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Extensively Drug-Resistant Pseudomonas aeruginosa ST309 Harboring Tandem Guiana Extended Spectrum ?-Lactamase Enzymes: A Newly Emerging Threat in the United States.


ABSTRACT: Background:Treatment of serious infections due to multidrug-resistant (MDR) Pseudomonas aeruginosa remains a challenge, despite the introduction of novel therapeutics. In this study, we report 2 extensively drug-resistant clinical isolates of sequence type (ST) 309 P aeruginosa resistant to all ?-lactams, including the novel combinations ceftolozane/tazobactam, ceftazidime/avibactam, and meropenem/vaborbactam. Methods:Isolates were sequenced using both short-read (Illumina) and long-read technology to identify resistance determinants, polymorphisms (compared with P aeruginosa PAO1), and reconstruct a phylogenetic tree. A pair of ?-lactamases, Guiana extended spectrum ?-lactamase (GES)-19 and GES-26, were cloned and expressed in a laboratory strain of Escherichia coli to examine their relative impact on resistance. Using cell lysates from E coli expressing the GES genes individually and in tandem, we determined relative rates of hydrolysis for nitrocefin and ceftazidime. Results:Two ST309 P aeruginosa clinical isolates were found to harbor the extended spectrum ?-lactamases GES-19 and GES-26 clustered in tandem on a chromosomal class 1 integron. The presence of both enzymes in E coli was associated with significantly elevated minimum inhibitory concentrations to aztreonam, cefepime, meropenem, ceftazidime/avibactam, and ceftolozane/tazobactam, compared with those expressed individually. The combination of ceftazidime/avibactam plus aztreonam was active in vitro and used to achieve cure in one patient. Phylogenetic analysis revealed ST309 P aeruginosa are closely related to MDR strains from Mexico also carrying tandem GES. Conclusions:The presence of tandem GES-19 and GES-26 is associated with resistance to all ?-lactams, including ceftolozane/tazobactam. Phylogenetic analysis suggests that ST309 P aeruginosa may be an emerging threat in the United States.

SUBMITTER: Khan A 

PROVIDER: S-EPMC6602888 | biostudies-literature | 2019 Jul

REPOSITORIES: biostudies-literature

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Extensively Drug-Resistant <i>Pseudomonas aeruginosa</i> ST309 Harboring Tandem Guiana Extended Spectrum β-Lactamase Enzymes: A Newly Emerging Threat in the United States.

Khan Ayesha A   Tran Truc T TT   Rios Rafael R   Hanson Blake B   Shropshire William C WC   Sun Zhizeng Z   Diaz Lorena L   Dinh An Q AQ   Wanger Audrey A   Ostrosky-Zeichner Luis L   Palzkill Timothy T   Arias Cesar A CA   Miller William R WR  

Open forum infectious diseases 20190606 7


<h4>Background</h4>Treatment of serious infections due to multidrug-resistant (MDR) <i>Pseudomonas aeruginosa</i> remains a challenge, despite the introduction of novel therapeutics. In this study, we report 2 extensively drug-resistant clinical isolates of sequence type (ST) 309 <i>P aeruginosa</i> resistant to all β-lactams, including the novel combinations ceftolozane/tazobactam, ceftazidime/avibactam, and meropenem/vaborbactam.<h4>Methods</h4>Isolates were sequenced using both short-read (Il  ...[more]

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