Occurrence of a Multidrug-Resistant Pseudomonas aeruginosa Clone in Different Hospitals in Rio de Janeiro, Brazil

Abstract

Multidrug-resistant Pseudomonas aeruginosa nosocomial infections are increasingly recognized worldwide. The existence of metallo-␤-lactamase-and extended-spectrum ␤-lactamase-producing isolates exhibiting resistance to most ␤-lactam antimicrobial agents greatly complicates the clinical management of patients infected with such isolates. Since 1998, P. aeruginosa isolates resistant to all commercially available antimicrobial agents have been detected at a university-affiliated public hospital in Rio de Janeiro, Brazil. The present study was designed to characterize the antimicrobial resistance profiles and the genetic diversity of the P. aeruginosa strains isolated at this hospital and four private hospitals in Rio de Janeiro. Between April 1999 and March 2000, 200 consecutive isolates were obtained and analyzed for antimicrobial resistance. The genetic diversity of a selected number of them was evaluated by pulsed-field gel electrophoresis and PCR with the ERIC-2 primer. A predominant genotype, designated genotype A, was identified among isolates from four of the five hospitals evaluated. Eighty-four ceftazidime-resistant isolates were evaluated for metallo-␤-lactamase production, which was detected in 20 (91%) of 22 genotype A isolates and 11 (18%) of 62 isolates belonging to other genotypes (P < 0.05). Two metallo-␤-lactamase-producing genotype A isolates also produced an extended-spectrum ␤-lactamase. The occurrence of multidrug-resistant P. aeruginosa strains belonging to a unique genotype in different hospitals in Rio de Janeiro underscores the importance of the contribution of a single clone to the increase in the incidence of multidrug-resistant P. aeruginosa nosocomial infections.

Metallo-beta-lactamase producing Pseudomonas aeruginosa strains isolated in hospitals in Recife, PE, Brazil

“…This resistance pattern was similar to that found in Rio de Janeiro (12). Present data showed a higher percentage of MβL-producing P. aeruginosa strains in Recife than that found in other Brazilian cities (12,17).…”

“…This resistance pattern was similar to that found in Rio de Janeiro (12). Present data showed a higher percentage of MβL-producing P. aeruginosa strains in Recife than that found in other Brazilian cities (12,17). The multiplicity of antibiotic resistance gives to the imipenem-resistant strains a notable advantage for perpetuation and spreading in hospital settings, either carbapenems are or not being used, since they can be selected by a non-specific way (11).…”

Prophylactic meropenem during neutropenia in allogeneic stem cell transplant recipients

“…2,3 However, after a honeymoon period, most of these strategies have been abandoned and strongly discouraged by experts 4,5 because more significant outcome variables (such as infectiousrelated death) were not influenced by these measures, [6][7][8] and the emergence of resistance. 9,10 Gram-negative resistance has been a major problem in hospitalized patients worldwide, 11,12 and the use of carbapenems has been identified as an independent risk factor for infection caused by multiresistant Gram-negative organisms. [13][14][15] Furthermore, among different anti-Gramnegative antibiotics, the carbapemems seem to be more associated with the development of multiresistant Pseudomonas aeruginosa.…”

Alternativas terapêuticas para o tratamento de infecções por Pseudomonas aeruginosa multirresistentes endêmicas no Brasil.

“…Vários fatores podem levar a seleção de cepas resistentes e à endemicidade, as quais são associadas às infecções hospitalares, como o uso de técnicas inadequadas de controle de infecção por profissionais da saúde, o contato direto e indireto com reservatórios das cepas, além de procedimentos não apropriados de assepsia, limpeza, desinfecção do ambiente e de equipamentos (Moura, 2007;Pellegrino et al, 2002).…”

“…Infecções ocasionadas por P. aeruginosa são de grande importância devido a expressão de múltiplos mecanismos de resistência, dificultando a ação de antibacterianos, ocasionando elevados índices de morbidade e mortalidade (Gales et al, 2004;Pellegrino et al, 2002;Poole, 2011;Sader et al, 2001). …”