Epidemiological and Genetic Characteristics of Clinical Carbapenem-Resistant Pseudomonas aeruginosa Strains in Guangdong Province, China

Abstract

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a major concern in clinical settings worldwide, yet few genetic and epidemiological studies on CRPA strains have been performed in China. Here, we sequence and analyze the genomes of 416 P. aeruginosa strains from hospitals in China to elucidate the genetic, phenotypic, and transmission characteristics of CRPA strains and to identify the molecular signatures responsible for the observed increase in the prevalence of CRPA infections in China.

Molecular characterization of extensively drug-resistant hypervirulent Pseudomonas aeruginosa isolates in China

“…Carbapenem-resistant P. aeruginosa usually shows resistance to the vast majority of clinical antibiotics and even XDR due to the production of carbapenemase, high efflux pump expression, and deletion of outer membrane protein. In our study, most XDR-hvPA strains were carbapenemase producers, suggesting that the production of this enzyme is the main mechanism leading to their drug resistance, which is inconsistent with previous research [ 22 – 24 ]; this inconsistency can be attributed to all strains in this study being XDR and plasmids carrying multidrug resistance genes being obtained from outside. It is worth noting that among these carbapenemases in XDR-PA in our study, bla GES was the most prevalent, which is mainly detected in P. aeruginosa [ 25 , 26 ].…”

Molecular Analysis of Carbapenem and Aminoglycoside Resistance Genes in Carbapenem-Resistant Pseudomonas aeruginosa Clinical Strains: A Challenge for Tertiary Care Hospitals

“…The predominant age group in our study was 31-40 years. Our data are in contrast with previously reported age groups such as 41-60 years from Pakistan [72], >60 years of age from China [12,79], 46-60 years from India [86] and 45-65 years from England [87]. It is evident from these reports that CRPA infections are frequently reported in old age group; however, its incidence among age groups 31-45 years and <20 years has been described in India and Oman [86,88].…”

“…This variability might be attributed to lower sample size in such studies. On the other hand, global data showed that CRPA prevalence variations based on different geographic locations such as European and Mediterranean countries (ranging from 10.9% in Sweden to 70.5% in Poland) [20], China (89.4%) [12], Egypt (64.2%) [73], Turkey (20%) [74], India (33%) [75] and Nigeria (40%) [76]. Similarly, a multicenter study in 10 different countries reported 22% [77] and the SENTRY surveillance program 23.9% [78].…”

“…The Antimicrobial Testing Leadership and Surveillance (ATLAS) program recorded approximately 20% CRPA prevalence during 2008 to 2018 [11]. The Chinese Antimicrobial Surveillance Network (CHINET) described 25-30% CRPA prevalence from 2005 to 2018 to 20-24% from 2019 to 2021 [12]. The enduring issue of the emergence of carbapenem resistance among P. aeruginosa has been growing exponentially over time with a significant global prevalence [12][13][14][15][16].…”

“…The Chinese Antimicrobial Surveillance Network (CHINET) described 25-30% CRPA prevalence from 2005 to 2018 to 20-24% from 2019 to 2021 [12]. The enduring issue of the emergence of carbapenem resistance among P. aeruginosa has been growing exponentially over time with a significant global prevalence [12][13][14][15][16]. Therefore, CRPA was classified as one of the three critical priority pathogens by the World Health Organization that demands urgent antimicrobial interventions due to exhausted reserves of antibiotics [17].…”