Emergence of carbapenemases in Pseudomonas aeruginosa: a worldwide problem

Abstract

Evaluation of: Edelstein MV, Skleenova EN, Shevchenko OV et al. Spread of extensively resistant VIM-2-positive ST235 Pseudomonas aeruginosa in Belarus, Kazakhstan, and Russia: a longitudinal epidemiological and clinical study. Lancet Infect. Dis. 13(10), 867–876 (2013).

The emergence of carbapenemases-producing Pseudomonas aeruginosa isolates, resistant to all antibiotics except colistin, is an important health problem due to the lack of effective antibiotic treatments. This article assesses the findings of a recently published investigation performed in Belarus, Kazakhstan and Russia, where a longitudinal epidemiological and clinical study of extensively drug-resistant P. aeruginosa was performed. This study highlights the progressive increase of VIM-2-positive ST235 P. aeruginosa via clonal dissemination. Strategies to prevent this emergency problem and a global surveillance system are needed in order to minimize this worldwide problem.

Keywords::

• carbapenemases
• metallo-β-lactamases
• multidrugresistant
• Pseudomonas aeruginosa
• VIM-2 positive

Acknowledgements

The author acknowledges the useful discussions held with C Gallegos-Alvarez and J Lalucat.

Financial & competing interests disclosure

M Gomila was supported by a postdoctoral contract from the University of the Balearic Islands, with funds from the Spanish Ministry of Education, Culture and Sports through the International Excellence Campus Program. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The dissemination of multidrug-resistant Pseudomonas aeruginosa in the nosocomial environment is a serious problem due to increasingly limited therapeutic options and supposes an emergent epidemiological threat.

• The most successful clones are also more likely to acquire multidrug-resistant determinants and to be selected under antibiotic pressure and, hence, being spread, becoming nationally and internationally pervasive and increasingly prevalent.

• In the last decade, the prevalence of multidrug-resistant P. aeruginosa resistant to carbapenems has escalated; the presence of MBL-producing strains is increasingly worrisome.

• In addition to preventing the dissemination of MBL-producing P. aeruginosa in hospitals, control of the clinical environment as possible reservoirs is needed. The complex routes of the propagation of such clones should be analyzed (i.e., the hands of healthcare personnel, medical equipment, reagents and environmental reservoirs).

• Identification of potential risk factors outside the hospital environment is important and should be explored.

• The establishment of global surveillance of multidrug and extensive drug resistance is needed. Good infection control policies are essential to avoid the unbridled spread of MBL-producing strains (i.e., VIM-2-positive ST235), as well as the appropriate use of antibiotics.