Carbapenemase-producing Pseudomonas aeruginosa in Spain: interregional dissemination of the high risk-clones ST175 and ST244 producing VIM-2, VIM-1, IMP-8, VIM-20 and KPC-2

To date, carbapenemase production (CP) in Pseudomonas aeruginosa has been rare in Spain and other countries in comparison with mutation-driven resistance, but this may be changing. We characterized a collection of CP P. aeruginosa isolated in Spanish hospitals. During 2016, 232 unduplicated carbapenem-resistant Pseudomonas aeruginosa were submitted to the Spanish antibiotic reference lab of which 71 (30.6%) produced carbapenemases and were further analysed by PFGE, MLST and WGS. Using WGS data, the cgMLST and resistome were also studied.Of the 71 CP P. aeruginosa, 39 (54.9%) produced VIM-2, 14 (19.7%) VIM-1, 8 (11.3%) IMP-8, 6 (8.5%) VIM-20, 2 (2.8%) VIM-2 plus KPC-2, one (1.4%) IMP-13 and one (1.4%) VIM-1 plus IMP-18. Four STs (ST175, ST244, ST815 and ST155) encompassed 83.1% of all CP P. aeruginosa. Using cgMLST, 4 clusters were detected: Clusters 1 consisted of nine ST815/VIM-2 isolates; Cluster 2 (n=8) consisted of eight ST175/VIM-2 isolates; Cluster 3 consisted of seven ST244 isolates (five VIM-2 and two VIM-2 plus KPC-2); and Cluster 4 consisted of 12 ST175 isolates (seven VIM-2 and five IMP-8). The average number of acquired resistance genes was significantly higher in the VIM-1-producing isolates (7.1 ± 0.94) than in the VIM-2-producing isolates (average of 4.5± 0.20); the most predominant ones were catB7 (97.2%) and sul1 (87.3%).CP P. aeruginosa isolates are spreading in Spain causing outbreaks and sporadic cases, mainly due to high risk clones such as ST175 and ST244 that have acquired the ability to produce VIM, IMP and KPC carbapenemases.