Agila Kumari Pragasam1, Balaji Veeraraghavan1, Shalini Anandan1, Vignesh Narasiman1, Sujatha Sistla2, Arti Kapil3, Purva Mathur3, Pallab Ray4, Chand Wattal5, Sanjay Bhattacharya6, Vijayashri Deotale7, K Subramani8, J V Peter8, T D Hariharan9, I Ramya10, S Iniyan11, Kamini Walia12, V C Ohri12. 1. Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India. 2. Department of Microbiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India. 3. Department of Microbiology, All India Institute of Medical Science, New Delhi, India. 4. Department of Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. 5. Department of Microbiology, Sir Ganga Ram Hospital, New Delhi, India. 6. Department of Microbiology, Tata Medical Centre, Kolkatta, West Bengal, India. 7. Department of Microbiology, Mahatma Gandhi Institute of Medical Science, Sevagram, Maharashtra, India. 8. Department of Critical Care, Christian Medical College, Vellore, Tamil Nadu, India. 9. Department of Orthopaedic Surgery, Christian Medical College, Vellore, Tamil Nadu, India. 10. Department of Medicine (Unit-5), Christian Medical College, Vellore, Tamil Nadu, India. 11. Department of Surgery, Christian Medical College, Vellore, Tamil Nadu, India. 12. Division of Epidemiology and Communicable Disease, Department of Microbiology, Indian Council of Medical Research, New Delhi, India.
Abstract
BACKGROUND: Pseudomonas aeruginosa is one of the most common opportunistic pathogens that cause severe infections in humans. The burden of carbapenem resistance is particularly high and is on the rise. Very little information is available on the molecular mechanisms and its clonal types of carbapenem-resistant P. aeruginosa seen in Indian hospitals. This study was undertaken to monitor the β-lactamase profile and to investigate the genetic relatedness of the carbapenemase-producing (CP) P. aeruginosa collected across different hospitals from India. MATERIALS AND METHODS: A total of 507 non-duplicate, carbapenem-resistant P. aeruginosa isolated from various clinical specimens collected during 2014-2017 across seven Indian hospitals were included. Conventional multiplex polymerase chain reaction for the genes encoding beta-lactamases such as extended-spectrum beta-lactamase (ESBL) and carbapenemase were screened. A subset of isolates (n = 133) of CP P. aeruginosa were genotyped by multilocus sequence typing (MLST) scheme. RESULTS: Of the total 507 isolates, 15%, 40% and 20% were positive for genes encoding ESBLs, carbapenemases and ESBLs + carbapenemases, respectively, whilst 25% were negative for the β-lactamases screened. Amongst the ESBL genes, blaVEB is the most predominant, followed by blaPER and blaTEM, whilst blaVIM and blaNDM were the most predominant carbapenemases seen. However, regional differences were noted in the β-lactamases profile across the study sites. Genotyping by MLST revealed 54 different sequence types (STs). The most common are ST357, ST235, ST233 and ST244. Six clonal complexes were found (CC357, CC235, CC244, CC1047, CC664 and CC308). About 24% of total STs are of novel types and these were found to emerge from the high-risk clones. CONCLUSION: This is the first large study from India to report the baseline data on the molecular resistance mechanisms and its association with genetic relatedness of CP P. aeruginosa circulating in Indian hospitals. blaVIM- and blaNDM-producing P. aeruginosa is the most prevalent carbapenemase seen in India. Majority of the isolates belongs to the high-risk international clones ST235, ST357 and ST664 which is a concern.
BACKGROUND: Pseudomonas aeruginosa is one of the most common opportunistic pathogens that cause severe infections in humans. The burden of carbapenem resistance is particularly high and is on the rise. Very little information is available on the molecular mechanisms and its clonal types of carbapenem-resistant P. aeruginosa seen in Indian hospitals. This study was undertaken to monitor the β-lactamase profile and to investigate the genetic relatedness of the carbapenemase-producing (CP) P. aeruginosa collected across different hospitals from India. MATERIALS AND METHODS: A total of 507 non-duplicate, carbapenem-resistant P. aeruginosa isolated from various clinical specimens collected during 2014-2017 across seven Indian hospitals were included. Conventional multiplex polymerase chain reaction for the genes encoding beta-lactamases such as extended-spectrum beta-lactamase (ESBL) and carbapenemase were screened. A subset of isolates (n = 133) of CP P. aeruginosa were genotyped by multilocus sequence typing (MLST) scheme. RESULTS: Of the total 507 isolates, 15%, 40% and 20% were positive for genes encoding ESBLs, carbapenemases and ESBLs + carbapenemases, respectively, whilst 25% were negative for the β-lactamases screened. Amongst the ESBL genes, blaVEB is the most predominant, followed by blaPER and blaTEM, whilst blaVIM and blaNDM were the most predominant carbapenemases seen. However, regional differences were noted in the β-lactamases profile across the study sites. Genotyping by MLST revealed 54 different sequence types (STs). The most common are ST357, ST235, ST233 and ST244. Six clonal complexes were found (CC357, CC235, CC244, CC1047, CC664 and CC308). About 24% of total STs are of novel types and these were found to emerge from the high-risk clones. CONCLUSION: This is the first large study from India to report the baseline data on the molecular resistance mechanisms and its association with genetic relatedness of CP P. aeruginosa circulating in Indian hospitals. blaVIM- and blaNDM-producing P. aeruginosa is the most prevalent carbapenemase seen in India. Majority of the isolates belongs to the high-risk international clones ST235, ST357 and ST664 which is a concern.