First case of infection by metallo-β-lactamase-producing Pseudomonas aeruginosa in Mato Grosso do Sul, Brazil

First case of infection by metallo-␤-lactamase-producing Pseudomonas aeruginosa in Mato Grosso do Sul, BrazilDear Editor, High-level carbapenem resistance in Pseudomonas aeruginosa is a recognized public health problem.Metallo-␤-lactamase (MBL) is one of the most common resistance mechanisms in these microorganisms.The gene bla SPM-1 , which is the most frequent metallo-␤-lactamase gene in Brazil, was first described in 2002 1 and has been found in different regions. 2 Until now there has been no record of carbapenemase enzyme production in P. aeruginosa isolated in Mato Grosso do Sul state.Here, we describe the first report of MBL-producing P. aeruginosa in this region.A 52-year-old female patient who had been diagnosed with Chagas disease 23 years ago and underwent sigmoidectomy and ileostomy surgery (2012) was admitted to a University Hospital of Mato Grosso do Sul on August 28, 2013 for intestinal reconstruction.Ten days after admission, the patient underwent enteronastomosis.Four days thereafter she presented surgical wound infection, which was treated with meropenem for 15 days.Despite this treatment, purulent fluid continued to drain.Pseudomonas aeruginosa was identified using the Vitek 2 compact system and presented resistance to the following antibiotics: ceftriaxone (MIC ≥ 64 g/mL), ceftazidime (MIC = 32 g/mL), imipenem (MIC ≥ 16 g/mL), meropenem (MIC ≥ 16 g/mL), and piperacillin-tazobactam (MIC > 128 g/mL).This strain was susceptible to amikacin, gentamicin, ciprofloxacin, and colistin.Thus, meropenem used for her treatment was switched to ciprofloxacin, and the patient was discharged after 30 days of total hospitalization.The bla SPM-1 , bla IMP-1 , bla SIM-1 , bla VIM-1 , and bla GIM-1 genes were investigated by multiplex polymerase chain reaction (PCR) using specific primers, 3 but only bla SPM-1 gene was detected.PCR conditions were as follows: denaturing step of 94 • C for 5 min, 35 cycles of 94 • C for 20 s, 53 • C for 45 s, 72 • for 30 s, and a final incubation at 72 • C for 10 min.Chagas disease has a chronic course, creating functional incompetence and surgical complications.Invasive procedures such as abdominal surgery and the use of intravascular 5. Gales AC, Jones RN, Sader HS. Contemporary activity of colistin and polymyxin B against a worldwide collection of Gram-negative pathogens: results from the SENTRY Antimicrobial Surveillance Program (2006-09).

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