Characterization of Imipenem Unsusceptible Pseudomonas Aeruginosa Isolates from Inpatients without Carbapenem Treatment

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Abstract

Objective To identify the risk factors for imipenem resistance development and transmission of clinical Pseudomonas aeruginosa isolates.

Methods Thirty-seven imipenem unsusceptible Pseudomonas aeruginosa isolates collected from patients in absence of carbapenem treatment were characterized by antimicrobial susceptibility test, pulsed field gel electrophoresis (PFGE) and carbapenem resistant mechanism analysis.

Results Before the collection of imipenem unsusceptible Pseudomonas aeruginosa isolates, the average time of patients treated with more than one antimicrobial (20.0 ± 9.5 days, n = 16) was significantly longer than those treated with only one antimicrobial (12.6 ± 4.4 days, n = 21; t-test, Welch, t = -2.9004, P < 0.01). And 32 isolates showed resistance to more than 3 classes of antimicrobials. Six PFGE clusters were identified and 26 isolates were grouped into one dominant cluster (C2). An ISpa1328 sequence insertion in oprD was detected in 33 isolates and the function of efflux was observed in all 37 isolates in the presence of a wide spectrum efflux inhibitor.

Conclusions Our data demonstrated that exposure to non-carbapenem drug classes, especially fluoroquinolones and β-lactams, may be important risk factors for the spread of carbapenem resistant Pseudomonas aeruginosa.

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  • 1. Strateva T Yordanov D. Pseudomonas aeruginosa - a phenomenon of bacterial resistance. J Med Microbiol 2009;58:1133-1148.

  • 2. McGowan JE Jr. Resistance in nonfermenting gram-negative bacteria: multidrug resistance to the maximum. Am J Infect Control 2006;34:s29-s37; discussion s64-s73.

  • 3. Mesaros N Nordmann P Plesiat P Roussel-Delvallez M Van Eldere J Glupczynski Y et al. Pseudomonas aeruginosa: resistance and therapeutic options at the turn of the new millennium. Clin Microbiol Infect 2007;13:560-578.

  • 4. Furtado GH Bergamasco MD Menezes FG Marques D Silva A Perdiz LB et al. Imipenem-resistant Pseudomonas aeruginosa infection at a medical-surgical intensive care unit: risk factors and mortality. J Crit Care 2009;24:625e629-614.

  • 5. Shigemi A Matsumoto K Yaji K Shimodozono Y Takeda Y Miyanohara H et al. Correlation between meropenem and doripenem use density and the incidence of carbapenemresistant Pseudomonas aeruginosa. Int J Antimicrob Agents 2009;34:589-591.

  • 6. Wolter DJ Acquazzino D Goering RV Sammut P Khalaf N Hanson ND. Emergence of carbapenem resistance in Pseudomonas aeruginosa isolates from a patient with cystic fibrosis in the absence of carbapenem therapy. Clin Infect Dis 2008;46:e137-141.

  • 7. Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing: Seventeenth Informational Supplement M100-S19. CLSI Wayne PA USA:2009.

  • 8. Pitout JD Chow BL Gregson DB Laupland KB Elsayed S Church DL. Molecular epidemiology of metallo-beta-lactamaseproducing Pseudomonas aeruginosa in the Calgary Health Region: emergence of VIM-2-producing isolates. J Clin Microbiol 2007;45:294-298.

  • 9. Castanheira M Toleman MA Jones RN Schmidt FJ Walsh TR. Molecular characterization of a beta-lactamase gene blaGIM-1 encoding a new subclass of metallo-beta-lactamase. Antimicrob Agents Chemother 2004;48:4654-4661.

  • 10. Lauretti L Riccio ML Mazzariol A Cornaglia G Amicosante G Fontana R et al. Cloning and characterization of blaVIM a new integron-borne metallo-beta-lactamase gene from a Pseudomonas aeruginosa clinical isolate. Antimicrob Agents Chemother 1999;43:1584-1590.

  • 11. Senda K Arakawa Y Ichiyama S Nakashima K Ito H Ohsuka S et al. PCR detection of metallo-beta-lactamase gene (blaIMP) in gram-negative rods resistant to broad-spectrum beta-lactams. J Clin Microbiol 1996;34:2909-2913.

  • 12. Toleman MA Simm AM Murphy TA Gales AC Biedenbach DJ Jones RN et al. Molecular characterization of SPM-1 a novel metallo-beta-lactamase isolated in Latin America: report from the SENTRY antimicrobial surveillance programme. J Antimicrob Chemother 2002;50:673-679.

  • 13. Tsakris A Pournaras S Woodford N Palepou MF Babini GS Douboyas J et al. Outbreak of infections caused by Pseudomonas aeruginosa producing VIM-1 carbapenemase in Greece. J Clin Microbiol 2000;38:1290-1292.

  • 14. Bert F Branger C Lambert-Zechovsky N. Identification of PSE and OXA beta-lactamase genes in Pseudomonas aeruginosa using PCR-restriction fragment length polymorphism. J Antimicrob Chemother 2002;50:11-18.

  • 15. Haeggman S Lofdahl S Paauw A Verhoef J Brisse S. Diversity and evolution of the class A chromosomal beta-lactamase gene in Klebsiella pneumoniae. Antimicrob Agents Chemother 2004;48:2400-2408.

  • 16. Wolter DJ Hanson ND Lister PD. Insertional inactivation of oprD in clinical isolates of Pseudomonas aeruginosa leading to carbapenem resistance. FEMS Microbiol Lett 2004;236:137-143.

  • 17. Quale J Bratu S Gupta J Landman D. Interplay of efflux system ampC and oprD expression in carbapenem resistance of Pseudomonas aeruginosa clinical isolates. Antimicrob Agents Chemother 2006;50:1633-1641.

  • 18. Fujimura S Nakano Y Sato T Shirahata K Watanabe A. Relationship between the usage of carbapenem antibiotics and the incidence of imipenem-resistant Pseudomonas aeruginosa. J Infect Chemother 2007;13:147-150.

  • 19. Lepelletier D Cady A Caroff N Marraillac J Reynaud A Lucet JC et al. Imipenem-resistant Pseudomonas aeruginosa gastrointestinal carriage among hospitalized patients: risk factors and resistance mechanisms. Diagn Microbiol Infect Dis 2010;66:1-6.

  • 20. Johnson JK Smith G Lee MS Venezia RA Stine OC Nataro JP et al. The role of patient-to-patient transmission in the acquisition of imipenem-resistant Pseudomonas aeruginosa colonization in the intensive care unit. J Infect Dis 2009;200:900-905.

  • 21. Rodriguez-Martinez JM Poirel L Nordmann P. Molecular epidemiology and mechanisms of carbapenem resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother 2009;53:4783-4788.

  • 22. Walsh F Amyes SG. Carbapenem resistance in clinical isolates of Pseudomonas aeruginosa. J Chemother 2007;19:376-381.

  • 23. Wang J Zhou JY Qu TT Shen P Wei ZQ Yu YS et al. Molecular epidemiology and mechanisms of carbapenem resistance in Pseudomonas aeruginosa isolates from Chinese hospitals. Int J Antimicrob Agents 2010;35:486-491.

  • 24. Walsh TR Toleman MA Poirel L Nordmann P. Metallo-betalactamases: the quiet before the storm? Clin Microbiol Rev 2005;18:306-325.

  • 25. Kohler T Epp SF Curty LK Pechere JC. Characterization of MexT the regulator of the MexE-MexF-OprN multidrug efflux system of Pseudomonas aeruginosa. J Bacteriol 1999;181:6300-6305.

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