High incidence of carbapenemase-producingPseudomonas aeruginosaclinical isolates from Lagos, Nigeria

Abstract

Background Carbapenem-resistant Pseudomonas aeruginosa strains are on the rise worldwide. This study characterized clinical isolates of P. aeruginosa from three Nigerian hospitals for carbapenem resistance. Methods Strains isolated from wounds (n = 88), urine/catheter tips (n = 25), sputum/tracheotomy aspirates (n = 5), ear swabs (n = 4) and vaginal swabs (n = 1) were identified by MALDI-TOF and antibiotic susceptibility testing was performed using the VITEK 2 system. The genomic DNA of each isolate was subject to sequencing using Illumina and Oxford nanopore technology. Bioinformatics analyses were performed to detect antimicrobial resistance genes, clonal affiliations and phylogenetic relations of 123 non-duplicate P. aeruginosa isolates, whereas assembly of the nanopore reads using the plasmIDent pipeline enabled the identification of plasmids. Results Forty-three percent of the isolates were resistant to all antibiotic categories tested. More than 40% of the isolates were resistant to the carbapenems imipenem and/or meropenem (39% and 44%, respectively). Among the meropenem-resistant isolates, 48 (89%) carried at least one carbapenemase gene. The predominant one was blaNDM-1 (n = 34), which conferred resistance to all five antibiotic categories and highly increased the MICs of both meropenem and imipenem. The other recurrent carbapenemase genes were blaVIM-2 (n = 4), and blaVIM-5-like (n = 11), which co-existed with blaNDM-1 in two isolates. Conclusions The study revealed a high rate of carbapenem resistance and conjugative, broad host range plasmids carrying carbapenemase-encoding genes, especially the NDM-1 type, among isolates of P. aeruginosa. This may forebode the emergency of ubiquitous carbapenem resistance urging the implementation of infection control and antimicrobial stewardship strategies in Nigerian hospitals.

Genomic epidemiology and molecular characteristics of blaNDM-1-positive carbapenem-resistant Pseudomonas aeruginosa belonging to international high-risk clone ST773 in the Gauteng region, South Africa

“…The ICE specifically carrying the aac C3, bla NDM-1 and rmt B4 genes was first reported in the P. aeruginosa isolate “ST773” in the USA in 2019, which was obtained from a returning traveller that underwent surgery in India [ 59 ]. The ICE with the same genetic structure, composition and direct repeat sequences, designated as ICE 6660-like , was also recently found in South Korea [ 55 ], Nepal [ 52 ], Saudi Arabia [ 54 ] and Nigeria [ 53 ]. The international distribution of the bla NDM-1 -positive ST773 clade carrying ARGs on the genetic platforms such as ICEs warrants special attention since ICEs are self-transmissible and can facilitate intra- and intercellular mobility of ARGs [ 60 , 61 ] to other carbapenem-susceptible P. aeruginosa isolates and other Gram-negative bacteria ( Enterobacterales ) in the same region and other countries by travelling, which may further increase the health burden caused by MDR and XDR P. aeruginosa infections.…”

“…ST773 is an international high-risk clone associated with MDR and XDR phenotypes that produce MBLs (VIMs, IMPs, NDMs), which is widely distributed in countries like Hungary [ 50 ], India [ 51 ], Nepal [ 52 ], Nigeria [ 53 ], Saudi Arabia [ 54 ], South Korea [ 55 ], the UK [ 56 ] and the USA [ 57 ]. The core SNP-based phylogenetic analysis of the study isolates with 19 global ST773 isolates revealed that the study isolates and the eight bla NDM-1 -positive ST773 isolates belonged to the same clade.…”

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

“…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].…”

Optimized Dosing and Delivery of Bacteriophage Therapy for Wound Infections

“…Pseudomonas aeruginosa (Pa) is a major human pathogen, responsible for extensive mortality (1), and billions of dollars in health care costs (2,3). Managing Pa infections presents a significant challenge due to its resistance to numerous antibiotics (4) including antibiotics of last resort (5)(6)(7)(8) . Multidrug-resistant (MDR) Pa is recognized as a serious threat by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), but there are few antibiotics in the clinical pipeline (9,10).…”

“…Pseudomonas aeruginosa (Pa) is the most prevalent Gram-negative bacterium associated with wound infections, implicated in 25-50% of all chronic wounds [8][9][10][11] . Managing Pa infections presents a significant challenge due to its chromosomally encoded resistance mechanisms 12 , leading to resistance against numerous antibiotics, including those considered as last-resort options [13][14][15][16] . Multidrug-resistant (MDR) Pa is recognized as a serious threat by the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) 17,18 , but there are few antipseudomonal antibiotics in the clinical pipeline.…”