Khan Mohd Shahid, Neyaz Arslan, Shukla Laxmi Kant, Saleem Mohd, Ahmad Irfan
Department of Microbiology, Hind Institute of Medical Sciences, Mau, Ataria, Sitapur, Uttar Pradesh, 261,303, India.
Department of Community Medicine, Hind Institute of Medical Sciences, Mau, Ataria, Sitapur, Uttar Pradesh, 261,303, India.
Naunyn Schmiedebergs Arch Pharmacol. 2025 Jul 11. doi: 10.1007/s00210-025-04442-y.
This study investigates the epidemiological and molecular characteristics of carbapenemase-producing Pseudomonas aeruginosa among 382 clinical isolates. Carbapenemase production was significantly associated with male gender (χ = 4.97; p = 0.025; Cramer's V = 0.114) and with higher prevalence in casualty (χ = 6.89; p = 0.009; Cramer's V = 0.134). A notably greater proportion of carbapenemase-producing isolates were recovered from pus specimens (χ = 5.50; p = 0.019; Cramer's V = 0.120), suggesting specific tissue tropism. Antibacterial susceptibility profiling revealed high resistance to β-lactams (e.g. cefepime (40.2%), ceftazidime (42.4%)) and fluoroquinolones (ciprofloxacin (36.5%), levofloxacin (38.9%)), while colistin (84.4%) and amikacin (83.1%) retained high efficacy. Among carbapenem-resistant strains (n = 258), multidrug resistance (MDR) was most prevalent (55.4%), followed by extensively drug-resistant (XDR, 35.7%) and pan-drug-resistant (PDR, 8.9%) phenotypes. Molecular analysis of 164 resistant isolates identified bla as the dominant gene (32.9%), followed by bla (17.1%) and bla (9.1%). Co-expression patterns were frequent, with dual and triple gene combinations suggesting horizontal gene transfer and clonal dissemination. Gene distribution showed male predominance and high prevalence in ICU, Surgery, and TB & Chest departments, indicating critical hotspots for MDR containment. Specimen-wise, bla was prominent in pus, wound swabs, and blood, while bla and bla were enriched in sputum, pleural fluid, and BAL. The triple gene combination was most prevalent in BAL and urine samples. These findings highlight a high burden of carbapenem resistance, driven by bla and its combinations, with significant clinical and infection control implications. Robust antibacterial stewardship and targeted surveillance in high-risk departments are imperative to curb the spread of these highly resistant pathogens.
本研究调查了382株临床分离的产碳青霉烯酶铜绿假单胞菌的流行病学和分子特征。产碳青霉烯酶与男性性别显著相关（χ = 4.97；p = 0.025；克莱默V系数 = 0.114），且在急诊科的患病率较高（χ = 6.89；p = 0.009；克莱默V系数 = 0.134）。从脓液标本中分离出的产碳青霉烯酶菌株比例显著更高（χ = 5.50；p = 0.019；克莱默V系数 = 0.120），表明存在特定的组织嗜性。抗菌药敏分析显示，该菌对β-内酰胺类药物（如头孢吡肟（40.2%）、头孢他啶（42.4%））和氟喹诺酮类药物（环丙沙星（36.5%）、左氧氟沙星（38.9%））具有高度耐药性，而黏菌素（84.4%）和阿米卡星（83.1%）仍保持高效。在耐碳青霉烯菌株（n = 258）中，多重耐药（MDR）最为普遍（55.4%），其次是广泛耐药（XDR，35.7%）和泛耐药（PDR，8.9%）表型。对164株耐药菌株的分子分析确定bla为主要基因（32.9%），其次是bla（17.1%）和bla（9.1%）。共表达模式频繁，双基因和三基因组合表明存在水平基因转移和克隆传播。基因分布显示男性占主导地位，且在重症监护病房、外科以及结核病和胸科科室患病率较高，表明这些科室是控制多重耐药的关键热点地区。按标本类型来看，bla在脓液、伤口拭子和血液中较为突出，而bla和bla在痰液、胸腔积液和支气管肺泡灌洗样本中更为富集。三基因组合在支气管肺泡灌洗样本和尿液样本中最为普遍。这些发现突出了由bla及其组合导致的碳青霉烯耐药的高负担，具有重大的临床和感染控制意义。加强抗菌药物管理以及对高危科室进行针对性监测对于遏制这些高度耐药病原体的传播至关重要。
