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

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...

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Autores principales: Schäfer, Elena, Malecki, Monika, Tellez-Castillo, Carlos J., Pfennigwerth, Niels, Marlinghaus, Lennart, Higgins, Paul G., Mattner, Frauke, Wendel, Andreas F.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937969/
https://www.ncbi.nlm.nih.gov/pubmed/31893042
http://dx.doi.org/10.1186/s13756-019-0665-5
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author Schäfer, Elena
Malecki, Monika
Tellez-Castillo, Carlos J.
Pfennigwerth, Niels
Marlinghaus, Lennart
Higgins, Paul G.
Mattner, Frauke
Wendel, Andreas F.
author_facet Schäfer, Elena
Malecki, Monika
Tellez-Castillo, Carlos J.
Pfennigwerth, Niels
Marlinghaus, Lennart
Higgins, Paul G.
Mattner, Frauke
Wendel, Andreas F.
author_sort Schäfer, Elena
collection PubMed
description 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: bla(VIM-1) (n = 2), bla(VIM-2) (n = 17), bla(NDM-1)/bla(GES-5) (n = 1) and the newly described bla(IMP-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.
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spelling pubmed-69379692019-12-31 Molecular surveillance of carbapenemase-producing Pseudomonas aeruginosa at three medical centres in Cologne, Germany Schäfer, Elena Malecki, Monika Tellez-Castillo, Carlos J. Pfennigwerth, Niels Marlinghaus, Lennart Higgins, Paul G. Mattner, Frauke Wendel, Andreas F. Antimicrob Resist Infect Control Short Report 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: bla(VIM-1) (n = 2), bla(VIM-2) (n = 17), bla(NDM-1)/bla(GES-5) (n = 1) and the newly described bla(IMP-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. BioMed Central 2019-12-30 /pmc/articles/PMC6937969/ /pubmed/31893042 http://dx.doi.org/10.1186/s13756-019-0665-5 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Short Report
Schäfer, Elena
Malecki, Monika
Tellez-Castillo, Carlos J.
Pfennigwerth, Niels
Marlinghaus, Lennart
Higgins, Paul G.
Mattner, Frauke
Wendel, Andreas F.
Molecular surveillance of carbapenemase-producing Pseudomonas aeruginosa at three medical centres in Cologne, Germany
title Molecular surveillance of carbapenemase-producing Pseudomonas aeruginosa at three medical centres in Cologne, Germany
title_full Molecular surveillance of carbapenemase-producing Pseudomonas aeruginosa at three medical centres in Cologne, Germany
title_fullStr Molecular surveillance of carbapenemase-producing Pseudomonas aeruginosa at three medical centres in Cologne, Germany
title_full_unstemmed Molecular surveillance of carbapenemase-producing Pseudomonas aeruginosa at three medical centres in Cologne, Germany
title_short Molecular surveillance of carbapenemase-producing Pseudomonas aeruginosa at three medical centres in Cologne, Germany
title_sort molecular surveillance of carbapenemase-producing pseudomonas aeruginosa at three medical centres in cologne, germany
topic Short Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937969/
https://www.ncbi.nlm.nih.gov/pubmed/31893042
http://dx.doi.org/10.1186/s13756-019-0665-5
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