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Mendes Pedro D, Paulo SE, Santos CM, Fonseca AB, Melo Cristino J, Pereira ÁA, Caneiras C. Extensively drug-resistant Pseudomonas aeruginosa: clinical features and treatment with ceftazidime/avibactam and ceftolozane/tazobactam in a tertiary care university hospital center in Portugal - A cross-sectional and retrospective observational study. Front Microbiol 2024; 15:1347521. [PMID: 38414772 PMCID: PMC10896734 DOI: 10.3389/fmicb.2024.1347521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 01/15/2024] [Indexed: 02/29/2024] Open
Abstract
Introduction Extensively drug-resistant Pseudomonas aeruginosa (XDR-PA) is a growing concern due to its increasing incidence, limited therapeutic options, limited data on the optimal treatment, and high mortality rates. The study aimed to characterize the population, the outcome and the microbiological characteristics of XDR-PA identified in a Portuguese university hospital center. Methods All XDR-PA isolates between January 2019 and December 2021 were identified. XDR-PA was defined as resistance to piperacillin-tazobactam, third and fourth generation cephalosporins, carbapenems, aminoglycosides and fluoroquinolones. A retrospective analysis of the medical records was performed. Results One hundred seventy-eight individual episodes among 130 patients with XDR-PA detection were identified. The most common sources of infection were respiratory (32%) and urinary tracts (30%), although skin and soft tissue infections (18%) and primary bacteremia (14%) were also prevalent. Colonization was admitted in 64 cases. Several patients had risk factors for complicated infections, most notably immunosuppression, structural lung abnormalities, major surgery, hemodialysis or foreign intravascular or urinary devices. XDR-PA identification was more frequent in male patients with an average age of 64.3 ± 17.5 years. One non-susceptibility to colistin was reported. Only 12.4% were susceptible to aztreonam. Ceftazidime-avibactam (CZA) was susceptible in 71.5% of the tested isolates. Ceftolozane-tazobactam (C/T) was susceptible in 77.5% of the tested isolates. Antibiotic regimens with XDR-PA coverage were reserved for patients with declared infection, except to cystic fibrosis. The most frequently administered antibiotics were colistin (41 cases), CZA (39 cases), and C/T (16 cases). When combination therapy was used, CZA plus colistin was preferred. The global mortality rate among infected patients was 35.1%, significantly higher in those with hematologic malignancy (50.0%, p < 0.05), followed by the ones with bacteremia (44.4%, p < 0.05) and those medicated with colistin (39.0%, p < 0.05), especially the ones with respiratory infections (60.0%). Among patients treated with CZA or C/T, the mortality rate seemed to be lower. Discussion XDR-PA infections can be severe and difficult to treat, with a high mortality rate. Even though colistin seems to be a viable option, it is likely less safe and efficient than CZA and C/T. To the best of the authors' knowledge, this is the first description of the clinical infection characteristics and treatment of XDR-PA in Portugal.
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Affiliation(s)
- Diogo Mendes Pedro
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
- Clínica Universitária de Doenças Infeciosas, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Instituto de Farmacologia e Neurociências, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Laboratório de Microbiologia na Saúde Ambiental, Laboratório Associado TERRA, Instituto de Saúde Ambiental, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Sérgio Eduardo Paulo
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
- Unidade Local do Programa de Prevenção e Controlo de Infeções e das Resistências aos Antimicrobianos, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - Carla Mimoso Santos
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
- Clínica Universitária de Doenças Infeciosas, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Unidade Local do Programa de Prevenção e Controlo de Infeções e das Resistências aos Antimicrobianos, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - Ana Bruschy Fonseca
- Serviço de Patologia Clínica, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - José Melo Cristino
- Serviço de Patologia Clínica, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
- Instituto de Microbiologia, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
| | - Álvaro Ayres Pereira
- Serviço de Doenças Infeciosas, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
- Unidade Local do Programa de Prevenção e Controlo de Infeções e das Resistências aos Antimicrobianos, Centro Hospitalar Universitário Lisboa Norte EPE, Lisbon, Portugal
| | - Cátia Caneiras
- Laboratório de Microbiologia na Saúde Ambiental, Laboratório Associado TERRA, Instituto de Saúde Ambiental, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
- Egas Moniz Center for Interdisciplinary Research (CiiEM), Egas Moniz School of Health and Science, Monte da Caparica, Portugal
- Instituto de Medicina Preventiva e Saúde Pública, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
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Barazandeh M, Shahin K, Hedayatkhah A, Komijani M, Mansoorianfar M. Characterization of a novel bullet-shaped lytic bacteriophage against extensively drug-resistant Pseudomonas aeruginosa isolated from human and domestic sources. VETERINARY RESEARCH FORUM : AN INTERNATIONAL QUARTERLY JOURNAL 2021; 12:401-407. [PMID: 35529810 PMCID: PMC9010831 DOI: 10.30466/vrf.2020.110372.2618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 01/08/2020] [Indexed: 11/23/2022]
Abstract
Global spread and emergence of the extensively drug-resistant (XDR) strains of P. aeruginosa have become a concern, thus, searching for new alternative treatment approaches are required. This study was aimed to isolate and characterize a novel lytic phage against P. aeruginosa. Seventy XDR isolates of P. aeruginosa were collected from May to September 2018. Wastewater samples were used for isolation of lytic phage against XDR P. aeruginosa isolates. Host range, thermal and pH stability, adsorption rate, latent period, burst size and morphology of phage were determined following the standard protocols. Morphological characteristics of the phage revealed that it belonged to Podoviridae family and it was named vB-PaeP-007. Although the phage had a narrow host range, 47 out of 70 XDR isolates were susceptible to it. The adsorption rate, latent period and burst size of vB-PaeP-007 were approximately 89.80% in 8 min, 10 min and 93 phages per cell, respectively. Its lysis activity remained at a wide range of pH (4 up to 12) and temperature (- 20.00 up to 70.00 ˚C). Regarding the physiological features and host range of the vB-PaeP-007 phage, it could be a promising candidate for phage therapy and bio-controlling of infections from XDR isolates of P. aeruginosa in human and livestock storage centers.
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Affiliation(s)
- Mohadeseh Barazandeh
- State Key Laboratory Cultivation Base of MOST, Institute of Food Safety and Nutrition, Jiangsu Academy of Agricultural Sciences, Nanjing, China; , Key Laboratory of Phage Research, International Phage Research Center, Jiangsu Academy of Agricultural Sciences, Nanjing, China;
| | - Khashayar Shahin
- State Key Laboratory Cultivation Base of MOST, Institute of Food Safety and Nutrition, Jiangsu Academy of Agricultural Sciences, Nanjing, China; , Key Laboratory of Phage Research, International Phage Research Center, Jiangsu Academy of Agricultural Sciences, Nanjing, China;
| | - Abolghasem Hedayatkhah
- Department of Marine Microbiology and Biogeo-chemistry, Royal Netherlands Institute for Sea Research and Utrecht University, Den Burg, The Netherlands; ,Department of Freshwater and Marine Ecology, Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands;
| | - Majid Komijani
- Department of Biology, Faculty of Science, Arak University, Arak, Iran; ,Correspondence Majid Komijani. PhD, Department of Biology, Faculty of Science, Arak University, Arak, Iran. E-mail:
| | - Mojtaba Mansoorianfar
- Department of Materials Science and Engineering, Sharif University of Technology, Tehran, Iran; ,Chinese Academy of Science, Suzhou Institute of Nano-Tech and Nano-Bionics, Suzhou, China.
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Beltrão EMB, Oliveira ÉMD, Lopes ACDS. First report of bla GES-1 in Proteus mirabilis clinical isolates. Rev Soc Bras Med Trop 2021; 54:e0864-2020. [PMID: 33759932 PMCID: PMC8008897 DOI: 10.1590/0037-8682-0864-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/05/2021] [Indexed: 11/29/2022] Open
Abstract
Proteus mirabilis is one of the main pathogens causing urinary tract infections and sepsis. To our knowledge, this is the first report of a P. mirabilis hosting blaGES. The presence of these genes was determined using PCR and sequencing. We identified the presence of blaGES-1 in all three isolates. In addition, we identified the blaKPC-2 and blaNDM-1 genes in the two strains. These data emphasize the importance of monitoring and surveillance of all enterobacteria. The circulation of P. mirabilis strains carrying blaGES-1 constitutes a new scenario of resistance in this species and should be an epidemiological alert for global health.
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Yoon EJ, Jeong SH. Mobile Carbapenemase Genes in Pseudomonas aeruginosa. Front Microbiol 2021; 12:614058. [PMID: 33679638 PMCID: PMC7930500 DOI: 10.3389/fmicb.2021.614058] [Citation(s) in RCA: 95] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/04/2021] [Indexed: 02/06/2023] Open
Abstract
Carbapenem-resistant Pseudomonas aeruginosa is one of the major concerns in clinical settings impelling a great challenge to antimicrobial therapy for patients with infections caused by the pathogen. While membrane permeability, together with derepression of the intrinsic beta-lactamase gene, is the global prevailing mechanism of carbapenem resistance in P. aeruginosa, the acquired genes for carbapenemases need special attention because horizontal gene transfer through mobile genetic elements, such as integrons, transposons, plasmids, and integrative and conjugative elements, could accelerate the dissemination of the carbapenem-resistant P. aeruginosa. This review aimed to illustrate epidemiologically the carbapenem resistance in P. aeruginosa, including the resistance rates worldwide and the carbapenemase-encoding genes along with the mobile genetic elements responsible for the horizontal dissemination of the drug resistance determinants. Moreover, the modular mobile elements including the carbapenemase-encoding gene, also known as the P. aeruginosa resistance islands, are scrutinized mostly for their structures.
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Affiliation(s)
- Eun-Jeong Yoon
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
| | - Seok Hoon Jeong
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
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Angles-Yanqui E, Huaringa-Marcelo J, Sacsaquispe-Contreras R, Pampa-Espinoza L. [Panorama of carbapenemases in PeruUm panorama das carbapenemases presentes no Peru]. Rev Panam Salud Publica 2020; 44:e61. [PMID: 32973907 PMCID: PMC7498286 DOI: 10.26633/rpsp.2020.61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/07/2020] [Indexed: 02/06/2023] Open
Abstract
Objetivo. Describir los genotipos de las carbapenemasas reportadas de aislamientos microbiológicos de pacientes en Perú. Métodos. Se realizó una búsqueda sistemática de la literatura biomédica publicada desde el 1 enero de 2000 hasta el 15 de setiembre de 2019 en las bases de datos PubMed, SCOPUS, Biblioteca Virtual de Salud, Biblioteca Virtual de CONCYTEC, Google Scholar y otras fuentes de publicaciones de resúmenes o póster en congresos nacionales o internacionales sobre carbapenemasas con confirmación genotípica; la selección y extracción de datos fue por pares. Resultados. Se incluyeron 14 estudios en los que se realizó la caracterización genotípica de 313 carbapenemasas. Ciento tres de estos reportes pertenecían a estudios efectuados en enterobacterias; de estos, 74 fueron en Klebsiella pneumoniae, 11 en Proteus mirabilis, 7 en Enterobacter cloacae y 11 en otras. Sesenta y una de estas 103 corresponden a blaNDM, 39 a blaKPC y 3 a blaIMP. Según su estructura molecular, 64 son metalobetalactamasas y 39 son serinbetalactamasas. En Pseudomonas aeruginosa se incluyeron 84 reportes, 79 corresponden a blaIMP, 4 a blaVIM, y 1 a blaGES. En Acinetobacter baumannii 126 reportes, 55 corresponden a blaOXA-23, 66 a blaOXA24, 3 a blaNDM y 2 a blaOXA-143. Conclusiones. Existe un número escaso de publicaciones respecto a carbapenemasas de pacientes en Perú; los reportes genotípicos provienen en su mayoría de hospitales de la capital del país. Esta es la primera revisión que intenta conocer los tipos de carbapenemasas reportadas en enterobacterias, P. aeruginosa y A. baumannii.
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Affiliation(s)
- Eddie Angles-Yanqui
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia Lima Perú Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Jorge Huaringa-Marcelo
- Facultad de Ciencias de la Salud, Universidad Científica del Sur Lima Perú Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Perú
| | | | - Luis Pampa-Espinoza
- Instituto Nacional de Salud Lima Perú Instituto Nacional de Salud, Lima, Perú
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García-Betancur JC, Appel TM, Esparza G, Gales AC, Levy-Hara G, Cornistein W, Vega S, Nuñez D, Cuellar L, Bavestrello L, Castañeda-Méndez PF, Villalobos-Vindas JM, Villegas MV. Update on the epidemiology of carbapenemases in Latin America and the Caribbean. Expert Rev Anti Infect Ther 2020; 19:197-213. [PMID: 32813566 DOI: 10.1080/14787210.2020.1813023] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Carbapenemases are β-lactamases able to hydrolyze a wide range of β-lactam antibiotics, including carbapenems. Carbapenemase production in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp., with and without the co-expression of other β-lactamases is a serious public health threat. Carbapenemases belong to three main classes according to the Ambler classification: class A, class B, and class D. AREAS COVERED Carbapenemase-bearing pathogens are endemic in Latin America. In this review, we update the status of carbapenemases in Latin America and the Caribbean. EXPERT OPINION Understanding the current epidemiology of carbapenemases in Latin America and the Caribbean is of critical importance to improve infection control policies limiting the dissemination of multi-drug-resistant pathogens and in implementing appropriate antimicrobial therapy.
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Affiliation(s)
| | - Tobias Manuel Appel
- Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque . Bogotá, Colombia
| | - German Esparza
- Programa de Aseguramiento de Calidad. PROASECAL SAS, Bogotá, Colombia
| | - Ana C Gales
- Division of Infectious Diseases, Department of Internal Medicine, Escola Paulista de Medicina/Universidade Federal de São Paulo - UNIFESP , São Paulo, Brazil
| | | | | | - Silvio Vega
- Complejo Hospitalario Metropolitano , Ciudad de Panamá, Panama
| | - Duilio Nuñez
- Infectious Diseases División, IPS Hospital Central , Asunción, Paraguay
| | - Luis Cuellar
- Servicio de Infectologia, Instituto Nacional de Enfermedades Neoplasicas , Lima, Peru
| | | | - Paulo F Castañeda-Méndez
- Department of Infectious Diseases, Hospital San Angel Inn Universidad , Ciudad de México, Mexico
| | | | - María Virginia Villegas
- Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque . Bogotá, Colombia.,Centro Médico Imbanaco . Cali, Colombia
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High frequency of the exoU+/exoS+ genotype associated with multidrug-resistant "high-risk clones" of Pseudomonas aeruginosa clinical isolates from Peruvian hospitals. Sci Rep 2019; 9:10874. [PMID: 31350412 PMCID: PMC6659710 DOI: 10.1038/s41598-019-47303-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 07/15/2019] [Indexed: 01/09/2023] Open
Abstract
The type III secretion system of Pseudomonas aeruginosa is an important virulence factor contributing to the cytotoxicity and the invasion process of this microorganism. The current study aimed to determine the presence of the exoU+/exoS+ genotype in P. aeruginosa clinical isolates. The presence of exoS, exoT, exoU and exoY was determined in 189 P. aeruginosa by PCR, and the presence/absence of exoU was analysed according to source infection, clonal relationships, biofilm formation, motility and antimicrobial susceptibility. The gyrA, parC, oprD, efflux pump regulators and β-lactamases genes were also analysed by PCR/sequencing. The exoS, exoT and exoY genes were found in 100% of the isolates. Meanwhile, exoU was present in 43/189 (22.8%) of the isolates, being significantly associated with multidrug resistance, extensively drug resistance as well as with higher level quinolone resistance. However, the presence of β-lactamases, mutations in gyrA and parC, and relevant modifications in efflux pumps and OprD were not significantly associated with exoU+ isolates. MLST analysis of a subset of 25 isolates showed 8 different STs displaying the exoU+/exoS+ genotype. The MDR basis of the exoU+ isolates remain to be elucidated. Furthermore, the clinical implications and spread of exoU+/exoS+ P. aeruginosa isolates need to be established.
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