Detection of <it>P. aeruginosa </it> harboring <it>bla </it>_CTX-M-2, <it>bla </it>_GES-1 and <it>bla </it>_GES-5,<it>bla </it>_IMP-1 and <it>bla </it>_SPM-1 causing infections in Brazilian tertiary-care hospital

<p>Abstract</p> <p>Background</p> <p>Nosocomial infections caused by <it>Pseudomonas aeruginosa</it> presenting resistance to beta-lactam drugs are one of the most challenging targets for antimicrobial therapy, leading to substantial increase in mortality rates in hospitals worldwide. In this context, <it>P. aeruginosa</it> harboring acquired mechanisms of resistance, such as production of metallo-beta-lactamase (MBLs) and extended-spectrum beta-lactamases (ESBLs) have the highest clinical impact. Hence, this study was designed to investigate the presence of genes codifying for MBLs and ESBLs among carbapenem resistant <it>P. aeruginosa</it> isolated in a Brazilian 720-bed teaching tertiary care hospital.</p> <p>Methods</p> <p>Fifty-six carbapenem-resistant <it>P. aeruginosa</it> strains were evaluated for the presence of MBL and ESBL genes. Strains presenting MBL and/or ESBL genes were submitted to pulsed-field gel electrophoresis for genetic similarity evaluation.</p> <p>Results</p> <p>Despite the carbapenem resistance, genes for MBLs (<it>bla</it>_SPM-1 or <it>bla</it>_IMP-1) were detected in only 26.7% of isolates. Genes encoding ESBLs were detected in 23.2% of isolates. The <it>bla</it>_CTX-M-2 was the most prevalent ESBL gene (19.6%), followed by <it>bla</it>_GES-1 and <it>bla</it>_GES-5 detected in one isolate each. In all isolates presenting MBL phenotype by double-disc synergy test (DDST), the <it>bla</it>_SPM-1 or <it>bla</it>_IMP-1 genes were detected. In addition, <it>bla</it>_IMP-1 was also detected in three isolates which did not display any MBL phenotype. These isolates also presented the <it>bla</it>_CTX-M-2 gene. The co-existence of <it>bla</it>_CTX-M-2 with <it>bla</it>_IMP-1 is presently reported for the first time, as like as co-existence of <it>bla</it>_GES-1 with <it>bla</it>_IMP-1.</p> <p>Conclusions</p> <p>In this study MBLs production was not the major mechanism of resistance to carbapenems, suggesting the occurrence of multidrug efflux pumps, reduction in porin channels and production of other beta-lactamases. The detection of <it>bla</it>_CTX-M-2,<it>bla</it>_GES-1 and <it>bla</it>_GES-5 reflects the recent emergence of ESBLs among antimicrobial resistant <it>P. aeruginosa</it> and the extraordinary ability presented by this pathogen to acquire multiple resistance mechanisms. These findings raise the concern about the future of antimicrobial therapy and the capability of clinical laboratories to detect resistant strains, since simultaneous production of MBLs and ESBLs is known to promote further complexity in phenotypic detection. Occurrence of intra-hospital clonal dissemination enhances the necessity of better observance of infection control practices.</p

Clinical and Molecular Epidemiology of Extended-Spectrum Beta-Lactamase-Producing Klebsiella spp.: A Systematic Review and Meta-Analyses

Healthcare-related infections caused by extended-spectrum beta-lactamase (ESBL)-producing Klebsiella spp. are of major concern. To control transmission, deep understanding of the transmission mechanisms is needed. This systematic review aimed to identify risk factors and sources, clonal relatedness using molecular techniques, and the most effective control strategies for ESBL-producing Klebsiella spp. A systematic search of PubMed, Embase, and Outbreak Database was performed. We identified 2771 articles from November 25th, 1960 until April 7th, 2014 of which 148 were included in the systematic review and 23 in a random-effects meta-analysis study. The random-effects meta-analyses showed that underlying disease or condition (odds ratio [OR] = 6.25; 95% confidence interval [CI] = 2.85 to 13.66) generated the highest pooled estimate. ESBL-producing Klebsiella spp. were spread through person-to-person contact and via sources in the environment; we identified both monoclonal and polyclonal presence. Multi-faceted interventions are needed to prevent transmission of ESBL-producing Klebsiella spp