Role of outer membrane permeability, efflux mechanism, and carbapenemases in carbapenem-nonsusceptible Pseudomonas aeruginosa from Dubai hospitals: Results of the first cross-sectional survey

Moubareck, Carole Ayoub; Halat, Dalal Hammoudi; Akkawi, Charbel; Nabi, Anju; Al-Sharhan, M.; AlDeesi, Zulfa O.; Peters, Christabel C.; Celiloglu, Handan; Sarkis, Dolla Karam

doi:10.1016/j.ijid.2019.04.027

Cited by 32 publications

(39 citation statements)

References 48 publications

(61 reference statements)

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“…5,[21][22][23] Class 1 integrons were detected in 14 (12.4%, 14/113) isolates, a similar finding to other research from China. 5,[21][22][23] However, this result is quite different from those of studies in which the determinants of drug resistance related to integrons were found in the isolates from several P. aeruginosa outbreaks. 6,24,25 Studies have shown that almost half of all drug-resistant P. aeruginosa strains carry integrons.…”

Section: Discussionsupporting

confidence: 89%

Antimicrobial Resistance and Molecular Characterization of Gene Cassettes from Class 1 Integrons in Pseudomonas aeruginosa Strains

Liu

Jia

et al. 2020

Microbial Drug Resistance

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We investigated the antibiotic-resistance phenotypes and molecularly characterized class 1 integron gene cassettes from 113 Pseudomonas aeruginosa isolates from patients. Primers specific for the class 1 integron integrase (intI1) gene were used to screen for these integrons using polymerase chain reactions (PCRs). The variable regions of the integrons were PCR-amplified and sequenced. Sputum was the most common specimen (69.9%; 79/113) followed by aseptic sites (21.2%; 24/113). Of the 113 isolates with phenotypic resistance to the tested antimicrobials, the highest resistances were to ciprofloxacin (CIP) (26.55%), imipenem (IPM) (23.89%), and meropenem (MEM) (23%). Carbapenem-sensitive P. aeruginosa (CS-PA) isolates displayed 23 patterns, and the predominant multidrug resistance phenotype was CIP-levofloxacin (7.23%, 6/83). Carbapenem-resistant P. aeruginosa (CR-PA) isolates displayed 12 patterns, and the predominant multidrug resistance phenotype was IPM-MEM (23.33%, 7/30). Class 1 integrons were detected in 14 (12.4%, 14/113) isolates, 7.22% (6/83) in CS-PA isolates, and 26.67% (8/30) in CR-PA isolates. Six gene cassette arrays were detected, the most prevalent being aacA4-blaOXA101-aadA5 in five isolates (4.4%, 5/113). Seventeen gene cassettes were detected. The most prevalent antibiotic-resistance gene cassettes were aacA4 (6.2%, 7/113), bla OXA-1 , and bla OXA-101. Extended-spectrum b-lactamase resistance genes were detected. Some of the genes carried were similar to those in other species, but some had shared characteristics among the P. aeruginosa isolates. Long-standing drug resistance genes appeared to be under elimination in P. aeruginosa, whereas integrons conferring resistance to commonly used clinical drugs such as b-lactamases, fluoroquinolones, and even carbapenems, as well as some other gene elements, were found to be newly integrated.

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Section: Discussionsupporting

confidence: 89%

Antimicrobial Resistance and Molecular Characterization of Gene Cassettes from Class 1 Integrons in Pseudomonas aeruginosa Strains

Liu

Jia

et al. 2020

Microbial Drug Resistance

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“…After original detection in North America, VIM-7 was recently described in another report from Brazil [90]. Our group has lately detected several VIM enzymes including VIM-2, VIM-30, VIM-31, and VIM-42 from nosocomial P. aeruginosa in Dubai, United Arab Emirates [67], with VIM-2 co-existing with the Ambler class A carbapenemase GES-5. Moreover, in Lebanon, we detected VIM-2 in 16% of a nationwide collection of nosocomial P. aeruginosa that were primarily spread among different hospitals by clonal dissemination [83].…”

Section: Ambler Class B Carbapenemases (Metallo-β-lactamases)mentioning

confidence: 72%

“…Later, over 20 GES variants were described, but only a few display carbapenemase activity. For instance, P. aeruginosa from Spain [66] and Dubai [67] revealed GES-5, while P. aeruginosa from Mexico revealed GES-20 [68]. In addition, Moubareck and Colleagues identified GES-11 in an isolate of A. baumannii in France [69], and the same enzyme was identified in nosocomial isolates of this organism from Lebanon [70].…”

Section: Ambler Class a Carbapenemasesmentioning

confidence: 96%

“…Recently, GES-5 and GES-24 carbapenemases were isolated from P. aeruginosa from long-term care facilities in South Korea [225]. GES-5 was also detected in studies from Canada [226], Indonesia [227], Dubai [67], and Japan [228]. A variant of GES-5 called GES-18 was isolated from P. aeruginosa recovered from the endotracheal aspirate of an elderly patient hospitalized in Belgium [229].…”

Section: Pseudomonasmentioning

confidence: 99%

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The Current Burden of Carbapenemases: Review of Significant Properties and Dissemination among Gram-Negative Bacteria

2020

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Carbapenemases are β-lactamases belonging to different Ambler classes (A, B, D) and can be encoded by both chromosomal and plasmid-mediated genes. These enzymes represent the most potent β-lactamases, which hydrolyze a broad variety of β-lactams, including carbapenems, cephalosporins, penicillin, and aztreonam. The major issues associated with carbapenemase production are clinical due to compromising the activity of the last resort antibiotics used for treating serious infections, and epidemiological due to their dissemination into various bacteria across almost all geographic regions. Carbapenemase-producing Enterobacteriaceae have received more attention upon their first report in the early 1990s. Currently, there is increased awareness of the impact of nonfermenting bacteria, such as Acinetobacter baumannii and Pseudomonas aeruginosa, as well as other Gram-negative bacteria that are carbapenemase-producers. Outside the scope of clinical importance, carbapenemases are also detected in bacteria from environmental and zoonotic niches, which raises greater concerns over their prevalence, and the need for public health measures to control consequences of their propagation. The aims of the current review are to define and categorize the different families of carbapenemases, and to overview the main lines of their spread across different bacterial groups.

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“…In a survey from Taiwan, the rate of resistance was close to 9% [ 189 ], which was about 6% in a German university hospital [ 190 ], 5% in Spain [ 191 ], 4% in Korea [ 192 ], and 2% in Thailand [ 193 ]. In a cross-sectional, multicenter survey from Dubai, all the studied P. aeruginosa isolates were colistin sensitive [ 194 ]. On the other hand, the rate of resistance was 22% in a report from India [ 195 ], and 15% in a nationwide Italian survey [ 196 ].…”

Section: Special Features and Spread Of Polymyxin Resistance Amongmentioning

confidence: 99%

Polymyxins and Bacterial Membranes: A Review of Antibacterial Activity and Mechanisms of Resistance

2020

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Following their initial discovery in the 1940s, polymyxin antibiotics fell into disfavor due to their potential clinical toxicity, especially nephrotoxicity. However, the dry antibiotic development pipeline, together with the rising global prevalence of infections caused by multidrug-resistant (MDR) Gram-negative bacteria have both rejuvenated clinical interest in these polypeptide antibiotics. Parallel to the revival of their use, investigations into the mechanisms of action and resistance to polymyxins have intensified. With an initial known effect on biological membranes, research has uncovered the detailed molecular and chemical interactions that polymyxins have with Gram-negative outer membranes and lipopolysaccharide structure. In addition, genetic and epidemiological studies have revealed the basis of resistance to these agents. Nowadays, resistance to polymyxins in MDR Gram-negative pathogens is well elucidated, with chromosomal as well as plasmid-encoded, transferrable pathways. The aims of the current review are to highlight the important chemical, microbiological, and pharmacological properties of polymyxins, to discuss their mechanistic effects on bacterial membranes, and to revise the current knowledge about Gram-negative acquired resistance to these agents. Finally, recent research, directed towards new perspectives for improving these old agents utilized in the 21st century, to combat drug-resistant pathogens, is summarized.

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Role of outer membrane permeability, efflux mechanism, and carbapenemases in carbapenem-nonsusceptible Pseudomonas aeruginosa from Dubai hospitals: Results of the first cross-sectional survey

Cited by 32 publications

References 48 publications

Antimicrobial Resistance and Molecular Characterization of Gene Cassettes from Class 1 Integrons in Pseudomonas aeruginosa Strains

Antimicrobial Resistance and Molecular Characterization of Gene Cassettes from Class 1 Integrons in Pseudomonas aeruginosa Strains

The Current Burden of Carbapenemases: Review of Significant Properties and Dissemination among Gram-Negative Bacteria

Polymyxins and Bacterial Membranes: A Review of Antibacterial Activity and Mechanisms of Resistance

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