High incidence of MDR and XDR Pseudomonas aeruginosa isolates obtained from patients with ventilator-associated pneumonia in Greece, Italy and Spain as part of the MagicBullet clinical trial

Journal Article · 08 February 2019 · Journal of Antimicrobial Chemotherapy

DOI: https://doi.org/10.1093/jac/dkz030 · OSTI ID:1494196

Pérez, Astrid ^[1]; Gato, Eva ^[1]; Pérez-Llarena, José ^[1]; Fernández-Cuenca, Felipe ^[2]; Gude, María José ^[1]; Oviaño, Marina ^[1]; Pachón, María Eugenia ^[3]; Garnacho, José ^[4]; González, Verónica ^[4]; Pascual, Álvaro ^[5]; Cisneros, José Miguel ^[4]; Bou, Germán ^[1]

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1. Microbiology Department, Biomedical Research Institute A Coruña (INIBIC), University Hospital A Coruña (CHUAC), University of A Coruña (UDC), A Coruña, Spain
2. Unidad de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain, Instituto de Biomedicina de Sevilla, Seville, Spain
3. Unidad de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain
4. Department of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocio, CSIC, University of Seville, Seville, Spain
5. Unidad de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Seville, Spain, Instituto de Biomedicina de Sevilla, Seville, Spain, Departamento de Microbiología, Universidad de Sevilla, Seville, Spain

Abstract Objectives To characterize the antimicrobial susceptibility, molecular epidemiology and carbapenem resistance mechanisms in Pseudomonas aeruginosa isolates recovered from respiratory tract samples from patients with ventilator-associated pneumonia enrolled in the MagicBullet clinical trial. Methods Isolates were collected from 53 patients from 12 hospitals in Spain, Italy and Greece. Susceptibility was determined using broth microdilution and Etest. MALDI-TOF MS was used to detect carbapenemase activity and carbapenemases were identified by PCR and sequencing. Molecular epidemiology was investigated using PFGE and MLST. Results Of the 53 isolates, 2 (3.8%) were considered pandrug resistant (PDR), 19 (35.8%) were XDR and 16 (30.2%) were MDR. Most (88.9%) of the isolates from Greece were MDR, XDR or PDR, whereas fewer of the isolates from Spain (33.3%) and Italy (43.5%) showed antibiotic resistance. Three Greek isolates were resistant to colistin. Overall, the rates of resistance of P. aeruginosa isolates to imipenem, ciprofloxacin, ceftolozane/tazobactam and ceftazidime/avibactam were 64.1%, 54.7%, 22.6% and 24.5%, respectively. All isolates resistant to ceftolozane/tazobactam and ceftazidime/avibactam (Greece, n = 10; and Italy, n = 2) carried blaVIM-2. Spanish isolates were susceptible to the new drug combinations. Forty-eight restriction patterns and 27 STs were documented. Sixty percent of isolates belonged to six STs, including the high-risk clones ST-111, ST-175 and ST-235. Conclusions MDR/XDR isolates were highly prevalent, particularly in Greece. The most effective antibiotic against P. aeruginosa was colistin, followed by ceftolozane/tazobactam and ceftazidime/avibactam. blaVIM-2 is associated with resistance to ceftolozane/tazobactam and ceftazidime/avibactam, and related to highly resistant phenotypes. ST-111 was the most frequent and disseminated clone and the clonal diversity was lower in XDR and PDR strains.

• Sponsoring Organization: USDOE Office of Electricity (OE), Advanced Grid Research & Development. Power Systems Engineering Research
• OSTI ID: 1494196
• Journal Information: Journal of Antimicrobial Chemotherapy, Journal Name: Journal of Antimicrobial Chemotherapy Journal Issue: 5 Vol. 74; ISSN 0305-7453
• Publisher: Oxford University PressCopyright Statement
• Country of Publication: United Kingdom
• Language: English