期刊
DRUG RESISTANCE UPDATES
卷 21-22, 期 -, 页码 41-59出版社
CHURCHILL LIVINGSTONE
DOI: 10.1016/j.drup.2015.08.002
关键词
Pseudomonas aeruginosa; Molecular epidemiology; High-risk clones; Epidemic clones; International clones; Multidrug resistance; ST235; ST111; ST175
资金
- Ministerio de Economia y Competitividad of Spain
- Instituto de Salud Carlos III, through the Spanish Network for Research in Infectious Diseases [RD06/0008, RD12/0015]
- Fondo Europeo de Desarrollo Regional (FEDER)
- [PI12/00103]
- [SAF2012-35474]
- [PI15/00088]
The increasing prevalence of chronic and hospital-acquired infections produced by multidrug-resistant (MDR) or extensively drug-resistant (XDR) Pseudomonas aeruginosa strains is associated with significant morbidity and mortality. This growing threat results from the extraordinary capacity of this pathogen for developing resistance through chromosomal mutations and from the increasing prevalence of transferable resistance determinants, particularly those encoding carbapenemases or extended-spectrum beta-lactamases (ESBLs). P. aeruginosa has a nonclonal epidemic population structure, composed of a limited number of widespread clones which are selected from a background of a large quantity of rare and unrelated genotypes that are recombining at high frequency. Indeed, recent concerning reports have provided evidence of the existence of MDR/XDR global clones, denominated high-risk clones, disseminated in hospitals worldwide; ST235, ST111, and ST175 are likely those more widespread. Noteworthy, the vast majority of infections by MDR, and specially XDR, strains are produced by these and few other clones worldwide. Moreover, the association of high-risk clones, particularly ST235, with transferable resistance is overwhelming; nearly 100 different horizontally-acquired resistance elements and up to 39 different acquired beta-lactamases have been reported so far among ST235 isolates. Likewise, MDR internationally-disseminated epidemic strains, such as the Liverpool Epidemic Strain (LES, ST146), have been noted as well among cystic fibrosis patients. Here we review the population structure, epidemiology, antimicrobial resistance mechanisms and virulence of the P. aeruginosa high-risk clones. The phenotypic and genetic factors potentially driving the success of high-risk clones, the aspects related to their detection in the clinical microbiology laboratory and the implications for infection control and public health are also discussed. (C) 2015 Elsevier Ltd. All rights reserved.
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