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We described a comprehensive analysis of the molecular epidemiology of multidrug-resistant (MDR)  P .  aeruginosa . Molecular analysis included typing by Pulsed Field Gel Electrophoresis, identification of genes of interest through PCR-based assays and sequencing of target genes. Case-control study was conducted to better understand the prognostic of patients and the impact of inappropriate therapy in patients with bacteremia, as well as the risk factors of MDR infections. We observed a high rate of MDR isolates (40.7%), and 51.0% of them was independently associated with inappropriate antibiotic therapy. Bacteremia was detected in 66.9% of patients, and prolonged hospital stay was expressive in those resistant to fluoroquinolone. Plasmid-mediated quinolone resistance genes (PMQR),  qnrS   1   and  aac(6’)Ib-cr , were detected in two different nosocomial isolates (5.3%), and the  aac(6’)-Ib   7   variant was detected at a high frequency (87.5%) in those negative to PMQR. The presence of mutations in  gyrA  and  parC  genes was observed in 100% and 85% of selected isolates, respectively. Isolates harboring PMQR genes or mutations in  gyrA  and  parC  were not closely related, except in those containing SPM (São Paulo metallo-β-lactamase) clone. In addition, there is no study published in Brazil to date reporting the presence of  Pseudomonas aeruginosa  isolates harboring both  qnrS   1   and  aac(6’)Ib-cr  genes, with alarming frequency of patients with inappropriate therapy.

Clinical and Molecular Epidemiology of Multidrug-Resistant P. aeruginosa Carrying aac(6')-Ib-cr, qnrS1 and blaSPM Genes in Brazil