Virulence factors and integrons are associated with MDR and XDR phenotypes in nosocomial strains of Pseudomonas aeruginosa in a Venezuelan university hospital
Abstract:Multidrug resistance (MDR), virulence and transferable elements potentiate
Pseudomonas aeruginosa
's role as an opportunistic pathogen
creating a high risk for public health. In this study, we evaluated the possible
association of multidrug resistance, virulence factors and integrons with
intrahospital
P. aeruginosa
strains isolated from patients at
Cumana hospital, Venezuela. Relevant clinical-epidemiological data were
collected to study 176 strains (2009-2016) is… Show more
“…Additionally, many authors described a significant positive correlation between MBL and AmpC β-lactamase production and biofilm formation 35. In contrast to our results, other studies found no significant difference in the association of biofilm formation and the presence of multidrug resistance 22,36. Also, no statistical significance was found between MBL and biofilm formation 31…”
Section: Discussioncontrasting
confidence: 99%
“…The same finding was previously reported 23,29. This high rate of imipenem resistance may be due to uncontrolled carbapenem use in hospital infections 22. Carbapenem resistance among P. aeruginosa isolates is attributed mainly to carbapenemase production 5.…”
Section: Discussionsupporting
confidence: 74%
“…Furthermore, more than half of these MDR and XDR isolates were carbapenem resistant. A similar rate was reported in Venezuela in which MDR and XDR P. aeruginosa increased to 71.9% in 2016 22. Also, Rossi Goncalves23 concluded a high rate of MDR (73.9%).…”
PurposeThe problem of carbapenem-resistant Pseudomonas aeruginosa in health-care settings is growing worse. This study was conducted to investigate the rate of carbapenemase genes, antibiotic resistance, and virulence factors in carbapenem-resistant P. aeruginosa associated with hospital-acquired infections.Patients and methodsIsolates of P. aeruginosa were collected from patients with hospital-acquired infections at Mansoura University Hospital in Mansoura. Carbapenem susceptibility was done by broth dilution. The presence of carbapenemase genes and quorum-sensing genes was assessed by PCR. Production of protease, pyocyanin, twitching motility, hemolytic activity and biofilm formation was evaluated.ResultsOut of 80 P. aeruginosa isolates, 34 (42.5%) were resistant to carbapenem. Among carbapenem-resistant P. aeruginosa isolates, 21 (61.8%) were carbapenemase producers. The most prevalent gene detected was blaVIM. The frequency of protease, pyocyanin, twitching motility, hemolytic activity and biofilm formation was 76.2%, 58.8%, 83.8%, 93.8% and 77.5%, respectively. Biofilm formation was significantly associated with carbapenem-resistant P. aeruginosa. On the other hand, pyocyanin production was significantly lower in carbapenem-resistant isolates. No correlation existed between carbapenem resistance and any other studied virulence factors or quorum-sensing genes.ConclusionAssociation of carbapenem-resistant P. aeruginosa with other antibiotic resistance or the presence of virulence factors in hospital-acquired infection may represent a warning that enhances the need for a stringent surveillance program.
“…Additionally, many authors described a significant positive correlation between MBL and AmpC β-lactamase production and biofilm formation 35. In contrast to our results, other studies found no significant difference in the association of biofilm formation and the presence of multidrug resistance 22,36. Also, no statistical significance was found between MBL and biofilm formation 31…”
Section: Discussioncontrasting
confidence: 99%
“…The same finding was previously reported 23,29. This high rate of imipenem resistance may be due to uncontrolled carbapenem use in hospital infections 22. Carbapenem resistance among P. aeruginosa isolates is attributed mainly to carbapenemase production 5.…”
Section: Discussionsupporting
confidence: 74%
“…Furthermore, more than half of these MDR and XDR isolates were carbapenem resistant. A similar rate was reported in Venezuela in which MDR and XDR P. aeruginosa increased to 71.9% in 2016 22. Also, Rossi Goncalves23 concluded a high rate of MDR (73.9%).…”
PurposeThe problem of carbapenem-resistant Pseudomonas aeruginosa in health-care settings is growing worse. This study was conducted to investigate the rate of carbapenemase genes, antibiotic resistance, and virulence factors in carbapenem-resistant P. aeruginosa associated with hospital-acquired infections.Patients and methodsIsolates of P. aeruginosa were collected from patients with hospital-acquired infections at Mansoura University Hospital in Mansoura. Carbapenem susceptibility was done by broth dilution. The presence of carbapenemase genes and quorum-sensing genes was assessed by PCR. Production of protease, pyocyanin, twitching motility, hemolytic activity and biofilm formation was evaluated.ResultsOut of 80 P. aeruginosa isolates, 34 (42.5%) were resistant to carbapenem. Among carbapenem-resistant P. aeruginosa isolates, 21 (61.8%) were carbapenemase producers. The most prevalent gene detected was blaVIM. The frequency of protease, pyocyanin, twitching motility, hemolytic activity and biofilm formation was 76.2%, 58.8%, 83.8%, 93.8% and 77.5%, respectively. Biofilm formation was significantly associated with carbapenem-resistant P. aeruginosa. On the other hand, pyocyanin production was significantly lower in carbapenem-resistant isolates. No correlation existed between carbapenem resistance and any other studied virulence factors or quorum-sensing genes.ConclusionAssociation of carbapenem-resistant P. aeruginosa with other antibiotic resistance or the presence of virulence factors in hospital-acquired infection may represent a warning that enhances the need for a stringent surveillance program.
“…30 We found a high frequency of exoU in our isolates indicating that more than half of the isolates display the cytotoxic phenotype, 31 which is associated with more pulmonary damage than invasive phenotypes. 32 This finding is consistent with Rodulfo et al, 33 who found a high frequency of exoU in MDR P. aeruginosa isolates. On the other hand, exoS was detected in a relatively similar frequency as exoU; with 17 isolates (43%) harboring exoS gene alone and 3 isolates possessing both genes (7.6%).…”
Ventilator-associated pneumonia caused by Pseudomonas aeruginosa (P. aeruginosa) is a major health-care problem. In this study, we explored the epidemiology of virulence determinants among multi-drug-resistant (MDR) clinical P. aeruginosa isolates from hospitalized patients with ventilator-associated pneumonia in intensive care units in Upper Egypt. Patients and Methods: MDR P. aeruginosa isolates were screened for the presence of eight virulence factors and typed by ERIC-PCR. Results: A total of 39 clinical MDR isolates were selected out of 173 isolated P. aeruginosa showing a combination of adhesion and cytotoxicity virulence patterns, with the detection of aprA, exoU, exoS, lasB, algD, toxA in 74.3%, 58.9%, 46.1%, 41.2%, 30.7%, 20.5% of the isolates, respectively. The MDR isolates were grouped into 13 different virulence profiles according to the pattern of virulence gene distribution. exoU genotype was more predominant among the P. aeruginosa isolates with more than 48% of the isolates harboring this gene alone, 7% harboring both exoU and exoS and 43.5% harboring exoS gene. An intermediate degree of diversity was detected by ERIC-PCR typing where the isolates were clustered in 7 major groups, indicating possible cross-infection within the hospital. Conclusion: Our results highlight the increased frequency of virulent P. aeruginosa isolates with a shift to the more virulent cytotoxic exoU genotype. Further hospital infection-control measures are mandatory to control the hospital cross-transmission of these highly virulent isolates. This study could vastly be a help to develop efficient treatment policies against P. aeruginosa induced ventilator-associated pneumonia.
“…In addition to the presence of Car-R/Ceph-S isolates (reported to be~13% of the overall pool of isolates), their report highlighted the continuous increase in resistance rates to β-lactam antibiotics and class I integrons between 2009 and 2016 (37.1% vs. 50.0% for piperacillin-tazobactam, 32.3% vs. 50% for ceftazidime, 33.9% vs. 50% for cefepime, 38.7% vs. 65.6% for imipenem, and 37.1% vs. 59.4% for meropenem). They have also found a positive association between the MDR/XDR phenotype and the presence of hemolysin, the exoU gene, and integrase I [243]. In the study of Khan et al, the resistance characteristics of keratitis-causing P. aeruginosa isolates, originating from Australia and India, were compared [73].…”
Section: Carbapenem-resistant But Cephalosporin-susceptible P Aerugimentioning
Pseudomonas aeruginosa is the most frequent cause of infection among non-fermenting Gram-negative bacteria, predominantly affecting immunocompromised patients, but its pathogenic role should not be disregarded in immunocompetent patients. These pathogens present a concerning therapeutic challenge to clinicians, both in community and in hospital settings, due to their increasing prevalence of resistance, and this may lead to prolonged therapy, sequelae, and excess mortality in the affected patient population. The resistance mechanisms of P. aeruginosa may be classified into intrinsic and acquired resistance mechanisms. These mechanisms lead to occurrence of resistant strains against important antibiotics—relevant in the treatment of P. aeruginosa infections—such as β-lactams, quinolones, aminoglycosides, and colistin. The occurrence of a specific resistotype of P. aeruginosa, namely the emergence of carbapenem-resistant but cephalosporin-susceptible (Car-R/Ceph-S) strains, has received substantial attention from clinical microbiologists and infection control specialists; nevertheless, the available literature on this topic is still scarce. The aim of this present review paper is to provide a concise summary on the adaptability, virulence, and antibiotic resistance of P. aeruginosa to a readership of basic scientists and clinicians.
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