Molecular surveillance of carbapenemase-producing Pseudomonas aeruginosa at three medical centres in Cologne, Germany

Autor: Andreas F. Wendel, Niels Pfennigwerth, Paul G. Higgins, Monika Malecki, Lennart Marlinghaus, Frauke Mattner, Elena Schäfer, Carlos J. Tellez-Castillo
Rok vydání: 2019
Předmět:
Male
0301 basic medicine
Imipenem
Ceftazidime
Drug resistance
medicine.disease_cause
0302 clinical medicine
Germany
Prevalence
Pharmacology (medical)
030212 general & internal medicine
Aged
80 and over
Surveillance
Middle Aged
Anti-Bacterial Agents
Bacterial Typing Techniques
Infectious Diseases
Epidemiological Monitoring
Pseudomonas aeruginosa
Female
medicine.drug
Adult
DNA
Bacterial
Microbiology (medical)
Genotype
Cefepime
030106 microbiology
Short Report
Microbial Sensitivity Tests
Meropenem
beta-Lactamases
lcsh:Infectious and parasitic diseases
Microbiology
Carbapenemase
Young Adult
03 medical and health sciences
Bacterial Proteins
Intensive care
medicine
Humans
Pseudomonas Infections
lcsh:RC109-216
Aged
business.industry
Public Health
Environmental and Occupational Health
biochemical phenomena
metabolism
and nutrition
bacterial infections and mycoses
Carbapenems
VIM-2
business
Multilocus Sequence Typing
Piperacillin
Zdroj: Antimicrobial Resistance and Infection Control, Vol 8, Iss 1, Pp 1-7 (2019)
Antimicrobial Resistance and Infection Control
ISSN: 2047-2994
Popis: Background Pseudomonas aeruginosa is a common pathogen causing hospital-acquired infections. Carbapenem resistance in P. aeruginosa is either mediated via a combination of efflux pumps, AmpC overexpression, and porin loss, or through an acquired carbapenemase. Carbapenemase-producing P. aeruginosa (CPPA) strains are known to cause outbreaks and harbour a reservoir of mobile antibiotic resistance genes, however, few molecular surveillance data is available. The aim of this study was to analyse the prevalence and epidemiology of CPPA in three German medical centres from 2015 to 2017. Methods Identification and susceptibility testing were performed with VITEK 2 system. P. aeruginosa non-susceptible to piperacillin, ceftazidime, cefepime, imipenem, meropenem and ciprofloxacin (4MRGN according to the German classification guideline) isolated from 2015 to 2017 were analysed. A two-step algorithm to detect carbapenemases was performed: phenotypic tests (EDTA- and cloxacillin-combined disk tests) followed by PCR, Sanger sequencing, and eventually whole genome sequencing. CPPA isolates were further genotyped by RAPD and PFGE. In-hospital transmission was investigated using conventional epidemiology. Results Sixty two P. aeruginosa isolates were available for further analysis, of which 21 were CPPA as follows: blaVIM-1 (n = 2), blaVIM-2 (n = 17), blaNDM-1/blaGES-5 (n = 1) and the newly described blaIMP-82 (n = 1). CPPA were mostly hospital-acquired (71.4%) and isolated on intensive care units (66.7%). All (except one) were from the tertiary care centre. PFGE typing revealed one large cluster of VIM-2-producing CPPA containing 13 isolates. However, using conventional epidemiology, we were only able to confirm three patient-to-patient transmissions, and one room-to-patient transmission, on several intensive care units. Conclusions These data give insight into the epidemiology of CPPA in three centres in Germany over a period of 3 years. Carbapenemases are a relevant resistance mechanism in 4MRGN-P. aeruginosa, illustrated by genetically related VIM-2-producing strains that seem to be endemic in this region. Our data suggest that infection control measures should especially focus on controlling transmission on the ICU and support the need for a local molecular surveillance system.
Databáze: OpenAIRE
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