{
  "abstract": "Background\n\nDifficult-to-treat resistant Pseudomonas aeruginosa (DTRPA) represents a challenging resistance phenotype with carbapenem-resistant P. aeruginosa playing a major role. However, carbapenemase-negative DTRPA (CN-DTRPA) are more susceptible to reserve antibiotics and rarely reported in outbreaks, differing from frequently outbreak-associated carbapenemase-producing DTRPA (CP-DTRPA) with limited therapeutic options. Despite, international guidelines recommend equal infection prevention and control (IPC) measures. Here, we analysed the transmission of CP-DTRPA and CN-DTRPA using epidemiology and whole-genome sequencing (WGS).Methods\n\nClinical DTRPA isolates collected between 2019 and 2024 were subjected to WGS. Genetic clusters were defined using cgMLST thresholds of ≤ 11 and ≤ 3 allelic differences. Epidemiological relatedness was estimated on hospital stay, interpatient contact and environmental exposures. For possibly epidemiologically linked cases, precolonisation with carbapenem-susceptible P. aeruginosa (CSPA) and antibiotic exposure during hospitalisation were assessed.Results\n\nAmong 190 DTRPA isolates, CN-DTRPA (79.5%) was predominant compared to 20.5% CP-DTRPA, mainly carrying blaVIM-2. Twelve genetic clusters involving 39 patients were identified. Seven clusters (CP-DTRPA n = 4; CN-DTRPA n = 2, CP-DTRPA/CN-DTRPA-mixed n = 1) showed possible epidemiological relatedness. CP-DTRPA isolates were frequently associated with clusters (OR 17.47, 95% CI 7.43-41.08) and environmental transmission. Diverse CN-DTRPA were rather linked to interpatient CSPA-transmission following CN-DTRPA emergence after prolonged antibiotic exposure.Conclusion\n\nCN-DTRPA predominated and displayed high diversity, consistent with possible antibiotic-driven resistance development in precolonised patients. In contrast, less frequent and less diverse CP-DTRPA were associated to outbreaks. These findings highlight the need to evaluate differentiated IPC strategies, including targeted screening and environmental interventions for CP-DTRPA, while further investigating the potential role of antimicrobial stewardship in preventing the emergence of CN-DTRPA. Multicentre studies are required for evidence-based IPC strategies.",
  "abstract_shown": true,
  "affiliations": [
    "Department for Infection Prevention and Control, Institute for Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany. j.jasuja@uke.de.",
    "Department for Infection Prevention and Control, Institute for Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.",
    "Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany."
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Jasmin Kaur Jasuja"
    },
    {
      "affs": [
        1
      ],
      "name": "Philipp Maximilian Maurer"
    },
    {
      "affs": [
        1
      ],
      "name": "Laura Carlsen"
    },
    {
      "affs": [
        1
      ],
      "name": "Eva-Maria Theresia Klupp"
    },
    {
      "affs": [
        1,
        2
      ],
      "name": "Cristina Elena Belmar Campos"
    },
    {
      "affs": [
        2
      ],
      "name": "Holger Rohde"
    },
    {
      "affs": [
        2
      ],
      "name": "Martin Aepfelbacher"
    },
    {
      "affs": [
        1
      ],
      "name": "Johannes Karl-Mark Knobloch"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/5bmrcf17sr89d.bib",
  "cited_by": 0,
  "doi": "10.1186/s13756-026-01851-3",
  "fulltext_url": "https://europepmc.org/articles/PMC13723103",
  "id": "5bmrcf17sr89d",
  "issns": [
    "2047-2994"
  ],
  "landing_url": "https://europepmc.org/article/MED/42963799",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Research"
    ],
    [
      "openalex",
      "1313|Antibiotic Resistance in Bacteria"
    ]
  ],
  "openalex": "W7224866583",
  "pdf_url": "https://europepmc.org/articles/PMC13723103?pdf=render",
  "pmcid": "PMC13723103",
  "pmid": "42963799",
  "published": "2026-10-30",
  "publisher": "BMC",
  "ris": "https://research.draconitic.com/paper/5bmrcf17sr89d.ris",
  "sources": [
    {
      "first_seen": "2026-11-02T03:21:21Z",
      "native_id": "MED:42963799",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42963799"
    },
    {
      "first_seen": "2026-11-04T12:21:46Z",
      "native_id": "PMC13723103",
      "source": "pmc",
      "url": "https://doi.org/10.1186/s13756-026-01851-3"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:1313|Antibiotic Resistance in Bacteria",
      "subfield": "general"
    }
  ],
  "title": "Retrospective analysis of the transmission of difficult-to-treat resistant Pseudomonas aeruginosa - genotype beats phenotype.",
  "title_text": "Retrospective analysis of the transmission of difficult-to-treat resistant Pseudomonas aeruginosa - genotype beats phenotype.",
  "type": "peer-reviewed",
  "updated_at": "2026-11-04T12:21:46Z",
  "url": "https://research.draconitic.com/paper/5bmrcf17sr89d",
  "venue": "Antimicrobial resistance and infection control",
  "versions": []
}