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Unusually High Prevalence of Cosecretion of Ambler Class A and B Carbapenemases and Nonenzymatic Mechanisms in Multidrug-Resistant Clinical Isolates of Pseudomonas aeruginosa in Lebanon.

Authors
  • Yaghi, Joseph1
  • Fattouh, Nour1
  • Akkawi, Charbel1
  • El Chamy, Laure1
  • Maroun, Richard G1
  • Khalil, Georges2, 3
  • 1 Campus des Sciences et Technologies, UR-EGP, Faculté des Sciences, Université Saint-Joseph de Beyrouth, Beirut, Lebanon. , (Lebanon)
  • 2 Campus des Sciences Médicales, Faculté de Médecine, Université Saint-Joseph de Beyrouth, Beirut, Lebanon. , (Lebanon)
  • 3 Centre Médical Raymond et Aida Najjar Beirut, Hôpital Saint Joseph des Sœurs de la Croix, Beirut, Lebanon. , (Lebanon)
Type
Published Article
Journal
Microbial Drug Resistance
Publisher
Mary Ann Liebert
Publication Date
Feb 01, 2020
Volume
26
Issue
2
Pages
150–159
Identifiers
DOI: 10.1089/mdr.2019.0040
PMID: 31424353
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

The opportunistic pathogen, Pseudomonas aeruginosa, is a main cause of nosocomial infections in Lebanese hospitals. This pathogen is highly threatening due to its ability to develop multiresistance toward a large variety of antibiotics, including the carbapenem subgroup of β-lactams. In this study, we surveyed the enzymatic and nonenzymatic mechanisms of carbapenem resistance in several multidrug-resistant (MDR) strains of P. aeruginosa isolated from patients suffering from nosocomial urinary tract infections in a Lebanese hospital. The occurrence of β-lactamase-encoding genes notably GES, KPC, IMP, VIM, NDM, and OXA, which are characterized by a carbapenemase activity was checked by genomic analyses. Our results provide a first evidence of the occurrence of GES in clinical P. aeruginosa isolates resistant to carbapenems in Lebanon. More interestingly, we showed that almost 40% of the analyzed strains have acquired a dual-carbapenemase secretion of GES-6 and VIM-2 or IMP-15, this being a rare phenomenon among this type of multidrug resistance. Moreover, LC-MS/MS analyses revealed a high prevalence of another enzymatic mechanism of resistance; this is the coexistence of AmpC and Pdc-13 as well as a number of virulence proteins, for instance pilin, lytic transglycosylase, ecotin, chitin-binding protein (Cbp), and TolB-dependent receptor. It is to be noted that a mutation of the oprD2 gene encoding a porin selective for carbapenems has been detected in almost 66% of our strains. All in all, our study reveals by the use of different methods, unusual simultaneous enzymatic (GES, IMP, VIM, pdc13, and AmpC) and nonenzymatic mechanisms of resistance (reduction of OprD2 expression) for MDR Pseudomonas aeruginosa.

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