Detection of bla SPM-1, bla KPC, bla TEM and bla CTX-M genes in isolates of Pseudomonas aeruginosa, Acinetobacter spp. and Klebsiella spp. from cancer patients with healthcare-associated infections

Abstract

Pseudomonas aeruginosa, Acinetobacter spp. and Klebsiella spp. are three of the pathogens most frequently involved in infections of cancer patients, and the production of b-lactamases is a major mechanism of resistance due to its wide diversity of existing enzymes. Therefore, the aim of the present study was to investigate the microbiological profile and data related to patients and infections, and to search for b-lactamase genes in bacterial isolates from hospitalized cancer patients in a hospital in Recife, Pernambuco, Brazil. A total of 169 isolates were recovered between 2012 and 2014, of which 58 were P. aeruginosa, 36 were Acinetobacter spp. and 75 were Klebsiella spp. A high percentage of carbapenem resistance was observed in P. aeruginosa and Acinetobacter spp. Among the carbapenem-resistant bacteria, the bla SPM-1 gene was detected in P. aeruginosa (35.5 %) and Acinetobacter spp. (3.8 %), while bla KPC was detected in P. aeruginosa (25.8 %) only. Among the third-and fourth-generation cephalosporin-resistant strains, in Klebsiella spp. we detected the genes bla TEM (30.6 %), bla CTX-M (58.3 %) and bla KPC (5.6 %), and in Acinetobacter spp. only bla TEM (25.9 %). This the first report of an Acinetobacter baumannii bla SPM-1 gene carrier that has been isolated in Brazil. The most frequent cancer types were bowel tumour [14.8 %; 95 % confidence interval (CI 95 % ) 9.8-21.1 %], breast cancer (13.6 %; CI 95 % 8.8-19.7 %) and prostate cancer (11.2%; CI 95 % 6.9-17.0 %). These results therefore provide knowledge of susceptibility profile and resistance mechanisms and thus can contribute to the strategic formulation of hospital infection control plans and the rational use of antimicrobials, reducing mortality from infection levels in cancer patients. frequency and severity of infections may be related to the use of potent cytotoxic drugs and increasingly invasive diagnostic tools (Maschmeyer & Haas, 2008;Wang et al., 2011). INTRODUCTIONGiven this vulnerability among patients with cancer, this population is more susceptible to community and healthcare-associated infections (HAIs). According to a recent survey by the Centers for Disease Control and Prevention (CDC), one in 25 hospitalized patients [4.0 %; 95 % confidence interval (CI 95 % ), 3.7-4.4] is battling an HAI, defined as those infections acquired in hospital or healthcare service unit that first appear 48 h or more after hospital admission or within 30 days after discharge following in-patient care (Revelas, 2012;Magill et al., 2014). Other causes for concern in many healthcare centres for patients with cancer are the high bacterial resistance rates and the rise of opportunistic multidrug-resistant (MDR) pathogens such as Pseudomonas aeruginosa and Acinetobacter baumannii (Pongas et al., 2012;Fukuta et al., 2013;Marín et al., 2014).Gram-positive bacteria are described as the most frequent cause of HAIs in cancer patients, especially through bloodstream infection (Wisplinghoff et al., 2003;Maschmeyer & Haas, 2008;Wang et al., 2011; Kosmidis & Chandrasekar...

Synergistic Effect between Usnic Acid and Polymyxin B against Resistant Clinical Isolates of Pseudomonas aeruginosa

“…Studies developed in Brazil between 2009 and 2017 reported that drugs such as the polymyxins should be the last therapeutic resource against multidrug-resistant strains of P. aeruginosa and Acinetobacter spp. Besides, pan-resistant strains of these same species have been found in clinical isolates from patients admitted in intensive care units (ICUs) in Brazilian hospitals [3,28,29].…”

“…and P. aeruginosa isolates compared to the present study. e presence of different percentages of polymyxinresistant strains in different parts of the world is related to the public health characteristics, number of inhabitants, sanitation, and economic development, those being considered determinant factors in the health-disease process [28][29][30]32]. Clinical isolates of P. aeruginosa which presented an intermediate susceptibility to polymyxin B were present in tracheal secretion samples, whereas resistant isolates were found in urine (3/5), catheter tip (1/5), and ulcer secretion (1/5).…”

High mortality by nosocomial infections caused by carbapenem-resistant P. aeruginosa in a referral hospital in Brazil: facing the perfect storm

“…Studies have reported heightened resistance levels in P. aeruginosa, with an increasing prevalence, ranging between 15 and 60 % in certain countries [3][4][5]. Carbapenem resistance in P. aeruginosa isolates is an emerging problem, with nosocomial outbreaks of this micro-organism occurring worldwide, mainly in Brazil, contributing to increased morbidity and mortality rates, hospitalization time and treatment costs [6][7][8]. The resistance of P. aeruginosa to carbapenems has been reported as over 60 % in some Brazilian hospitals, and around 50 % in other developing countries, like Iran [9,10].…”

The H-NS Regulator Plays a Role in the Stress Induced by Carbapenemase Expression in Acinetobacter baumannii

“…The impact of SPM-1 production by AB5075 might explain in part why A. baumannii strains carrying bla SPM-1 have rarely been reported, especially in Brazil, where the SPM-1-producing Pseudomonas aeruginosa ST277 clone is endemic. To date, only one case of an A. baumannii strain producing SPM-1 has been reported in that country ( 13 ), and such a result is open to question, since the identification at species level was performed only by a phenotypic automated system, and the bla SPM-1 gene was not sequenced. Finally, when the IMI MICs were determined in AB5075 Δ- hns expressing the different MBLs, an amplified effect of toxicity and a detrimental impact on the antibiotic resistance phenotype was observed ( Fig.…”