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Lasarte-Monterrubio C, Guijarro-Sánchez P, Alonso-Garcia I, Outeda M, Maceiras R, González-Pinto L, Martínez-Guitián M, Fernández-Lozano C, Vázquez-Ucha JC, Bou G, Arca-Suárez J, Beceiro A. Epidemiology, resistance genomics and susceptibility of Acinetobacter species: results from the 2020 Spanish nationwide surveillance study. Euro Surveill 2024; 29:2300352. [PMID: 38606569 PMCID: PMC11010588 DOI: 10.2807/1560-7917.es.2024.29.15.2300352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/13/2023] [Indexed: 04/13/2024] Open
Abstract
BackgroundAs increasing antibiotic resistance in Acinetobacter baumannii poses a global healthcare challenge, understanding its evolution is crucial for effective control strategies.AimWe aimed to evaluate the epidemiology, antimicrobial susceptibility and main resistance mechanisms of Acinetobacter spp. in Spain in 2020, and to explore temporal trends of A. baumannii.MethodsWe collected 199 single-patient Acinetobacter spp. clinical isolates in 2020 from 18 Spanish tertiary hospitals. Minimum inhibitory concentrations (MICs) for nine antimicrobials were determined. Short-read sequencing was performed for all isolates, and targeted long-read sequencing for A. baumannii. Resistance mechanisms, phylogenetics and clonality were assessed. Findings on resistance rates and infection types were compared with data from 2000 and 2010.ResultsCefiderocol and colistin exhibited the highest activity against A. baumannii, although colistin susceptibility has significantly declined over 2 decades. A. non-baumannii strains were highly susceptible to most tested antibiotics. Of the A. baumannii isolates, 47.5% (56/118) were multidrug-resistant (MDR). Phylogeny and clonal relationship analysis of A. baumannii revealed five prevalent international clones, notably IC2 (ST2, n = 52; ST745, n = 4) and IC1 (ST1, n = 14), and some episodes of clonal dissemination. Genes bla OXA-23, bla OXA-58 and bla OXA-24/40 were identified in 49 (41.5%), eight (6.8%) and one (0.8%) A. baumannii isolates, respectively. ISAba1 was found upstream of the gene (a bla OXA-51-like) in 10 isolates.ConclusionsThe emergence of OXA-23-producing ST1 and ST2, the predominant MDR lineages, shows a pivotal shift in carbapenem-resistant A. baumannii (CRAB) epidemiology in Spain. Coupled with increased colistin resistance, these changes underscore notable alterations in regional antimicrobial resistance dynamics.
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Affiliation(s)
- Cristina Lasarte-Monterrubio
- Microbiology Department, A Coruña University Hospital (CHUAC), Institute of Biomedical Research of A Coruña (INIBIC), Spain
| | - Paula Guijarro-Sánchez
- Microbiology Department, A Coruña University Hospital (CHUAC), Institute of Biomedical Research of A Coruña (INIBIC), Spain
| | - Isaac Alonso-Garcia
- Microbiology Department, A Coruña University Hospital (CHUAC), Institute of Biomedical Research of A Coruña (INIBIC), Spain
| | - Michelle Outeda
- Microbiology Department, A Coruña University Hospital (CHUAC), Institute of Biomedical Research of A Coruña (INIBIC), Spain
| | - Romina Maceiras
- Microbiology Department, A Coruña University Hospital (CHUAC), Institute of Biomedical Research of A Coruña (INIBIC), Spain
| | - Lucia González-Pinto
- Microbiology Department, A Coruña University Hospital (CHUAC), Institute of Biomedical Research of A Coruña (INIBIC), Spain
| | - Marta Martínez-Guitián
- NANOBIOFAR, Centre for Research in Molecular Medicine and Chronic Diseases (CiMUS), Universidad de Santiago de Compostela, Santiago de Compostela, Spain
- Microbiology Department, A Coruña University Hospital (CHUAC), Institute of Biomedical Research of A Coruña (INIBIC), Spain
| | - Carlos Fernández-Lozano
- Department of Computer Science and Information Technologies, Faculty of Computer Science, Research Center of Information and Communication Technologies (CITIC), University of A Coruña, A Coruña, Spain
| | - Juan Carlos Vázquez-Ucha
- CIBER de Enfermedades Infecciosas (CIBERINFEC), A Coruña, Spain
- Microbiology Department, A Coruña University Hospital (CHUAC), Institute of Biomedical Research of A Coruña (INIBIC), Spain
| | - German Bou
- CIBER de Enfermedades Infecciosas (CIBERINFEC), A Coruña, Spain
- Microbiology Department, A Coruña University Hospital (CHUAC), Institute of Biomedical Research of A Coruña (INIBIC), Spain
| | - Jorge Arca-Suárez
- CIBER de Enfermedades Infecciosas (CIBERINFEC), A Coruña, Spain
- Microbiology Department, A Coruña University Hospital (CHUAC), Institute of Biomedical Research of A Coruña (INIBIC), Spain
| | - Alejandro Beceiro
- CIBER de Enfermedades Infecciosas (CIBERINFEC), A Coruña, Spain
- Microbiology Department, A Coruña University Hospital (CHUAC), Institute of Biomedical Research of A Coruña (INIBIC), Spain
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Lasarte-Monterrubio C, Guijarro-Sánchez P, Vázquez-Ucha JC, Alonso-Garcia I, Alvarez-Fraga L, Outeda M, Martinez-Guitian M, Peña-Escolano A, Maceiras R, Lence E, González-Bello C, Arca-Suárez J, Bou G, Beceiro A. Antimicrobial Activity of Cefiderocol against the Carbapenemase-Producing Enterobacter cloacae Complex and Characterization of Reduced Susceptibility Associated with Metallo-β-Lactamase VIM-1. Antimicrob Agents Chemother 2023; 67:e0150522. [PMID: 37195077 PMCID: PMC10190674 DOI: 10.1128/aac.01505-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 03/16/2023] [Indexed: 05/18/2023] Open
Abstract
Emergence of cefiderocol resistance among carbapenemase-producing Enterobacterales, particularly those in the Enterobacter cloacae complex (ECC), is becoming of alarming concern; however, the mechanistic basis of this phenomenon remains poorly understood. We describe the acquisition of VIM-1-mediated reduced cefiderocol susceptibility (MICs 0.5 to 4 mg/L) in a collection of 54 carbapenemase-producing isolates belonging to the ECC. MICs were determined by reference methodologies. Antimicrobial resistance genomic analysis was performed through hybrid WGS. The impact of VIM-1 production on cefiderocol resistance in the ECC background was examined at microbiological, molecular, biochemical, and atomic levels. Antimicrobial susceptibility testing yielded 83.3% susceptible isolates and MIC50/90 values of 1/4 mg/L. Decreased susceptibility to cefiderocol was mainly associated with isolates producing VIM-1, with cefiderocol MICs 2- to 4-fold higher than for isolates carrying other types of carbapenemases. E. cloacae and Escherichia coli VIM-1 transformants displayed significantly enhanced cefiderocol MICs. Biochemical assays with purified VIM-1 protein revealed low but detectable cefiderocol hydrolysis. Simulation studies revealed how cefiderocol is anchored to the VIM-1 active site. Additional molecular assays and WGS data analysis highlighted the implication of SHV-12 coproduction and suggested the inactivation of the FcuA-like siderophore receptor as further contributors to the higher cefiderocol MICs. Our findings warn of the potential of the VIM-1 carbapenemase to at least partly limit the activity of cefiderocol in the ECC. This effect is probably enhanced due to combination with additional mechanisms, such as ESBL production and siderophore inactivation, and indicates the need for active surveillance to extend the life span of this promising cephalosporin.
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Affiliation(s)
- Cristina Lasarte-Monterrubio
- Microbiology Department, A Coruña University Hospital Complex (CHUAC), A Coruña Institute for Biomedical Research (INIBIC), CIBER de Enfermedades Infecciosas (CIBERINFEC), A Coruña, Spain
| | - Paula Guijarro-Sánchez
- Microbiology Department, A Coruña University Hospital Complex (CHUAC), A Coruña Institute for Biomedical Research (INIBIC), CIBER de Enfermedades Infecciosas (CIBERINFEC), A Coruña, Spain
| | - Juan Carlos Vázquez-Ucha
- Microbiology Department, A Coruña University Hospital Complex (CHUAC), A Coruña Institute for Biomedical Research (INIBIC), CIBER de Enfermedades Infecciosas (CIBERINFEC), A Coruña, Spain
| | - Isaac Alonso-Garcia
- Microbiology Department, A Coruña University Hospital Complex (CHUAC), A Coruña Institute for Biomedical Research (INIBIC), CIBER de Enfermedades Infecciosas (CIBERINFEC), A Coruña, Spain
| | - Laura Alvarez-Fraga
- Microbiology Department, A Coruña University Hospital Complex (CHUAC), A Coruña Institute for Biomedical Research (INIBIC), CIBER de Enfermedades Infecciosas (CIBERINFEC), A Coruña, Spain
| | - Michelle Outeda
- Microbiology Department, A Coruña University Hospital Complex (CHUAC), A Coruña Institute for Biomedical Research (INIBIC), CIBER de Enfermedades Infecciosas (CIBERINFEC), A Coruña, Spain
| | - Marta Martinez-Guitian
- Microbiology Department, A Coruña University Hospital Complex (CHUAC), A Coruña Institute for Biomedical Research (INIBIC), CIBER de Enfermedades Infecciosas (CIBERINFEC), A Coruña, Spain
- NANOBIOFAR, Centre for Research in Molecular Medicine and Chronic Diseases (CiMUS), Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - Andrea Peña-Escolano
- Microbiology Department, A Coruña University Hospital Complex (CHUAC), A Coruña Institute for Biomedical Research (INIBIC), CIBER de Enfermedades Infecciosas (CIBERINFEC), A Coruña, Spain
| | - Romina Maceiras
- Microbiology Department, A Coruña University Hospital Complex (CHUAC), A Coruña Institute for Biomedical Research (INIBIC), CIBER de Enfermedades Infecciosas (CIBERINFEC), A Coruña, Spain
| | - Emilio Lence
- Centre for Research in Biological Chemistry and Molecular Materials (CiQUS), Department of Organic Chemistry, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Concepción González-Bello
- Centre for Research in Biological Chemistry and Molecular Materials (CiQUS), Department of Organic Chemistry, Universidade de Santiago de Compostela, Santiago de Compostela, Spain
| | - Jorge Arca-Suárez
- Microbiology Department, A Coruña University Hospital Complex (CHUAC), A Coruña Institute for Biomedical Research (INIBIC), CIBER de Enfermedades Infecciosas (CIBERINFEC), A Coruña, Spain
| | - German Bou
- Microbiology Department, A Coruña University Hospital Complex (CHUAC), A Coruña Institute for Biomedical Research (INIBIC), CIBER de Enfermedades Infecciosas (CIBERINFEC), A Coruña, Spain
| | - Alejandro Beceiro
- Microbiology Department, A Coruña University Hospital Complex (CHUAC), A Coruña Institute for Biomedical Research (INIBIC), CIBER de Enfermedades Infecciosas (CIBERINFEC), A Coruña, Spain
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Vázquez-Ucha JC, Alonso-Garcia I, Guijarro-Sánchez P, Lasarte-Monterrubio C, Álvarez-Fraga L, Cendón-Esteve A, Outeda M, Maceiras R, Peña-Escolano A, Martínez-Guitián M, Arca-Suárez J, Bou G, Beceiro A. Activity of aztreonam in combination with novel β-lactamase inhibitors against metallo-β-lactamase-producing Enterobacterales from Spain. Int J Antimicrob Agents 2023; 61:106738. [PMID: 36736925 DOI: 10.1016/j.ijantimicag.2023.106738] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 12/05/2022] [Accepted: 01/21/2023] [Indexed: 02/05/2023]
Abstract
Metallo-β-lactamase (MBL)-producing Enterobacterales are of particular concern because they are widely disseminated and difficult to treat, being resistant to almost all β-lactam antibiotics. Aztreonam is not hydrolysed by MBLs but is labile to serine β-lactamases (SBLs), which are usually co-produced by MBL-producing Enterobacterales. This study investigated the activity of aztreonam in combination with novel β-lactamase inhibitors (BLIs) against a national multi-centre study collection of strains co-producing MBLs and SBLs. Fifty-five clinical isolates co-producing MBLs (41 VIM producers, 10 NDM producers and 4 IMP producers) and SBLs were selected, and whole-genome sequencing (WGS) was performed. The minimum inhibitory concentration (MIC) values of aztreonam, aztreonam/avibactam, aztreonam/relebactam, aztreonam/zidebactam, aztreonam/taniborbactam, aztreonam/vaborbactam and aztreonam/enmetazobactam were determined. β-lactam/BLI resistance mechanisms were analysed by WGS. All BLIs decreased the MIC values of aztreonam for strains that were not susceptible to aztreonam. Aztreonam/zidebactam (MIC ≤1 mg/L for 96.4% of isolates), aztreonam/avibactam (MIC ≤1 mg/L for 92.7% of isolates) and aztreonam/taniborbactam (MIC ≤1 mg/L for 87.3 % of isolates) were the most active combinations. For other aztreonam/BLI combinations, 50-70% of the isolates yielded MIC values ≤1 mg/L. WGS data revealed that mutations in PBP3, defective OmpE35/OmpK35 porins, and the presence of extended-spectrum β-lactamases and class C β-lactamases were some of the resistance mechanisms involved in reduced susceptibility to aztreonam/BLIs. Combinations of aztreonam with new BLIs show promising activity against Enterobacterales co-producing MBLs and SBLs, particularly aztreonam/zidebactam, aztreonam/avibactam and aztreonam/taniborbactam. The present results show that these novel drugs may represent innovative therapeutic strategies by their use in yet-unexplored combinations as solutions for difficult-to-treat infections.
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Affiliation(s)
- Juan Carlos Vázquez-Ucha
- Microbiology Department, University Hospital A Coruña, Institute of Biomedical Research of A Coruña, A Coruña, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain.
| | - Isaac Alonso-Garcia
- Microbiology Department, University Hospital A Coruña, Institute of Biomedical Research of A Coruña, A Coruña, Spain
| | - Paula Guijarro-Sánchez
- Microbiology Department, University Hospital A Coruña, Institute of Biomedical Research of A Coruña, A Coruña, Spain
| | - Cristina Lasarte-Monterrubio
- Microbiology Department, University Hospital A Coruña, Institute of Biomedical Research of A Coruña, A Coruña, Spain
| | - Laura Álvarez-Fraga
- Microbiology Department, University Hospital A Coruña, Institute of Biomedical Research of A Coruña, A Coruña, Spain
| | - Arnau Cendón-Esteve
- Microbiology Department, University Hospital A Coruña, Institute of Biomedical Research of A Coruña, A Coruña, Spain
| | - Michelle Outeda
- Microbiology Department, University Hospital A Coruña, Institute of Biomedical Research of A Coruña, A Coruña, Spain
| | - Romina Maceiras
- Microbiology Department, University Hospital A Coruña, Institute of Biomedical Research of A Coruña, A Coruña, Spain
| | - Andrea Peña-Escolano
- Microbiology Department, University Hospital A Coruña, Institute of Biomedical Research of A Coruña, A Coruña, Spain
| | - Marta Martínez-Guitián
- NANOBIOFAR, Centre for Research in Molecular Medicine and Chronic Diseases, Universidad de Santiago de Compostela, Santiago de Compostela, Spain; Microbiology Department, University Hospital A Coruña, Institute of Biomedical Research of A Coruña, University of A Coruña, A Coruña, Spain
| | - Jorge Arca-Suárez
- Microbiology Department, University Hospital A Coruña, Institute of Biomedical Research of A Coruña, A Coruña, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Germán Bou
- Microbiology Department, University Hospital A Coruña, Institute of Biomedical Research of A Coruña, A Coruña, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Alejandro Beceiro
- Microbiology Department, University Hospital A Coruña, Institute of Biomedical Research of A Coruña, A Coruña, Spain; CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
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Elberdín L, Fernández-Torres R, Paradela S, Blanco E, Outeda M, Martín I, Fonseca E. Ustekinumab treatment for moderate to severe psoriasis. Eight-year real-world follow-up of 61 cases in a tertiary level hospital. J DERMATOL TREAT 2019; 31:698-701. [DOI: 10.1080/09546634.2019.1605140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- L. Elberdín
- Department of Pharmacy, Complexo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - Rm Fernández-Torres
- Department of Dermatology, Complexo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - S. Paradela
- Department of Dermatology, Complexo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - E. Blanco
- Department of Dermatology, Complexo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - M. Outeda
- Department of Pharmacy, Complexo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - I. Martín
- Department of Pharmacy, Complexo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
| | - E. Fonseca
- Department of Dermatology, Complexo Hospitalario Universitario de A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Universidade da Coruña (UDC), A Coruña, Spain
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Martín-Suárez A, Falcao AC, Outeda M, Hernández FJ, González MC, Quero M, Arranz I, Lanao JM. Population pharmacokinetics of digoxin in pediatric patients. Ther Drug Monit 2002; 24:742-5. [PMID: 12451291 DOI: 10.1097/00007691-200212000-00010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Digoxin pharmacokinetics were studied in a pediatric population with an age range of 6 days to 1 year using the population pharmacokinetic approach. Digoxin data were analyzed by mixed-effects modeling according to a one-compartment steady-state pharmacokinetic model using NONMEM software. The final model selected for the population prediction of digoxin clearance in pediatric patients was as follows: [equation: see text] Individual empirical Bayesian estimates were generated on the basis of the population estimates and were used to correlate the optimum dose of digoxin and patient age according to the following equation: [equation: see text] This equation and its derived nomogram may be used for the initial dosing of digoxin in children aged between 0 and 1 year. The use of this nomogram in routine monitoring requires further pharmacokinetic and clinical validation.
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Affiliation(s)
- A Martín-Suárez
- Department of Pharmacy and Pharmaceutical Technology, University of Salamanca, Spain
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