https://orcid.org/0000-0003-2736-9206
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Abstract
Background
The rising resistance to carbapenems in Gram-negative bacteria worldwide poses a major clinical and public health risk. This study aimed to characterise carbapenem- and colistin-resistance genes, blaNDM-1 and mcr-1 located on IncX4 plasmid in MDR Pseudomonas aeruginosa, isolated from paediatric patients undergoing chemotherapy as a result of leukaemia.
Methods
In this study, six carbapenem-resistant strains of P. aeruginosa were isolated from two paediatric patients under chemotherapy treatment (1.8 years old female and 2.1 years male) from the Shenzhen Hospital, China, in the year 2019. Isolates were screened for conventional antibiotics such as tobramycin, cefepime, imipenem, and ciprofloxacin in additional colistin by using the broth dilution method. Furthermore, resistance determinants: mcr-1, blaNDM-1, blaKPC-1, and blaGES were screened using PCR and sequencing followed by multi-locus sequence typing. The horizontal gene transfer and location of mcr-1 and blaNDM-1 were determined by a liquid mating assay. In addition, Incompatibility type (Inc), PCR-based replicon type, and subgroup (MOB) of plasmid were studied.
Results
The screening for conventional antibiotics isolates showed 100% resistance to all the tested antibiotics except tobramycin. All isolates harboured carbapenemase encoding blaNDM-1, of which three also had mcr-1 located on a single IncX4 transferable plasmid. MLST typing revealed that four strains had a novel (new) STs type, while two belonged to ST1966.
Conclusion
This study identified for the first time colistin- and carbapenem-resistant MDR P. aeruginosa in paediatric patients with leukaemia in Shenzhen, China. It highlights the need for continuous surveillance in high-risk clones of MDR P. aeruginosa. Prudent use of antibiotics based on local antimicrobial susceptibility and clinical characteristics can help in reducing mortality in immunocompromised patients.
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© 2022 Chen et al. This work is published by Dove Medical Press Limited, and licensed under Creative Commons Attribution - Non Commerical (unported, v3.0) License. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.
Abbreviations
NDM, New Delhi Metallo-beta-lactamase; AMR, Antimicrobial-resistant; EUCAST, European Committee on Antimicrobial Susceptibility Testing; PCR, Polymerase Chain Reaction; PBRT, PCR-based replicon typing; MLST, Multi-locus sequence typing (MLST) method and (PFGE); Inc, Incompatibility; STs, Sequence types..
Ethics Approval and Consent to Participate
The study was approved by the Shenzhen Children’s Hospital (Research) ethics committee (Reference number: 2018 (013).
Consent to Publish
The clinical isolate samples used in this research were part of the routine Hospital Laboratory procedure. Because we did not use the patient’s name or personal information, therefore no written informed consent was required. In addition, verbal consent was taken from the parents’ patients but not written.
Author Contributions
All authors made a significant contribution to the work including conceptualization, study design, execution, acquisition of data, analysis and interpretation, and were involved in drafting, revising and critically reviewing the manuscript. The final version of this manuscript has been approved by all authors and agreed to be accountable for all aspects of the work.
Disclosure
The authors declare no competing conflicts of interest in this work.