Repeated isolation of Pseudomonas aeruginosa isolates resistant to both polymyxins and carbapenems from 1 patient

Emergence of polymyxin resistance in carbapenem-resistant isolates is a great concern in clinical settings because it may mean the end of treatment options against Gram-negative bacterial infections. Polymyxin-nonsusceptible and -susceptible Pseudomonas aeruginosa isolates resistant to carbapenems and harboring bla _IMP-6 were alternatively isolated from a patient. In vitro antimicrobial susceptibility testing, multilocus sequence typing, and pulsed-field gel electrophoresis were performed. Metallo-β-lactamase genes such as bla _IMP, bla _VIM, bla _SPM, bla _GIM, and bla _SIM and bla _OXA-50 were detected by polymerase chain reaction. Sequences of 2-component systems, PmrAB and PhoPQ, were also determined. All showed ST235 and the same pulsotype. Amino acid substitutions were identified in PmrB and PhoP from polymyxin-nonsusceptible isolates. Colistin exposure might be associated with the recovery of polymyxin-nonsusceptible isolates in this patient.