Metallo-β-lactamases of non-fermenting Gram-negative bacteria:

Resistance to antibiotics in clinical isolates of Pseudomonas aeruginosa

OBJECTIVES

To analyse the global resistance to some antibiotics used to treat nosocomial infections by Pseudomonas aeruginosa, specially to carbapenems, and its relationship with the presence of carbapenemases, OXA, VIM and IMP.

METHODS

The study included 229 P. aeruginosa isolates from a Hospital in Northern Spain (year 2002). Susceptibility to antimicrobial agents was determined by the analysis of the MIC. Genetic typing was carried out by RAPD-PCR fingerprinting with primer ERIC-2. Genetic experiments to detect class-1 integrons were performed by PCR with primers 5'CS and 3'CS. Detection of carbapenemases was done by phenotypic (Hodge test and DDST) and genotypic methods (PCR with primers for imp, vim1, vim2 and oxa40 genes).

RESULTS

23.9% of isolates were resistant to ceftazidime, 35.9% to cefotaxime, 5.3% to amikacin, 54.9% to gentamicin, 14.6% to imipenem and 6.6% to meropenem. Isolates resistant to imipenem (33) were furtherly tested. Genetic typing didn't show clonal relatedness among the most of the isolates. Class-1 integrons were present in most isolates (sizes 600-1700 bp). Phenotypic methods for carbapenemases showed 5 positive isolates. Genotypic methods showed the presence of two isolates with the oxa40 gene.

CONCLUSIONS

Meropenem, amikacin and imipenem were the most active agents to treat infections caused by Pseudomonas aeruginosa. In our study, the presence of carbapenemase enzymes wasn't high. Phenotypic tests cannot be considered as accurate screening tool to detect carbapenemases. This is the fist report of the oxa40 gene in Pseudomonas aeruginosa isolates.

Molecular epidemiology of acquired-metallo-beta-lactamase-producing bacteria in Poland

We have analyzed 40 metallo-beta-lactamase (MBL)-producing isolates of Pseudomonas aeruginosa (n = 38), Pseudomonas putida (n = 1), and Acinetobacter genospecies 3 (n = 1) from 17 hospitals in 12 cities in Poland that were identified in 2000 to 2004. Pulsed field gel electrophoresis typing classified the P. aeruginosa isolates into eight types, with two types differentiated further into subtypes. Each of the types was specific either to a given center or to several hospitals of the same or neighboring geographic area. Almost all of the organisms produced beta-lactamase VIM-2; the only exceptions were several P. aeruginosa isolates from two centers which expressed VIM-4. The bla(VIM) genes resided exclusively within class 1 integrons, and these were located in either chromosomal or plasmid DNA. PCR-restriction fragment length polymorphism study of the variable regions of the integrons, followed by DNA sequencing, revealed the presence of eight different, mostly novel gene cassette arrays, six of which contained bla(VIM-2) and two of which contained bla(VIM-4). The occurrence of the integron variants correlated well with the geographic distribution of the MBL-producing organisms, and this suggested that their emergence in particular parts of the country had been likely due to a number of independent events. The following regional dissemination of MBL producers could be attributed to various phenomena, including their clonal spread, horizontal transmission of resistance determinants, or both. All of the data collected in this study revealed that even at this early stage of detection, the epidemiological situation concerning MBL producers in Poland has already been complex and very dynamic.

Resistance pattern and assessment of phenicol agents' minimum inhibitory concentration in multiple drug resistant Chryseobacterium isolates from fish and aquatic habitats

AIMS

To assess the susceptibility of Chryseobacterium isolates of fish and aquatic habitats to antimicrobial compounds. Special attention was paid to the resistance to chloramphenicol and florfenicol, a phenicol derivative recently licensed for use in veterinary medicine and fish farming.

METHODS AND RESULTS

Sixty-seven Chryseobacterium spp. isolates and reference strains, originating mainly from different aquatic habitats, were tested using the disk-diffusion method. In addition, agar dilution was used for assessing minimum inhibitory concentration of chloramphenicol and florfenicol. In spite of (i) conditions that hampered properly standardized experiments and (ii) the heterogeneity of the isolates resulting in some aberrant values in diffusion, correlation between the two methods was confirmed. Most of the isolates exhibited considerable multiresistance to most antimicrobial drug families, and many were clearly resistant to phenicols. Molecular investigations conducted on 10 strains selected for high resistance to florfenicol did not establish the existence of floR or cmlA genes currently reported in the literature as responsible for florfenicol resistance. Nevertheless, when an efflux pump inhibitor, phenyl-arginin-beta-naphthylamide, was combined with diffusion tests, drug susceptibility to florfenicol was restored, suggesting that Chryseobacterium's resistance to this molecule is under the control of efflux mechanisms.

CONCLUSIONS

Constitutive multiresistance to antibiotics is common in chryseobacteria isolated from the aquatic environment. Although no gene related to the floR family could be detected, efflux mechanisms could partly support the resistance to phenicols.

SIGNIFICANCE AND IMPACT OF THE STUDY

These results explain the difficulty of treatment and clearly reflect the properties previously reported in Chryseobacterium isolates of human origin. Because several species have been involved in opportunistic infections in humans, the possible role of aquatic organisms as a source of infection should be considered.