{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T19:24:38Z","timestamp":1777922678668,"version":"3.51.4"},"reference-count":36,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2013,10,1]],"date-time":"2013-10-01T00:00:00Z","timestamp":1380585600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Microbial Drug Resistance"],"published-print":{"date-parts":[[2013,10]]},"abstract":"<jats:p>\n                    A panel of 29 multidrug-resistant (MDR)\n                    <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                    isolates recovered from seven hospitals as part of a country-wide surveillance of antimicrobial resistance in Bulgarian hospitals was studied. Molecular typing through multiple-locus variable number tandem-repeat analysis (MLVA6) yielded 23 different profiles. Phenotypic and genotypic tests for the detection of acquired carbapenemases yielded negative results in all cases. In contrast, 76% of the isolates produced other acquired \u03b2-lactamases, including extended-spectrum \u03b2-lactamases (ESBLs). Namely, 6 of the isolates (21%) produced a VEB-1 ESBL; 14 (48%) produced an OXA-10-type enzyme (7 OXA-10 and 7 OXA-10 ESBL variants, including 2 OXA-17 [A218G], 2 OXA-74 [C197T, A218G], and 3 OXA-142 [A218G, G470A]); 8 (28%) an OXA-2-type enzyme (all OXA-2); and 1 (3%) a PSE-1 carbenicillinase. Further analysis through multilocus sequence typing (MLST) revealed that the six VEB-1-producing strains, recovered from four hospitals, belonged to ST111 or ST244 international high-risk clones. Additionally, nearly all of the isolates (97%) lacked OprD production, explaining carbapenem resistance. Overexpression of AmpC was documented in 5 (17%) of the isolates, including most of the MDR isolates not producing any acquired \u03b2-lactamase. Particularly noteworthy was the very high prevalence of MexXY-OprM overexpression, documented in 72% of the isolates, whereas the prevalence of MexAB-OprM overexpression was lower (21%). In summary, while the production of metallo-\u03b2-lactamases is uncommon among\n                    <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                    isolates from Bulgarian hospitals, MDR profiles frequently result from the production of ESBLs combined with the lack of production of the carbapenem porin OprD and the overexpression of the MexXY-OprM efflux pump.\n                  <\/jats:p>","DOI":"10.1089\/mdr.2013.0004","type":"journal-article","created":{"date-parts":[[2013,4,21]],"date-time":"2013-04-21T10:09:53Z","timestamp":1366538993000},"page":"355-361","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":43,"title":["Molecular Epidemiology and Multidrug Resistance Mechanisms of\n                    <i>Pseudomonas aeruginosa<\/i>\n                    Isolates from Bulgarian Hospitals"],"prefix":"10.1177","volume":"19","author":[{"given":"Rossitza","family":"Vatcheva-Dobrevska","sequence":"first","affiliation":[{"name":"National Centre for Infectious and Parasitic Diseases","place":["Bulgaria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xavier","family":"Mulet","sequence":"additional","affiliation":[{"name":"Hospital Universitario Son Espases","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Ivanov","sequence":"additional","affiliation":[{"name":"National Centre for Infectious and Parasitic Diseases","place":["Bulgaria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Laura","family":"Zamorano","sequence":"additional","affiliation":[{"name":"Hospital Universitario Son Espases","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elina","family":"Dobreva","sequence":"additional","affiliation":[{"name":"National Centre for Infectious and Parasitic Diseases","place":["Bulgaria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tzvetan","family":"Velinov","sequence":"additional","affiliation":[{"name":"National Centre for Infectious and Parasitic Diseases","place":["Bulgaria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Todor","family":"Kantardjiev","sequence":"additional","affiliation":[{"name":"National Centre for Infectious and Parasitic Diseases","place":["Bulgaria"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Oliver","sequence":"additional","affiliation":[{"name":"Hospital Universitario Son Espases","place":["Spain"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2013,10]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1093\/jac\/dkf069","article-title":"Identification of PSE and OXA beta-lactamase genes in Pseudomonas aeruginosa using PCR-restriction fragment length polymorphism","volume":"50","author":"Bert F.","year":"2002","unstructured":"Bert F., , Branger C., , Lambert-Zechovsky N. 2002. Identification of PSE and OXA beta-lactamase genes in Pseudomonas aeruginosa using PCR-restriction fragment length polymorphism. J. Antimicrob. Chemother., 50:11\u201318.","journal-title":"J. Antimicrob. Chemother."},{"key":"e_1_3_3_3_2","doi-asserted-by":"crossref","first-page":"6349","DOI":"10.1128\/AAC.01388-12","article-title":"Genetic markers of widespread extensively drug-resistant (XDR) Pseudomonas aeruginosa high-risk clones","volume":"56","author":"Cabot G.","year":"2012","unstructured":"Cabot G., , Ocampo-Sosa A.A., , Dom\u00ednguez M.A., , Gago J.F., , Juan C., , Tubau F., , Rodr\u00edguez C., , Moy\u00e0 B., , Pe\u00f1a C., , Mart\u00ednez-Mart\u00ednez L., , Oliver A. Spanish Network for Research in Infectious Diseases (REPI). 2012. Genetic markers of widespread extensively drug-resistant (XDR) Pseudomonas aeruginosa high-risk clones. Antimicrob. Agents Chemother., 56:6349\u20136357.","journal-title":"Antimicrob. Agents Chemother."},{"key":"e_1_3_3_4_2","first-page":"1906","article-title":"Spanish Network for Research in Infectious Diseases (REIPI). 2011. Overexpression of AmpC and efflux pumps in Pseudomonas aeruginosa isolates from bloodstream infections: prevalence and impact on resistance in a Spanish multicenter study","volume":"55","author":"Cabot G.","unstructured":"Cabot G., , Ocampo-Sosa A.A., , Tubau F., , Macia M.D., , Rodr\u00edguez C., , Moya B., , Zamorano L., , Su\u00e1rez C., , Pe\u00f1a C., , Mart\u00ednez-Mart\u00ednez L., , Oliver A. Spanish Network for Research in Infectious Diseases (REIPI). 2011. Overexpression of AmpC and efflux pumps in Pseudomonas aeruginosa isolates from bloodstream infections: prevalence and impact on resistance in a Spanish multicenter study. Antimicrob. Agents Chemother., 55:1906\u20131911.","journal-title":"Antimicrob. 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