| Congresso Brasileiro de Microbiologia 2023 | Resumo: 1281-1 | ||||
Resumo:Pseudomonas aeruginosa (Pa) is an of the most important opportunistic human pathogen, considered a difficult-to-control microorganism due to wide dissemination and strong ability to develop multidrug resistance. Carbapenem-resistant Pa (CRPa) was included in the critical priority pathogens by WHO, highlighting the challenge of antimicrobial therapy. The main mechanism of carbapenem resistance is carbapenemase production, categorized into distinct classes, including the metallo α -lactamases (MBL). The first report of New Delhi MBL (NDM) encodes by blaNDM gene in Brazil occur in 2013 in Enterobacteriales members and later in Acinetobacter spp. Recently, this gene was reported in Pa with an alarming increase in the last two years. However, regional data are still scarce and constitute an unknown scenario about the real blaNDM gene spread in the country. Therefore, we aimed to investigate the molecular aspects of CRPa in a tertiary hospital in Fortaleza, Ceará, Brazil. The screening of CRPa isolates was carried out at the microbiology and epidemiology sectors of the General Hospital in Fortaleza, between October 2022 and March 2023. Culture from institutionalized patients came with a clinical request, and the identification and TSA of the isolates were performed in the microbiology sector of the hospital and assessed by the automated system Vitek®2. The positive samples remained stored in refrigeration for up to 7 days before being sent for reisolation and DNA extraction for further investigation of the blaNDM1 and blaKPC2 genes. The strains ATCC BAA1705 and ATCCBAA2146 were used as positive controls, respectively. This study was approved by CEP number 5.631.557. Sixty strains of CRPa were identified. Tracheal aspirate (78%) was the most common origin followed by bloodstream (11.6%), bronchoalveolar lavage, urine (3.33%), tissue fragment, and abscess secretion (1.6%). Only two strains isolated from 2023 were submitted for molecular analysis from tracheal aspirate and abscess. Both samples were positive for the blaNDM1 gene. Additionally, resistance to gentamicin, ciprofloxacin, and piperacillin/tazobactam was detected. NDM is an enzyme of great epidemiological importance worldwide. Its wide dispersion is related to the insertion of the gene in a transposon in a conjugative plasmid. Furthermore, more than 20 variants of NDM are described. In this study, both isolates carried the blaNDM1 variant, corroborating with studies previously realized in Brazil. Many NDM-producing strains present an MDR phenotype, as observed in this study according to Magiorako’s criteria. MDR is a clinical and laboratory challenge for suitable patient management and constant vigilance is required. The NDM in Pa was previously reported in Paraná and Santa Catarina states, including co-detection with KPC. Currently, a scary increase in this resistance was demonstrated in Brazil. Besides this, studies in the northeast region are still scarce even when included in multicenter studies. To our knowledge, this is the first report of Pa blaNDM1 in Fortaleza, CE. The detection of NDM-producing isolates is important to aid in antimicrobial prescription and calls our attention to reinforce laboratory surveillance of Pa infections. Finally, the background genetics of these strains still needs to be explored, and future studies based on multilocus sequence typing may characterize the clonal type involved in the transmission of the blaNDM1 gene in this region. Palavras-chave: P.aeruginosa, carbapenemase, antimicrobial resistance, molecular diagnosis Agência de fomento:Fundação Universidade Estadual do Ceará and Fundação Nacional de Desenvolvimento de Ensino Superior Particular - Funadesp | |||||