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Article summary:
1. Carbapenem resistance in Pseudomonas aeruginosa strains responsible for chronic lung infections in cystic fibrosis (CF) patients is mainly due to loss of the OprD protein and, limited to meropenem and doripenem, to overexpression of efflux pumps.
2. This study investigates the contribution of other factors such as OpdP porin as an alternative route of entry for carbapenems other than OprD and the overexpression of two chromosomal carbapenemases, the Pseudomonas-derived cephalosporinase (PDC) and the PoxB oxacillinase.
3. The results suggest that even if OprD inactivation remains the most important determinant of carbapenem resistance in strains infecting the CF lung, the interplay of other determinants might have a nonnegligible impact on bacterial susceptibility.
Article analysis:
This article provides a comprehensive overview of how multiple factors can contribute to determining a pattern of resistance or susceptibility to carbapenems in clinical isolates of Pseudomonas aeruginosa, focusing on previously poorly understood determinants such as OpdP porin and chromosomal carbapenemases AmpC and PoxB. The authors provide evidence for their claims by assessing competition between glycine-glutamate, OpdP’s natural substrate, against imipenem uptake at a functional level and comparing expression levels of opdP genes by quantitative real-time PCR (qRT-PCR). Moreover, they also investigate overexpression of chromosomal carbapenemases in some isolates by qRT-PCR.
The article is generally reliable and trustworthy; however there are some potential biases that should be noted. For example, it does not explore counterarguments or present both sides equally; instead it focuses solely on supporting its own claims without considering any opposing views or evidence. Additionally, there is no mention of possible risks associated with this research or any potential implications for patient care. Furthermore, while the authors do provide evidence for their claims through qRT-PCR analysis, they do not provide any additional evidence from other sources which could further strengthen their argument. Finally, there is no discussion about how this research could be applied clinically or what implications it may have for patient care which could be explored further.