High mortality of bloodstream infection outbreak caused by carbapenem-resistant P. aeruginosa producing SPM-1 in a bone marrow transplant unit

Chaves, Lucas; Tomich, Lísia Gomes Martins de Moura; Salomão, Matias Chiarastelli; Leite, Gleice Cristina; Ramos, Jéssica Fernandes; Martins, Roberta Ruedas; Rizek, Camila; Neves, Patrícia; Batista, Marjorie Vieira; Amigo, Ulysses; Guimarães, Thaís; Levin, Anna S.; Costa, Sílvia Figueiredo

doi:10.1099/jmm.0.000631

Cited by 19 publications

(19 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…P. aeruginosa ST277 is a clone spread throughout the Brazilian territory and related to high mortality rates [2,10,18]. A greater similarity within Brazilian strains was found when compared to ST277 genomes isolated from other countries, showing that strains from Brazil share a high number of exclusively SNPs.…”

Section: Discussionmentioning

confidence: 96%

See 1 more Smart Citation

Exploring the success of Brazilian endemic clone Pseudomonas aeruginosa ST277 and its association with the CRISPR-Cas system type I-C

et al. 2020

View full text Add to dashboard Cite

Background: The Brazilian endemic clone Pseudomonas aeruginosa ST277 carries important antibiotic resistance determinants, highlighting the gene coding for SPM-1 carbapenemase. However, the resistance and persistence of this clone is apparently restricted to the Brazilian territory. To understand the differences between Brazilian strains from those isolated in other countries, we performed a phylogenetic analysis of 47 P. aeruginosa ST277 genomes as well as analyzed the virulence and resistance gene profiles. Furthermore, we evaluated the distribution of genomic islands and assessed in detail the characteristics of the CRISPR-Cas immunity system in these isolates. Results: The Brazilian genomes presented a typical set of resistance and virulence determinants, genomic islands and a high frequency of the CRISPR-Cas system type I-C. Even though the ST277 genomes are closely related, the phylogenetic analysis showed that the Brazilian strains share a great number of exclusively SNPs when compared to other ST277 genomes. We also observed a standard CRISPR spacers content for P. aeruginosa ST277, confirming a strong link between sequence type and spacer acquisition. Most CRISPR spacer targets were phage sequences. Conclusions: Based on our findings, P. aeruginosa ST277 strains circulating in Brazil characteristically acquired In163 and PAGI-25, which can distinguish them from strains that do not accumulate resistance mechanisms and can be found on the Asian, European and North American continents. The distinctive genetic elements accumulated in Brazilian samples can contribute to the resistance, pathogenicity and transmission success that characterize the ST277 in this country.

show abstract

Section: Discussionmentioning

confidence: 96%

“…It has been reported that In163, rmtD and bla SPM-1 are frequently associated to ST277 [2,10,17,18]. Together, these mechanisms cause resistance to the main antimicrobials used against P. aeruginosa in clinical practice.…”

Section: Discussionmentioning

confidence: 99%

Exploring the success of Brazilian endemic clone Pseudomonas aeruginosa ST277 and its association with the CRISPR-Cas system type I-C

et al. 2020

View full text Add to dashboard Cite

show abstract

“…These bacteria can harbour multiple antibiotic resistance mechanisms, leading to limited therapeutic options [4]. Recently, during an outbreak in our hospital, we conduct a casecontrol study and observed that prior use of carbapenem was the only independent risk factor for carbapenems-resistant P. aeruginosa (CRPA) BSI (P=0.043) [5].…”

Section: Introductionmentioning

confidence: 99%

Carbapenems-resistant Pseudomonas aeruginosa bloodstream infection in Hematopoietic stem cell transplant patients: in vitro synergy and clinical outcome

Ramos

Leite

Martins

et al. 2019

Preprint

Self Cite

View full text Add to dashboard Cite

Summary Bloodstream infection (BSI) caused by Pseudomonas aeruginosa has high mortality in hematopoietic stem cell transplant (HSCT) recipients. Objectives: To evaluate clinical, in vitro synergy and molecular features of 30 BSI caused by carbapenems-resistant P. aeruginosa (CRPA) in HSCT patients. Methods: Demographic and clinical data including treatment were collected and a database was built using EPIINFO, bivariate and multivariate analysis were run to assess outcome using SPSS. In vitro synergy using time-kill assays, pulsed-field electrophoresis (PFGE) and PCR for carbapenemases and virulence genes were performed for all isolates. Whole genome sequence (WGS) of main clones was done by Nextera XT, using Illumina MiSeq technology. Results: Mortality was 71%; most patients who died were allogeneic HSCT (78%) (p=0.02). Clinical isolates showed a high resistance level to meropenem: 50% had a MIC of 512 µg/mL; two thirds were susceptible to amikacin (MIC 2-512 µg/mL) and 100% to colistin. Many (17/30) isolates achieved synergistic effect with meropenem plus colistin but not with amikacin. None antagonism was observed. The presence of synergy by time-kill between colistin and meropenem showed a tendency towards a better outcome (HR 0.68 95%CI 0.02-1.02; p=0.06). The most frequent carbapenemase gene identified was blaSPM, and six co-harboured both blaKPC and blaSPM. Isolates presented genes related with virulence factors such as toxA, exoS and more patients with BSI caused by P. aeruginosa harbouring gene lasB evolved to death. The WGS showed that all five clones harboured SPM-1, Tn4371 and belonged to ST277; however, the resistance and virulence genes differ among the clones. Conclusion: CRPA BSI showed high mortality in HSCT patients. All clones carried SPM-1, Tn4371 and belonged to ST277. Synergy by time-kill between colistin and meropenem showed a tendency towards a better outcome

show abstract

“…Carbapenem-resistant Pseudomonas aeruginosa bloodstream infection (CRPA-BSI) has been associated with high morbidity and mortality in hematopoietic stem cell transplantation (HSCT) patients. Nowadays, it is a challenge with limited therapeutic options (1–2). Thus, in vitro synergy studies are important to define combination therapy that can be useful to treat these infections.…”

Section: Introductionmentioning

confidence: 99%

“…Thus, in vitro synergy studies are important to define combination therapy that can be useful to treat these infections. To date, few studies evaluated antimicrobial synergy against CRPA (3 5) and the role of virulence on the high mortality associated with CRPA-BSI is controversial as well (2, 3).…”

Section: Introductionmentioning

confidence: 99%

Carbapenem-resistant Pseudomonas aeruginosa bloodstream infection: in vitro synergy, virulence and clinical outcome

Rizek

et al. 2018

Preprint

Self Cite

View full text Add to dashboard Cite

34 Página2In the current study carbapanem-resistant P. aeruginosa bloodstream 35 infection (CRPA-BSI) was associated with high 14-day mortality. Although, 36 highly resistant to meropenem, half of the isolates achieved in vitro synergy 37 with the combination of meropenem with colistin, and the patients that 38 received this combination therapy showed a tendency towards lower mortality. 39Our strains did not carry exoU gene, on the other hand, patients with CRPA-40 BSI caused by strains harboring gene lasB evolved more frequent to death. 41 42

show abstract

High mortality of bloodstream infection outbreak caused by carbapenem-resistant P. aeruginosa producing SPM-1 in a bone marrow transplant unit

Abstract: The predominant clone belonging to ST277 showed high mortality. Carbapenem use was the only risk factor associated with CRPa-BSI. This finding is a wake-up call for the need to improve management in BMT units.

Cited by 19 publications

References 39 publications

Exploring the success of Brazilian endemic clone Pseudomonas aeruginosa ST277 and its association with the CRISPR-Cas system type I-C

Exploring the success of Brazilian endemic clone Pseudomonas aeruginosa ST277 and its association with the CRISPR-Cas system type I-C

Carbapenems-resistant Pseudomonas aeruginosa bloodstream infection in Hematopoietic stem cell transplant patients: in vitro synergy and clinical outcome

Carbapenem-resistant Pseudomonas aeruginosa bloodstream infection: in vitro synergy, virulence and clinical outcome

Contact Info

Product

Resources

About