Emerging carbapenem-resistant Aeromonas spp. infections in Cali, Colombia

Abstract

Introduction: Aeromonas species are renowned enteric pathogens with virulence determinants linked to human diseases, such as gastroenteritis, skin, soft-tissue and muscle infections, and septicemia. A recent concern of resistance in this organism has emerged, especially the presence carbapenemases. Herein we describe a case series of emerging carbapenem-resistant Aeromonas species infection in our hospital in Cali, Colombia.

Materials and methods: Cases from 2012 to 2018 are reported. Clinical data was abstracted from the clinical charts and laboratory information. Phenotypic detection of resistance was identified using the VITEK®2 system (BioMérieux) and broth microdilution MicroScan WalkAway plus System (Beckman Coulter). CARBA NP-test and multiplex qPCR assay was performed in 11 isolates to identify genes encoding carbapenemases (bla_KPC, bla_VIM, bla_IMP and bla_NDM).

Results: 21 cases of Aeromonas infection in hospitalized patients with phenotypic resistance to carbapenems were studied. The median age was 50 years, 55% (12/21) were male, and 67% (14/21) were healthcare-associated infections (HAI). Aeromonas hydrophila was the most common species (19/21). Forty-three percent (9/21) of the patients were immunocompromised. The mortality was 33% (7/21), and in patients with bacteremia was 100%. Most patients received empirical treatment with meropenem and failed to this treatment. PCR amplification tests showed negative results for the carbapenemases analyzed.

Conclusion: Emerging phenotypic carbapenem-resistant infection has been seen in our hospital, most as HAI. High mortality was found, especially in immunocompromised patients and in those who failled empirical treatment with carbapenems. As the main carbapenemases tested were negative, carbapenem-resistant could be attributed to an intrinsic metallo-β-lactamase, CphA encoded by the cphA gene, possible hyperproduction of ampC β-lactamase and/or porins expression.

Keywords: Aeromonas; Aeromonas hydrophila; Carbapenems; Real-time polymerase chain; cphA protein.

Fig. 1

Ocular and lower member Aeromonas infection. (A) Postseptal cellulitis by carbapenem-resistant Aeromonas infection. (B) Axial CT scan showing an increased volume and density of the left periorbital soft tissues associated with ocular proptosis and enhancement of the orbital septum. Alteration in intraconal fat density with laminar fluid in the posterior and medial region of the eyeball. (C) Soft-tissue infection by carbapenem-resistant Aeromonas in the right lower limb.