| Autor: |
Teo JQ; Department of Pharmacy, Singapore General Hospital, Singapore, Singapore.; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore., Tang CY; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore., Lim JC; Department of Pharmacy, National University of Singapore, Singapore, Singapore., Lee SJ; Department of Pharmacy, Singapore General Hospital, Singapore, Singapore., Tan SH; Department of Pharmacy, Singapore General Hospital, Singapore, Singapore., Koh TH; Department of Microbiology, Singapore General Hospital, Singapore, Singapore., Sim JH; Department of Microbiology, Singapore General Hospital, Singapore, Singapore., Tan TT; Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.; Singhealth Duke-NUS Medicine Academic Clinical Programme, Singapore, Singapore., Kwa AL; Department of Pharmacy, Singapore General Hospital, Singapore, Singapore.; Singhealth Duke-NUS Medicine Academic Clinical Programme, Singapore, Singapore.; Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore, Singapore., Ong RT; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore. |
| Abstrakt: |
Pseudomonas aeruginosa is a clinically important pathogen implicated in many hospital-acquired infections. Its propensity to acquire broad-spectrum resistance has earned the organism its status as a severe public health threat requiring urgent control measures. While whole-genome sequencing-based genomic surveillance provides a means to track antimicrobial resistance, its use in molecular epidemiological surveys of P. aeruginosa remains limited, especially in the Southeast Asian region. We sequenced the whole genomes of 222 carbapenem-non-susceptible P. aeruginosa (CNPA) isolates collected in 2006-2020 at the largest public acute care hospital in Singapore. Antimicrobial susceptibilities were determined using broth microdilution. Clonal relatedness, multi-locus sequence types, and antimicrobial resistance determinants (acquired and chromosomal) were determined. In this study, CNPA exhibited broad-spectrum resistance (87.8% multi-drug resistance), retaining susceptibility only to polymyxin B (95.0%) and amikacin (55.0%). Carbapenemases were detected in 51.4% of the isolates, where IMP and NDM metallo- β -lactamases were the most frequent. Carbapenem resistance was also likely associated with OprD alterations or efflux mechanisms (ArmZ/NalD mutations), which occurred in strains with or without carbapenemases. The population of CNPA in the hospital was diverse; the 222 isolates grouped into 68 sequence types (ST), which included various high-risk clones. We detected an emerging clone, the NDM-1-producing ST308, in addition to the global high-risk ST235 clone which was the predominant clone in our population. Our results thus provide a "snapshot" of the circulating lineages of CNPA locally and the prevailing genetic mechanisms contributing to carbapenem resistance. This database also serves as the baseline for future prospective surveillance studies. |
