Carbapenem-resistant Pseudomonas aeruginosa: clonal spread in southern Brazil and in the state of Goiás

Scheffer, Mara Cristina; Gales, Ana Cristina; Barth, Afonso Luís; Filho, José Rodrigues do Carmo; Dalla-Costa, Líbera Maria

doi:10.1590/s1413-86702010000500014

Cited by 3 publications

(4 citation statements)

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“…Carbapenem-resistant P. aeruginosa has become common worldwide. In vitro and in vivo studies have already documented that exposure to carbapenems increases the risk of acquiring carbapenemresistant P. aeruginosa [27,28]. We observed that the variation of imipenem resistance in P. aeruginosa was associated with carbapenem use, which is in accordance with these studies.…”

Section: Discussionsupporting

confidence: 91%

Trends and correlation of antibacterial usage and bacterial resistance: time series analysis for antibacterial stewardship in a Chinese teaching hospital (2009–2013)

Zou

Liu

et al. 2014

Eur J Clin Microbiol Infect Dis

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The purpose of this investigation was to describe the effect of antibacterial stewardship and evaluate the trends and correlation of antibacterial resistance and usage from 2009 to 2013 in a tertiary-care teaching hospital in northwest China. Antibacterial usage was expressed as defined daily doses per 100 patients per day (DDDs/100 PDs). Hospital-wide population-level data and time series analysis were used to evaluate the trends and determine associations between antibacterial exposure and acquisition of resistance. Yearly consumption of overall antibacterials significantly decreased from 66.54 to 28.08 DDDs/100 PDs (β = -10.504, p < 0.01). The resistant rates of the five most frequently isolated species (including Escherichia coli, Acinetobacter baumannii, Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae) significantly decreased or remained stable, and none of them showed a statistically significant upward trend. The medical quality indicators got better or remained stable. Autoregressive integrated moving average (ARIMA) models demonstrated that the monthly resistance rate of P. aeruginosa to imipenem was strongly correlated with antipseudomonal carbapenems usage (β = 34.94, p < 0.001), as did the correlation of P. aeruginosa to meropenem with antipseudomonal third-generation cephalosporins usage (β = 32.76, p < 0.01) and K. pneumoniae to amikacin with aminoglycosides usage (β = 22.01, p < 0.001). The decreased antibacterial use paralleled the improved bacterial resistance without deteriorating medical quality indicators during antimicrobial stewardship. It also suggests that optimum antibiotic use is necessary to alleviate the threat posed by resistant microorganisms at the hospital level.

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Section: Discussionsupporting

confidence: 91%

Trends and correlation of antibacterial usage and bacterial resistance: time series analysis for antibacterial stewardship in a Chinese teaching hospital (2009–2013)

Zou

Liu

et al. 2014

Eur J Clin Microbiol Infect Dis

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“…Among the 2480 P. aeruginosa reported, nearly 42% were resistant to carbapenems. To date, the production of SPM-1, São Paulo metallo-β-lactamase, has been the most common mechanism of carbapenem resistance identified in P. aeruginosa isolated from Brazilian medical centers (Toleman et al, 2002; Scheffer et al, 2010; Rossi, 2011). However, unlike other carbapenemases such as NDM, IMP, and KPC, SPM-1 has been only reported in P. aeruginosa isolates.…”

Section: Introductionmentioning

confidence: 99%

“…However, unlike other carbapenemases such as NDM, IMP, and KPC, SPM-1 has been only reported in P. aeruginosa isolates. Previous studies have shown the presence of a SPM-1-producing P. aeruginosa clone belonging to the ST277, clone SP, widely spread within the Brazilian territory (Gales et al, 2003; Scheffer et al, 2010; Silva et al, 2011; Silveira et al, 2014). …”

Section: Introductionmentioning

confidence: 99%

Intraclonal Genome Stability of the Metallo-β-lactamase SPM-1-producing Pseudomonas aeruginosa ST277, an Endemic Clone Disseminated in Brazilian Hospitals

et al. 2016

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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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“…Doripenem was the most active drug against these resistant isolates (12). The presence of carbapenem-nonsusceptible P. aeruginosa isolates has been described worldwide, particularly in relation to outbreaks (1,5,6,17,18,25,28,30,31,37). Most of these studies focused on clinical isolates, and genetic relatedness was established using molecular typing tools based on macrorestriction-fragment analysis or PCR of repetitive DNA sequences on the chromosome.…”

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confidence: 99%

Wide Dispersion of ST175 Clone despite High Genetic Diversity of Carbapenem-Nonsusceptible Pseudomonas aeruginosa Clinical Strains in 16 Spanish Hospitals

et al. 2011

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During the COMParative Activity of Carbapenems Testing (COMPACT) surveillance study, 448 Pseudomonas aeruginosa clinical isolates were obtained from 16 Spanish hospitals. Nonsusceptibility (EUCAST breakpoints) to imipenem (35%), meropenem (33%), and/or doripenem (33%) was observed with 175 isolates (39%). Simultaneous resistance to these three drugs was observed with 126 of the 175 isolates (72%). Except for colistin, high resistance rates were observed among noncarbapenem antibiotics. Clonal relatedness was investigated by pulsed-field gel electrophoresis (PFGE) with SpeI, discriminating 68 patterns. Multilocus sequence typing (MLST) was performed on 84 isolates representing different PFGE types and all participating hospitals. Thirty-nine sequence types (STs) could be distinguished, and of these, ST175 (48 isolates, 10 hospitals), ST646 (16 isolates, 4 hospitals), ST532 (13 isolates, 3 hospitals), and ST111 (13 isolates, 7 hospitals) were the most frequently encountered. Minimum-spanning tree analysis confirmed a wide dissemination of different clones among participant hospitals, particularly ST175. PFGE pattern comparison within the four most frequent STs revealed that ST175 isolates were relatively uniform, while ST646, ST532, and ST111 isolates were highly diverse, with almost every isolate belonging to a unique pulsotype, even when originating from the same center. The population of carbapenem-nonsusceptible P. aeruginosa isolates from 16 hospitals is highly diverse, with one ST (ST175) representing a highly conserved clone disseminated in 10 of the 16 participant hospitals. This ST175 clone should be added to the list of P. aeruginosa clones at high risk for epidemic spread, such as the Liverpool, Manchester, and Melbourne clones previously found in cystic fibrosis patients and ST235 in the nosocomial setting.Antibiotic surveillance studies are necessary not only for the better understanding of bacterial epidemiology, but also for the design of control strategies for preventing bacterial resistance and establishing therapeutic guidelines. In this context, the COMParative Activity of Carbapenems Testing (COMPACT) multicenter study was performed in 16 European countries, including Spain (23). The main objectives of this surveillance study were to test the activity of currently used carbapenems against Pseudomonas aeruginosa clinical isolates and to detect carbapenem nonsusceptible isolates (12).In this multicenter study, Spanish authors concluded that percentages of carbapenem resistance among P. aeruginosa clinical isolates in their country (range of 21.4% to 32.6%) are very similar to those previously reported in other European countries. Doripenem was the most active drug against these resistant isolates (12). The presence of carbapenem-nonsusceptible P. aeruginosa isolates has been described worldwide, particularly in relation to outbreaks (1,5,6,17,18,25,28,30,31,37). Most of these studies focused on clinical isolates, and genetic relatedness was established using molecular typing tools based on macror...

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Carbapenem-resistant Pseudomonas aeruginosa: clonal spread in southern Brazil and in the state of Goiás

Cited by 3 publications

References 6 publications

Trends and correlation of antibacterial usage and bacterial resistance: time series analysis for antibacterial stewardship in a Chinese teaching hospital (2009–2013)

Trends and correlation of antibacterial usage and bacterial resistance: time series analysis for antibacterial stewardship in a Chinese teaching hospital (2009–2013)

Intraclonal Genome Stability of the Metallo-β-lactamase SPM-1-producing Pseudomonas aeruginosa ST277, an Endemic Clone Disseminated in Brazilian Hospitals

Wide Dispersion of ST175 Clone despite High Genetic Diversity of Carbapenem-Nonsusceptible Pseudomonas aeruginosa Clinical Strains in 16 Spanish Hospitals

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