Spanish nationwide survey on Pseudomonas aeruginosa antimicrobial resistance mechanisms and epidemiology

Barrio-Tofiño, Ester del; Zamorano, Laura; Cortés-Lara, Sara; López-Causapé, Carla; Sánchez-Diener, Irina; Cabot, Gabriel; Bou, Germán; Martı́nez-Martı́nez, Luis; Oliver, Antonio; Gemara-Seimc,

doi:10.1093/jac/dkz147

Cited by 99 publications

(80 citation statements)

References 42 publications

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“…Furthermore, most were focused only on carbapenem-resistant or MDR P. aeruginosa strains, but not specifically on XDR isolates, which have only few active drugs available and are more prone to be linked to high-risk clones. In line with this, previous studies showed that almost all XDR isolates analyzed at our institution belonged to well-described P. aeruginosa high-risk clones, with sequence type 175 (ST175) being by far the most frequent high-risk clone observed [18][19][20][21]. Unpublished local data also showed that 85% of our XDR P. aeruginosa isolates were clonally related, showing an endemic situation at our center.…”

Section: Introductionsupporting

confidence: 86%

“…In a Spanish multicenter study by our group (COLIMERO study) [18], 17/21 (81%) strains included from our center belonged to the ST175 high-risk clone. In another recent survey of P. aeruginosa molecular epidemiology and antimicrobial resistance in Spain, del Barrio-Tofiño et al [19] found that all isolates recovered from our site also belonged to the ST175 high-risk clone. In these two previous reports [18,19], the underlying resistance mechanisms in the XDR phenotype were mainly a combination of chromosomal mutations such as hyperproduction of chromosomal AmpC β-lactamases, efflux pumps, OprD deficiency and/or quinolone resistance-determining region mutations, rather than horizontally acquired carbapenemases.…”

Section: Discussionsupporting

confidence: 48%

“…Our data show that the vast majority of XDR P. aeruginosa strains were non-susceptible to all antipseudomonal agents apart from colistin and amikacin. Although clonality and the resistance mechanisms of the isolates were not specifically investigated in this study, previous ones found that, in XDR P. aeruginosa strains, the ST175 high-risk clone was by far the most frequent at our site [18][19][20][21]. In a Spanish multicenter study by our group (COLIMERO study) [18], 17/21 (81%) strains included from our center belonged to the ST175 high-risk clone.…”

Section: Discussionmentioning

confidence: 70%

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Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes?

Montero

López-Montesinos

Knobel

et al. 2020

JCM

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This study aimed to assess the impact of extensively drug-resistant (XDR) phenotype on mortality in Pseudomonas aeruginosa bacteremia. A retrospective cohort study was performed in a tertiary hospital from January 2000 to December 2018. All consecutive prospectively recorded P. aeruginosa bacteremia in adult patients were assessed. In this study, 382 patients were included, of which 122 (31.9%) due to XDR P. aeruginosa. Independent factors associated with 14-day mortality were as follows: high-risk source of bacteremia (hazard ratio (HR) 3.07, 95% confidence interval (CI), 1.73–5.46), septic shock (HR 1.75, 95% CI, 1.12–2.75), and higher Pitt scores (one-point increments; HR 1.25, 95% CI, 1.12–1.38). Otherwise, the appropriateness of definitive antibiotic therapy was a protective factor (HR 0.39, 95% CI, 0.24–0.62). The same variables were also associated with 30-day mortality. XDR phenotype was not associated with 14- or 30-day mortality. In a subanalysis considering only high-risk source cases, combined antimicrobial therapy was independently associated with 14-day favorable outcome (HR 0.56, 95% CI, 0.33–0.93). In conclusion, XDR phenotype was not associated with poor prognosis in patients with P. aeruginosa bacteremia in our cohort. However, source of infection, clinical severity, and inappropriate definitive antibiotic therapy were risk factors for mortality. Combined antimicrobial therapy should be considered for high-risk sources.

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Section: Introductionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 70%

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Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes?

Montero

López-Montesinos

Knobel

et al. 2020

JCM

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“…The collection studied included up to 30 consecutive healthcare-associated non-duplicated (one per patient) P. aeruginosa clinical isolates collected during October 2017 from each of the 51 participating hospitals, covering all 17 Spanish regions. 11 A total of 1445 isolates were studied. The distribution of sample types was as follows: respiratory (32.8%), urine (23.7%), soft tissue and osteoarticular (23.1%), blood culture (5.7%) and others (14.9%).…”

Section: P Aeruginosa Strain Collectionmentioning

confidence: 99%

“…Thus, the objective of this work was to determine the association between P. aeruginosa O-antigen serotypes, resistance profiles and high-risk clones, taking advantage of a recent large-scale Spanish nationwide survey of P. aeruginosa infections. 11 Material and methods…”

Section: Introductionmentioning

confidence: 99%

Association between Pseudomonas aeruginosa O-antigen serotypes, resistance profiles and high-risk clones: results from a Spanish nationwide survey

Barrio-Tofiño

Sánchez-Diener

Zamorano

et al. 2019

Journal of Antimicrobial Chemotherapy

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Objectives To evaluate the correlation of O-antigen serotypes with resistance profiles and high-risk clones in a Spanish nationwide survey. Methods Up to 30 consecutive healthcare-associated Pseudomonas aeruginosa isolates were collected during October 2017 from each of 51 hospitals (covering all Spanish regions) with a total of 1445 isolates studied. MICs of 13 antipseudomonal agents and MDR/XDR profiles had been previously determined, as well as whole-genome sequences of 185 representative XDR isolates. O-antigen serotypes (O1–O16) were determined by agglutination using serotype-specific antisera (BioRad). The Pseudomonas aeruginosa serotyper (PAst) program was used for in silico serotyping. Results The most frequent serotypes were O6 (17.8%), O1 (15.4%) and O11 (13.3%). In contrast, the most frequent serotype among XDR isolates (17.3%) was O4 (34.1%), distantly followed by O11 (15.9%). Within serotypes, XDR phenotypes were more frequent for O12 (60.0%) and O4 (57.3%). The most frequent clone among the XDR isolates was ST175 (40.9%), followed by CC235 (10.7%), ST308 (5.2%) and CC111 (3.6%). Up to 81.6% of XDR ST175 isolates typed O4, whereas 18.4% were non-typeable. O4 genotype was detected in all sequenced (n=55) ST175 isolates. On the other hand, CC235 and ST308 were associated with O11, whereas CC111 was linked to serotype O12. Conclusions O4 serotype is linked to the MDR/XDR profile of widespread ST175 (typically only susceptible to colistin, amikacin and the novel combinations ceftolozane/tazobactam and ceftazidime/avibactam) and therefore, after local validation, its detection in the microbiology laboratory might be useful for guiding semi-empirical antipseudomonal therapies and infection control measures in Spanish hospitals.

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What Makes Pseudomonas aeruginosa a Pathogen?

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2022

Advances in Experimental Medicine and Biology

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Spanish nationwide survey on Pseudomonas aeruginosa antimicrobial resistance mechanisms and epidemiology

Cited by 99 publications

References 42 publications

Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes?

Risk Factors for Mortality among Patients with Pseudomonas aeruginosa Bloodstream Infections: What Is the Influence of XDR Phenotype on Outcomes?

Association between Pseudomonas aeruginosa O-antigen serotypes, resistance profiles and high-risk clones: results from a Spanish nationwide survey

What Makes Pseudomonas aeruginosa a Pathogen?

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