National surveillance pilot study unveils a multicenter, clonal outbreak of VIM-2-producing Pseudomonas aeruginosa ST111 in the Netherlands between 2015 and 2017

Abstract

Verona Integron-encoded Metallo-beta-lactamase (VIM) is the most frequently-encountered carbapenemase in the healthcare-related pathogen Pseudomonas aeruginosa. In the Netherlands, a low-endemic country for antibiotic-resistant bacteria, no national surveillance data on the prevalence of carbapenemase-producing P. aeruginosa (CPPA) was available. Therefore, in 2016, a national surveillance pilot study was initiated to investigate the occurrence, molecular epidemiology, genetic characterization, and resistomes of CPPA among P. aeruginosa isolates submitted by medical microbiology laboratories (MMLs) throughout the country. From 1221 isolates included in the study, 124 (10%) produced carbapenemase (CIM-positive); of these, the majority (95, 77%) were positive for the blaVIM gene using PCR. Sequencing was performed on 112 CIM-positive and 56 CIM-negative isolates (n = 168), and genetic clustering revealed that 75/168 (45%) isolates were highly similar. This genetic cluster, designated Group 1, comprised isolates that belonged to high-risk sequence type ST111/serotype O12, had similar resistomes, and all but two carried the blaVIM-2 allele on an identical class 1 integron. Additionally, Group 1 isolates originated from around the country (i.e. seven provinces) and from multiple MMLs. In conclusion, the Netherlands had experienced a nationwide, inter-institutional, clonal outbreak of VIM-2-producing P. aeruginosa for at least three years, which this pilot study was crucial in identifying. A structured, national surveillance program is strongly advised to monitor the spread of Group 1 CPPA, to identify emerging clones/carbapenemase genes, and to detect transmission in and especially between hospitals in order to control current and future outbreaks.

Epidemiology, Evolution of Antimicrobial Profile and Genomic Fingerprints of Pseudomonas aeruginosa before and during COVID-19: Transition from Resistance to Susceptibility

“…A review from 2018 assessed the global prevalence of P. aeruginosa clonality by ERIC-PCR, PFGE, or MLST, but in cystic fibrosis patients; the data were reported by a limited number of countries, but nevertheless showed the sharing of P. aeruginosa strains among individuals with this specific pathology [43]. A study in the Netherlands presented a 3-year clonal outbreak of carbapenem-resistant P. aeruginosa infections, which was unnoticed until molecular testing was performed [44]. This further highlights the importance of epidemiological surveillance by genotypic methods, complementary to the phenotypical findings.…”

Multidrug-resistant organisms in patients from Ukraine in the Netherlands, March to August 2022

“…All submitted CPE, CPPA and CRAB isolates (n = 62, from 44 patients from Ukraine) produced carbapenemase as assessed by the carbapenem inactivation method; the individual results are provided separately in Supplementary Table S1 We performed wgMLST using established in-house wgMLST schemes for K. pneumoniae, E. coli, P. aeruginosa [10,16] and A. baumannii, which indicated four potential transmission events of K. pneumoniae between patients from Ukraine and the Netherlands. Comparative wgMLST analysis of Dutch surveillance isolates with publicly available sequencing data from bacterial isolates from war-injured patients in military hospitals during the Eastern Ukraine conflict between 2014 and 2020 [7] indicates comparable sequence types (ST23, ST395, ST773), but no genetic clustering.…”

Genomic-based transmission analysis of carbapenem-resistant Pseudomonas aeruginosa at a tertiary care centre in Cologne (Germany) from 2015 to 2020

“…We compared our Cluster 1 bla VIM-2 -harbouring ST111 isolates with those from previous studies in the UK and the Netherlands. 21 , 22 Raw reads were downloaded from the European Nucleotide Archive with the study number ERP010395 and PRJEB39528, and assembled as described in the materials and methods. The resulting minimum spanning tree is shown in Figure S1 .…”

“… 4 , 30 Other surveillance studies from the UK and the Netherlands reported that ST111 P. aeruginosa was linked mostly to VIM-2 production. 21 , 22 Epidemiological data and high resolution genotyping by WGS showed evidence for spread within and between hospitals in different regions of the UK. 21 It is important to note that in our study most isolates were hospital-acquired and a limited number of isolates were also present on admission and healthcare-associated.…”