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- Title
Multidrug Resistant Pseudomonas aeruginosa Causing Prosthetic Valve Endocarditis: A Genetic-Based Chronicle of Evolving Antibiotic Resistance.
- Authors
Domitrovic, T. Nicholas; Hujer, Andrea M.; Perez, Federico; Marshall, Steven H.; Hujer, Kristine M.; Woc-Colburn, Laila E.; Parta, Mark; Bonomo, Robert A.
- Abstract
Background. Successful treatment of infections caused by multidrug-resistant (MDR) Pseudomonas aeruginosa is thwarted by the emergence of antibiotic resistance and biofilm formation on prosthetic devices. Our aims were to decipher the molecular basis of resistance in a unique case of prosthetic valve endocarditis (PVE) caused by MDR P. aeruginosa. Methods. Five sequential MDR P. aeruginosa blood isolates collected during a 7-month period were recovered from a patient suffering from PVE previously exposed to β-lactam antibiotics. Minimum inhibitory concentrations (MICs) of several classes of antibiotics were used to indicate clinical resistance characteristics; relatedness of the isolates was determined using multilocus sequence typing and repetitive sequence-based polymerase chain reaction. Amplification and sequencing of regulatory and resistance genes was performed. Results. All isolates belonged to ST 298, possessed blaPDC-16, and were resistant to fluoroquinolones and carbapenems. In the course of therapy, we observed a >2-fold increase in cephalosporin resistance (4 μg/mL to >16 μg/mL). Sequencing of the AmpC regulator, ampR, revealed a D135N point mutation in cephalosporin-resistant isolates. Common carbapenemase genes were not identified. All isolates demonstrated a premature stop codon at amino acid 79 of the outer membrane protein OprD and mutations in the quinolone resistance-determining regions of gyrA and parC. Point mutations in nalC, an efflux pump regulator, were also observed. Conclusions. In this analysis, we chart the molecular evolution of β-lactam resistance in a case of PVE.We show that mutations in regulatory genes controlling efflux and cephalosporinase production contributed to the MDR phenotype.
- Subjects
MULTIDRUG resistance; PSEUDOMONAS aeruginosa; ENDOCARDIUM diseases
- Publication
Open Forum Infectious Diseases, 2016, Vol 3, Issue 4, p1
- ISSN
2328-8957
- Publication type
Article
- DOI
10.1093/ofid/ofw188