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High Rates of Extensively Drug-Resistant Pseudomonas aeruginosa in Children with Cystic Fibrosis

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Abstract

Pseudomonas aeruginosa has a high adaptive capacity, favoring the selection of antibiotic-resistant strains, which are currently considered a global health problem. The purpose of this work was to investigate the rate and distribution of extensively drug-resistant (XDR) P. aeruginosa in pediatric patients with cystic fibrosis (CF) with recurrent infections and to distinguish the current efficacy of antibiotics commonly used in eradication therapy at a Mexican institute focused on children. A total of 118 P. aeruginosa isolates from 25 children with CF (2015–2019) underwent molecular identification, antimicrobial sensitivity tests, and Random Amplified Polymorphic DNA genotyping (RAPD-PCR). The bacterial isolates were grouped in 84 RAPD profiles, revealing a cross-infection between two sisters, whose resistance profile remained unchanged for more than 2 years. Furthermore, 77.1% (91/118) and 51.7% (61/118) of isolates showed in vitro susceptibility to ceftazidime and amikacin, respectively, antibiotics often used in eradication therapy at our institution. As well, 42.4% (50/118) were categorized as multi-drug resistant (MDR) and 12.7% (15/118) were XDR. Of these resistant isolates, 84.6% (55/65) were identified from patients with recurrent infections. The high frequency of XDR strains in children with CF should be considered a caution mark, as such resistance patterns are more commonly found in adult patients. Additionally, amikacin may soon prove ineffective. Careful use of available antibiotics is crucial before therapeutic possibilities are reduced and “antibiotic resistance crisis” worsens.

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Data Availability

The datasets generated during and/or analyzed during the current study are not publicly available due to confidential information obtained from patients, but the characteristics of hosts and strains are provided in Table A1 in Supplementary material. Additional data can be available from the corresponding author on reasonable request.

Code Availability

Software: GNU Image Manipulation Program, RRID: SCR_003182; PAST, RRID: SCR_019129.

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Acknowledgements

We thank the members of LBE-INP and the students of Biological and Pharmaceutical Chemistry career track at Metropolitan Autonomous University-Xochimilco, Mexico, i.e., Diana Gloria Contreras Valencia, Pau-Yo Melanie Hernández García, and Miguel Angel González Ortíz, for their support in the extraction of gDNA from the strains included in this study.

Funding

This work was supported by federal funds from the National Institute of Pediatrics, Mexico (authorization 068/2019). Furthermore, J.C.G.S. was supported by scholarship 2018-000068-02NACF-28106 from the National Council of Science and Technology (Consejo Nacional de Ciencia y Tecnología [CONACyT]), Mexico.

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Authors and Affiliations

  1. Doctorado en Ciencias Biológicas y de la Salud, Universidad Autónoma Metropolitana, Mexico, Mexico

    Juan C. Gutiérrez-Santana

  2. Laboratory of Experimental Bacteriology, Instituto Nacional de Pediatría, Insurgentes sur 3700-C, Col. Insurgentes Cuicuilco, Coyoacán, C.P. 04530, Mexico, Mexico

    Juan C. Gutiérrez-Santana, Armando Gerónimo-Gallegos & Victor R. Coria-Jiménez

  3. Department of Man and His Environment, Universidad Autónoma Metropolitana, Xochimilco, Calzada del Hueso 1100, Col. Villa Quietud, Coyoacán, C.P. 04960, Mexico, Mexico

    Mónica B. Martínez-Corona

  4. Department of Biological Systems, Universidad Autónoma Metropolitana, Xochimilco, Calzada del Hueso 1100, Col. Villa Quietud, Coyoacán, C.P. 04960, Mexico, Mexico

    Marisol López-López

  5. Directorate for Planning, Education and Research, Hospital Regional de Alta Especialidad de Ixtapaluca, Carretera Federal México-Puebla Km. 34.5, Pueblo de Zoquiapan, C. P. 56530, Ixtapaluca, Estado de Mexico, Mexico

    Julia D. Toscano-Garibay

  6. Department of Pulmonology and Chest Surgery, Instituto Nacional de Pediatría, Insurgentes Sur 3700-C, Col. Insurgentes Cuicuilco, Coyoacán, C.P. 04530, Mexico, Mexico

    Francisco Cuevas-Schacht

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  1. Juan C. Gutiérrez-Santana
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Contributions

All authors contributed to the creation of the article as follows: Conceptualization: JCG-S, and VRCJ; Data curation: JCG-S, and AG-G; Formal analysis and Methodology: MBM-C, AG-G, and JCG-S; Resources: VRCJ, FCS, JDTG, and MLL; Supervision: VRCJ: Writing of the original draft: JCG-S and MBM-C; Writing, reviewing, & editing of the manuscript: VRCJ, JDTG, and MLL. All the authors have reviewed the manuscript and vouch for the accuracy and completeness of the data.

Corresponding authors

Correspondence to Juan C. Gutiérrez-Santana or Victor R. Coria-Jiménez.

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Competing interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could indicate a potential conflict of interest.

Ethical Approval

This prospective and observational research is part of a larger project (registration number 068/2019) approved by the Research Committee of the National Institute of Pediatrics (INP). Letters of assent or informed consent were not required by the Ethics Committee of the INP because sampling of respiratory secretions in pediatric patients with CF treated at the SNCT-INP is part of the usual diagnostic and therapeutic regime for these individuals; therefore, they were not subjected to additional risk for this study, and the personal information obtained from the patients remained confidential. The materials, reagents, sample handling and waste disposal, and methodological strategies were approved by the Biosafety Committee of the INP.

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Gutiérrez-Santana, J.C., Gerónimo-Gallegos, A., Martínez-Corona, M.B. et al. High Rates of Extensively Drug-Resistant Pseudomonas aeruginosa in Children with Cystic Fibrosis. Curr Microbiol 79, 353 (2022). https://doi.org/10.1007/s00284-022-03048-4

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