1. Spanish nationwide survey on Pseudomonas aeruginosa antimicrobial resistance mechanisms and epidemiology
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del Barrio-Tofiño, Ester, Zamorano, Laura, Cortes-Lara, Sara, López-Causapé, Carla, Sánchez-Diener, Irina, Cabot, Gabriel, Bou, Germán, Martínez-Martínez, Luis, Oliver, Antonio, Galán, Fátima, Gracia, Irene, Rodríguez, Manuel Antonio, Martín, Lina, Sánchez, Juan Manuel, Viñuela, Laura, García, Mª Victoria, Lepe, José Antonio, Aznar, Javier, López-Hernández, Inma, Seral, Cristina, Javier Castillo-García, Francisco, López-Calleja, Ana Isabel, Aspiroz, Carmen, de la Iglesia, Pedro, Ramón, Susana, Riera, Elena, Cruz Pérez, María, Gallegos, Carmen, Calvo, Jorge, Dolores Quesada, María, Marco, Francesc, Hoyos, Yannick, Pablo Horcajada, Juan, Larrosa, Nieves, González, Juan José, Tubau, Fe, Capilla, Silvia, Pérez-Moreno, Mar Olga, Centelles, Mª José, Padilla, Emma, Rivera, Alba, Mirelis, Beatriz, Elisa Rodríguez-Tarazona, Raquel, Arenal-Andrés, Noelia, del Pilar Ortega, María, Megías, Gregoria, García, Inmaculada, Colmenarejo, Cristina, González, José Carlos, Martínez, Nora Mariela, Gomila, Bárbara, Giner, Salvador, Tormo, Nuria, Garduño, Eugenio, Agulla, José Andrés, Seoane, Alejandro, Pita, Julia, Vidal, Isabel Paz, Guzmán, David Mauricio, García, Marta, Pérez del Molino, María Luisa, Barbeito, Gema, Artiles, Fernando, Azcona-Gutiérrez, José Manuel, Sáenz, Yolanda, Antonio Oteo, José, González, Ana, Villa, Jennifer, Chaves, Fernando, Cercenado, Emilia, Alarcón, Teresa, Zurita, Nelly Daniela, Merino, Irene, Morosini, María Isabel, Cantón, Rafael, Isabel Sánchez, María, Moreno, Laura, Yagüe, Genoveva, Leiva, José, Luis Barrios, José, Canut, Andrés, and Oteo, Jesús
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0301 basic medicine ,Microbiology (medical) ,Genotype ,Avibactam ,030106 microbiology ,Ceftazidime ,Microbial Sensitivity Tests ,Drug resistance ,Biology ,Polymerase Chain Reaction ,Tazobactam ,Microbiology ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Drug Resistance, Bacterial ,medicine ,Humans ,Pseudomonas Infections ,Pharmacology (medical) ,030212 general & internal medicine ,Phylogeny ,Pharmacology ,Cross Infection ,Molecular Epidemiology ,Molecular epidemiology ,Hospitals ,Anti-Bacterial Agents ,Electrophoresis, Gel, Pulsed-Field ,3. Good health ,Infectious Diseases ,chemistry ,Spain ,Pseudomonas aeruginosa ,Colistin ,Multilocus sequence typing ,Ceftolozane ,Multilocus Sequence Typing ,medicine.drug - Abstract
Objectives To undertake a Spanish nationwide survey on Pseudomonas aeruginosa molecular epidemiology and antimicrobial resistance. Methods Up to 30 consecutive healthcare-associated P. aeruginosa isolates collected in 2017 from each of 51 hospitals were studied. MICs of 13 antipseudomonal agents were determined by broth microdilution. Horizontally acquired β-lactamases were detected by phenotypic methods and PCR. Clonal epidemiology was evaluated through PFGE and MLST; at least one XDR isolate from each clone and hospital (n = 185) was sequenced. Results The most active antipseudomonals against the 1445 isolates studied were colistin and ceftolozane/tazobactam (both 94.6% susceptible, MIC50/90 = 1/2 mg/L) followed by ceftazidime/avibactam (94.2% susceptible, MIC50/90 = 2/8 mg/L). Up to 252 (17.3%) of the isolates were XDR. Carbapenemases/ESBLs were detected in 3.1% of the isolates, including VIM, IMP, GES, PER and OXA enzymes. The most frequent clone among the XDR isolates was ST175 (40.9%), followed by CC235 (10.7%), ST308 (5.2%) and CC111 (4.0%). Carbapenemase production varied geographically and involved diverse clones, including 16.5% of ST175 XDR isolates. Additionally, 56% of the sequenced XDR isolates showed horizontally acquired aminoglycoside-modifying enzymes, which correlated with tobramycin resistance. Two XDR isolates produced QnrVC1, but fluoroquinolone resistance was mostly caused by QRDR mutations. Beyond frequent mutations (>60%) in OprD and AmpC regulators, four isolates showed AmpC mutations associated with resistance to ceftolozane/tazobactam and ceftazidime/avibactam. Conclusions ST175 is the most frequent XDR high-risk clone in Spanish hospitals, but this nationwide survey also indicates a complex scenario in which major differences in local epidemiology, including carbapenemase production, need to be acknowledged in order to guide antimicrobial therapy.
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