Emergence of KPC-Producing Pseudomonas aeruginosa in Trinidad and Tobago

Abstract

In 2006, the first isolate of KPC-2-producing Pseudomonas aeruginosa in the world was identified in Colombia. Recently, similar strains have been reported in Puerto Rico. We now report KPC-2-producing P. aeruginosa in Trinidad and Tobago. Surveillance for similar strains is warranted, considering their wide geographic spread and known association with mobile genetic elements. CASE REPORTA 63-year-old male patient was admitted to a hospital in Mount Hope, Trinidad and Tobago, with hematuria, dysuria, fever, and chills. He had no history of travel abroad. Four months prior to his presentation, he had a left hip fracture caused by a fall and was hospitalized at another regional hospital for 10 weeks without any surgical intervention but with conservative care. He had remained bedridden since the fracture.Upon physical examination, he appeared chronically ill, was stuporous, febrile (38°C), severely pale, and dehydrated, had bedsores on the buttocks and sacral area, and had a urinary catheter. He had swelling of the left thigh, which was tender and warm to the touch, with subcutaneous emphysema.Blood and urine specimens were submitted for culture. Radiological investigations of the pelvis and legs revealed a fracture of the neck of the left femur, with subcutaneous emphysema and fluid collection along the lateral compartment of the thigh, extending to the inguinal region, hip joint, and left lower abdominal wall.He was given gentamicin, ceftazidime, and metronidazole. A fasciotomy was performed, revealing gas gangrene. Two liters of greenish yellow pus from the anterior compartment of the left thigh, extending to the left lower abdomen, was drained. This pus was cultured.Blood and urine cultures were negative. However, the culture of the pus from surgery yielded Pseudomonas aeruginosa. Antimicrobial susceptibility testing using the MicroScan WalkAway 96 SI system (Siemens) revealed that the isolate was resistant to all tested antimicrobials, including gentamicin, ceftazidime, ciprofloxacin, and carbapenems. Meropenem monotherapy was given despite in vitro resistance, while efforts were made to procure polymyxin B or colistin; unfortunately, these efforts were unsuccessful, and the patient died 10 days postadmission.The P. aeruginosa isolate was sent to the International Center for Medical Research and Training, Cali, Colombia, where the MIC was determined using the Clinical and Laboratory Standards Institute (CLSI)-approved broth microdilution method (2). Ertapenem, imipenem, and meropenem MICs were Ͼ128 g/ml. This isolate was also resistant to ceftazidime (MIC, 128 g/ml), cefepime (MIC, Ͼ128 g/ml), aztreonam (MIC, Ͼ128 g/ml), piperacillin-tazobactam (MICs, Ͼ256 and 4 g/ml), and ciprofloxacin (MIC, Ͼ8 g/ml) and remained susceptible only to polymyxin B (MIC, 2 g/ml).A three-dimensional test to screen for carbapenemases was performed as reported previously (10) with some modifications. This test uses a carbapenem-susceptible organism as an indicator for carbapenemases in a cellular extract. To detect the carbapenemase...

Similar Frequencies of Pseudomonas aeruginosa Isolates Producing KPC and VIM Carbapenemases in Diverse Genetic Clones at Tertiary-Care Hospitals in Medellín, Colombia

“…Conversely, there is only one report on the ST362 clone (26). Although KPC-2 harboring P. aeruginosa has also been detected in Trinidad and Tobago, the United States, Puerto Rico, Brazil, Argentina, and China, the global spread of epidemic strains has been difficult to assess due to MLST not having been used in the majority of countries (8)(9)(10)(11)(12). Contrary to the situation in Colombia, where the emergence of KPC-2 producing isolates has been linked to several clones, mainly of ST235 but also of ST308, ST1006, and ST1060, in Argentina it seems that the spread of KPC-2 in five provinces occurred through the dissemination of one successful clone, ST654 (8,27).…”

“…Ambler class B ␤-lactamases, such as VIM and IMP, are the most frequent carbapenemases involved in P. aeruginosa carbapenem resistance, while Ambler class A carbapenemases, such as KPC, frequently reported in Enterobacteriaceae, have started to be detected in P. aeruginosa isolates (8). In 2007, the presence of KPC was first reported in P. aeruginosa in Colombia, a country where KPC is endemic, and it has been reported subsequently in other countries from the Americas, such as Trinidad and Tobago, Argentina, and the United States, including Puerto Rico (8)(9)(10)(11)(12). Recently, an increasing frequency of KPCproducing P. aeruginosa isolates has been reported in hospitals from several Colombian cities, including Medellín (13,14).…”

Detection of the KPC Gene in Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii during a PCR-Based Nosocomial Surveillance Study in Puerto Rico

“…Ten KPC variants (KPC-2 to -11) are currently known. The KPC enzyme has been detected worldwide in Enterobacteriaceae and recently in Pseudomonas aeruginosa isolates from Colombia, Puerto Rico, Trinidad and Tobago, and the United States and in Acinetobacter baumannii in Puerto Rico (1,8,11,13). The KPC gene has been found associated with the plasmid-borne transposon Tn4401, which may be responsible for its rapid dissemination (4,6).…”

Detection of KPC in Acinetobacter spp. in Puerto Rico

“…Pseudomonas aeruginosa positive for the bla KPC gene has been recently identified in Colombia, Puerto Rico, and Trinidad and Tobago (3,28,29).…”