Multidrug and Extensive Drug Resistance inPseudomonas aeruginosaClinical Isolates from a Portuguese Central Hospital: 10-Year Survey

Abstract

Multidrug-resistant (MDR) Pseudomonas aeruginosa isolates are increasing worldwide and greatly limit therapeutic options, particularly when considering extensively drug-resistant (XDR) or pandrug-resistant isolates. The resistance profile of P. aeruginosa isolates from a Portuguese central hospital was surveyed during 10 years (n=3,778). About 39.9% were classified as MDR and 2.9% as XDR. Statistical analysis (Mann-Whitney test and regression modeling) revealed a decrease in total MDR rates over time but an increase in XDR rates. This suggests a tendency for higher proportions of XDR isolates in the future, which is of great concern. Isolates of nosocomial origin presented similar results to total population but, when analyzing them according to the different wards of origin, it was still observed a trend of increase in MDR rates in some wards, particularly pneumology, neurology, and neurosurgery. Similar analysis considering the nosocomial specimen source revealed a negative trend of evolution in MDR rates of respiratory origin and a positive trend over time in XDR rates of isolates collected from urine. Regarding the association of antibiotic resistance to MDR and XDR profiles, it was observed a negative relation over time between imipenem resistance and MDR and gentamicin resistance and XDR, suggesting that resistance to these antibiotics may predict the absence of MDR or XDR in P. aeruginosa isolates, respectively. Similar studies in other European hospitals should be performed to give further information to physicians, important for their empirical antibiotherapy regimens.

Non-Antimicrobial Drugs: Etodolac as a Possible Antimicrobial or Adjuvant Agent Against ESKAPE Pathogens

“…An estimation of 10 million deaths/year in 2050 due to untreatable infections is already established [ 18 ]. Finding novel alternatives to treat infections caused by MDR, XDR or PDR pathogens is paramount to prevent an increasingly announced involution of global health due to the rise of untreatable infections [ 1 , 2 ]. Drug development is highly burdensome and time consuming.…”

“…Regarding gram-negatives, despite the observed overall poor influence of ET in IPG and IBF, the compound showed some IPG and IBF activity against one of the two tested A. baumanii isolates. Variability on antimicrobial resistance and virulence in clinical isolates is known and associated to poorer outcomes [ 2 , 25 ]. A. baumannii is not an exception and its increasingly variable rates of drug resistance in different countries, particularly against carbapenems, are known and contribute to its inclusion in the ESKAPE group and in WHO critical priority level for research of new antibiotics [ 4 ].…”

“…However, with a galloping increase of its use since the very beginning, physicians rapidly assisted to an also galloping emergence and dissemination of different types of Antimicrobial Resistance (AMR), especially among bacteria. Currently, AMR is considered one of the 21 st century major concerns, particularly multiple-Drug Resistance (MDR) and the even more concerning Extensively Drug-Resistance (XDR) and Pan Drug-Resistance (PDR) [ 2 ]. The “antibiotic era” is now threatened and scientific community is already announcing the rise of a fateful “post-antibiotic era”, with no options to treat infections [ 1 , 3 ].…”

Prevalence and risk factors associated with colonization and infection of extensively drug-resistantPseudomonas aeruginosa: a systematic review

“…Further data on drug-resistant P. aeruginosa incidence has also been reported from various other countries. Recent studies from Portugal [47], the USA [48], Thailand [49] and Taiwan [50,51] indicate high rates of drug-resistant P. aeruginosa, but data are not sufficient for classification of XDR-PA. Data on XDR-PA is available from Italy [52], Greece [53], the USA [54], Brazil [55], South Korea [56] and Taiwan [54]. However, estimation of prevalence or incidence from the latter studies is not possible as they have investigated strains collected without concurrently providing information on the numbers of non-XDR-PA during the respective time periods.…”

First Complete Genome Sequence of Pseudomonas aeruginosa (Schroeter 1872) Migula 1900 (DSM 50071 T ), Determined Using PacBio Single-Molecule Real-Time Technology

“…It is a major opportunistic human pathogen and is also an important causative agent of hospital-acquired nosocomial infections, characteristically in immunocompromised individuals ( 1 – 4 ). The emergence of antibiotic-resistant forms of P. aeruginosa is a worldwide problem in clinical medicine ( 5 , 6 ). For instance, a total of 161 clinical isolates of multidrug-resistant P. aeruginosa were obtained between July and September 2011 from 161 hospitals in 30 of 47 prefectures in Japan, where two novel IMP-type metallo-β-lactamase variants were identified ( 7 ).…”