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Open Access Research

Prevalence and genotypic relatedness of carbapenem resistance among multidrug-resistant P. aeruginosa in tertiary hospitals across Thailand

Piyatip Khuntayaporn1, Preecha Montakantikul2, Piroon Mootsikapun3, Visanu Thamlikitkul4 and Mullika Traidej Chomnawang1*

Author Affiliations

1 Department of Microbiology, Faculty of Pharmacy, Mahidol University, 447 Sri Ayudthaya Road, Rachathevi, Bangkok, 10400, Thailand

2 Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand

3 Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand

4 Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand

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Annals of Clinical Microbiology and Antimicrobials 2012, 11:25  doi:10.1186/1476-0711-11-25

Published: 13 September 2012

Abstract

Background

Increased infection caused by multidrug resistant (MDR) Pseudomonas aeruginosa has raised awareness of the resistance situation worldwide. Carbapenem resistance among MDR (CR-MDR) P. aeruginosa has become a serious life-threatening problem due to the limited therapeutic options. Therefore, the objectives of this study were to determine the prevalence, the antibiotic susceptibility patterns and the relatedness of CR-MDR P. aeruginosa in tertiary hospitals across Thailand.

Methods

MDR P. aeruginosa from eight tertiary hospitals across Thailand were collected from 2007–2009. Susceptibility of P. aeruginosa clinical isolates was determined according to the Clinical and Laboratory Standards Institute guideline. Selected CR-MDR P. aeruginosa isolates were genetically analyzed by pulsed-field gel electrophoresis.

Results

About 261 clinical isolates were identified as MDR P. aeruginosa and approximately 71.65% were found to be CR-MDR P. aeruginosa. The result showed that the meropenem resistance rate was the highest reaching over 50% in every hospitals. Additionally, the type of hospitals was a major factor affecting the resistance rate, as demonstrated by significantly higher CR-MDR rates among university and regional hospitals. The fingerprinting map identified 107 clones with at least 95% similarity. Only 4 clones were detected in more than one hospital.

Conclusions

Although the antibiotic resistance rate was high, the spreading of CR-MDR was found locally. Specific strains of CR-MDR did not commonly spread from one hospital to another. Importantly, clonal dissemination ratio indicated limited intra-hospital transmission in Thailand.

Keywords:
Antimicrobial susceptibility; Pulsed-field gel electrophoresis; Carbapenem resistance; Multidrug resistance; Pseudomonas aeruginosa; Epidemiology