Molecular Characterization of Multidrug-Resistant Pseudomonas aeruginosa Isolates in Hospitals in Myanmar

Abstract

The emergence of multidrug-resistant (MDR) Pseudomonas aeruginosa has become a serious worldwide medical problem. This study was designed to clarify the genetic and epidemiological properties of MDR P. aeruginosa strains isolated from hospitals in Myanmar. Forty-five MDR P. aeruginosa isolates obtained from different patients in seven hospitals in Myanmar were screened using the broth microdilution method. The whole genomes of the MDR isolates were sequenced using a MiSeq platform (Illumina). Phylogenetic trees were constructed from single nucleotide polymorphism concatemers. Multilocus sequence types were deduced, and drug resistance genes were identified. Of the 45 isolates, 38 harbored genes encoding carbapenemases, including DIM-1, IMP-1, NDM-1, VIM-2, and VIM-5, and 9 isolates had genes encoding 16S rRNA methylases, including RmtB, RmtD3, RmtE, and RmtF2. Most MDR P. aeruginosa strains isolated in Myanmar belonged to sequence type 1047 (ST1047). This is the first molecular epidemiological analysis of MDR P. aeruginosa clinical isolates in Myanmar. These findings strongly suggest that P. aeruginosa ST1047 strains harboring carbapenemases, including DIM-, IMP-, NDM-, and VIM-type metallo-␤lactamases, have been spreading throughout medical settings in Myanmar.

High-Risk International Clones of Carbapenem-Nonsusceptible Pseudomonas aeruginosa Endemic to Indonesian Intensive Care Units: Impact of a Multifaceted Infection Control Intervention Analyzed at the Genomic Level

“…A recent study of MDR P. aeruginosa in Malaysia also found ST235, ST357, and ST446 in a hospital setting (20). ST823 was previously described as a minor sequence type found in a multicenter study undertaken in the Gulf Cooperation Council states; more specifically, this clone was found among isolates from Qatar and the United Arab Emirates (21).…”

Mobile Carbapenemase Genes in Pseudomonas aeruginosa

“…Thus far, a total of 66 variants of VIM have been identified, and subtype 2-producing P. aeruginosa has been extensively spread, with a few regional exceptions by specific outbreaks. VIM-producing P. aeruginosa clinical strains have been identified in almost all countries reporting surveillance data in six continents: in Europe ( Poirel et al, 2000 ; Pournaras et al, 2002 ; Bahar et al, 2004 ; Deplano et al, 2007 ; Juan et al, 2008 ; Schneider et al, 2008 ; Siarkou et al, 2009 ; Bosnjak et al, 2010 ; Samuelsen et al, 2010 ; Mazzariol et al, 2011 ; Edelstein et al, 2013 ; Dortet et al, 2015 ; Kazmierczak et al, 2016b ), in Asia ( Wang et al, 2006b ; Khosravi and Mihani, 2008 ; Nho et al, 2008 ; Al-Agamy et al, 2009 ; Castanheira et al, 2009 ; Azim et al, 2010 ; Khosravi et al, 2010 ; Koh et al, 2010 ; Mano et al, 2015 ; Kazmierczak et al, 2016b ; Tada et al, 2017 , 2019 ; Tohya et al, 2019 ; Yaghi et al, 2019 ), in North ( Toleman et al, 2004 ; Pitout et al, 2007 ) and South America ( Crespo et al, 2004 ; Pasteran et al, 2005 ; Kazmierczak et al, 2016a ; Rios et al, 2018 ; Pacheco et al, 2019 ), in Africa ( Pitout et al, 2008 ; Ktari et al, 2011 ; Jeannot et al, 2013 ; Moyo et al, 2015 ; Kateete et al, 2016 ; Adam and Elhag, 2018 ), and in Oceania ( Tai et al, 2015 ; Figure 4 ). P. aeruginosa ST111 mostly produces VIM-2 and has been identified in European countries [the Czech Republic ( Papagiannitsis et al, 2017 ), Portugal ( Botelho et al, 2018 ), Italy ( Giani et al, 2018 ), Greece, and Belgium ( Castanheira et al, 2014b )] and in Latin American countries [Colombia ( Correa...…”

“…Notably, IMP-6 has better hydrolyzing activity to meropenem than to imipenem compared to the other subtypes of IMP enzymes ( Yano et al, 2001 ). IMP is the second most common carbapenemase produced by P. aeruginosa regardless of whether the strain was isolated in Europe ( Hrabak et al, 2009 , 2011 ; Samuelsen et al, 2010 ), in Asia ( Xiong et al, 2006 ; Kouda et al, 2007 ; Nho et al, 2008 ; Ryoo et al, 2009 ; Azim et al, 2010 ; Khosravi et al, 2010 ; Koh et al, 2010 ; Tada et al, 2019 ; Yaghi et al, 2019 ), in North ( Gibb et al, 2002 ; Hanson et al, 2006 ), and South America ( Garza-Ramos et al, 2008 ; Kazmierczak et al, 2016b ), in Africa ( Kateete et al, 2016 ; Adam and Elhag, 2018 ), and in Oceania ( McCarthy et al, 2017 ; Figure 4 ). P. aeruginosa ST357 mostly produces IMP.…”

“…The first report of NDM-1-producing P. aeruginosa was in Serbia in Jovcic et al (2011) , and subsequent dissemination was observed in the Balkans ( Jovcic et al, 2013 ; Kulkova et al, 2015 ). NDM-producing P. aeruginosa has been identified mostly in Asia ( Khajuria et al, 2013 ; Paul et al, 2015 ; Tada et al, 2017 , 2019 ; Honda et al, 2019 ; Tohya et al, 2019 ), in Europe ( Jovcic et al, 2011 ; Carattoli et al, 2013 ; Janvier et al, 2013 ; Kulkova et al, 2015 ; Urbanowicz et al, 2019 ), and in Africa ( Manenzhe et al, 2015 ; Kateete et al, 2016 ; Adam and Elhag, 2018 ). And, as a sporadic emergence, it was also identified in North America ( Mataseje et al, 2016 ; Figure 4 ).…”

“…The SPM producer was subsequently identified in Switzerland ( Salabi et al, 2010 ), the United Kingdom ( Salabi et al, 2010 ), India ( Azim et al, 2010 ), China ( Cai et al, 2016 ), and Uganda ( Kateete et al, 2016 ; Figure 4 ). DIM-producing P. aeruginosa clinical strains were regionally disseminated mostly in Asia ( Tada et al, 2017 , 2019 ) and Europe ( Urbanowicz et al, 2019 ). GIM-producing P. aeruginosa was identified in Germany ( Castanheira et al, 2004 ; Wendel et al, 2015 ) and India ( Azim et al, 2010 ).…”