Evolving landscape of carbapenem-resistant Pseudomonas aeruginosa at a single centre in the USA.
Evolving landscape of carbapenem-resistant Pseudomonas aeruginosa at a single centre in the USA.
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DOI：
10.1093/jacamr/dlad070
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发表时间：
2023-06
影响因子：
3.4
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中科院分区：
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碳青霉烯类耐药铜绿假单胞菌（CR-PA）的鉴定增加是一个持续的问题。然而，随着时间的推移，CR-PA的耐药性和分子流行病学的信息是稀缺的。因此，我们进行了横断面分析，以研究在不同时间段内回收的CR-PA的表型和基因型特征，重点是表现出头孢洛扎/他唑巴坦耐药表型的分离株。研究了从美国德克萨斯州休斯顿的一个中心的临床标本中分离的共169株CR-PA。其中，1999年至2005年收集的61株被定义为历史菌株，2017年至2018年收集的108株被定义为当代菌株。测定了对所选β-内酰胺类的抗菌活性。WGS数据用于鉴定抗生素耐药决定簇和系统发育分析。从历史采集到当代采集，头孢洛扎/他唑巴坦和头孢他啶/阿维巴坦的不敏感性分别从2%（1/59）增加至17%（18/108）和从7%（4/59）增加至17%（18/108）。4.6%（5/108）的当代菌株携带碳青霉烯酶基因，ESBL基因的检出率也从3.3%（2/61）上升到16%（17/108）。编码获得性β-内酰胺酶的基因主要局限于高风险克隆。在头孢洛扎/他唑巴坦耐药分离株中，分别观察到94%（15/16）、56%（9/16）和12.5%（2/16）的菌株对头孢他啶/阿维巴坦、亚胺培南/阿替巴坦和头孢地罗可不敏感。对头孢洛扎/他唑巴坦和亚胺培南/曲马巴坦的耐药主要与外源性β-内酰胺酶的存在相关。获得外源性碳青霉烯酶和ESBLs可能是铜绿假单胞菌中令人担忧的趋势。
The increased identification of carbapenem-resistant Pseudomonas aeruginosa (CR-PA) is an ongoing concern. However, information on the evolving antimicrobial resistance profile and molecular epidemiology of CR-PA over time is scarce. Thus, we conducted a cross-sectional analysis to investigate the phenotypic and genotypic characteristics of CR-PA recovered over different time periods, focusing on the isolates exhibiting a ceftolozane/tazobactam resistance phenotype. A total of 169 CR-PA isolated from clinical specimens at a single centre in Houston, TX, USA were studied. Among them, 61 isolates collected between 1999 and 2005 were defined as historical strains, and 108 collected between 2017 and 2018 were defined as contemporary strains. Antimicrobial susceptibilities against selected β-lactams was determined. WGS data were used for the identification of antimicrobial resistance determinants and phylogenetic analysis. Non-susceptibility to ceftolozane/tazobactam and ceftazidime/avibactam increased from 2% (1/59) to 17% (18/108) and from 7% (4/59) to 17% (18/108) from the historical to the contemporary collection, respectively. Carbapenemase genes, which were not identified in the historical collection, were harboured by 4.6% (5/108) of the contemporary strains, and the prevalence of ESBL genes also increased from 3.3% (2/61) to 16% (17/108). Genes encoding acquired β-lactamases were largely confined to the high-risk clones. Among ceftolozane/tazobactam-resistant isolates, non-susceptibility to ceftazidime/avibactam, imipenem/relebactam and cefiderocol was observed in 94% (15/16), 56% (9/16) and 12.5% (2/16), respectively. Resistance to ceftolozane/tazobactam and imipenem/relebactam was primarily associated with the presence of exogenous β-lactamases. Acquisition of exogenous carbapenemases and ESBLs may be a worrisome trend in P. aeruginosa.