypic susceptibility pattern of the isolates was determined by VITEK®2. Minimum inhibitory concentrations (MICs) were determined by the broth microdilution method for amikacin, meropenem and colistin. WGS was performed using an Illumina MiSeq system. A Galleria mellonella infection model was used to evaluate the virulence of the strains. RESULTS WGS demonstrated that mutations in genes encoding outer membrane proteins and efflux pumps in an isolate harbouring blaVIM-36 (ST308) differed from those in isolates harbouring blaSPM (ST277). The mexT gene harboured a mutation resulting in a frameshift in all isolates; in addition, the oprD gene of the blaVIM-36-carrying isolate had an insertion leading to a frameshift. Virulence genes did not differ between ST277 and ST308 strains. Moreover, only two isolates harbouring blaSPM showed virulence in the G. mellonella model, killing 100% of larvae after 18-24h. CONCLUSIONS P. aeruginosa carrying blaVIM-36 belonging to ST308 was identified for the first time in our hospital. Although the virulence gene profiles were similar in isolates carrying blaSPM and the isolate carrying blaVIM-36, only two isolates harbouring blaSPM showed virulence in the G. mellonella model.
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Affiliation(s)
- Patrícia R Neves
- Department of Infectious Diseases and LIM-54, Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | | | - Roberta Cristina Ruedas Martins
- Department of Infectious Diseases and LIM-54, Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Jéssica F Ramos
- Department of Infectious Diseases and LIM-54, Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Gleice Leite
- Department of Infectious Diseases and LIM-54, Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Flavia Rossi
- Laboratory of Microbiology, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Sabri Saeed Sanabani
- Laboratory of Medical Investigation 56 (LIM-56), Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Bone Marrow Transplant Unit, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Marjorie Vieira Batista
- Department of Infectious Diseases and LIM-54, Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil
| | - Thais Guimaraes
- Department of Infection Control, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Anna S Levin
- Department of Infectious Diseases and LIM-54, Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil; Department of Infection Control, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Sílvia F Costa
- Department of Infectious Diseases and LIM-54, Institute of Tropical Medicine of São Paulo, University of São Paulo, São Paulo, Brazil; Department of Infection Control, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil.
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15
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Martins WMBS, Narciso AC, Cayô R, Santos SV, Fehlberg LCC, Ramos PL, da Cruz JB, Gales AC. SPM-1-producing Pseudomonas aeruginosa ST277 clone recovered from microbiota of migratory birds. Diagn Microbiol Infect Dis 2017; 90:221-227. [PMID: 29224710 DOI: 10.1016/j.diagmicrobio.2017.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 11/01/2017] [Accepted: 11/02/2017] [Indexed: 02/02/2023]
Abstract
The production of São Paulo metallo-β-lactamase (SPM-1) is the most common carbapenem resistance mechanism detected among multidrug-resistant Pseudomonas aeruginosa clinical isolates in Brazil. Dissemination of SPM-1-producing P. aeruginosa has been restricted to the nosocomial settings, with sporadic reports of environmental isolates due to contamination by hospital sewage. Herein, we described the detection and molecular characterization of SPM-1-producing P. aeruginosa recovered from the microbiota of migratory birds in Brazil. Three hundred gram-negative bacilli were recovered from cloacal and choanal swabs of Dendrocygna viduata during a surveillance study for detection of carbapenem-resistant isolates. All isolates were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Molecular typing was performed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. MICs were determined by agar dilution, except for polymyxin B. Antibiotic resistance genes were detected by polymerase chain reaction (PCR) followed by DNA sequencing. Transcriptional levels of oprD and efflux system encoding genes were also carried out by quantitative real-time PCR. Nine imipenem-resistant P. aeruginosa isolates were recovered with 7 of them carrying blaSPM-1. Additional resistance genes (rmtD-1, blaOXA-56,aacA4, and aac(6')-Ib-cr) were also detected in all 9 isolates. The SPM-1-producing isolates showed high MICs for all β-lactams, fluoroquinolones, and aminoglycosides, being susceptible only to polymyxin B. Interestingly, all isolates showed the same PFGE pattern and belonged to ST277. Overexpression of MexXY-OprM and MexAB-OprM was observed in those isolates that did not harbor blaSPM-1. Our results suggest that migratory birds might have played a role in the dissemination of SPM-1-producing P. aeruginosa within the Brazilian territory.
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Affiliation(s)
- Willames M B S Martins
- Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina/Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil.
| | - Ana Clara Narciso
- Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina/Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - Rodrigo Cayô
- Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina/Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - Stéfanie Vanessa Santos
- Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina/Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - Lorena C C Fehlberg
- Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina/Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
| | - Patrícia Locosque Ramos
- Departamento de Pesquisas Aplicadas, Fundação Parque Zoológico de São Paulo, São Paulo, SP, Brazil
| | | | - Ana Cristina Gales
- Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina/Universidade Federal de São Paulo-UNIFESP, São Paulo, Brazil
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16
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Chaves L, Tomich LM, Salomão M, Leite GC, Ramos J, Martins RR, Rizek C, Neves P, Batista MV, Amigo U, Guimaraes T, Levin AS, Costa SF. High mortality of bloodstream infection outbreak caused by carbapenem-resistant P. aeruginosa producing SPM-1 in a bone marrow transplant unit. J Med Microbiol 2017; 66:1722-1729. [PMID: 29095142 DOI: 10.1099/jmm.0.000631] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE Carbapenem resistance in P. aeruginosa is increasing worldwide. In Brazil, SPM-1 is the main P. aeruginosa carbapenemase identified. Little is known about the virulence factor in SPM-1 clones.Methodolgy. We describe a carbapenem-resistant P. aeruginosa bloodstream infection (CRPa-BSI) outbreak in a bone marrow transplant Unit (BMT). Twenty-nine CRPa-BSI cases were compared to 58 controls. Microbiological characteristics of isolates, such as sensitivity, carbapenemase gene PCR for P. aeruginosa, and PFGE are described, as well as the whole-genome sequence (WGS) of three strains.Results/Key findings. The cultures from environmental and healthcare workers were negative. Some isolates harboured KPC and SPM. The WGS showed that the 03 strains belonged to ST277, presented the same mutations in outer membrane protein, efflux pump, and virulence genes such as those involved in adhesion, biofilm, quorum-sensing and the type III secretion system, but differ regarding the carbapenemase profile. A predominant clone-producing SPM harbouring Tn 4371 was identified and showed cross-transmission; no common source was found. Overall mortality rate among cases was 79 %. The first multivariate analysis model showed that neutropenia (P=0.018), GVHD prophylaxis (P=0.016) and prior use of carbapenems (P=0.0089) were associated with CRPa-BSI. However, when MASCC>21 points and platelets were added in the final multivariate analysis, only prior use of carbapenems remained as an independent risk factor for CRPa-BSI (P=0.043). CONCLUSIONS The predominant clone belonging to ST277 showed high mortality. Carbapenem use was the only risk factor associated with CRPa-BSI. This finding is a wake-up call for the need to improve management in BMT units.
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Affiliation(s)
- Lucas Chaves
- Department of Infectious Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Lísia Moura Tomich
- Department of Infectious Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Matias Salomão
- Department of Infectious Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Gleice Cristina Leite
- Laboratory of Bacteriology-LIM54, Hospital das Clínicas, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Jessica Ramos
- Department of Infectious Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Roberta Ruedas Martins
- Department of Infectious Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Camila Rizek
- Laboratory of Bacteriology-LIM54, Hospital das Clínicas, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Patricia Neves
- Laboratory of Bacteriology-LIM54, Hospital das Clínicas, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Marjorie Vieira Batista
- Department of Infectious Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Ulysses Amigo
- Bone Marrow Transplantation Unit, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Thais Guimaraes
- Infection Control Committee, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | - Anna Sara Levin
- Department of Infectious Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil.,Laboratory of Bacteriology-LIM54, Hospital das Clínicas, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | - Silvia Figueiredo Costa
- Laboratory of Bacteriology-LIM54, Hospital das Clínicas, Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil.,Department of Infectious Diseases, School of Medicine, University of São Paulo, São Paulo, Brazil
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17
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de Almeida Silva KDCF, Calomino MA, Deutsch G, de Castilho SR, de Paula GR, Esper LMR, Teixeira LA. Molecular characterization of multidrug-resistant (MDR) Pseudomonas aeruginosa isolated in a burn center. Burns 2017; 43:137-143. [DOI: 10.1016/j.burns.2016.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 06/29/2016] [Accepted: 07/14/2016] [Indexed: 11/16/2022]
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18
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Escandón-Vargas K, Reyes S, Gutiérrez S, Villegas MV. The epidemiology of carbapenemases in Latin America and the Caribbean. Expert Rev Anti Infect Ther 2016; 15:277-297. [PMID: 27915487 DOI: 10.1080/14787210.2017.1268918] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Enterobacteriaceae, Pseudomonas spp., and Acinetobacter spp. infections are major causes of morbidity and mortality, especially due to the emergence and spread of β-lactamases. Carbapenemases, which are β-lactamases with the capacity to hydrolyze or inactivate carbapenems, have become a serious concern as they have the largest hydrolytic spectrum and therefore limit the utility of most β-lactam antibiotics. Areas covered: Here, we present an update of the current status of carbapenemases in Latin America and the Caribbean. Expert commentary: The increased frequency of reports on carbapenemases in Latin America and the Caribbean shows that they have successfully spread and have even become endemic in some countries. Countries such as Brazil, Colombia, Argentina, and Mexico account for the majority of these reports. Early suspicion and detection along with implementation of antimicrobial stewardship programs in all healthcare settings are crucial for the control and prevention of carbapenemase-producing bacteria.
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Affiliation(s)
- Kevin Escandón-Vargas
- a Bacterial Resistance and Hospital Epidemiology Unit , International Center for Medical Research and Training (CIDEIM) , Cali , Colombia
| | - Sergio Reyes
- a Bacterial Resistance and Hospital Epidemiology Unit , International Center for Medical Research and Training (CIDEIM) , Cali , Colombia
| | - Sergio Gutiérrez
- a Bacterial Resistance and Hospital Epidemiology Unit , International Center for Medical Research and Training (CIDEIM) , Cali , Colombia
| | - María Virginia Villegas
- a Bacterial Resistance and Hospital Epidemiology Unit , International Center for Medical Research and Training (CIDEIM) , Cali , Colombia.,b Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics , Universidad El Bosque , Bogotá , Colombia
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19
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Quiles MG, Carlesse F, da Silva MAA, Mingrone RC, Fonseca JM, Silva DC, Pignatari ACC. High mortality outbreak of carbapenem-resistant Pseudomonas aeruginosa infection in a Brazilian pediatric oncology hospital. Braz J Infect Dis 2016; 21:205-206. [PMID: 27986489 PMCID: PMC9427553 DOI: 10.1016/j.bjid.2016.10.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Revised: 10/25/2016] [Accepted: 10/29/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Milene Gonçalves Quiles
- Universidade Federal de São Paulo (Unifesp), Laboratório Especial de Microbiologia Clínica (LEMC), São Paulo, SP, Brazil.
| | - Fabianne Carlesse
- Universidade Federal de São Paulo (Unifesp), Instituto de Oncologia Pediátrica, (IOP-GRAACC), São Paulo, SP, Brazil
| | | | - Roberta Cabral Mingrone
- Universidade Federal de São Paulo (Unifesp), Laboratório Especial de Microbiologia Clínica (LEMC), São Paulo, SP, Brazil
| | - Juliane Melo Fonseca
- Universidade Federal de São Paulo (Unifesp), Laboratório Especial de Microbiologia Clínica (LEMC), São Paulo, SP, Brazil
| | - Dafne Cardoso Silva
- Universidade Federal de São Paulo (Unifesp), Instituto de Oncologia Pediátrica, (IOP-GRAACC), São Paulo, SP, Brazil
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20
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Nascimento APB, Ortiz MF, Martins WMBS, Morais GL, Fehlberg LCC, Almeida LGP, Ciapina LP, Gales AC, Vasconcelos ATR. Intraclonal Genome Stability of the Metallo-β-lactamase SPM-1-producing Pseudomonas aeruginosa ST277, an Endemic Clone Disseminated in Brazilian Hospitals. Front Microbiol 2016; 7:1946. [PMID: 27994579 PMCID: PMC5136561 DOI: 10.3389/fmicb.2016.01946] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 11/21/2016] [Indexed: 01/30/2023] Open
Abstract
Carbapenems represent the mainstay therapy for the treatment of serious P. aeruginosa infections. However, the emergence of carbapenem resistance has jeopardized the clinical use of this important class of compounds. The production of SPM-1 metallo-β-lactamase has been the most common mechanism of carbapenem resistance identified in P. aeruginosa isolated from Brazilian medical centers. Interestingly, a single SPM-1-producing P. aeruginosa clone belonging to the ST277 has been widely spread within the Brazilian territory. In the current study, we performed a next-generation sequencing of six SPM-1-producing P. aeruginosa ST277 isolates. The core genome contains 5899 coding genes relative to the reference strain P. aeruginosa PAO1. A total of 26 genomic islands were detected in these isolates. We identified remarkable elements inside these genomic islands, such as copies of the blaSPM−1 gene conferring resistance to carbapenems and a type I-C CRISPR-Cas system, which is involved in protection of the chromosome against foreign DNA. In addition, we identified single nucleotide polymorphisms causing amino acid changes in antimicrobial resistance and virulence-related genes. Together, these factors could contribute to the marked resistance and persistence of the SPM-1-producing P. aeruginosa ST277 clone. A comparison of the SPM-1-producing P. aeruginosa ST277 genomes showed that their core genome has a high level nucleotide similarity and synteny conservation. The variability observed was mainly due to acquisition of genomic islands carrying several antibiotic resistance genes.
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Affiliation(s)
- Ana P B Nascimento
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica Petrópolis, Brazil
| | - Mauro F Ortiz
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica Petrópolis, Brazil
| | - Willames M B S Martins
- Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
| | - Guilherme L Morais
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica Petrópolis, Brazil
| | - Lorena C C Fehlberg
- Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
| | - Luiz G P Almeida
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica Petrópolis, Brazil
| | - Luciane P Ciapina
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica Petrópolis, Brazil
| | - Ana C Gales
- Laboratório Alerta, Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina, Universidade Federal de São Paulo São Paulo, Brazil
| | - Ana T R Vasconcelos
- Laboratório de Bioinformática, Laboratório Nacional de Computação Científica Petrópolis, Brazil
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21
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Cacci LC, Chuster SG, Martins N, do Carmo PR, Girão VBDC, Nouér SA, de Freitas WV, de Matos JA, Magalhães ACDG, Ferreira ALP, Picão RC, Moreira BM. Mechanisms of carbapenem resistance in endemic Pseudomonas aeruginosa isolates after an SPM-1 metallo-β-lactamase producing strain subsided in an intensive care unit of a teaching hospital in Brazil. Mem Inst Oswaldo Cruz 2016; 111:551-8. [PMID: 27653359 PMCID: PMC5027862 DOI: 10.1590/0074-02760160116] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 07/08/2016] [Indexed: 12/02/2022] Open
Abstract
Carbapenem-resistance mechanisms are a challenge in the treatment of Pseudomonas aeruginosa infections. We investigated changes in P. aeruginosa carbapenem-resistance determinants over a time period of eight years after the emergence of São Paulo metallo-β-lactamase in a university hospital in Rio de Janeiro, Brazil. Patients admitted to the intensive care unit (ICU) were screened for P. aeruginosa colonisation and followed for the occurrence of infections from April 2007 to April 2008. The ICU environment was also sampled. Isolates were typed using random amplified polymorphic DNA, pulsed-field gel electrophoresis and multilocus sequence typing. Antimicrobial susceptibility was determined by disk diffusion and E-test, production of carbapenemases by a modified-CarbaNP test and presence of carbapenemase-encoding genes by polymerase chain reaction. Non-carbapenemase resistance mechanisms studied included efflux and AmpC overexpression by PAβN and cloxacillin susceptibility enhancement, respectively, as well as oprD mutations. From 472 P. aeruginosa clinical isolates (93 patients) and 17 isolates from the ICU environment, high genotypic diversity and several international clones were observed; one environment isolate belonged to the blaSPM-1 P. aeruginosa epidemic genotype. Among isolates from infections, 10 (29%) were carbapenem resistant: none produced carbapenemases, three exhibited all non-carbapenemase mechanisms studied, six presented a combination of two mechanisms, and one exclusively displayed oprD mutations. Carbapenem-resistant P. aeruginosa displayed a polyclonal profile after the SPM-1 epidemic genotype declined. This phenomenon is connected with blaSPM-1 P. aeruginosa replaced by other carbapenem-resistant pathogens.
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Affiliation(s)
- Luciana Camila Cacci
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de
Janeiro, RJ, Brasil
| | - Stephanie Gomes Chuster
- Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde,
Instituto de Microbiologia, Rio de Janeiro, RJ, Brasil
| | - Natacha Martins
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de
Janeiro, RJ, Brasil
| | - Pâmella Rodrigues do Carmo
- Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde,
Instituto de Microbiologia, Rio de Janeiro, RJ, Brasil
| | | | - Simone Aranha Nouér
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de
Janeiro, RJ, Brasil
| | | | | | | | | | - Renata Cristina Picão
- Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde,
Instituto de Microbiologia, Rio de Janeiro, RJ, Brasil
| | - Beatriz Meurer Moreira
- Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde,
Instituto de Microbiologia, Rio de Janeiro, RJ, Brasil
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22
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Description of genomic islands associated to the multidrug-resistant Pseudomonas aeruginosa clone ST277. INFECTION GENETICS AND EVOLUTION 2016; 42:60-5. [DOI: 10.1016/j.meegid.2016.04.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 04/13/2016] [Accepted: 04/20/2016] [Indexed: 12/11/2022]
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23
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Hopkins KL, Meunier D, Findlay J, Mustafa N, Parsons H, Pike R, Wright L, Woodford N. SPM-1 metallo-β-lactamase-producing Pseudomonas aeruginosa ST277 in the UK. J Med Microbiol 2016; 65:696-697. [DOI: 10.1099/jmm.0.000269] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Katie L. Hopkins
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Danièle Meunier
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Jacqueline Findlay
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Nazim Mustafa
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Helena Parsons
- Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK
| | - Rachel Pike
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Laura Wright
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Neil Woodford
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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24
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da Silva KE, Maciel WG, Sacchi FPC, Carvalhaes CG, Rodrigues-Costa F, da Silva ACR, Croda MG, Negrão FJ, Croda J, Gales AC, Simionatto S. Risk factors for KPC-producing Klebsiella pneumoniae: watch out for surgery. J Med Microbiol 2016; 65:547-553. [DOI: 10.1099/jmm.0.000254] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Kesia Esther da Silva
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados - UFGD, Dourados, Mato Grasso do Sul, Brazil
| | - Wirlaine Glauce Maciel
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados - UFGD, Dourados, Mato Grasso do Sul, Brazil
| | - Flávia Patussi Correia Sacchi
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados - UFGD, Dourados, Mato Grasso do Sul, Brazil
- Hospital Universitário de Dourados, Universidade Federal da Grande Dourados - UFGD, Dourados, Mato Grasso do Sul, Brazil
| | - Cecilia Godoy Carvalhaes
- Laboratório ALERTA, Disciplina de Infectologia, Departamento de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Fernanda Rodrigues-Costa
- Laboratório ALERTA, Disciplina de Infectologia, Departamento de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Ana Carolina Ramos da Silva
- Laboratório ALERTA, Disciplina de Infectologia, Departamento de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
| | - Mariana Garcia Croda
- Hospital Universitário de Dourados, Universidade Federal da Grande Dourados - UFGD, Dourados, Mato Grasso do Sul, Brazil
| | - Fábio Juliano Negrão
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados - UFGD, Dourados, Mato Grasso do Sul, Brazil
| | - Julio Croda
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados - UFGD, Dourados, Mato Grasso do Sul, Brazil
- Laboratório ALERTA, Disciplina de Infectologia, Departamento de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
- Fundação Osvaldo Cruz, Campo Grande, Mato Grasso do Sul, Brazil
| | - Ana Cristina Gales
- Hospital Universitário de Dourados, Universidade Federal da Grande Dourados - UFGD, Dourados, Mato Grasso do Sul, Brazil
| | - Simone Simionatto
- Laboratório de Pesquisa em Ciências da Saúde, Universidade Federal da Grande Dourados - UFGD, Dourados, Mato Grasso do Sul, Brazil
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25
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Cavalcanti FLDS, Mirones CR, Paucar ER, Montes LÁ, Leal-Balbino TC, Morais MMCD, Martínez-Martínez L, Ocampo-Sosa AA. Mutational and acquired carbapenem resistance mechanisms in multidrug resistant Pseudomonas aeruginosa clinical isolates from Recife, Brazil. Mem Inst Oswaldo Cruz 2015; 110:1003-9. [PMID: 26676375 PMCID: PMC4708020 DOI: 10.1590/0074-02760150233] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/18/2015] [Indexed: 01/10/2023] Open
Abstract
An investigation was carried out into the genetic mechanisms responsible for
multidrug resistance in nine carbapenem-resistant Pseudomonas
aeruginosaisolates from different hospitals in Recife, Brazil.
Susceptibility to antimicrobial agents was determined by broth microdilution.
Polymerase chain reaction (PCR) was employed to detect the presence of genes encoding
β-lactamases, aminoglycoside-modifying enzymes (AMEs), 16S rRNA methylases,
integron-related genes and OprD. Expression of genes coding for efflux pumps and AmpC
cephalosporinase were assessed by quantitative PCR. The outer membrane proteins were
separated by sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The
blaSPM-1, blaKPC-2 and blaGES-1
genes were detected in P. aeruginosaisolates in addition to
different AME genes. The loss of OprD in nine isolates was mainly due to frameshift
mutations, premature stop codons and point mutations. An association of loss of OprD
with the overexpression of MexAB-OprM and MexXY-OprM was observed in most isolates.
Hyper-production of AmpC was also observed in three isolates. Clonal relationship of
the isolates was determined by repetitive element palindromic-PCR and multilocus
sequence typing. Our results show that the loss of OprD along with overexpression of
efflux pumps and β-lactamase production were responsible for the multidrug resistance
in the isolates analysed.
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Affiliation(s)
- Felipe Lira de Sá Cavalcanti
- Laboratório de Resistência Microbiana, Instituto de Ciências Biológicas, Universidade de Pernambuco, Recife, PE, Brasil
| | - Cristina Rodríguez Mirones
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla, Santander, Spain
| | - Elena Román Paucar
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla, Santander, Spain
| | - Laura Álvarez Montes
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla, Santander, Spain
| | | | | | - Luis Martínez-Martínez
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla, Santander, Spain
| | - Alain Antonio Ocampo-Sosa
- Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla, Santander, Spain
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26
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Oliver A, Mulet X, López-Causapé C, Juan C. The increasing threat of Pseudomonas aeruginosa high-risk clones. Drug Resist Updat 2015; 21-22:41-59. [PMID: 26304792 DOI: 10.1016/j.drup.2015.08.002] [Citation(s) in RCA: 402] [Impact Index Per Article: 44.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 08/04/2015] [Indexed: 01/01/2023]
Abstract
The increasing prevalence of chronic and hospital-acquired infections produced by multidrug-resistant (MDR) or extensively drug-resistant (XDR) Pseudomonas aeruginosa strains is associated with significant morbidity and mortality. This growing threat results from the extraordinary capacity of this pathogen for developing resistance through chromosomal mutations and from the increasing prevalence of transferable resistance determinants, particularly those encoding carbapenemases or extended-spectrum β-lactamases (ESBLs). P. aeruginosa has a nonclonal epidemic population structure, composed of a limited number of widespread clones which are selected from a background of a large quantity of rare and unrelated genotypes that are recombining at high frequency. Indeed, recent concerning reports have provided evidence of the existence of MDR/XDR global clones, denominated high-risk clones, disseminated in hospitals worldwide; ST235, ST111, and ST175 are likely those more widespread. Noteworthy, the vast majority of infections by MDR, and specially XDR, strains are produced by these and few other clones worldwide. Moreover, the association of high-risk clones, particularly ST235, with transferable resistance is overwhelming; nearly 100 different horizontally-acquired resistance elements and up to 39 different acquired β-lactamases have been reported so far among ST235 isolates. Likewise, MDR internationally-disseminated epidemic strains, such as the Liverpool Epidemic Strain (LES, ST146), have been noted as well among cystic fibrosis patients. Here we review the population structure, epidemiology, antimicrobial resistance mechanisms and virulence of the P. aeruginosa high-risk clones. The phenotypic and genetic factors potentially driving the success of high-risk clones, the aspects related to their detection in the clinical microbiology laboratory and the implications for infection control and public health are also discussed.
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Affiliation(s)
- Antonio Oliver
- Servicio de Microbiología and Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Ctra. Valldemossa 79, 07010 Palma de Mallorca, Spain.
| | - Xavier Mulet
- Servicio de Microbiología and Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Ctra. Valldemossa 79, 07010 Palma de Mallorca, Spain
| | - Carla López-Causapé
- Servicio de Microbiología and Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Ctra. Valldemossa 79, 07010 Palma de Mallorca, Spain
| | - Carlos Juan
- Servicio de Microbiología and Unidad de Investigación, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma (IdISPa), Ctra. Valldemossa 79, 07010 Palma de Mallorca, Spain
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27
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Miranda C, de Filippis I, Pinto L, Coelho-Souza T, Bianco K, Cacci L, Picão R, Clementino M. Genotypic characteristics of multidrug-resistant Pseudomonas aeruginosa
from hospital wastewater treatment plant in Rio de Janeiro, Brazil. J Appl Microbiol 2015; 118:1276-86. [DOI: 10.1111/jam.12792] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 01/16/2015] [Accepted: 02/24/2015] [Indexed: 11/27/2022]
Affiliation(s)
- C.C. Miranda
- Instituto Nacional de Controle de Qualidade em Saúde; FIOCRUZ; Rio de Janeiro Brazil
| | - I. de Filippis
- Instituto Nacional de Controle de Qualidade em Saúde; FIOCRUZ; Rio de Janeiro Brazil
| | - L.H. Pinto
- Departamento de Bioquímica; Instituto de Biologia Roberto Alcântara Gomes; Universidade do Estado do Rio de Janeiro; Rio de Janeiro Brazil
| | - T. Coelho-Souza
- Instituto Nacional de Controle de Qualidade em Saúde; FIOCRUZ; Rio de Janeiro Brazil
| | - K. Bianco
- Instituto Nacional de Controle de Qualidade em Saúde; FIOCRUZ; Rio de Janeiro Brazil
| | - L.C. Cacci
- Instituto de Microbiologia Paulo de Góes; Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
| | - R.C. Picão
- Instituto de Microbiologia Paulo de Góes; Universidade Federal do Rio de Janeiro; Rio de Janeiro Brazil
| | - M.M. Clementino
- Instituto Nacional de Controle de Qualidade em Saúde; FIOCRUZ; Rio de Janeiro Brazil
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Korb A, Nazareno ERD, Costa LD, Nogueira KDS, Dalsenter PR, Tuon FF, Pomba MC. Tipagem molecular e resistência aos antimicrobianos em isolados de Escherichia coli de frangos de corte e de tratadores na Região Metropolitana de Curitiba, Paraná. PESQUISA VETERINARIA BRASILEIRA 2015. [DOI: 10.1590/s0100-736x2015000300008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Este estudo verificou o perfil de resistência aos antimicrobianos entre isolados de Escherichia coli de frangos de corte de criação intensiva e de subsistência e dos respectivos tratadores e a similaridade genotípica entre isolados de E.coli de frangos de corte de criação intensiva e isolados de E. coli de tratadores de frangos de criação intensiva pela técnica de Eletroforese em Gel de Campo Pulsado (PFGE). 60 amostras de fezes de frangos de criação intensiva, 60 de frangos de corte de criação de subsistência (caipira) e 20 amostras dos tratadores de frangos de criação intensiva e 20 de tratadores de frangos de criação de subsistência. E. coli foram isoladas, identificadas e submetidas ao teste de suscetibilidade a 12 antimicrobianos. Pela PFGE foram analisados 24 isolados de E. coli de frangos de corte de criação intensiva e oito de tratadores. Em isolados E. coli de frangos de criação intensiva a resistência para a ampicilina foi de 100%, cefotaxima 43%, ceftriaxona 48%, ácido nalidíxico 62%, enrofloxacina 23%, ciprofloxacina 23%, tetraciclina 83% e 45% para trimetoprim-sulfametoxazol. Nos isolados de frangos de criação de subsistência foi de 20%, 0%, 0%, 5%, 2%, 4%, 33% e 8%, respectivamente. Resistência à fosfomicina e à nitrofurantoína foi encontrada em isolados de frangos de criação de subsistência. Em isolados de E. coli de tratadores de frangos de corte de criação intensiva a resistência para ampicilina foi de 60%, para ciprofloxacina 25% e para tetraciclina 45%, enquanto nos tratadores de subsistência foram de 20%, 5% e 30%, respectivamente. Isolados de E. coli de frangos em criação de subsistência apresentaram 46,6%(28/60) de suscetibilidade a todos os antimicrobianos testados enquanto que na criação intensiva 81%(49/60) foram multirresistentes. Sete clusters de isolados de E. coli de frangos de diferentes aviários apresentaram similaridade acima de 80%, e dois destes foram superiores a 95%. Três clusters de isolados de frangos e de tratadores apresentaram similaridade superior a 80%. Somente um destes clusters foi de isolado de tratador e de frango do mesmo aviário.
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Affiliation(s)
- Arnildo Korb
- Universidade do Estado de Santa Catarina, Brazil
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Gheorghe I, Novais Â, Grosso F, Rodrigues C, Chifiriuc MC, Lazar V, Peixe L. Snapshot on carbapenemase-producing Pseudomonas aeruginosa and Acinetobacter baumannii in Bucharest hospitals reveals unusual clones and novel genetic surroundings for blaOXA-23. J Antimicrob Chemother 2015; 70:1016-20. [PMID: 25630639 DOI: 10.1093/jac/dku527] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The present study was designed to provide a snapshot on carbapenemase-producing Pseudomonas aeruginosa (n=11) and Acinetobacter baumannii (n=7) isolates in hospitalized patients (November 2011, January-March 2012) from two main hospitals in Bucharest, south Romania. METHODS Clonality among isolates was established by PFGE, MLST and Fourier transform infrared spectroscopy. Carbapenemases were screened by the Blue-Carba test, PCR and sequencing. Transferability of blaOXA-23 was tested by conjugation and plasmid typing (number, size and identity) was assessed by S1-PFGE, replicon typing, hybridization and PCR mapping. RESULTS All P. aeruginosa isolates carried chromosomally located blaVIM-2, associated with a common class 1 integron (aacA7-blaVIM-2) or an atypical configuration (aacA7-blaVIM-2-dfrB5-tniC). These isolates belonged to unusual lineages; mostly ST233 disseminated in one hospital unit, with ST364 and ST1074 also being detected. A. baumannii isolates carried blaOXA-23 in Tn2008, which was found truncating a TnaphA6 transposon located in a common 60 kb GR6 (aci6) pABKp1-like conjugative plasmid in highly related CC92 clones (ST437, ST764 and ST765), where CC stands for clonal complex. CONCLUSIONS Our results show the spread of VIM-2-producing P. aeruginosa and OXA-23-producing A. baumannii clinical isolates in two hospitals from Bucharest and highlight a peculiar population structure in this Eastern European country. Also, we demonstrate the dissemination of a common and conjugative aci6 pABKp1-like plasmid scaffold in different A. baumannii clones and we report the first known identification of Tnaph6-carrying pACICU2-like plasmids in Europe.
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Affiliation(s)
- Irina Gheorghe
- Department of Microbiology, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Ângela Novais
- UCIBIO/REQUIMTE, Laboratório de Microbiologia, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Filipa Grosso
- UCIBIO/REQUIMTE, Laboratório de Microbiologia, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | - Carla Rodrigues
- UCIBIO/REQUIMTE, Laboratório de Microbiologia, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
| | | | - Veronica Lazar
- Department of Microbiology, Faculty of Biology, University of Bucharest, Bucharest, Romania
| | - Luísa Peixe
- UCIBIO/REQUIMTE, Laboratório de Microbiologia, Faculdade de Farmácia, Universidade do Porto, Porto, Portugal
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Silveira M, Albano R, Asensi M, Assef APC. The draft genome sequence of multidrug-resistant Pseudomonas aeruginosa strain CCBH4851, a nosocomial isolate belonging to clone SP (ST277) that is prevalent in Brazil. Mem Inst Oswaldo Cruz 2014; 109:1086-7. [PMID: 25466623 PMCID: PMC4325612 DOI: 10.1590/0074-0276140336] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Accepted: 11/05/2014] [Indexed: 11/21/2022] Open
Abstract
The high occurrence of nosocomial multidrug-resistant (MDR) microorganisms is considered a global health problem. Here, we report the draft genome sequence of a MDR Pseudomonas aeruginosa strain isolated in Brazil that belongs to the endemic clone ST277. The genome encodes important resistance determinant genes and consists of 6.7 Mb with a G+C content of 66.86% and 6,347 predicted coding regions including 60 RNAs.
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Affiliation(s)
- Melise Silveira
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, RJ, Brasil
| | - Rodolpho Albano
- Departamento de Bioquímica, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
| | - Marise Asensi
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, RJ, Brasil
| | - Ana Paula Carvalho Assef
- Laboratório de Pesquisa em Infecção Hospitalar, Instituto Oswaldo Cruz-Fiocruz, Rio de Janeiro, RJ, Brasil
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The resistome of Pseudomonas aeruginosa in relationship to phenotypic susceptibility. Antimicrob Agents Chemother 2014; 59:427-36. [PMID: 25367914 DOI: 10.1128/aac.03954-14] [Citation(s) in RCA: 189] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Many clinical isolates of Pseudomonas aeruginosa cause infections that are difficult to eradicate due to their resistance to a wide variety of antibiotics. Key genetic determinants of resistance were identified through genome sequences of 390 clinical isolates of P. aeruginosa, obtained from diverse geographic locations collected between 2003 and 2012 and were related to microbiological susceptibility data for meropenem, levofloxacin, and amikacin. β-Lactamases and integron cassette arrangements were enriched in the established multidrug-resistant lineages of sequence types ST111 (predominantly O12) and ST235 (O11). This study demonstrates the utility of next-generation sequencing (NGS) in defining relevant resistance elements and highlights the diversity of resistance determinants within P. aeruginosa. This information is valuable in furthering the design of diagnostics and therapeutics for the treatment of P. aeruginosa infections.
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Wright LL, Turton JF, Livermore DM, Hopkins KL, Woodford N. Dominance of international 'high-risk clones' among metallo-β-lactamase-producing Pseudomonas aeruginosa in the UK. J Antimicrob Chemother 2014; 70:103-10. [PMID: 25182064 DOI: 10.1093/jac/dku339] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVES Carbapenem-resistant isolates of Pseudomonas aeruginosa producing metallo-β-lactamases (MBLs) are increasingly reported worldwide and often belong to particular 'high-risk clones'. This study aimed to characterize a comprehensive collection of MBL-producing P. aeruginosa isolates referred to the UK national reference laboratory from multiple UK laboratories over a 10 year period. METHODS Isolates were referred to the UK national reference laboratory between 2003 and 2012 for investigation of resistance mechanisms and/or outbreaks. MBL genes were detected by PCR. Typing was carried out by nine-locus variable-number tandem repeat (VNTR) analysis and MLST. RESULTS MBL-producing P. aeruginosa isolates were referred from 267 source patients and 89 UK laboratories. The most common isolation sites were urine (24%), respiratory (18%), wounds (17%) and blood (13%). VIM-type MBLs predominated (91% of all MBLs found), but a few IMP- and NDM-type enzymes were also identified. Diverse VNTR types were seen, but 86% of isolates belonged to six major complexes. MLST of representative isolates from each complex showed that they corresponded to STs 111, 233, 235, 357, 654 and 773, respectively. Isolates belonging to these complexes were received from between 9 and 25 UK referring laboratories each. CONCLUSIONS The incidence of MBL-producing P. aeruginosa is increasing in the UK. The majority of these isolates belong to several 'high-risk clones', which have been previously reported internationally as host clones of MBLs.
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Affiliation(s)
- Laura L Wright
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, Colindale, London NW9 5EQ, UK Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK
| | - Jane F Turton
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, Colindale, London NW9 5EQ, UK
| | - David M Livermore
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, Colindale, London NW9 5EQ, UK Norwich Medical School, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK
| | - Katie L Hopkins
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, Colindale, London NW9 5EQ, UK
| | - Neil Woodford
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, Colindale, London NW9 5EQ, UK
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Labarca JA, Salles MJC, Seas C, Guzmán-Blanco M. Carbapenem resistance in Pseudomonas aeruginosa and Acinetobacter baumannii in the nosocomial setting in Latin America. Crit Rev Microbiol 2014; 42:276-92. [PMID: 25159043 DOI: 10.3109/1040841x.2014.940494] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Increasing prevalence of carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii strains in the nosocomial setting in Latin America represents an emerging challenge to public health, as the range of therapeutic agents active against these pathogens becomes increasingly constrained. We review published reports from 2002 to 2013, compiling data from throughout the region on prevalence, mechanisms of resistance and molecular epidemiology of carbapenem-resistant strains of P. aeruginosa and A. baumannii. We find rates of carbapenem resistance up to 66% for P. aeruginosa and as high as 90% for A. baumannii isolates across the different countries of Latin America, with the resistance rate of A. baumannii isolates greater than 50% in many countries. An outbreak of the SPM-1 carbapenemase is a chief cause of resistance in P. aeruginosa strains in Brazil. Elsewhere in Latin America, members of the VIM family are the most important carbapenemases among P. aeruginosa strains. Carbapenem resistance in A. baumannii in Latin America is predominantly due to the oxacillinases OXA-23, OXA-58 and (in Brazil) OXA-143. Susceptibility of P. aeruginosa and A. baumannii to colistin remains high, however, development of resistance has already been detected in some countries. Better epidemiological data are needed to design effective infection control interventions.
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Affiliation(s)
- Jaime A Labarca
- a Department of Infectious Diseases , School of Medicine, Pontificia Universidad Católica de Chile , Lira , Santiago , Chile
| | | | - Carlos Seas
- c Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia , Lima , Perú , and
| | - Manuel Guzmán-Blanco
- d Hospital Privado Centro Médico de Caracas and Hospital Vargas de Caracas , Caracas , Venezuela
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Evaluation of the total MBL confirm kit (ROSCO) for detection of metallo-β-lactamases in Pseudomonas aeruginosa and Acinetobacter baumannii. Diagn Microbiol Infect Dis 2014; 79:486-8. [DOI: 10.1016/j.diagmicrobio.2013.12.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 11/27/2013] [Accepted: 12/03/2013] [Indexed: 11/23/2022]
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Gheorghe I, Czobor I, Chifiriuc MC, Borcan E, Ghiţă C, Banu O, Lazăr V, Mihăescu G, Mihăilescu DF, Zhiyong Z. Molecular screening of carbapenemase-producing Gram-negative strains in Romanian intensive care units during a one year survey. J Med Microbiol 2014; 63:1303-1310. [PMID: 25060972 DOI: 10.1099/jmm.0.074039-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This is the first study, to our knowledge, performed on a significant number of strains (79 carbapenem-resistant Enterobacteriaceae and 84 carbapenem-resistant non-fermenting Gram-negative rods, GNRs) isolated from tissue samples taken from patients in the intensive care units of two large hospitals in Bucharest, Romania, between 2011 and 2012. The results revealed a high prevalence and great diversity of carbapenemase genes (CRG), in both fermenting and non-fermenting Gram-negative carbapenem-resistant strains. The molecular screening of carbapenem-resistant GNRs revealed the presence of worldwide-distributed CRGs (i.e. blaOXA-48 and blaNDM-1 in Enterobacteriaceae and blaOXA-23, blaVIM-4, blaOXA-10-like, blaOXA-60-like, blaSPM-like and blaGES-like in non-fermenting GNRs), reflecting the rapid evolution and spread of carbapenemase producers, particularly in hospitals. Rapid identification of the colonized or infected patients is required, as are epidemiological investigations to establish the local or imported origin of the respective strains.
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Affiliation(s)
- Irina Gheorghe
- Department of Microbiology, Faculty of Biology, University of Bucharest, Portocalelor 1-3, Bucharest, Romania
| | - Ilda Czobor
- Department of Microbiology, Faculty of Biology, University of Bucharest, Portocalelor 1-3, Bucharest, Romania
| | - Mariana Carmen Chifiriuc
- Cantacuzino National Institute of Research and Development for Microbiology and Immunology, Splaiul Independenţei 103, Bucharest, Romania.,Research Institute of the University of Bucharest, University of Bucharest, B.P. Hasdeu Street 10, Bucharest, Romania.,Department of Microbiology, Faculty of Biology, University of Bucharest, Portocalelor 1-3, Bucharest, Romania
| | - Elvira Borcan
- Fundeni Clinical Hospital, Fundeni Road 258, Bucharest, Romania
| | - Camelia Ghiţă
- Fundeni Clinical Hospital, Fundeni Road 258, Bucharest, Romania
| | - Otilia Banu
- C. C. Iliescu Institute of Cardiovascular Diseases, Fundeni Road 258, Bucharest
| | - Veronica Lazăr
- Department of Microbiology, Faculty of Biology, University of Bucharest, Portocalelor 1-3, Bucharest, Romania
| | - Grigore Mihăescu
- Department of Microbiology, Faculty of Biology, University of Bucharest, Portocalelor 1-3, Bucharest, Romania
| | - Dan Florin Mihăilescu
- Department of Anatomy and Biophysics, Faculty of Biology, University of Bucharest, Splaiul Independenţei 91-95, Bucharest, Romania
| | - Zong Zhiyong
- Centre of Infectious Diseases, West China Hospital, Sichuan University, Guoxuexiang 37, Chengdu, China
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Complete Genome Sequence of an F8-Like Lytic Myovirus ({varphi}SPM-1) That Infects Metallo-β-Lactamase-Producing Pseudomonas aeruginosa. GENOME ANNOUNCEMENTS 2014; 2:2/2/e00061-14. [PMID: 24699949 PMCID: PMC3974931 DOI: 10.1128/genomea.00061-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Pseudomonas aeruginosa is an important cause of infection, especially in immunocompromised patients. In this regard, strains producing carbapenemases, mainly metallo-β-lactamases (MBLs), have become a significant public health concern. Here, we present the complete annotated genome sequence (65.7 kb) of an F8-related lytic myovirus (Pbunalikevirus genus) that infects MBL-producing P. aeruginosa strains.
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Maya JJ, Ruiz SJ, Blanco VM, Gotuzzo E, Guzman-Blanco M, Labarca J, Salles M, Quinn JP, Villegas MV. Current status of carbapenemases in Latin America. Expert Rev Anti Infect Ther 2014; 11:657-67. [PMID: 23879607 DOI: 10.1586/14787210.2013.811924] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Enterobacteriaceae and non fermenting Gram-negative bacilli have become a threat to public health, in part due to their resistance to multiple antibiotic classes, which ultimately have led to an increase in morbidity and mortality. β-lactams are currently the mainstay for combating infections caused by these microorganisms, and β-lactamases are the major mechanism of resistance to this class of antibiotics. Within the β-lactamases, carbapenemases pose one of the gravest threats, as they compromise one of our most potent lines of defense, the carbapenems. Carbapenemases are being continuously identified worldwide; and in Latin America, numerous members of these enzymes have been reported. In this region, the high incidence of reports implies that carbapenemases have become a menace and that they are an issue that must be carefully studied and analyzed.
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Affiliation(s)
- Juan J Maya
- CIDEIM International Center for Medical Research and Training, Cali, Colombia
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González LJ, Moreno DM, Bonomo RA, Vila AJ. Host-specific enzyme-substrate interactions in SPM-1 metallo-β-lactamase are modulated by second sphere residues. PLoS Pathog 2014; 10:e1003817. [PMID: 24391494 PMCID: PMC3879351 DOI: 10.1371/journal.ppat.1003817] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2013] [Accepted: 10/21/2013] [Indexed: 11/18/2022] Open
Abstract
Pseudomonas aeruginosa is one of the most virulent and resistant non-fermenting Gram-negative pathogens in the clinic. Unfortunately, P. aeruginosa has acquired genes encoding metallo-β-lactamases (MβLs), enzymes able to hydrolyze most β-lactam antibiotics. SPM-1 is an MβL produced only by P. aeruginosa, while other MβLs are found in different bacteria. Despite similar active sites, the resistance profile of MβLs towards β-lactams changes from one enzyme to the other. SPM-1 is unique among pathogen-associated MβLs in that it contains “atypical” second sphere residues (S84, G121). Codon randomization on these positions and further selection of resistance-conferring mutants was performed. MICs, periplasmic enzymatic activity, Zn(II) requirements, and protein stability was assessed. Our results indicated that identity of second sphere residues modulates the substrate preferences and the resistance profile of SPM-1 expressed in P. aeruginosa. The second sphere residues found in wild type SPM-1 give rise to a substrate selectivity that is observed only in the periplasmic environment. These residues also allow SPM-1 to confer resistance in P. aeruginosa under Zn(II)-limiting conditions, such as those expected under infection. By optimizing the catalytic efficiency towards β-lactam antibiotics, the enzyme stability and the Zn(II) binding features, molecular evolution meets the specific needs of a pathogenic bacterial host by means of substitutions outside the active site. The presence of Zn(II)-containing metallo-β-lactamases (MβLs) that confer resistance to all penicillins, cephalosporins and carbapenems in Pseudomonas aeruginosa adds significantly to the threat of this pathogen in our health care system. SPM-1 is an MβLs widely distributed in South America and only found in P. aeruginosa. In common with all MβLs, the active site residues are highly conserved. In this work we asked the following question: how would substrate specificity evolve in SPM-1 if the active site residues are highly uniform and do not permit substitutions. To this end, we explored the role of two amino acids (S84 and G121) that are outside the active site (second sphere) and are unique in the SPM-1 β-lactamase. We discovered that replacing these amino acids impacts resistance to cephalosporins and carbapenems and that this resistance profile depends on the enzymatic behavior and the availability of Zn(II) in the environment. This work demonstrates how protein evolution by means of subtle substitutions outside the active site meets the specific needs of a pathogenic bacterial host.
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Affiliation(s)
- Lisandro J. González
- Instituto de Biología Molecular y Celular de Rosario (IBR, CONICET-UNR) and Area Biofísica, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Diego M. Moreno
- Instituto de Química Rosario (IQUIR, CONICET-UNR), Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Robert A. Bonomo
- Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center and Departments of Medicine, Pharmacology, Molecular Biology and Microbiology, Case Western Reserve University, School of Medicine, Cleveland, Ohio, United States of America
| | - Alejandro J. Vila
- Instituto de Biología Molecular y Celular de Rosario (IBR, CONICET-UNR) and Area Biofísica, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
- * E-mail:
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Maâtallah M, Bakhrouf A, Habeeb MA, Turlej-Rogacka A, Iversen A, Pourcel C, Sioud O, Giske CG. Four genotyping schemes for phylogenetic analysis of Pseudomonas aeruginosa: comparison of their congruence with multi-locus sequence typing. PLoS One 2013; 8:e82069. [PMID: 24349186 PMCID: PMC3859543 DOI: 10.1371/journal.pone.0082069] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Accepted: 10/21/2013] [Indexed: 11/28/2022] Open
Abstract
Several molecular typing schemes have been proposed to differentiate among isolates and clonal groups, and hence establish epidemiological or phylogenetic links. It has been widely accepted that multi-locus sequence typing (MLST) is the gold standard for phylogenetic typing/long-term epidemiological surveillance, but other recently described methods may be easier to carry out, especially in settings with limited access to DNA sequencing. Comparing the performance of such techniques to MLST is therefore of relevance. A study was therefore carried out with a collection of P. aeruginosa strains (n = 133) typed by four typing schemes: MLST, multiple-locus variable number tandem repeat analysis (MLVA), pulsed-field gel electrophoresis (PFGE) and the commercial DiversiLab microbial typing system (DL). The aim of this study was to compare the results of each typing method with MLST. The Simpson's indices of diversity were 0.989, 0.980, 0.961 and 0.906 respectively for PFGE, MLVA, DL and MLST. The congruence between techniques was measured by the adjusted Wallace index (W): this coefficient indicates the probability that a pair of isolates which is assigned to the same type by one typing method is also typed as identical by the other. In this context, the congruence between techniques was recorded as follow: MLVA-type to predict MLST-type (93%), PFGE to MLST (92%), DL to MLST (64.2%), PFGE to MLVA (63.5%) and PFGE to DL (61.7%). Conversely, for all above combinations, prediction was very poor. The congruence was increased at the clonal complex (CC) level. MLST is regarded the gold standard for phylogenetic classification of bacteria, but is rather laborious to carry out in many settings. Our data suggest that MLVA can predict the MLST-type with high accuracy, and even higher when studying the clonal complex level. Of the studied three techniques MLVA was therefore the best surrogate method to predict MLST.
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Affiliation(s)
- Makaoui Maâtallah
- Laboratoire d'Analyse, Traitement et Valorisation des Polluants de l'Environnement et des Produits, Faculté de Pharmacie, Monastir, Tunisia
| | - Amina Bakhrouf
- Laboratoire d'Analyse, Traitement et Valorisation des Polluants de l'Environnement et des Produits, Faculté de Pharmacie, Monastir, Tunisia
| | - Muhammed Asif Habeeb
- Clinical Microbiology L2:02, MTC – Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Agata Turlej-Rogacka
- Clinical Microbiology L2:02, MTC – Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Aina Iversen
- Clinical Microbiology L2:02, MTC – Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Christine Pourcel
- Univ Paris-Sud, Institut de Génétique et Microbiologie, Orsay, France
- CNRS, Orsay, France
| | - Olfa Sioud
- Laboratoire de Microbiologie CHU Fattouma Bourguiba, Monastir, Tunisia
| | - Christian G. Giske
- Clinical Microbiology L2:02, MTC – Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
- * E-mail:
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Pournaras S, Köck R, Mossialos D, Mellmann A, Sakellaris V, Stathopoulos C, Friedrich AW, Tsakris A. Detection of a phylogenetically distinct IMP-type metallo-β-lactamase, IMP-35, in a CC235 Pseudomonas aeruginosa from the Dutch-German border region (Euregio). J Antimicrob Chemother 2013; 68:1271-6. [PMID: 23341129 DOI: 10.1093/jac/dkt004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To characterize a highly divergent IMP-type metallo-β-lactamase (MBL) variant detected in a multidrug-resistant Pseudomonas aeruginosa clinical isolate. METHODS P. aeruginosa isolate 1876 was recovered from an anal swab of an inpatient at a German hospital in the Dutch-German border region (Euregio), where cross-border patient healthcare occurs. MICs were determined by agar dilution and phenotypic screening for MBL production by Etest MBL. Typing was performed by multilocus sequence typing (MLST). PCR assays and nucleotide sequencing were employed for identification of bla gene types. The class 1 integron carrying the blaIMP-type gene was characterized by PCR mapping and sequencing using a set of specific primers. A phylogenetic tree was constructed for the new blaIMP variant. RESULTS Isolate 1876 was phenotypically positive for MBL production, exhibited resistance to carbapenems and harboured a new blaIMP-type gene, blaIMP-35. MLST showed that the allelic profile corresponded to ST622, which belongs to the prevalent international clonal complex CC235. The blaIMP-35 gene was located in a class 1 integron as the first gene cassette, followed by blaOXA-35, aacA6, qacEΔ1 and sul1, suggesting its recent integration. IMP-35 was highly divergent, possessing 33/246 (13.4%) different amino acid residues from its closest IMP variants (IMP-8 and IMP-12) and was phylogenetically distinct, representing a separate group in the phylogenetic tree of IMP proteins. CONCLUSIONS The identification of this phylogenetically distinct IMP-type variant in a CC235 P. aeruginosa suggests the ongoing spread of new IMP-type carbapenemases as well as the potential of the blaIMP-35 gene to evolve in the hospital environment.
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Affiliation(s)
- Spyros Pournaras
- Department of Microbiology, Medical School, University of Thessaly, Larissa, Greece.
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Polotto M, Casella T, de Lucca Oliveira MG, Rúbio FG, Nogueira ML, de Almeida MT, Nogueira MC. Detection of P. aeruginosa harboring bla CTX-M-2, bla GES-1 and bla GES-5, bla IMP-1 and bla SPM-1 causing infections in Brazilian tertiary-care hospital. BMC Infect Dis 2012; 12:176. [PMID: 22863113 PMCID: PMC3512492 DOI: 10.1186/1471-2334-12-176] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 07/24/2012] [Indexed: 12/27/2022] Open
Abstract
Background Nosocomial infections caused by Pseudomonas aeruginosa presenting resistance to beta-lactam drugs are one of the most challenging targets for antimicrobial therapy, leading to substantial increase in mortality rates in hospitals worldwide. In this context, P. aeruginosa harboring acquired mechanisms of resistance, such as production of metallo-beta-lactamase (MBLs) and extended-spectrum beta-lactamases (ESBLs) have the highest clinical impact. Hence, this study was designed to investigate the presence of genes codifying for MBLs and ESBLs among carbapenem resistant P. aeruginosa isolated in a Brazilian 720-bed teaching tertiary care hospital. Methods Fifty-six carbapenem-resistant P. aeruginosa strains were evaluated for the presence of MBL and ESBL genes. Strains presenting MBL and/or ESBL genes were submitted to pulsed-field gel electrophoresis for genetic similarity evaluation. Results Despite the carbapenem resistance, genes for MBLs (blaSPM-1 or blaIMP-1) were detected in only 26.7% of isolates. Genes encoding ESBLs were detected in 23.2% of isolates. The blaCTX-M-2 was the most prevalent ESBL gene (19.6%), followed by blaGES-1 and blaGES-5 detected in one isolate each. In all isolates presenting MBL phenotype by double-disc synergy test (DDST), the blaSPM-1 or blaIMP-1 genes were detected. In addition, blaIMP-1 was also detected in three isolates which did not display any MBL phenotype. These isolates also presented the blaCTX-M-2 gene. The co-existence of blaCTX-M-2 with blaIMP-1 is presently reported for the first time, as like as co-existence of blaGES-1 with blaIMP-1. Conclusions In this study MBLs production was not the major mechanism of resistance to carbapenems, suggesting the occurrence of multidrug efflux pumps, reduction in porin channels and production of other beta-lactamases. The detection of blaCTX-M-2,blaGES-1 and blaGES-5 reflects the recent emergence of ESBLs among antimicrobial resistant P. aeruginosa and the extraordinary ability presented by this pathogen to acquire multiple resistance mechanisms. These findings raise the concern about the future of antimicrobial therapy and the capability of clinical laboratories to detect resistant strains, since simultaneous production of MBLs and ESBLs is known to promote further complexity in phenotypic detection. Occurrence of intra-hospital clonal dissemination enhances the necessity of better observance of infection control practices.
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Affiliation(s)
- Milena Polotto
- Laboratório de Microbiologia, Departamento de Doenças Dermatológicas, Infecciosas e Parasitárias, São José do Rio Preto, SP, Brazil
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Livermore DM. Current epidemiology and growing resistance of gram-negative pathogens. Korean J Intern Med 2012; 27:128-42. [PMID: 22707882 PMCID: PMC3372794 DOI: 10.3904/kjim.2012.27.2.128] [Citation(s) in RCA: 233] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Accepted: 04/09/2012] [Indexed: 12/24/2022] Open
Abstract
In the 1980s, gram-negative pathogens appeared to have been beaten by oxyimino-cephalosporins, carbapenems, and fluoroquinolones. Yet these pathogens have fought back, aided by their membrane organization, which promotes the exclusion and efflux of antibiotics, and by a remarkable propensity to recruit, transfer, and modify the expression of resistance genes, including those for extended-spectrum β-lactamases (ESBLs), carbapenemases, aminoglycoside-blocking 16S rRNA methylases, and even a quinolone-modifying variant of an aminoglycoside-modifying enzyme. Gram-negative isolates--both fermenters and non-fermenters--susceptible only to colistin and, more variably, fosfomycin and tigecycline, are encountered with increasing frequency, including in Korea. Some ESBLs and carbapenemases have become associated with strains that have great epidemic potential, spreading across countries and continents; examples include Escherichia coli sequence type (ST)131 with CTX-M-15 ESBL and Klebsiella pneumoniae ST258 with KPC carbapenemases. Both of these high-risk lineages have reached Korea. In other cases, notably New Delhi Metallo carbapenemase, the relevant gene is carried by promiscuous plasmids that readily transfer among strains and species. Unless antibiotic stewardship is reinforced, microbiological diagnosis accelerated, and antibiotic development reinvigorated, there is a real prospect that the antibiotic revolution of the 20th century will crumble.
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Maatallah M, Cheriaa J, Backhrouf A, Iversen A, Grundmann H, Do T, Lanotte P, Mastouri M, Elghmati MS, Rojo F, Mejdi S, Giske CG. Population structure of Pseudomonas aeruginosa from five Mediterranean countries: evidence for frequent recombination and epidemic occurrence of CC235. PLoS One 2011; 6:e25617. [PMID: 21984923 PMCID: PMC3184967 DOI: 10.1371/journal.pone.0025617] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 09/06/2011] [Indexed: 01/01/2023] Open
Abstract
Several studies in recent years have provided evidence that Pseudomonas aeruginosa has a non-clonal population structure punctuated by highly successful epidemic clones or clonal complexes. The role of recombination in the diversification of P. aeruginosa clones has been suggested, but not yet demonstrated using multi-locus sequence typing (MLST). Isolates of P. aeruginosa from five Mediterranean countries (n = 141) were subjected to pulsed-field gel electrophoresis (PFGE), serotyping and PCR targeting the virulence genes exoS and exoU. The occurrence of multi-resistance (≥3 antipseudomonal drugs) was analyzed with disk diffusion according to EUCAST. MLST was performed on a subset of strains (n = 110) most of them had a distinct PFGE variant. MLST data were analyzed with Bionumerics 6.0, using minimal spanning tree (MST) as well as eBURST. Measurement of clonality was assessed by the standardized index of association (IAS). Evidence of recombination was estimated by ClonalFrame as well as SplitsTree4.0. The MST analysis connected 70 sequence types, among which ST235 was by far the most common. ST235 was very frequently associated with the O11 serotype, and frequently displayed multi-resistance and the virulence genotype exoS−/exoU+. ClonalFrame linked several groups previously identified by eBURST and MST, and provided insight to the evolutionary events occurring in the population; the recombination/mutation ratio was found to be 8.4. A Neighbor-Net analysis based on the concatenated sequences revealed a complex network, providing evidence of frequent recombination. The index of association when all the strains were considered indicated a freely recombining population. P. aeruginosa isolates from the Mediterranean countries display an epidemic population structure, particularly dominated by ST235-O11, which has earlier also been coupled to the spread of ß-lactamases in many countries.
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Affiliation(s)
- Makaoui Maatallah
- Laboratoire d'Analyse, Traitement et Valorisation des Polluants de l'Environnement et des Produits, Faculté de Pharmacie, Monastir, Tunisia
| | - Jihane Cheriaa
- Laboratoire d'Analyse, Traitement et Valorisation des Polluants de l'Environnement et des Produits, Faculté de Pharmacie, Monastir, Tunisia
| | - Amina Backhrouf
- Laboratoire d'Analyse, Traitement et Valorisation des Polluants de l'Environnement et des Produits, Faculté de Pharmacie, Monastir, Tunisia
| | - Aina Iversen
- Clinical Microbiology L2:02, MTC-Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Hajo Grundmann
- University Medical Centre Groningen, Rijksuniversiteit Groningen, Groningen, The Netherlands
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Thuy Do
- Infection Research Group, Dental Institute, King's College London and Biomedical Research Centre at Guy's and St Thomas' NHS and Foundation Trust, London, United Kingdom
| | - Philippe Lanotte
- CHRU de Tours, Service de Bactériologie-Virologie, Hôpital Bretonneau, Tours, France ; Université François Rabelais, Tours, France
| | - Maha Mastouri
- Laboratoire de Microbiologie CHU Fattouma Bourguiba, Monastir, Tunisia
| | - Mohamed Salem Elghmati
- Departement of Microbiology and Immunology, Faculty of Pharmacy, University of Alfateh of Tripoli, Tripoli, Libya
| | - Fernando Rojo
- Departamento de Biotecnología Microbiana, Centro Nacional de Biotecnología, CSIC, Campus U.A.M., Cantoblanco, Madrid, Spain
| | - Snoussi Mejdi
- Laboratoire d'Analyse, Traitement et Valorisation des Polluants de l'Environnement et des Produits, Faculté de Pharmacie, Monastir, Tunisia
| | - Christian G. Giske
- Clinical Microbiology L2:02, MTC-Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
- * E-mail:
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