Rodulfo Hectorina, Arcia Anlenys, Hernández Aldo, Michelli Elvia, Martinez Dianny Del Valle, Guzman Militza, Sharma Ashutoch, Donato Marcos De
Tecnologico de Monterrey, Escuela de Ingenieria y Ciencias, Queretaro, Mexico.
Universidad de Oriente, Laboratório de Genética Molecular, Cumaná, Venezuela.
Rev Inst Med Trop Sao Paulo. 2019;61:e20. doi: 10.1590/S1678-9946201961020. Epub 2019 Apr 4.
Multidrug resistance (MDR), virulence and transferable elements potentiate Pseudomonas aeruginosa's role as an opportunistic pathogen creating a high risk for public health. In this study, we evaluated the possible association of multidrug resistance, virulence factors and integrons with intrahospital P. aeruginosa strains isolated from patients at Cumana hospital, Venezuela. Relevant clinical-epidemiological data were collected to study 176 strains (2009-2016) isolated from different hospital units. Bacterial resistance was classified as susceptible, low-level resistant (LDR), multidrug resistant (MDR) and extensively drug-resistant (XDR). Most strains produced pyoverdine, DNase, gelatinase and hemolysin. Around 73% of the strains showed some type of movement. MDR and XDR strains increased from 2009 (24.2% and 4.8%, respectively) to 2016 (53.1% and 18.8%); while LDR decreased from 64.5% to 6.3%. The exoU and exoS genes were found in a significant number of strains (38.1 and 7.4%, respectively). Class I integrons were detected in 35.8% of the strains and the frequency was associated with resistance (42.9, 22.4, 41.4 and 61.9%, for susceptible, LDR, MDR and XDR, respectively). The MDR/XDR strains were positively associated with hemolysins and exoU, but negatively associated with bacterial twitching. MDR/XDR phenotypes were also associated with the Intensive Care Unit (ICU), septicemia, bronchial infection and diabetic foot ulcers, as well as long hospital stay (≥10 days) and previous antimicrobial treatment. High frequency of MDR/XDR strains and their association with class I integrons and virulence factors can increase the infection potential, as well as morbidity and mortality of patients attending this hospital and could spread infection to the community, creating a health risk for the region.
多重耐药性（MDR）、毒力和可转移元件增强了铜绿假单胞菌作为机会致病菌的作用，给公共卫生带来了高风险。在本研究中，我们评估了委内瑞拉库马纳医院分离出的院内铜绿假单胞菌菌株中多重耐药性、毒力因子和整合子之间可能存在的关联。收集了相关临床流行病学数据，以研究从不同医院科室分离出的176株菌株（2009 - 2016年）。细菌耐药性分为敏感、低水平耐药（LDR）、多重耐药（MDR）和广泛耐药（XDR）。大多数菌株产生绿脓菌素、DNA酶、明胶酶和溶血素。约73%的菌株表现出某种类型的运动。MDR和XDR菌株从2009年（分别为24.2%和4.8%）增加到2016年（分别为53.1%和18.8%）；而LDR从64.5%降至6.3%。在大量菌株中发现了exoU和exoS基因（分别为38.1%和7.4%）。在35.8%的菌株中检测到I类整合子，其频率与耐药性相关（敏感、LDR、MDR和XDR分别为42.9%、22.4%、41.4%和61.9%）。MDR/XDR菌株与溶血素和exoU呈正相关，但与细菌的颤动呈负相关。MDR/XDR表型还与重症监护病房（ICU）、败血症、支气管感染和糖尿病足溃疡相关联，以及与住院时间长（≥10天）和先前的抗菌治疗有关。MDR/XDR菌株的高频率及其与I类整合子和毒力因子的关联会增加感染潜力，以及该医院患者的发病率和死亡率，并可能将感染传播到社区，给该地区带来健康风险。
