For the first time in Spain and for the second time in Europe, the mechanism of antibiotic resistance DIM-1 has been identified in a patient with infection by the bacterium Pseudomonas aeruginosa. DIM-1 is an extremely rare mechanism that has been detected less than ten times in different sporadic cases around the world, and gives the bacterium a resistance profile to multiple antibiotics, especially broad-spectrum antibiotics.
This time, the P. aeruginosa strain has been isolated from the urine sample of a patient from the Bellvitge Hospital who had arrived at the center after multiple admissions and having received several rounds of broad-spectrum antibiotics. Thanks to the work of the hospital’s Microbiology Service, it was possible to study the antibiotic resistance profile and adapt the patient’s treatment to resolve the infection with the appropriate drugs. “The genomic study of the resistant strain was carried out a posteriori and allowed us to understand the reason for the resistance, but the important thing is the rapid determination of this resistance in the laboratory to adapt the initial treatment,” says Dr. Sara Martí, co-head of the research group on Epidemiology of Bacterial Infections at IDIBELL and member of the Microbiology Service of the Bellvitge University Hospital.
Continuous monitoring to mitigate risk and optimise treatment
This finding is an example of the effectiveness and importance of the routine epidemiological surveillance protocols applied at the center, which are designed precisely to keep this type of resistant bacteria under control. “Finding and identifying these rare mechanisms of resistance allows us to have them on the radar, to be aware that we have them out there and to closely monitor them throughout the health network to know how to treat them,” explains Irene Cadenas, PhD student at IDIBELL and Bellvitge Hospital and first author of the study published in Antimicrobial Agents and Chemotherapy.
DIM-1, a rare and mobile mechanism
The first two cases where this resistance mechanism was detected in the early 2000s originated in India and the Netherlands. Since then, only resistant strains of Pseudomonas have been found in scattered parts of the globe, such as Myanmar, China or Tanzania. All of them share the blaDIM-1 gene, which encodes the DIM-1 enzyme, which is capable of breaking down and rendering a wide variety of antibiotics useless. The gene in question is located on a mobile island in the bacterium’s genome, known for its mobility and dynamism.
Such a mobile genomic context would normally give potential for dissemination, but it seems that the different strains of Pseudomonas found around the world are genetically different and have acquired resistance independently. The dispersed geography and isolated cases support the idea that there has been no global spread of DIM-1 resistance.
There is no risk to the population, but a prudent use of antibiotics is necessary
The detection of the first case in Spain only confirms the critical and urgent need to control the appearance, evolution and spread of bacterial resistance. “From hospitals and microbiology laboratories we can detect resistance in time and have them controlled, as is the case with DIM-1, but it is absolutely essential that the population helps us: the prudent use of antibiotics, the fact of using them correctly and only when they are necessary, is the most powerful tool we have to protect the effectiveness of antibiotics and ensure that infections continue to be treatable“, concludes Dra. Sara Martí.
A further step in Bellvitge’s leadership in antimicrobial resistance
IDIBELL and the Microbiology Service of the Bellvitge Hospital are benchmarks in epidemiological surveillance, high-throughput genomic sequencing and applied research in antimicrobial resistance. This case reinforces the role of the Bellvitge Health Campus as an ecosystem that integrates care, research and teaching and facilitates the transfer of knowledge between the Hospital, IDIBELL, the University of Barcelona and the Catalan Institute of Oncology.
This collaborative model makes it possible to accelerate the detection of emerging mechanisms of resistance, promote translational research projects and offer a faster and more coordinated response to new public health challenges.
About IDIBELL
The Bellvitge Biomedical Research Institute (IDIBELL) is a research center created in 2004 and specialized in cancer, neuroscience, translational medicine and regenerative medicine. It has a team of more than 1,500 professionals who, from 73 research groups, publish more than 1,400 scientific articles a year. IDIBELL is supported by the Bellvitge University Hospital and the Viladecans Hospital of the Catalan Institute of Health, the Catalan Institute of Oncology, the University of Barcelona and the City Council of L ́Hospitalet de Llobregat.
IDIBELL is a member of the Campus of International Excellence of the University of Barcelona HUBc and is part of the CERCA institution of the Generalitat de Catalunya. In 2009 it became one of the first five Spanish research centers accredited as a health research institute by the Carlos III Health Institute. In addition, it is part of the European Union’s HR Excellence in Research program and is a member of EATRIS and REGIC. Since 2018, IDIBELL has been an Accredited Center of the AECC Scientific Foundation (FCAECC).
About Bellvitge University Hospital
Bellvitge Hospital is a public, university, research and innovative hospital. With more than 5,200 expert and committed professionals, it is the local hospital for the citizens of L’Hospitalet and El Prat de Llobregat and a reference centre of maximum complexity for 2 million people, throughout the southern axis of Catalonia. It is the Catalan health centre that performs the most complex surgery, especially oncological surgery, and is part of the Bellvitge Health Campus, recognised by the Organisation of European Cancer Institutes (OECI) as a Comprehensive Cancer Centre for its excellence in cancer care, research and teaching. It integrates into the projects the orientation to improve the patient experience and networking with primary care and the surrounding hospitals. Oriented towards personalized medicine, it has the best genetic diagnosis and imaging tools for cancer and rare diseases, which are complemented by the High Diagnostic Precision Center, which has the first PET/Magnetic Resonance imaging in the healthcare network in Spain. It registers about 26,000 major surgery operations annually; 39,000 discharges; 400,000 outpatient visits and about 100,000 diagnostic tests.