title: Microbiological and epidemiological characterization of imipenem-resistant Pseudomonas aeruginosa strains from a Brazilian tertiary hospital: report from the SENTRY Antimicrobial Surveillance Program.
abstract: OBJECTIVE
  To evaluate the antimicrobial susceptibility profile, the genetic similarity, and the mechanisms of carbapenem resistance among imipenem-resistant Pseudomonas aeruginosa isolates collected from a Brazilian tertiary teaching hospital.
  
  
  METHODS
  Seventy-eight consecutive samples of P. aeruginosa were evaluated during 2000 and 2001. The antimicrobial susceptibility was evaluated by reference broth microdilution methods and the imipenem-resistant isolates were screened for metallo-beta-lactamase (MbetaL) production throughout disc approximation test and MbetaL Etest strips and isolates with positive screen test result were submitted to PCR assays using primers blaIMP-1, bla VIM-1, blaVIM-2 e blaSPM-1. The genetic similarity of MbetaL-producing strains was evaluated by automated ribotyping for epidemiological typing purpose.
  
  
  RESULTS
  Resistance rates were high to the majority of antimicrobial agents tested except polymyxin B, which inhibited all samples at the Clinical and Laboratory Standards Institute breakpoint (< or = 2 microg/ml). Twenty-nine (37.2%) isolates were resistant to imipenem and these isolates showed great genomic variability. MbetaL production was demonstrated in two imipenem-resistant isolates, which were detected using blaSPM-1 and blaIMP-2-specific primers. Sequence analysis revealed the presence of blaSPM-1 and a novel blaIMP-type gene, blaIMP-16.
  
  
  CONCLUSIONS
  The results of this study showed high resistance rates to the majority of antimicrobial agents among P. aeruginosa samples. High imipenem resistance rates were probably due to continuous selection of resistant mutants. The production of MbetaL did not represent a frequent mechanism of carbapenem resistance in this medical center; but a novel MbetaL was identified. Continued antimicrobial surveillance and infection control measures should be emphasized to minimize the emergence and dissemination of antimicrobial resistance.
authors.affiliation: Infection Control Committee, Hospital de Base do Distrito Federal, Brasília, DF, Brazil. jribeiro@abordo.com.br
authors.forename: J
authors.initials: J
authors.lastname: Ribeiro
authors.forename: R E
authors.initials: RE
authors.lastname: Mendes
authors.forename: R
authors.initials: R
authors.lastname: Domingos
authors.forename: E
authors.initials: E
authors.lastname: França
authors.forename: S
authors.initials: S
authors.lastname: Silbert
authors.forename: R N
authors.initials: RN
authors.lastname: Jones
authors.forename: H S
authors.initials: HS
authors.lastname: Sader
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use; D015373:Bacterial Typing Techniques / Q000379:methods; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015378:Imipenem / Q000494:pharmacology* / Q000627:therapeutic use; D007223:Infant; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects*; D018571:Sentinel Surveillance; D018440:beta-Lactam Resistance / Q000235:genetics / Q000502:physiology*
chemical_list: D000890:Anti-Infective Agents; D015378:Imipenem