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Background  Multi-drug efflux pumps have been increasingly recognized as a major component of resistance in  P. aeruginosa . We have investigated the expression level of efflux systems among clinical isolates of  P. aeruginosa , regardless of their antimicrobial susceptibility profile.    Results  Aztreonam exhibited the highest in vitro activity against the  P. aeruginosa  isolates studied (64.4% susceptibility), whereas susceptibility rates of imipenem and meropenem were both 47.5%. The MexXY-OprM and MexAB-OprM efflux systems were overexpressed in 50.8% and 27.1% of isolates studied, respectively. Overexpression of the MexEF-OprN and MexCD-OprJ systems was not observed. AmpC β-lactamase was overexpressed in 11.9% of  P. aeruginosa  isolates. In addition, decreased  oprD  expression was also observed in 69.5% of the whole collection, and in 87.1% of the imipenem non-susceptible  P. aeruginosa  clinical isolates. The MBL-encoding genes  bla  SPM-1  and  bla  IMP-1  were detected in 23.7% and 1.7%  P. aeruginosa  isolates, respectively. The  bla  GES-1  was detected in 5.1% of the isolates, while  bla  GES-5  and  bla  CTX-M-2  were observed in 1.7% of the isolates evaluated. In the present study, we have observed that efflux systems represent an adjuvant mechanism for antimicrobial resistance.    Conclusions  Efflux systems in association of distinct mechanisms such as the porin down-regulation, AmpC overproduction and secondary β-lactamases play also an important role in the multi-drug resistance phenotype among  P. aeruginosa  clinical isolates.

bmc microbiology

Efflux pumps expression and its association with porin down-regulation and β-lactamase production among Pseudomonas aeruginosa causing bloodstream infections in Brazil