Outbreak of
            <i>Pseudomonas aeruginosa</i>
            Infections with PER-1 Extended-Spectrum β-Lactamase in Warsaw, Poland: Further Evidence for an International Clonal Complex

Empel, Joanna; Filczak, K; Mrówka, Agnieszka; Hryniewicz, Waleria; Livermore, David M.; Gniadkowski, Marek

doi:10.1128/jcm.00997-07

Cited by 92 publications

(79 citation statements)

References 54 publications

(40 reference statements)

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“…Initial reports on PER-1 refer to P. aeruginosa strains [34], which, compared to our findings, indicates a low involvement of these enzymes in resistance to b-lactams in non-fermentative bacilli. The appearance of PER b-lactamases in new species of bacteria in various regions suggests the continuous spread of resistance determinants.…”

Section: Discussioncontrasting

confidence: 41%

Susceptibility, phenotypes of resistance, and extended-spectrum β-lactamases in Acinetobacter baumannii strains

Sacha

Wieczorek

Ojdana

et al. 2012

Folia Histochem Cytobiol.

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Abstract:Acinetobacter baumannii plays an increasing role in the pathogenesis of infections in humans. The bacilli are frequently isolated from patients treated in intensive care units. A growing resistance to antibiotics is leading to the emergence of strains that are multidrug-resistant and resistant to all available agents. The objective of this study was to assess susceptibility to antibiotics and to determine the presence and current level of the extended-spectrum b-lactamases (ESBLs) and attempt to isolate the Acinetobacter baumannii strain carrying the bla PER gene. A total of 51 strains of A. baumannii identified by phenotypic features were examined. That the strains belonged to the species was confirmed by the presence of the bla OXA-51-like gene. A broth microdilution method was used for antibacterial susceptibility testing. The occurrence of ESBLs was determined using phenotypic double-disk synergy tests. The PCR technique was used to confirm the presence of the bla PER-1 gene encoding ESBL. The most active antibiotics were meropenem, cefepime and ampicillin/sulbactam, with susceptibility shown by 76.5%, 60.8% and 56.9% of the strains, respectively. The strains exhibited the highest resistance (> 75%) to piperacillin, tetracycline, ciprofloxacin and cefotaxime. Phenotypic tests revealed ESBL mechanism of resistance in approximately 20% of Acinetobacter baumannii isolates. However, the PCR technique did not confirm the presence of the bla PER-1 gene in any of the Acinetobacter baumannii strains examined in our hospital. Acinetobacter baumannii strains demonstrate considerable resistance to many groups of antibiotics. Our findings indicate the involvement of enzymes belonging to families other than PER b-lactamase in resistance to b-lactams in

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Section: Discussioncontrasting

confidence: 41%

Susceptibility, phenotypes of resistance, and extended-spectrum β-lactamases in Acinetobacter baumannii strains

Sacha

Wieczorek

Ojdana

et al. 2012

Folia Histochem Cytobiol.

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“…These genes were found mainly in P. aeruginosa isolates from Turkey (22) and France (23). This aspect is important in order to identify and track the spread of MDRPA clones since blaOXA50 may be a potential clonality marker for P. aeruginosa (24).…”

Section: Discussionmentioning

confidence: 99%

Correlation between antibiotic resistance and virulence ofPseudomonas aeruginosa clinical isolates

Sonbol¹,

Khalil²,

Badr³

et al. 2015

Turk J Med Sci

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IntroductionThe increasing frequency of multidrug-resistant Pseudomonas aeruginosa (MDRPA) strains is concerning, as efficacious antimicrobial options are severely limited. Risk factors for MDRPA infection include prolonged hospitalization, exposure to antimicrobial therapy, and immunocompromised states such as human immunodeficiency virus infection. The emergence of MDRPA isolates during therapy was reported in 27%-72% of patients with initially susceptible P. aeruginosa isolates. Patients with severe MDRPA infections should be treated with combination therapy, consisting of an antipseudomonal β-lactam with an aminoglycoside or fluoroquinolone, rather than aminoglycoside and fluoroquinolone combinations, to provide adequate therapy and improve patient outcomes (1).P. aeruginosa produces a number of virulence factors, which, after colonization, can cause extensive tissue damage, bloodstream invasion, and dissemination (2). Pathogenesis is based on multiple virulence factors: endotoxin, exotoxins, and enzymes. Its endotoxin, like that of other gram-negative bacteria, causes the symptoms of sepsis and septic shock (3). Most strains of P. aeruginosa produce 2 exotoxins, exotoxin A and exoenzyme S; a variety of cytotoxic substances including phospholipases, pyocyanin, and proteases; and an alginate-like exopolysaccharide that is responsible for the mucoid phenotype. The importance of these putative virulence factors depends upon the site and nature of infection. Proteases play a key role in corneal ulceration, are important in burn infection, and are associated with chronic pulmonary colonization (4). Chitinase produced by P. aeruginosa has been investigated as a virulence factor associated with plant diseases (5). Folders et al. ( 6) reported that ChiC chitinase was produced by clinical isolates of P. aeruginosa. These virulence factors help the bacteria Background/aim: Virulent Pseudomonas aeruginosa is frequently life-threatening and often challenging to treat, and the emergence of multidrug-resistant isolates presents a critical problem for patients. The aim of the study was concerned with molecular analysis of the virulence factors and antimicrobial resistance profile of multidrug-resistant P. aeruginosa (MDRPA).Materials and methods: Out of 44 MDRPA isolates, 12 isolates representing different resistance profiles and sources of samples were selected for further molecular studies. Polymerase chain reaction (PCR) approaches were applied to identify the genes implicated in antimicrobial resistance or virulence factors in the selected MDRPA isolates.Results: Multidrug-resistance (pstS), β-lactamase (IMP7, IMP10, IMP13, and IMP25), and extended spectrum β-lactamase (blaOXA50) genes were detected in all of the selected MDRPA isolates. However, only 4 (33%) MDRPA isolates were positive for the presence of the extended spectrum β-lactamase (blaOXA2) gene. Furthermore, the hemolytic phospholipase C precursor gene (plcH) was detected in all PCR products of the tested MDRPA isolates while the exotoxin A (toxA) gene was ab...

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“…We used a twostep typing scheme, with PFGE typing of all isolates and MLST for 1 randomly selected isolate of each pulsotype. In contrast with other recent studies focusing mostly on particular resistance mechanisms (i.e., ESBLs or MBLs) (8,10,11,15,17,27), we attempted to determine the genetic diversity of all MDR P. aeruginosa isolates recovered during a long period (32 months) in a large population (all the university hospitals of the northeast part of France). Our results show that the majority of multidrug-resistant isolates belong to a few clonal types: ST235, ST111, and ST175.…”

Section: Discussionmentioning

confidence: 99%

“…ST235 was the founder ST of the clonal complex CC235 (previously described as CC11/BG11). CC235 has been long known as responsible for outbreaks throughout Europe, Asia, and South America (8,11,15,17,18,20,27) while armed with various ESBLs (such as PER-1, GES-1, and BEL-1) as well as MBLs (such as VIM-1, VIM-4, and IMP-1) (Fig. 2).…”

Section: Discussionmentioning

confidence: 99%

Most Multidrug-Resistant Pseudomonas aeruginosa Isolates from Hospitals in Eastern France Belong to a Few Clonal Types

et al. 2011

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This study aimed to determine the genetic diversity of clinical multidrug-resistant Pseudomonas aeruginosa. We used pulsed-field gel electrophoresis and multilocus sequence typing to analyze 187 strains isolated in different French hospitals. To illustrate the diversity of resistance mechanisms to antibiotics in a given clone, we identified ␤-lactamases with an extended spectrum by using phenotypic and genotypic methods. Typing results showed that the majority of our multidrug-resistant isolates belong to a few clonal types (ST235, ST111, and ST175) that are already spreading worldwide. These successful international clones sporadically produced extended-spectrum ␤-lactamase-encoding genes but mostly became extensively resistant to ␤-lactams after derepression of intrinsic resistance mechanisms (i.e., AmpC cephalosporinase). Our results indicate that cross-transmission plays a major role in the spread of multidrug-resistant P. aeruginosa in hospital settings.Pseudomonas aeruginosa is the third most important nosocomial pathogen in French hospitals, responsible for 10% of hospital-acquired infections (13). Additionally, the growing threat of antimicrobial resistance in P. aeruginosa is driven by its extraordinary capacity for developing resistance to almost any antibiotic by selection of mutations in chromosomal genes in conjunction with spread of horizontally acquired resistance (21, 30). Multidrug resistance in P. aeruginosa makes treatment of infections both difficult and expensive and can increase morbidity and mortality (16).There appears to be a consensus that the P. aeruginosa population structure is nonclonal epidemic, that clinical isolates are indistinguishable from environmental isolates, and that there are no specific clones with a specific habitat or disease (25). However, some important controversial issues remain. First, since the 1980s, several studies have reported the emergence, spread, and persistence of multidrug-resistant clones in hospitals, evidencing a lack of genetic diversity (25). Second, cystic fibrosis (CF) clones have been reported worldwide, suggestive of an emergence of specific clones spreading within the CF population (25,29).The objective of this study was to assess the genetic diversity, by using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST), of a large panel of multidrugresistant (MDR) P. aeruginosa isolates from patients hospitalized in different French hospitals. MATERIALS AND METHODSSettings. Five university hospitals (Besançon, Dijon, Nancy, Reims, and Strasbourg) of five administrative regions in eastern France took part in this survey over a 32-month period (from October 2007 to May 2010). These regions account for 8.5 million inhabitants, corresponding to 14% of the French population.Bacterial strains. All P. aeruginosa clinical and screening (if performed) isolates, except CF isolates, were collected and tested for antimicrobial resistance. The susceptibilities to ticarcillin, tazobactam/piperacillin, ceftazidime, cefepime, aztreonam, me...

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Outbreak of Pseudomonas aeruginosa Infections with PER-1 Extended-Spectrum β-Lactamase in Warsaw, Poland: Further Evidence for an International Clonal Complex

Cited by 92 publications

References 54 publications

Susceptibility, phenotypes of resistance, and extended-spectrum β-lactamases in Acinetobacter baumannii strains

Susceptibility, phenotypes of resistance, and extended-spectrum β-lactamases in Acinetobacter baumannii strains

Correlation between antibiotic resistance and virulence ofPseudomonas aeruginosa clinical isolates

Most Multidrug-Resistant Pseudomonas aeruginosa Isolates from Hospitals in Eastern France Belong to a Few Clonal Types

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