The results showed a linkage between the bla(VIM-1) and the qnrS and the aac(6')-Ib-cr genes, and between the bla(CTX-M-9) and the qnrA genes.

Information is presented on the plasmid-determined beta-lactamases identified in 204 strains of ampicillin-resistant Enterobacteriaceae. The type most frequently identified was TEM-1 (in 85.3% of the strains), followed by SHV-1 (14.70%). Two types of plasmid-determined beta-lactamase were identified in 20 strains; in 18 of them one of the two was TEM-1 and in 13, SHV-1 (the TEM-1 + SHV-1 combination was observed in 12 strains). In the 41 Klebsiella strains the most frequently identified enzyme was SHV-1 (in 28 of the strains) and the proportion of strains with two plasmid-determined beta-lactamases was higher than in the other species studied.

The action of OXA-24/40 and OXA-58 β-lactamase-like enzymes represents the main mechanism underlying resistance to carbapenems in Spain in the last decade. AbkA/AbkB proteins in the toxin/antitoxin system may be involved in the successful dissemination of plasmids carrying the bla(OXA-24/40)-like gene, and probably also the bla(OXA-58)-like gene, thus contributing to the plasmid stability.

 CMS doses used in daily clinical practice are not enough to achieve optimal PK/PD targets  Rates of clinical cure and microbiological clearance in urinary tract infections (UTI) caused by extensively drug resistant (XDR) P. aeruginosa are high despite not reaching these PK/PD targets  There were no differences between colistin monotherapy and combined antibiotic treatment in the clinical and microbiological outcomes of patients with (UTI) caused by XDR P. aeruginosa  CMS dosage regimens for UTI need to be reviewed to avoid unnecessary nephrotoxicity

Clonal dissemination of multidrug-resistant Pseudomonas aeruginosa (MDRPA) is a major concern worldwide. The aim of this study was to explore the mechanisms leading to the carbapenem resistance of an MDRPA clone. Isolates were obtained from a surgical wound, sputum, urine and a blood culture. Pulsed-field gel electrophoresis (PFGE) showed high genomic homogeneity of these isolates and confirmed the circulation of an endemic clone belonging to serotype O4. Outer membrane protein (OMP) bands were visualized by SDS-PAGE, meropenem accumulation was measured in a bioassay and integrons were detected by PCR. Efflux pumps were studied for several antimicrobial agents and synergic combinations thereof in the presence or absence of both carbonyl cyanide m-chlorophenylhydrazone (CCCP) and Phe-Arg-bnaphthylamide (PAbN) at final concentrations of 10 and 40 mg l "1 , respectively. On OMP electrophoretic profiles, MDRPA showed a reduction of outer membrane porin D (OprD) and PCR demonstrated the presence of a class 1 integron with a cassette encoding aminoglycoside adenyltransferase B (aadB). Meropenem accumulation was slightly higher in bacilli than in the filamentous cells that formed in the presence of antibiotics. Overexpression of the efflux pump MexAB-OprM and a functional MexXY-OprM were detected in all isolates.