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Carbapenemase-producing Pseudomonas aeruginosa -an emerging challenge
Fred C Tenover1, David P Nicolau2,3, Christian M Gill2
1Cepheid, Sunnyvale, CA, USA.
Abstract:
Carbapenem-resistant Pseudomonas aeruginosa (CR-PA) is a major healthcare-associated pathogen worldwide. In the United States, 10-30% of P. aeruginosa isolates are carbapenem-resistant, while globally the percentage varies considerably. A subset of carbapenem-resistant P. aeruginosa isolates harbour carbapenemases, although due in part to limited screening for these enzymes in clinical laboratories, the actual percentage is unknown. Carbapenemase-mediated carbapenem resistance in P. aeruginosa is a significant concern as it greatly limits the choice of anti-infective strategies, although detecting carbapenemase-producing P. aeruginosa in the clinical laboratory can be challenging. Such organisms also have been associated with nosocomial spread requiring infection prevention interventions. The carbapenemases present in P. aeruginosa vary widely by region but include the Class A beta-lactamases, KPC and GES; metallo-beta-lactamases IMP, NDM, SPM, and VIM; and the Class D, OXA-48 enzymes. Rapid confirmation and differentiation among the various classes of carbapenemases is key to the initiation of early effective therapy. This may be accomplished using either molecular genotypic methods or phenotypic methods, although both have their limitations. Prompt evidence that rules out carbapenemases guides clinicians to more optimal therapeutic selections based on local phenotypic profiling of non-carbapenemase-producing, carbapenem-resistant P. aeruginosa. This article will review the testing strategies available for optimizing therapy of P. aeruginosa infections.
Insights
Carbapenem-resistant Pseudomonas aeruginosa (CR-PA) poses a global healthcare threat. Rapidly detecting carbapenemase enzymes in CR-PA is crucial for effective treatment and infection control.
Area of Science:
- Clinical Microbiology
- Infectious Diseases
- Antimicrobial Resistance
Background:
- Carbapenem-resistant Pseudomonas aeruginosa (CR-PA) is a significant healthcare-associated pathogen with increasing prevalence globally.
- Carbapenemase-producing CR-PA presents treatment challenges due to limited therapeutic options and potential for nosocomial spread.
- Accurate and timely detection of carbapenemases in P. aeruginosa is hindered by limited clinical laboratory screening.
Purpose of the Study:
- To review current testing strategies for carbapenemase detection in Pseudomonas aeruginosa.
- To highlight the importance of rapid confirmation and differentiation of carbapenemases for optimizing patient therapy.
- To discuss the implications of carbapenemase presence or absence on therapeutic selection for P. aeruginosa infections.
Main Methods:
- Review of molecular genotypic methods for carbapenemase detection.
- Review of phenotypic methods for carbapenemase detection.
- Discussion of the limitations associated with both genotypic and phenotypic testing approaches.
Main Results:
- Carbapenemase-producing CR-PA is a growing concern, with diverse carbapenemase types (KPC, GES, IMP, NDM, SPM, VIM, OXA-48) varying by region.
- Both molecular and phenotypic testing methods are available for carbapenemase detection, each with inherent limitations.
- Prompt diagnostic evidence is essential for guiding appropriate antimicrobial therapy and infection prevention strategies.
Conclusions:
- Effective management of CR-PA infections relies on accurate and rapid identification of carbapenemase-producing isolates.
- A combination of testing strategies may be necessary to overcome limitations and ensure timely therapeutic decisions.
- Understanding local resistance patterns and the presence of specific carbapenemases is vital for optimizing treatment of P. aeruginosa infections.
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