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Antibacterial susceptibility of isolates to antibiotic agents, AmpC \u03b2-lactamase production, and biofilm formation were determined. Minimum biofilm inhibitory concentrations (MBIC) of isolates to cefepime (FEP), imipenem (IPM), ceftazidime (CAZ), and meropenem (MEM) were evaluated with\/without cloxacillin (CLX). The carbapenemase and 16\u00a0S rRNA methylase genes were identified by PCR, and the transcription levels of\n                      <jats:italic>oprD<\/jats:italic>\n                      ,\n                      <jats:italic>ampC<\/jats:italic>\n                      , and\n                      <jats:italic>mexA<\/jats:italic>\n                      genes were determined by quantitative real-time PCR (qPCR). ERIC-PCR was used to detect genetic relationships among isolates.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      All isolates were multidrug resistant (MDR) and strong biofilm producers. The resistance genes including\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>NDM<\/jats:sub>\n                      ,\n                      <jats:italic>bl<\/jats:italic>\n                      a\n                      <jats:sub>IMP<\/jats:sub>\n                      ,\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>VIM<\/jats:sub>\n                      ,\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>SIM<\/jats:sub>\n                      ,\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>GES,<\/jats:sub>\n                      and\n                      <jats:italic>armA<\/jats:italic>\n                      were detected in 21 (70%), 6 (20%), 3 (10%), 2 (6.6%), 1 (3.3%), and 17 (56.6%) of the isolates, respectively. CLX at 500 and 1000\u00a0\u00b5g\/mL significantly reduced the level of MIC to MEM, IPM, CAZ, and FEP, also at 2000\u00a0\u00b5g\/mL significantly reduced the level of MBIC to MEM, IPM, CAZ, and FEP. In all isolates, the transcription levels of\n                      <jats:italic>oprD<\/jats:italic>\n                      were significantly downregulated as well as significantly increased for\n                      <jats:italic>ampC<\/jats:italic>\n                      and\n                      <jats:italic>mexA<\/jats:italic>\n                      . ERIC-PCR typing results divided 30 isolates into four clusters A to D.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>\n                      In this study, we reported the spread of different clones of CRPA harboring co-existence of various carbapenemase genes with\n                      <jats:italic>armA<\/jats:italic>\n                      16\u00a0S rRNA methylase for the first time in Kerman, Iran. Also, our isolates had several mechanisms of resistance to carbapenems as well as ability biofilm formation along with resistance to aminoglycosides, the further spread of which could cause serious challenges in our hospital settings. Therefore, serious monitoring is necessary to reduce their prevalence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-024-10085-w","type":"journal-article","created":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T14:03:19Z","timestamp":1729519399000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Critical resistance to carbapenem and aminoglycosides in Pseudomonas aeruginosa: spread of blaNDM\/16S methylase armA harboring isolates with intrinsic resistance mechanisms in Kerman, Iran"],"prefix":"10.1186","volume":"24","author":[{"given":"Behnaz","family":"Soltani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roya","family":"Ahmadrajabi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davood","family":"Kalantar-Neyestanaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,10,21]]},"reference":[{"issue":"6","key":"10085_CR1","doi-asserted-by":"publisher","first-page":"1650","DOI":"10.1093\/jac\/dkv004","volume":"70","author":"SD Lahiri","year":"2014","unstructured":"Lahiri SD, et al. 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No. 400000560 was approved by ethical committee of Kerman University of Medical Sciences, Kerman, Iran. The Ethic approval Code is IR.KMU.REC.1400.523. All methods were carried out following respective guidelines and regulations. Bacterial isolates were collected from teaching hospital laboratories as part of routine hospital procedure and informed consent was obtained from the participants during hospitalization.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"All authors of this manuscript have no conflicts of interest to disclose.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The authors declare no competing interests.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1188"}}