A significant relationship between the mexR-nalC-nalD haplotypes and phylogenetically related STs was observed, suggesting mutational changes in these repressors are highly maintained within genetic lineages. Haplotype 5 was highly associated with XDR and related to dead when compared to ST1725 and ST233 (RRR 23.34 p = 0.009 and RRR 32.01 p = 0.025). Haplotype 12 (n = 9) was identified in ST233 and phylogenetically related STs, with 100% of the strains exhibiting XDR and 90% producing metallo-β-lactamases. Haplotype 1 was the most frequent (n = 40), and mainly identified in strains ST1725 (33/40), with 57.5% pan drug resistant strains, 36.5% extensive drug resistant and two strains exhibiting serin-carbapenemases. Sixty-two mutational changes were identified, 13 non-synonymous. SNPs in the mexR, nalC, and nalD genes revealed 27 different haplotypes (patterns).
Twenty-three new STs and high-risk clones ST111 and ST233 were identified. Eight strains produced serine carbapenemases, and 11 strains metallo-β-lactamases.
The 96.7% of the strains were classified as multidrug resistant. The mexAB-oprM transcript expression was determined. aeruginosa strains were classified according to their resistance to antibiotics, typified by multilocus sequencing, and mexR, nalC, and nalD genes sequenced for SNPs identification. This study identifies SNPs in the mexR, nalC, and nalD genes in clinical and environmental isolates of P. Single nucleotide polymorphisms (SNPs) in the mexR, nalC, and nalD repressors of this efflux pump can contribute to antimicrobial resistance however, it is unknown whether these changes are mainly related to genetic lineages or environmental pressure. Pseudomonas aeruginosa has different resistant mechanisms including the constitutive MexAB-OprM efflux pump.
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