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

igh-level carbapenem resistance in Pseudomonas aeruginosa s a recognized public health problem. Metallo-lactamase MBL) is one of the most common resistance mechanisms n these microorganisms. The gene blaSPM-1, which is the ost frequent metallo-lactamase gene in Brazil, was first escribed in 20021 and has been found in different regions.2 ntil now there has been no record of carbapenemase enzyme roduction in P. aeruginosa isolated in Mato Grosso do Sul tate. Here, we describe the first report of MBL-producing . aeruginosa in this region. A 52-year-old female patient who had been diagnosed with hagas disease 23 years ago and underwent sigmoidectomy nd ileostomy surgery (2012) was admitted to a University ospital of Mato Grosso do Sul on August 28, 2013 for intestinal econstruction. Ten days after admission, the patient underwent nteronastomosis. Four days thereafter she presented surical wound infection, which was treated with meropenem or 15 days. Despite this treatment, purulent fluid contined to drain. Pseudomonas aeruginosa was identified using he Vitek 2 compact system and presented resistance to he following antibiotics: ceftriaxone (MIC ≥ 64 g/mL), eftazidime (MIC = 32 g/mL), imipenem (MIC ≥ 16 g/mL), eropenem (MIC ≥ 16 g/mL), and piperacillin-tazobactam MIC > 128 g/mL). This strain was susceptible to amikacin, entamicin, ciprofloxacin, and colistin. Thus, meropenem sed for her treatment was switched to ciprofloxacin, and the atient was discharged after 30 days of total hospitalization. The blaSPM-1, blaIMP-1, blaSIM-1, blaVIM-1, and blaGIM-1 genes ere investigated by multiplex polymerase chain reaction PCR) using specific primers,3 but only blaSPM-1 gene was etected. PCR conditions were as follows: denaturing step of 4 ◦C for 5 min, 35 cycles of 94 ◦C for 20 s, 53 ◦C for 45 s, 72◦ for 0 s, and a final incubation at 72 ◦C for 10 min. Chagas disease has a chronic course, creating functional ncompetence and surgical complications. Invasive proceures such as abdominal surgery and the use of intravascular 4 l, Brazil