High Prevalence of GES-5 Variant and Co-Expression of VIM-2 and GES-45 among Clinical IPseudomonas aeruginosa/I Strains in Tunisia

• Published in: Antibiotics (Basel) 2023-08, Vol.12 (9)
• Main Authors: Fethi, Meha, Rojo-Bezares, Beatriz, Arfaoui, Ameni, Dziri, Raoudha, Chichón, Gabriela, Barguellil, Farouk, López, María, El Asli, Mohamed Selim, Toledano, Paula, Ouzari, Hadda-Imen, Sáenz, Yolanda, Klibi, Naouel
• Format: Article
• Language: English
• Subjects: Antibacterial agents; Care and treatment; Cloxacillin; Cystic fibrosis; Ethylenediaminetetraacetic acid; Health aspects; Hospital patients; Pseudomonas aeruginosa; Ticarcillin; Urinary tract infections
• ISSN: 2079-6382; 2079-6382
• DOI: 10.3390/antibiotics12091394

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) are a global health concern. The antimicrobial resistance, virulence, and molecular typing of 57 CRPA isolated from 43 patients who attended a specific Tunisian hospital from September 2018 to July 2019 were analyzed. All but one were multidrug-resistant CRPA, and 77% were difficult-to-treat-resistant (DTR) isolates. The bla[sub.VIM-2] gene was detected in four strains (6.9%), and among the 36 bla[sub.GES]-positive CRPA (62%), the bla[sub.GES-5] gene was the predominant variant (86%). Three strains co-harbored the bla[sub.VIM-2] and bla[sub.GES-45] genes, and seven CRPA carried the bla[sub.SHV-2a] gene (14%). OprD alterations, including truncations by insertion sequences, were observed in 18 strains. Regarding the 46 class 1 integron-positive CRPA (81%), the bla[sub.GES-5] gene was located in integron In717, while the bla[sub.GES-29] and bla[sub.GES-45] genes were found in two new integrons (In2122 and In4879), and the bla[sub.VIM-2] gene was found in In1183 and the new integron In2142. Twenty-four PFGE patterns and thirteen sequence types (three new ones) were identified. The predominant serotype O:11 and exoU (81%) were mostly associated with ST235 and the new ST3385 clones. The seven bla[sub.SHV-2a-]CRPA from different patients belonged to ST3385 and the same PFGE pattern. The bla[sub.GES-5]- and bla[sub.VIM-2] + bla[sub.GES-45]-positive CRPA recovered mostly from ICU patients belonged to the high-risk clone ST235. Our results highlight the alarming prevalence of bla[sub.GES-5-] and ST235-CRPA, the co-existence of bla[sub.GES-45] and bla[sub.VIM-2], and their location within integrons favoring their dissemination.