Whole Genome Sequencing of Ceftolozane-Tazobactam and Ceftazidime-Avibactam Resistant Pseudomonas aeruginosa Isolated from a Blood Stream Infection Reveals VEB and Chromosomal Metallo-Beta Lactamases as Genetic Determinants: A Case Report

Figures & data

Figure 1 Standard PA chest x-ray demonstrating widened superior mediastinum with homogenous opacity seen in the right upper lung zone.

Figure 2 Microbiological summary timeline.

Table 1 Phenotypic Antimicrobial Susceptibility Pattern of the Strain PA179

Antimicrobial	VITEK 2 Result*	E-Test MIC
Piperacillin	> 128 ug/mL (R)	–
Piperacillin-tazobactam	> 128/4 ug/mL (R)	–
Aztreonam	> 64 ug/mL (R)	–
Cefepime	> 32 ug/mL (R)	–
Ceftazidime	> 32 ug/mL (R)	–
Ceftriaxone	> 32 ug/mL (R)	–
Ciprofloxacin	> 4 ug/mL (R)	–
Levofloxacin	> 8 ug/mL (R)	–
Amikacin	> 64 ug/mL (R)	–
Gentamicin	> 32 ug/mL (R)	–
Tobramycin	> 64 ug/mL (R)	–
Tetracycline	> 16 ug/mL (R)	–
Imipenem	> 16 ug/mL (R)	> 32 ug/mL
Meropenem	> 16 ug/mL (R)	> 32 ug/mL
Ceftazidime-avibactam	–	> 256 ug/mL

Note: *R: resistant.

Table 2 Summary of Genome Features of the Strain PA179

Features of Strain	PA179
Specimen	Homo sapien blood
NCBI Accession No	CP058257
Genome size	6580692 bp
No of Contigs	1
No of CDS (total)	6023
No of Genes (total)	6083
No of Genes (coding)	5942
CRISPR arrays	3
Ribosomal RNA	20
t RNA	56
Non coding RNA	4
Pseudo genes	81
Frameshifted genes	33
Genome coverage	100.0x
Reference Guided assembly	NC_002516.2
MLST Type	ST-357
Genomic Islands	47

Figure 3 Circular Genome Representation of P. aeruginosa strain PA179. The DNAPlotter software from the Artemis Package was used standalone. Custom colors were assigned for the Visualization of tRNA and rRNA as well as for CDS, in the forward and reverse strands. The CDS in the forward strand is colored in Violet, CDS in Reverse is colored in blue, tRNA, and rRNA were colored in pink and orange small vertical lines, and the GC content and GC skew are colored in brown and violet, respectively.

Figure 4 Genomic Islands in P. aeruginosa PA179.