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Background  Nosocomial infections caused by  Pseudomonas aeruginosa  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,  P. aeruginosa  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  P. aeruginosa  isolated in a Brazilian 720-bed teaching tertiary care hospital.    Methods  Fifty-six carbapenem-resistant  P. aeruginosa  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.    Results  Despite the carbapenem resistance, genes for MBLs ( bla  SPM-1  or  bla  IMP-1 ) were detected in only 26.7% of isolates. Genes encoding ESBLs were detected in 23.2% of isolates. The  bla  CTX-M-2  was the most prevalent ESBL gene (19.6%), followed by  bla  GES-1  and  bla  GES-5  detected in one isolate each. In all isolates presenting MBL phenotype by double-disc synergy test (DDST), the  bla  SPM-1  or  bla  IMP-1  genes were detected. In addition,  bla  IMP-1  was also detected in three isolates which did not display any MBL phenotype. These isolates also presented the  bla  CTX-M-2  gene. The co-existence of  bla  CTX-M-2  with  bla  IMP-1  is presently reported for the first time, as like as co-existence of  bla  GES-1  with  bla  IMP-1 .    Conclusions  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  bla  CTX-M-2,  bla  GES-1  and  bla  GES-5  reflects the recent emergence of ESBLs among antimicrobial resistant  P. aeruginosa  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.

bmc infectious diseases

Detection of P. aeruginosa harboring bla CTX-M-2, bla GES-1 and bla GES-5, bla IMP-1 and bla SPM-1causing infections in Brazilian tertiary-care hospital