The Open Microbiology Journal

ISSN: 1874-2858 ― Volume 13, 2019

Risk Factors for Acquisition of Fluoroquinolone or Aminoglycoside Resistance in Addition to Carbapenem Resistance in Pseudomonas aeruginosa

Kosuke Kosai1, *, Norihito Kaku2, Naoki Uno2, Tomomi Saijo3, Yoshitomo Morinaga2, Yoshifumi Imamura3, Hiroo Hasegawa1, Taiga Miyazaki4, Koichi Izumikawa4, Hiroshi Mukae3, Katsunori Yanagihara2
1 Department of Laboratory Medicine, Nagasaki University Hospital, Nagasaki, Japan
2 Department of Laboratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
3 Department of Respiratory Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
4 Department of Infectious Diseases, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan



Carbapenems, fluoroquinolones (FQs), and aminoglycosides (AGs) are key drugs for treating Pseudomonas aeruginosa infections, and accumulation of drug resistances make antibiotic therapy difficult.


We evaluated 169 patients with imipenem (IPM)-resistant P. aeruginosa and compared patient background and microbiological characteristics between groups with or without FQ resistance. Similar analyses were performed for AG.


Of the 169 IPM-resistant strains, 39.1% showed resistance to FQs and 7.1% to AGs. The frequency of exposure to FQs within 90 days previously was higher in the group with FQ resistance (45.5%) than in the group without FQ resistance (13.6%). Similarly, 33.3% of patients in the group with AG resistance had been previously administered AGs, higher than the 7.6% of patients without AG resistance. Frequencies of metallo-β-lactamase (MBL) production were higher in the group with FQ or AG resistance (16.7% or 33.3%) than in the group without FQ or AG resistance (2.9% or 6.4%). Multivariate analyses showed exposures to FQs or AGs were related to the respective resistances. MBL production was a common factor for resistance to FQs or AGs, in addition to IPM-resistant P. aeruginosa.


As well as promoting appropriate use of antibiotics, MBL production should be detected as a target of intervention for infection control.

Keywords: Metallo-β-lactamase, Drug resistance, Infection control, Antibiotic therapy.

Article Information

Identifiers and Pagination:

Year: 2017
Volume: 11
First Page: 92
Last Page: 97
Publisher Id: TOMICROJ-11-92
DOI: 10.2174/1874285801711010092

Article History:

Received Date: 10/02/2017
Revision Received Date: 31/03/2017
Acceptance Date: 26/04/2017
Electronic publication date: 31/05/2017
Collection year: 2017

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© 2017 Kosai et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Laboratory Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki 852-8501, Japan, Tel: +81-95-819-7574; Fax: +81-95-819-7422, E-mail:


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