Identification of carbapenem-resistant Pseudomonas aeruginosa in selected hospitals of the Gulf Cooperation Council States: dominance of high-risk clones in the region

Zowawi, Hosam M.; Syrmis, Melanie W.; Kidd, Timothy J.; Balkhy, Hanan H.; Walsh, Timothy R.; Johani, Sameera M. Al; Jindan, Reem Y. Al; Alfaresi, Mubarak; Ibrahim, Emad; Al-Jardani, Amina; Salman, Jameela Al; Dashti, Ali A.; Sidjabat, Hanna E.; Baz, Omar; Trembizki, Ella; Whiley, David M.; Paterson, David L.

doi:10.1099/jmm.0.000730

“…Carbapenem resistance in the current study was highest in Acinetobacter and Pseudomonas, which exceeded NHSN figures [21], may reflect the local heavy use of carbapenems, which has been recently documented [34]. Emergence of novel resistant strains and increasing prevalence of high-risk clones has been suggested to explain the increasing carbapenem resistance in Pseudomonas in Saudi Arabia and GCC region [35]. Interestingly, Acinetobacter contribution to HAI and its carbapenem resistance were decreasing during the current study.…”

Section: Discussionmentioning

confidence: 45%

Ten-year resistance trends in pathogens causing healthcare-associated infections; reflection of infection control interventions at a multi-hospital healthcare system in Saudi Arabia, 2007–2016

Balkhy

¹

,

El-Saed

²

,

Alshamrani

³

et al. 2020

Antimicrob Resist Infect Control

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Background: Studying temporal changes in resistant pathogens causing healthcare-associated infections (HAIs) is crucial in improving local antimicrobial and infection control practices. The objective was to describe ten-year trends of resistance in pathogens causing HAIs in a tertiary care setting in Saudi Arabia and to compare such trends with those of US National Health Surveillance Network (NHSN).Methods: Pooled analysis of surveillance data that were prospectively collected between 2007 and 2016 in four hospitals of Ministry of National Guard Health Affairs. Definitions and methodology of HAIs and antimicrobial resistance were based on NHSN. Consecutive NHSN reports were used for comparisons.Results: A total 1544 pathogens causing 1531 HAI events were included. Gram negative pathogens (GNP) were responsible for 63% of HAIs, with a significant increasing trend in Klebsiella spp. and a decreasing trend in Acinetobacter. Methicillin-resistant Staphylococcus aureus (27.0%) was consistently less frequent than NHSN. Vancomycin-resistant Enterococci (VRE, 20.3%) were more than doubled during the study, closing the gap with NHSN. Carbapenem resistance was highest with Acinetobacter (68.3%) and Pseudomonas (36.8%). Increasing trends of carbapenem resistance were highest in Pseudomonas and Enterobacteriaceae, closing initial gaps with NHSN. With the exception of Klebsiella and Enterobacter, multidrug-resistant (MDR) GNPs were generally decreasing, mainly due to the decreasing resistance towards cephalosporins, fluoroquinolones, and aminoglycosides. Conclusion:The findings showed increasing trends of carbapenem resistance and VRE, which may reflect heavy use of carbapenems and vancomycin. These findings may highlight the need for effective antimicrobial stewardship programs, including monitoring and feedback on antimicrobial use and resistance.

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“…This is consistent with the known predominance of VIM enzymes, and to a lesser extent IMP enzymes, in P. aeruginosa from the Middle East. (25)(26)(27) Unlike other geographic settings such as in Indian subcontinent, NDM enzymes have not been detected in P. aeruginosa from the Arabian Peninsula. (26,28) Apart from areas with a high prevalence of MBL in P. aeruginosa, the presence of Class A ESBL b-lactamases can result in resistance to ceftolozanetazobactam.…”

Section: Discussionmentioning

confidence: 99%

“…(25)(26)(27) Unlike other geographic settings such as in Indian subcontinent, NDM enzymes have not been detected in P. aeruginosa from the Arabian Peninsula. (26,28) Apart from areas with a high prevalence of MBL in P. aeruginosa, the presence of Class A ESBL b-lactamases can result in resistance to ceftolozanetazobactam. (14) Avibactam is an e cient inhibitor of Class A b-lactamases and hence ceftazidime-avibactam combination retains its activity in this situation but not ceftolozane-tazobactam.…”

Section: Discussionmentioning

confidence: 99%

β-lactamase-mediated Resistance in MDR-Pseudomonas Aeruginosa from Qatar

Ahmed

¹

,

Khan

²

,

Sultan

³

et al. 2020

Preprint

0

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Background: Anti-pseudomonal b-lactam antibiotics are of paramount importance in the management of Pseudomonas aeruginosa infections. The distribution of b-lactam resistance genes in P. aeruginosa is often closely related to the distribution of certain high-risk international clones. In the present study whole-genome sequencing (WGS) was used to identify the predominant sequence types (STs) and b-lactamase genes in clinical isolates of multidrug-resistant (MDR)-P. aeruginosa from QatarMethods: Microbiological identification and susceptibility tests were performed by automated BD PhoenixTM system and manual Liofilchem MIC Test Strips. Seventy-five MDR-P. aeruginosa isolates were subsequently processed for WGS. Results: Among 75 MDR-P. aeruginosa isolates; the largest proportions of susceptibility were to ceftazidime-avibactam (n=36, 48%), followed by ceftolozane-tazobactam (30, 40%), ceftazidime (n=21, 28%) and aztreonam (n=16, 21.33%). Almost all isolates possessed Class C and Class D b-lactamases (n=72, 96% each), while metallo-β-lactamases were detected in 20 (26.67%) isolates. Eight (40%) metallo-β-lactamases producers were susceptible to aztreonam and did not produce any concomitant extended-spectrum b-lactamases. The most frequent sequence types identified were ST235 (n=16, 21.33%), ST357 (n=8, 10.67%), ST389 and ST1284 (6, 8% each). Nearly all ST235 (15/16; 93.75%) were resistant to all tested b-lactams.Conclusion: MDR-P. aeruginosa isolates from Qatar are highly resistant to antipseudomonal b-lactams. Global high-risk STs are predominant in Qatar and their associated multi-resistant phenotypes are a cause for considerable concern. The molecular epidemiology trends of P. aeruginosa should be surveillance at national levels to track their trends and institute the appropriate control strategies.

show abstract

“…This is consistent with the known predominance of VIM enzymes, and to a lesser extent IMP enzymes, in P. aeruginosa from the Middle East. (25)(26)(27) Unlike other geographic settings such as in Indian subcontinent, NDM enzymes have not been detected in P. aeruginosa from the Arabian Peninsula. (26,28) Apart from areas with a high prevalence of MBL in P. aeruginosa, the presence of Class A ESBL β-lactamases can result in resistance to ceftolozanetazobactam.…”

Section: Discussionmentioning

confidence: 99%

“…(25)(26)(27) Unlike other geographic settings such as in Indian subcontinent, NDM enzymes have not been detected in P. aeruginosa from the Arabian Peninsula. (26,28) Apart from areas with a high prevalence of MBL in P. aeruginosa, the presence of Class A ESBL β-lactamases can result in resistance to ceftolozanetazobactam. (14) Avibactam is an e cient inhibitor of Class A β-lactamases and hence ceftazidime-avibactam combination retains its activity in this situation but not ceftolozane-tazobactam.…”

Section: Discussionmentioning

confidence: 99%

β-Lactamase-Mediated Resistance in MDR-Pseudomonas Aeruginosa from Qatar

Ahmed

¹

,

Khan

²

,

Sultan

³

et al. 2020

Preprint

1

0

View full text Add to dashboard Cite

Background: Anti-pseudomonal b-lactam antibiotics are of paramount importance in the management of Pseudomonas aeruginosa infections. The distribution of b-lactam resistance genes in P. aeruginosa is often closely related to the distribution of certain high-risk international clones. In the present study whole-genome sequencing (WGS) was used to identify the predominant sequence types (STs) and b-lactamase genes in clinical isolates of multidrug-resistant (MDR)-P. aeruginosa from QatarMethods: Microbiological identification and susceptibility tests were performed by automated BD PhoenixTM system and manual Liofilchem MIC Test Strips. Seventy-five MDR-P. aeruginosa isolates were subsequently processed for WGS. Results: Among 75 MDR-P. aeruginosa isolates; the largest proportions of susceptibility were to ceftazidime-avibactam (n=36, 48%), followed by ceftolozane-tazobactam (30, 40%), ceftazidime (n=21, 28%) and aztreonam (n=16, 21.33%). Almost all isolates possessed Class C and Class D b-lactamases (n=72, 96% each), while metallo-β-lactamases were detected in 20 (26.67%) isolates. Eight (40%) metallo-β-lactamases producers were susceptible to aztreonam and did not produce any concomitant extended-spectrum b-lactamases. The most frequent sequence types identified were ST235 (n=16, 21.33%), ST357 (n=8, 10.67%), ST389 and ST1284 (6, 8% each). Nearly all ST235 (15/16; 93.75%) were resistant to all tested b-lactams.Conclusion: MDR-P. aeruginosa isolates from Qatar are highly resistant to antipseudomonal b-lactams. Global high-risk STs are predominant in Qatar and their associated multi-resistant phenotypes are a cause for considerable concern. The molecular epidemiology trends of P. aeruginosa should be surveillance at national levels to track their trends and institute the appropriate control strategies.

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Identification of carbapenem-resistant Pseudomonas aeruginosa in selected hospitals of the Gulf Cooperation Council States: dominance of high-risk clones in the region

Abstract: Overall our data show that 'high-risk' CRPA clones are now detected in the region and highlight the need for strategies to limit further spread of such organisms, including enhanced surveillance, infection control precautions and further promotion of antibiotic stewardship programmes.

Cited by 51 publications

References 43 publications

Ten-year resistance trends in pathogens causing healthcare-associated infections; reflection of infection control interventions at a multi-hospital healthcare system in Saudi Arabia, 2007–2016

Ten-year resistance trends in pathogens causing healthcare-associated infections; reflection of infection control interventions at a multi-hospital healthcare system in Saudi Arabia, 2007–2016

β-lactamase-mediated Resistance in MDR-Pseudomonas Aeruginosa from Qatar

β-Lactamase-Mediated Resistance in MDR-Pseudomonas Aeruginosa from Qatar

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Identification of carbapenem-resistant Pseudomonas aeruginosa in selected hospitals of the Gulf Cooperation Council States: dominance of high-risk clones in the region

Abstract: Overall our data show that 'high-risk' CRPA clones are now detected in the region and highlight the need for strategies to limit further spread of such organisms, including enhanced surveillance, infection control precautions and further promotion of antibiotic stewardship programmes.

Cited by 51 publications

References 43 publications

Ten-year resistance trends in pathogens causing healthcare-associated infections; reflection of infection control interventions at a multi-hospital healthcare system in Saudi Arabia, 2007–2016

Ten-year resistance trends in pathogens causing healthcare-associated infections; reflection of infection control interventions at a multi-hospital healthcare system in Saudi Arabia, 2007–2016

β-lactamase-mediated Resistance in MDR-Pseudomonas Aeruginosa from Qatar

β-Lactamase-Mediated Resistance in MDR-Pseudomonas Aeruginosa&nbsp;from Qatar

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β-Lactamase-Mediated Resistance in MDR-Pseudomonas Aeruginosa from Qatar