Extensively Drug-Resistant Pseudomonas aeruginosa Isolates Containing bla VIM-2 and Elements of Salmonella Genomic Island 2: a New Genetic Resistance Determinant in Northeast Ohio
Open Access
- 1 October 2014
- journal article
- Published by American Society for Microbiology in Antimicrobial Agents and Chemotherapy
- Vol. 58 (10), 5929-5935
- https://doi.org/10.1128/aac.02372-14
Abstract
Carbapenems are a mainstay of treatment for infections caused by Pseudomonas aeruginosa. Carbapenem resistance mediated by metallo-β-lactamases (MBLs) remains uncommon in the United States, despite the worldwide emergence of this group of enzymes. Between March 2012 and May 2013, we detected MBL-producing P. aeruginosa in a university-affiliated health care system in northeast Ohio. We examined the clinical characteristics and outcomes of patients, defined the resistance determinants and structure of the genetic element harboring the blaMBL gene through genome sequencing, and typed MBL-producing P. aeruginosa isolates using pulsed-field gel electrophoresis (PFGE), repetitive sequence-based PCR (rep-PCR), and multilocus sequence typing (MLST). Seven patients were affected that were hospitalized at three community hospitals, a long-term-care facility, and a tertiary care center; one of the patients died as a result of infection. Isolates belonged to sequence type 233 (ST233) and were extensively drug resistant (XDR), including resistance to all fluoroquinolones, aminoglycosides, and β-lactams; two isolates were nonsusceptible to colistin. The blaMBL gene was identified as blaVIM-2 contained within a class 1 integron (In559), similar to the cassette array previously detected in isolates from Norway, Russia, Taiwan, and Chicago, IL. Genomic sequencing and assembly revealed that In559 was part of a novel 35-kb region that also included a Tn501-like transposon and Salmonella genomic island 2 (SGI2)-homologous sequences. This analysis of XDR strains producing VIM-2 from northeast Ohio revealed a novel recombination event between Salmonella and P. aeruginosa, heralding a new antibiotic resistance threat in this region's health care system.Keywords
This publication has 50 references indexed in Scilit:
- Multiresistant Gram-negative bacteria: the role of high-risk clones in the dissemination of antibiotic resistanceFEMS Microbiology Reviews, 2011
- The Antibiotic Crisis: Can We Reverse 65 Years of Failed Stewardship?Archives of Internal Medicine, 2011
- Increasing prevalence and dissemination of NDM-1 metallo- -lactamase in India: data from the SMART study (2009)Journal of Antimicrobial Chemotherapy, 2011
- Acinetobacter baumannii 2002–2008: Increase of Carbapenem-Associated Multiclass Resistance in the United StatesMicrobial Drug Resistance, 2010
- Carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae across a hospital system: impact of post-acute care facilities on disseminationJournal of Antimicrobial Chemotherapy, 2010
- Unusual Class 1 Integron Configuration Found in S almonella Genomic Island 2 from Salmonella enterica Serovar EmekAntimicrobial Agents and Chemotherapy, 2010
- Molecular Epidemiology of KPC-Producing Klebsiella pneumoniae Isolates in the United States: Clonal Expansion of Multilocus Sequence Type 258Antimicrobial Agents and Chemotherapy, 2009
- The First Metallo-β-Lactamase Identified in Norway Is Associated with a TniC-Like Transposon in a Pseudomonas aeruginosa Isolate of Sequence Type 233 Imported from GhanaAntimicrobial Agents and Chemotherapy, 2009
- IMP-15-Producing Pseudomonas aeruginosa Strain Isolated in a U.S. Medical Center: a Recent Arrival from MexicoAntimicrobial Agents and Chemotherapy, 2008
- Analysis of Antibiotic Resistance Genes in Multidrug-Resistant Acinetobacter sp. Isolates from Military and Civilian Patients Treated at the Walter Reed Army Medical CenterAntimicrobial Agents and Chemotherapy, 2006