title: Extensively drug-resistant pseudomonas aeruginosa isolates containing blaVIM-2 and elements of Salmonella genomic island 2: a new genetic resistance determinant in Northeast Ohio.
abstract: Carbapenems are a mainstay of treatment for infections caused by Pseudomonas aeruginosa. Carbapenem resistance mediated by metallo-β-lactamases (MBLs) remains uncommon in the United States, despite the worldwide emergence of this group of enzymes. Between March 2012 and May 2013, we detected MBL-producing P. aeruginosa in a university-affiliated health care system in northeast Ohio. We examined the clinical characteristics and outcomes of patients, defined the resistance determinants and structure of the genetic element harboring the blaMBL gene through genome sequencing, and typed MBL-producing P. aeruginosa isolates using pulsed-field gel electrophoresis (PFGE), repetitive sequence-based PCR (rep-PCR), and multilocus sequence typing (MLST). Seven patients were affected that were hospitalized at three community hospitals, a long-term-care facility, and a tertiary care center; one of the patients died as a result of infection. Isolates belonged to sequence type 233 (ST233) and were extensively drug resistant (XDR), including resistance to all fluoroquinolones, aminoglycosides, and β-lactams; two isolates were nonsusceptible to colistin. The blaMBL gene was identified as blaVIM-2 contained within a class 1 integron (In559), similar to the cassette array previously detected in isolates from Norway, Russia, Taiwan, and Chicago, IL. Genomic sequencing and assembly revealed that In559 was part of a novel 35-kb region that also included a Tn501-like transposon and Salmonella genomic island 2 (SGI2)-homologous sequences. This analysis of XDR strains producing VIM-2 from northeast Ohio revealed a novel recombination event between Salmonella and P. aeruginosa, heralding a new antibiotic resistance threat in this region's health care system.
authors: Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
authors: Federico
authors: F
authors: Perez
authors: Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
authors: Andrea M
authors: AM
authors: Hujer
authors: Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA.
authors: Steven H
authors: SH
authors: Marshall
authors: Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA University Hospitals Case Medical Center, Cleveland, Ohio, USA.
authors: Amy J
authors: AJ
authors: Ray
authors: Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, Georgia, USA Research Service, Department of Veterans Affairs Medical Center, Decatur, Georgia, USA.
authors: Philip N
authors: PN
authors: Rather
authors: University Hospitals Case Medical Center, Cleveland, Ohio, USA.
authors: Nuntra
authors: N
authors: Suwantarat
authors: University Hospitals Case Medical Center, Cleveland, Ohio, USA.
authors: Donald
authors: D
authors: Dumford
authors: Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA.
authors: Patrick
authors: P
authors: O'Shea
authors: Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA.
authors: T Nicholas J
authors: TN
authors: Domitrovic
authors: Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA University Hospitals Case Medical Center, Cleveland, Ohio, USA.
authors: Robert A
authors: RA
authors: Salata
authors: Public Health Research Institute Center, New Jersey Medical School-Rutgers University, Newark, New Jersey, USA.
authors: Kalyan D
authors: KD
authors: Chavda
authors: Public Health Research Institute Center, New Jersey Medical School-Rutgers University, Newark, New Jersey, USA.
authors: Liang
authors: L
authors: Chen
authors: Public Health Research Institute Center, New Jersey Medical School-Rutgers University, Newark, New Jersey, USA.
authors: Barry N
authors: BN
authors: Kreiswirth
authors: Instituto de Biología Molecular y Celular de Rosario, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina.
authors: Alejandro J
authors: AJ
authors: Vila
authors: Hannover Medical School and Helmholtz Center for Infection Research, Hannover, Germany.
authors: Susanne
authors: S
authors: Haussler
authors: Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA Department of Pathology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA University Hospitals Case Medical Center, Cleveland, Ohio, USA.
authors: Michael R
authors: MR
authors: Jacobs
authors: Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA robert.bonomo@va.gov.
authors: Robert A
authors: RA
authors: Bonomo
mesh_terms: D000617:Aminoglycosides / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016521:Electrophoresis, Gel, Pulsed-Field; D024841:Fluoroquinolones / Q000494:pharmacology; D044404:Genomic Islands / Q000235:genetics*; D058885:Multilocus Sequence Typing; D009820:Ohio; D016133:Polymerase Chain Reaction; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000235:genetics*; D012475:Salmonella / Q000187:drug effects / Q000235:genetics*; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D047090:beta-Lactams