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Emergence of Resistance to Novel Cephalosporin-beta-Lactamase Inhibitor Combinations through the Modification of the Pseudomonas aeruginosa MexCD-OprJ Efflux Pump #MMPMID34060900
Gomis-Font MA; Pitart C; Del Barrio-Tofino E; Zboromyrska Y; Cortes-Lara S; Mulet X; Marco F; Vila J; Lopez-Causape C; Oliver A
Antimicrob Agents Chemother 2021[Jul]; 65 (8): e0008921 PMID34060900show ga
A ceftolozane-tazobactam- and ceftazime-avibactam-resistant Pseudomonas aeruginosa isolate was recovered after treatment (including azithromycin, meropenem, and ceftolozane-tazobactam) from a patient that had developed ventilator-associated pneumonia after COVID-19 infection. Whole-genome sequencing revealed that the strain, belonging to ST274, had acquired a nonsense mutation leading to truncated carbapenem porin OprD (W277X), a 7-bp deletion (nt213Delta7) in NfxB (negative regulator of the efflux pump MexCD-OprJ), and two missense mutations (Q178R and S133G) located within the first large periplasmic loop of MexD. Through the construction of mexD mutants and complementation assays with wild-type nfxB, it was evidenced that resistance to the novel cephalosporin-beta-lactamase inhibitor combinations was caused by the modification of MexD substrate specificity.