First case of infection by metallo-β-lactamase-producing Pseudomonas aeruginosa in Mato Grosso do Sul, Brazil

Kalinca Miranda Ferreira Ana Claudia de Souza Rodrigues Ana Carolina Watanabe Yanara Miranda Ferreira Marilene Rodrigues Chang About the authors

High-level carbapenem resistance in Pseudomonas aeruginosa is a recognized public health problem. Metallo-β-lactamase (MBL) is one of the most common resistance mechanisms in these microorganisms. The gene blaSPM-1, which is the most frequent metallo-β-lactamase gene in Brazil, was first described in 200211 Toleman MA, Simm AM, Murphy TA, et al. Molecular characterization of SPM-1, a novel metallo-beta-lactamase isolated in Latin America: report from the SENTRY antimicrobial surveillance programme. J Antimicrob Chemother. 2002;50:673-9. and has been found in different regions.22 Sader HS, Castanheira M, Mendes RE, Toleman M, Walsh TR, Jones RN. Dissemination and diversity of metallo-β-lactamases in Latin America: report from the SENTRY Antimicrobial Surveillance Program. Int J Antimicrob Agents. 2005;25:57-61. Until now there has been no record of carbapenemase enzyme production in P. aeruginosa isolated in Mato Grosso do Sul state. Here, we describe the first report of MBL-producing P. aeruginosa in this region.

A 52-year-old female patient who had been diagnosed with Chagas disease 23 years ago and underwent sigmoidectomy and ileostomy surgery (2012) was admitted to a University Hospital of Mato Grosso do Sul on August 28, 2013 for intestinal reconstruction.

Ten days after admission, the patient underwent enteronastomosis. Four days thereafter she presented surgical wound infection, which was treated with meropenem for 15 days. Despite this treatment, purulent fluid continued to drain. Pseudomonas aeruginosa was identified using the Vitek 2 compact system and presented resistance to the following antibiotics: ceftriaxone (MIC ≥ 64 µg/mL), ceftazidime (MIC = 32 µg/mL), imipenem (MIC ≥ 16 µg/mL), meropenem (MIC ≥ 16 µg/mL), and piperacillin-tazobactam (MIC > 128 µg/mL). This strain was susceptible to amikacin, gentamicin, ciprofloxacin, and colistin. Thus, meropenem used for her treatment was switched to ciprofloxacin, and the patient was discharged after 30 days of total hospitalization.

The blaSPM-1, blaIMP-1, blaSIM-1, blaVIM-1, and blaGIM-1 genes were investigated by multiplex polymerase chain reaction (PCR) using specific primers,33 Mendes RE, Kiyota KA, Monteiro J, et al. Rapid detection and identification of metallo-beta-lactamase-encoding genes by multiplex real-time PCR assay and melt curve analysis. J Clin Microbiol. 2007;45:544-7. but only blaSPM-1 gene was detected. PCR conditions were as follows: denaturing step of 94 °C for 5 min, 35 cycles of 94 °C for 20 s, 53 °C for 45 s, 72° for 30 s, and a final incubation at 72 °C for 10 min.

Chagas disease has a chronic course, creating functional incompetence and surgical complications. Invasive procedures such as abdominal surgery and the use of intravascular devices are common risk factors for infection.44 Coura JR, Borges-Pereira J. Chagas disease. What is known and what should be improved: a systemic review. Rev Soc Bras Med Trop. 2012;45:286-96. Moreover, antibiotic treatment can select for multidrug-resistant microorganisms, such as P. aeruginosa. Antibiotic resistance is a serious public health problem owing to therapeutic failure.55 Gales AC, Jones RN, Sader HS. Contemporary activity of colistin and polymyxin B against a worldwide collection of Gram-negative pathogens: results from the SENTRY Antimicrobial Surveillance Program (2006–09). J Antimicrob Chemother. 2011;66:2070-4.

In contrast to other regions, infection with metallo-β-lactamase producing P. aeruginosa is a rare event in the Midwest region of Brazil. The emergence of MBL in our hospital should prompt the clinical staff to reinforce infection control measures and seek treatment alternatives other than carbapenem antibiotics.

References

  • 1
    Toleman MA, Simm AM, Murphy TA, et al. Molecular characterization of SPM-1, a novel metallo-beta-lactamase isolated in Latin America: report from the SENTRY antimicrobial surveillance programme. J Antimicrob Chemother. 2002;50:673-9.
  • 2
    Sader HS, Castanheira M, Mendes RE, Toleman M, Walsh TR, Jones RN. Dissemination and diversity of metallo-β-lactamases in Latin America: report from the SENTRY Antimicrobial Surveillance Program. Int J Antimicrob Agents. 2005;25:57-61.
  • 3
    Mendes RE, Kiyota KA, Monteiro J, et al. Rapid detection and identification of metallo-beta-lactamase-encoding genes by multiplex real-time PCR assay and melt curve analysis. J Clin Microbiol. 2007;45:544-7.
  • 4
    Coura JR, Borges-Pereira J. Chagas disease. What is known and what should be improved: a systemic review. Rev Soc Bras Med Trop. 2012;45:286-96.
  • 5
    Gales AC, Jones RN, Sader HS. Contemporary activity of colistin and polymyxin B against a worldwide collection of Gram-negative pathogens: results from the SENTRY Antimicrobial Surveillance Program (2006–09). J Antimicrob Chemother. 2011;66:2070-4.

Publication Dates

  • Publication in this collection
    May-Jun 2017

History

  • Received
    15 Nov 2016
  • Accepted
    10 Dec 2016
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