Molecular Epidemiology of Carbapenem-Resistant Pseudomonas aeruginosa Before the COVID-19 Pandemic: Resistance Profiles and Clonality in a Tertiary-Care Hospital

<b>Background/Objectives</b>: <i>Pseudomonas aeruginosa</i> is an opportunistic pathogen frequently implicated in healthcare-associated infections, particularly ventilator-associated pneumonia and other device-related infections. The global emergence of carbapenem-resistant <i>P. aeruginosa</i> (CRPA) represents a major clinical challenge due to its limited therapeutic options and high mortality rates. <b>Methods</b>: Relevant clinical data were obtained from medical records. Isolates were identified via 16S PCR, and antimicrobial susceptibility testing was performed using the Vitek2 Compact system following CLSI guidelines. Carbapenemase genes (blaGES, blaKPC, blaIMP, blaNDM, blaVIM) were detected via PCR. Clonal relationships were determined via RAPD-PCR, and some sequence types were assigned according to the global <i>P. aeruginosa</i> MLST database. <b>Results</b>: In this study, 40 non-duplicate CRPA isolates were collected from 35 patients in a tertiary-care hospital in Mexico. Most isolates originated from adult patients, predominantly from tracheal aspirates (32.5%) and urine cultures (25.0%). Mechanical ventilation was the most common invasive device associated with infection, and the overall mortality rate reached 14.3%. Antimicrobial susceptibility testing showed that 95% of isolates exhibited a multidrug-resistant phenotype, with high resistance rates to ciprofloxacin (70.0%) and β-lactams. Carbapenemase genes were detected in 55% of isolates, mainly <i>bla</i>_IMP, <i>bla</i>_GES, and <i>bla</i>_VIM, either alone or in combination. Notably, this is the first report of ST309 (<i>bla</i>_IMP), ST411 (<i>bla</i>_GES + <i>bla</i>_IMP), and ST167 (<i>bla</i>_GES + <i>bla</i>_VIM) carrying carbapenemase genes in Mexico. <b>Conclusions</b>: These findings highlight the persistence and genetic diversity of CRPA circulating in hospital settings and emphasize the urgent need for strengthened genomic surveillance and infection control programs to prevent the spread of these high-risk multidrug-resistant clones.