{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T23:25:32Z","timestamp":1784762732038,"version":"3.55.0"},"reference-count":40,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2018,10,1]],"date-time":"2018-10-01T00:00:00Z","timestamp":1538352000000},"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":[[2018,10]]},"abstract":"\n Pseudomonas aeruginosa<\/jats:italic>\n infections account for high morbidity and mortality rates worldwide. Increasing resistance toward \u03b2-lactams, especially carbapenems, poses a serious therapeutic challenge. However, the multilocus sequence typing (MLST) of extended-spectrum beta lactamase (ESBL)- and carbapenemase-producing clinical\n P. aeruginosa<\/jats:italic>\n has not been reported in Malaysia. This study aimed to determine the antibiotic susceptibility profiles, resistance genes, pulsotypes, and sequence types (STs) of clinical\n P. aeruginosa<\/jats:italic>\n from a Malaysian tertiary hospital. These characteristics were analyzed by disk diffusion, minimum inhibitory concentration, polymerase chain reaction, pulsed-field gel electrophoresis (PFGE), and MLST for 199 nonreplicate clinical strains. The susceptibility of the strains toward the carbapenems and piperacillin\u2013tazobactam was the lowest (\u226490%), while \u226590% of the strains remained susceptible to all other classes of antimicrobial agents tested. The multidrug-resistant strains displayed high level resistance to cephalosporins (48 to \u2265256\u2009mg\/L) and carbapenems (4\u201332\u2009mg\/L). Eleven strains harbored class 1 integrons containing\n bla<\/jats:italic>\n GES-13<\/jats:sub>\n ,\n bla<\/jats:italic>\n VIM-2<\/jats:sub>\n ,\n bla<\/jats:italic>\n VIM-6<\/jats:sub>\n ,\n bla<\/jats:italic>\n OXA-10<\/jats:sub>\n ,\n aacA(6\u2032)-Ib<\/jats:italic>\n ,\n aacA(6\u2032)-II<\/jats:italic>\n ,\n aadA6<\/jats:italic>\n , and\n gcuD<\/jats:italic>\n gene cassettes. Extra-integron genes,\n bla<\/jats:italic>\n GES-20<\/jats:sub>\n ,\n bla<\/jats:italic>\n IMP-4<\/jats:sub>\n ,\n bla<\/jats:italic>\n VIM-2<\/jats:sub>\n , and\n bla<\/jats:italic>\n VIM-11<\/jats:sub>\n , were also found. Overall, the maximum likelihood tree showed concordance in the clustering of strains having the same STs and PFGE clusters. ST708 was the predominant antibiotic-susceptible clone detected from the neonatal intensive care unit. The STs 235, 809, and 1076 clonal clusters consisted of multidrug resistant strains. ST235 is a recognized international high-risk clone. This is the first report of\n bla<\/jats:italic>\n GES-13<\/jats:sub>\n and\n bla<\/jats:italic>\n GES-20<\/jats:sub>\n ESBL-encoding gene variants and novel STs (STs 2329, 2335, 2337, 2338, 2340, and 2341) of\n P. aeruginosa<\/jats:italic>\n in Malaysia.\n <\/jats:p>","DOI":"10.1089\/mdr.2017.0258","type":"journal-article","created":{"date-parts":[[2018,2,13]],"date-time":"2018-02-13T15:01:33Z","timestamp":1518534093000},"page":"1108-1116","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":7,"title":["Molecular Characterization of Extended-Spectrum Beta Lactamase- and Carbapenemase-Producing\n Pseudomonas aeruginosa<\/i>\n Strains from a Malaysian Tertiary Hospital"],"prefix":"10.1177","volume":"24","author":[{"given":"Hannah Y.P.","family":"Phoon","sequence":"first","affiliation":[{"name":"Ampang Hospital","place":["Malaysia"]},{"name":"University of Malaya","place":["Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hazilawati","family":"Hussin","sequence":"additional","affiliation":[{"name":"Ampang Hospital","place":["Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Baizurah M.","family":"Hussain","sequence":"additional","affiliation":[{"name":"Ampang Hospital","place":["Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwai Lin","family":"Thong","sequence":"additional","affiliation":[{"name":"University of Malaya","place":["Malaysia"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,10,9]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.43.3.1198-1204.2005"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00040-09"},{"key":"e_1_3_4_4_2","unstructured":"Office of Infectious Diseases. 2013. Antibiotic Resistance Threats. Atlanta GA: U.S. Department for Health and Human Services. Centers for Disease Control and Prevention."},{"key":"e_1_3_4_5_2","doi-asserted-by":"crossref","first-page":"866","DOI":"10.1093\/jac\/dkq048","article-title":"Detection and characterization of class A extended-spectrum-beta-lactamase-producing Pseudomonas aeruginosa isolates in Belgian hospitals","volume":"65","author":"Glupczynski Y.","year":"2010","unstructured":"Glupczynski Y., , Bogaerts P., , Deplano A., , Berhin C., , Huang T.-D., , Van Eldere J ., , and Rodriguez-Villalobos H.. 2010. Detection and characterization of class A extended-spectrum-beta-lactamase-producing Pseudomonas aeruginosa isolates in Belgian hospitals. J. Antimicrob. Chemother., 65:866\u2013871.","journal-title":"J. Antimicrob. Chemother."},{"key":"e_1_3_4_6_2","first-page":"634","article-title":"Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: our worst nightmare? Clin","volume":"34","author":"Livermore D.M.","year":"2002","unstructured":"Livermore D.M. 2002. Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: our worst nightmare? Clin. Infect. Dis., 34:634\u2013640.","journal-title":"Infect. Dis."},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2011.03570.x"},{"key":"e_1_3_4_8_2","first-page":"45","article-title":"Antimicrobial susceptibility pattern of clinical isolates of Pseudomonas aeruginosa in a tertiary care hospital","volume":"40","author":"Raja N.S.","year":"2007","unstructured":"Raja N.S., , and Singh N.N.. 2007. Antimicrobial susceptibility pattern of clinical isolates of Pseudomonas aeruginosa in a tertiary care hospital. J. Microbiol. Immunol. Infect., 40:45\u201349.","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"e_1_3_4_9_2","first-page":"27","article-title":"Antimicrobial susceptibility of clinical isolates of Pseudomonas aeruginosa from a Malaysian Hospital","volume":"16","author":"Pathmanathan S.G.","year":"2009","unstructured":"Pathmanathan S.G., , Samat N.A., , and Mohamed R.. 2009. Antimicrobial susceptibility of clinical isolates of Pseudomonas aeruginosa from a Malaysian Hospital. Malaysian J. Med. Sci., 16:27\u201332.","journal-title":"Malaysian J. Med. Sci."},{"key":"e_1_3_4_10_2","first-page":"197","article-title":"Genetic fingerprinting and antimicrobial susceptibility profiles of Pseudomonas aeruginosa hospital isolates in Malaysia","volume":"42","author":"Lim K.-T.","year":"2009","unstructured":"Lim K.-T., , Yasin R.M., , Yeo C.-C., , Puthucheary S.-D., , Balan G., , Maning N., , Wahab Z.A., , Ismail N., , Tan E.-A., , Mustaffa A., , and Thong K.-L.. 2009. Genetic fingerprinting and antimicrobial susceptibility profiles of Pseudomonas aeruginosa hospital isolates in Malaysia. J. Microbiol. Immunol. Infect., 42:197\u2013209.","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"e_1_3_4_11_2","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/j.diagmicrobio.2010.02.010","article-title":"Metallo-beta-lactamase-producing imipenem-resistant Pseudomonas aeruginosa clinical isolates in a university teaching hospital in Malaysia: detection of IMP-7 and first identification of IMP-4, VIM-2, and VIM-11","volume":"67","author":"Khosravi Y.","year":"2010","unstructured":"Khosravi Y., , Tay S.T., , and Vadivelu J.. 2010. Metallo-beta-lactamase-producing imipenem-resistant Pseudomonas aeruginosa clinical isolates in a university teaching hospital in Malaysia: detection of IMP-7 and first identification of IMP-4, VIM-2, and VIM-11. Diagn. Microbiol. Infect. Dis., 67:294\u2013296.","journal-title":"Diagn. Microbiol. Infect. 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Wayne PA: Clinical and Laboratory Standards Institute."},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkp498"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.diagmicrobio.2010.12.002"},{"key":"e_1_3_4_18_2","doi-asserted-by":"crossref","first-page":"1823","DOI":"10.1128\/AAC.49.5.1823-1829.2005","article-title":"Integron content of extended-spectrum-beta-lactamase-producing Escherichia coli strains over 12 years in a single hospital in Madrid, Spain","volume":"49","author":"Machado E.","year":"2005","unstructured":"Machado E., , Canto R., , Baquero F., , Gala J., , and Coque T.M.. 2005. Integron content of extended-spectrum-beta-lactamase-producing Escherichia coli strains over 12 years in a single hospital in Madrid, Spain. Antimicrob. Agents Chemother., 49:1823\u20131829.","journal-title":"Antimicrob. 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An international multicenter retrospective study of Pseudomonas aeruginosa nosocomial pneumonia: impact of multidrug resistance. Crit. Care, 19:219.","journal-title":"Crit. Care"},{"key":"e_1_3_4_31_2","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1099\/jmm.0.081802-0","article-title":"Predominance of carbapenem-resistant Pseudomonas aeruginosa isolates carrying bla IMP and bla VIM metallo-b-lactamases in a major hospital in Costa Rica","volume":"64","author":"Toval F.","year":"2015","unstructured":"Toval F., , Guzma A., , Madriz V., , Somogyi T., , Rodriguez C., , and Garc\u0131a F.. 2015. Predominance of carbapenem-resistant Pseudomonas aeruginosa isolates carrying bla IMP and bla VIM metallo-b-lactamases in a major hospital in Costa Rica. J. Med. Microbiol., 64:37\u201343.","journal-title":"J. Med. 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Burns, 40:1575\u20131580.","journal-title":"Burns"},{"key":"e_1_3_4_34_2","doi-asserted-by":"crossref","first-page":"1331","DOI":"10.1128\/AAC.01561-09","article-title":"GES-13, a beta-lactamase variant possessing Lys-104 and Asn-170 in Pseudomonas aeruginosa","volume":"54","author":"Kotsakis S.D.","year":"2010","unstructured":"Kotsakis S.D., , Papagiannitsis C.C., , Tzelepi E., , Legakis N.J., , Miriagou V., , and Tzouvelekis L.S.. 2010. GES-13, a beta-lactamase variant possessing Lys-104 and Asn-170 in Pseudomonas aeruginosa. Antimicrob. Agents Chemother., 54:1331\u20131333.","journal-title":"Antimicrob. 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Microbiol."},{"key":"e_1_3_4_41_2","doi-asserted-by":"crossref","first-page":"1015","DOI":"10.1099\/jmm.0.055426-0","article-title":"Selective advantages of two major clones of carbapenem-resistant Pseudomonas aeruginosa isolates (CC235 and CC641) from Korea: antimicrobial resistance, virulence and biofilm-forming activity","volume":"62","author":"Lee J.Y.","year":"2013","unstructured":"Lee J.Y., , Peck K.R., , and Ko K.S.. 2013. Selective advantages of two major clones of carbapenem-resistant Pseudomonas aeruginosa isolates (CC235 and CC641) from Korea: antimicrobial resistance, virulence and biofilm-forming activity. J. Med. Microbiol., 62:1015\u20131024.","journal-title":"J. Med. 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