Molecular epidemiology of carbapenem-resistant Pseudomonas aeruginosa in an endemic area: comparison with global data

Abstract

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is an endemic problem in certain countries including Greece. CRPA and multidrug-resistant P. aeruginosa (MDRPA) firstly emerged in our region during the 80s, right after the launch of imipenem and meropenem as therapeutic agents against P. aeruginosa infections. The role of outer membrane protein (Opr) inactivation has been known to contribute to imipenem resistance since many years, while efflux overexpression systems have been mainly associated with meropenem resistance. Among carbapenemases, metallo-β-lactamases (MBL) and mostly Verona integron-mediated (VIM) MBL's have played the most crucial role in CRPA emergence. VIM-2 and VIM-4 producing CRPA, usually belonging to clonal complexes (CC) 111 and 235 respectively, have most frequently been isolated. Bla and bla are usually associated with a class 1 integron. VIM-17 also has appeared in Greece. On the other hand, other VIM subtypes detected in a global level, such as VIM-3, VIM-5, VIM-6, VIM-7, VIM-11, VIM-14, VIM-15, VIM-16 and VIM-18 have not yet emerged in Greece. However, new VIM subtypes will probably emerge in the future. In addition, MBL carbapenemases other than VIM, detected worldwide have not yet appeared. A single CRPA isolate producing KPC has emerged in our region several years ago. The study of the molecular basis of Opr deficiency and efflux overexpression remains a challenge for the future. In this article, we review the molecular epidemiology of CRPA in an endemic area, compared to global data.

Quercetin potentiates meropenem activity among pathogenic carbapenem‐resistantPseudomonas aeruginosaandAcinetobacter baumannii

“…Emergence and rapid dissemination of carbapenem resistance among P. aeruginosa and A. baumannii is considered to be one of the most serious global health issues (WHO ) . To date, most of the studies have demonstrated pivotal role of bla VIM and bla OXA in conferring carbapenem resistance among pathogenic P. aeruginosa and A. baumannii respectively (Karampatakis et al ; Karampatakis et al ). However, in Indian scenario, contribution of bla NDM in carbapenem resistance development cannot be overlooked.…”

“…). To date, most of the studies have demonstrated pivotal role of bla VIM and bla OXA in conferring carbapenem resistance among pathogenic P. aeruginosa and A. baumannii respectively(Karampatakis et al 2017;Karampatakis et al 2018). However, in Indian scenario, contribution of bla NDM in carbapenem resistance development cannot be overlooked.…”

Molecular diversity of extended-spectrum β-lactamases and carbapenemases, and antimicrobial resistance

“…For example, IMP-6, which has only one amino acid substitution (serine to glycine at position 214) from IMP-1 (Additional file 6: Figure S6), enhanced the resistance to meropenem, and meropenemresistant Enterobacteriaceae, K. pneumoniae, and P. aeruginosa carrying blaIMP-6 have been spreading in Japan since 2001 [67,68]. Similarly, VIM-4, which has only one amino acid insertion (arginine at position 44) and one amino acid substitution (serine to arginine at position 265) from VIM-1 (Additional file 7: Figure S7), enhanced the resistance to carbapemems, and P. aeruginosa carrying blaVIM-4, which was first reported in 2002, has already been detected worldwide [69,70]. IMP and VIM are mainly included in the integron structure and are integrated into chromosomal DNA and plasmid DNA in association with the transposon [60,65].…”

Bulgecins as β-Lactam Enhancers Against Multidrug Resistant (MDR) Pseudomonas aeruginosa

“…β-lactamases from all four Ambler classes have been described in P. aeruginosa, including Class A extended spectrum β-lactamases (ESBLs) of the TEM, SHV, CTX-M, GES, PER and VEB types; Class A carbapenemases such as KPC variants; metallo-β-lactamases such as the VIM, IMP, NDM and SPM B1 di-Zn 2+ enzymes: and OXA carbapenemases [9,12]. Weak imipenemases in the so-called Class C AmpCs have already been discussed above.…”