Outbreak of Multidrug-resistant Pseudomonas Aeruginosa Endophthalmitis Due to Contaminated Trypan Blue Solution

Purpose: To report the investigation of an outbreak of multidrug-resistant (MDR) Pseudomonas aeruginosa endophthalmitis in 13 patients after cataract surgery and to emphasize on the importance of clinical profile, risk factors, and treatment outcomes. Methods: This was a hospital-based, retrospective case study with 13 consecutive patients who had manual small-incision cataract surgery with intraocular lens (IOL) implantation and developed acute postoperative Pseudomonas aeruginosa endophthalmitis. The anterior chamber taps, vitreous aspirates, and environmental surveillance specimens were inoculated for culturing. Antibiotic susceptibility testing was performed using the agar diffusion method. Pulsed-field gel electrophoresis (PFGE) was used to determine the relationship between bacterial isolates recovered from study patients and contaminated surveillance samples. Results: Pseudomonas aeruginosa was isolated from all 13 eyes with acute postoperative endophthalmitis and the trypan blue solutions used during surgery. Sensitivity tests revealed that all isolates had an identical resistance to multiple drugs and were only susceptible to imipenem. Genomic DNA typing of Pseudomonas aeruginosa isolates recovered from patients and trypan blue solutions showed an identical banding pattern on the PFGE. Despite the prompt use of intravitreal antibiotics and early vitrectomy with IOL explantation in some patients, the outcome was poor in about 50% of patients. Conclusion: Positive microbiology and genomic DNA typing results proved that the contaminated trypan blue solutions were the source of infection in this outbreak. Postoperative endophthalmitis caused by Pseudomonas aeruginosa is often associated with a poor visual prognosis despite prompt treatment with intravitreal antibiotics.

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Curcumin as Efflux Pump Inhibitor Agent for Enhancement Treatment Against Multidrug Resistant Pseudomonas aeruginosa Isolates

Iraqi Journal of Science ◽

10.24996/ijs.2020.61.1.6 ◽

2020 ◽

pp. 59-67

Author(s):

Sulaiman D. Sulaiman ◽

Ghusoon A. Abdulhasan

Keyword(s):

Pseudomonas Aeruginosa ◽

Inhibitory Concentration ◽

Efflux Pump ◽

Multidrug Resistant ◽

Diffusion Method ◽

Disc Diffusion Method ◽

Efflux Pump Inhibitor ◽

Before And After ◽

Chromogenic Agar ◽

Susceptibility Patterns

Pseudomonas aeruginosa is considered as a developing opportunistic nosocomial pathogen and is well-known for its multidrug resistance that can be efficiently treated by a combination of antibiotics andefflux pump inhibitors (EPI). Therefore, the purpose of this study was to investigate the effect of curcumin as an EPI for the enhancement of the effectiveness of antibiotics against multidrug resistant (MDR) isolates ofP. aeruginosa. Susceptibility patterns of suspected bacteria was determined using the disc diffusion method andresistant bacteria were identified using chromogenic agar and 16S rDNA. The effectsof curcuminon the enhancement of antibiotics’s activity was evaluated usingthe broth microdilution method.The susceptibility patterns for 50 (67.6%) suspectedP. aeruginosaisolates showed that 36 (72%) of these isolateswere resistant to one of the used antibiotics,whereasonly 21 (42%) were MDR. The highest percentage of resistance was observedtoceftazidime (66%) followed by ciprofloxacin and levofloxacin (40%). Only 35 isolates were specified by chromogenic agar and 16S rDNAas P. aeruginosa.The minimal inhibitory concentration (MIC) of 35 isolates for ciprofloxacin resistant was between 4 and128 µg/ml while for ceftazidime was between 64and 512 µg/ml. After the addition of 50 μg/ml curcumin with ciprofloxacin, there wasa significant increase in the sensitivity (p≤ 0.01) of 13 MDR P.aeroginosa isolates whereas no differences in the sensitivity to ceftazidime were recorded before and after addition ofcurcumin. In conclusion, the results of this study show that curcumin can decrease the MIC value of ciprofloxacin in MDR isolates of P. aeruginosaand can be used as a native compound to enhance the treatment of resistant isolates with ciprofloxacin.

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Drug Resistance and Biofilm Production among Pseudomonas aeruginosa Clinical Isolates in a Tertiary Care Hospital of Nepal

Nepal Medical College Journal ◽

10.3126/nmcj.v21i2.25109 ◽

2019 ◽

Vol 21 (2) ◽

pp. 110-116

Author(s):

Rajani Shrestha ◽

N. Nayak ◽

D.R. Bhatta ◽

D. Hamal ◽

S.H. Subramanya ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Drug Resistance ◽

Biofilm Formation ◽

Tertiary Care ◽

Clinical Problem ◽

Multidrug Resistant ◽

Clinical Isolates ◽

Diffusion Method ◽

Care Hospital ◽

Microbiological Methods

Clinical isolates of Pseudomonas aeruginosa often exhibit multidrug resistance due to their inherent ability to form biofilms. Drug resistance in Ps. aeruginosa is a major clinical problem, especially in the management of patients with nosocomial infections and those admitted to ICUs with indwelling medical devices. To evaluate the biofilm forming abilities of the clinical isolates of Ps. aeruginosa and to correlate biofilm formation with antibiotic resistance. A total of 90 consecutive isolates of Ps. aeruginosa obtained from various specimens collected from patients visiting the Manipal Teaching Hospital, Pokhara, Nepal between January 2018 - October 2018 were studied. Isolates were identified by standard microbiological methods. Antibiotic susceptibility testing was performed by Kirby-Bauer disc diffusion method. All the isolates were tested for their biofilm forming abilities by employing the tissue culture plate assay. Of the 90 Ps. aeruginosa isolates, maximum i.e 42 (46.6%) were from patients in the age group of > 50 years. Majority (30; 33.3%) of the isolates were obtained from sputum samples. However, percentage isolation from other specimens like urine, endotracheal tube (ETT), pus, eye specimens and blood were 18.9%, 16.7%, 16.7%, 7.8% and 6.7% respectively. All the isolates were sensitive to polymixin B and colistin, 91.1% of the organisms were sensitive to imipenem, and more than 80% to aminoglycosides (80% to gentamicin, 83.3% to amikacin). A total of 29 (32.2%) organisms were biofilm producers. Maximum numbers of biofilm producing strains were obtained from ETT (8 of 15; 53.3%), pus (8 of 15; 53.3%) and blood (2 of 6; 33.3%) i.e from all invasive sites. None of the isolates from noninvasive specimens such as conjunctival swabs were biofilm positive. Significantly higher numbers of biofilm producers (23 of 29; 79.3%) were found to be multidrug resistant as compared to non-biofilm (6 of 61; 9.8%) producers (p=0.000). Ps. aeruginosa colonization leading to biofilm formation in deep seated tissues and on indwelling devices is a therapeutic challenge as majority of the isolates would be recalcitrant to commonly used antipseudomonal drugs. Effective monitoring of drug resistance patterns in all Pseudomonas clinical isolates should be a prerequisite for successful patient management.

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Molecular Typing and Virulence Analysis of Pseudomonas Aerugınosa Isolated From Burn Infections Recovered From Duhok and Erbil Hospitals/Iraq.

UKH Journal of Science and Engineering ◽

10.25079/ukhjse.v4n2y2020.pp1-10 ◽

2020 ◽

Vol 4 (2) ◽

pp. 1-10

Author(s):

Marwan Qader ◽

Hasan Solmaz ◽

Narmin Merza

Keyword(s):

Pseudomonas Aeruginosa ◽

Molecular Level ◽

Multidrug Resistant ◽

Rdna Locus ◽

Diffusion Method ◽

Dominant Marker ◽

Base Pairs ◽

Virulence Markers ◽

Virulence Analysis ◽

High Level

In this study, 225 isolates of Pseudomonas aeruginosa were recovered from burn wounds in major hospitals in Duhok and Erbil, Iraq, between April 2015 and September 2015. A total of 136 of these isolates were from men, comprising 60.4% of the total, whereas 89 (39.6%) were recovered from women. One hundred of these isolates were selected (50 from each province of Erbil and Duhok) and subjected to 16 different antibiotics using the disc diffusion method. The isolates showed a high level of resistance to most of the tested antibiotics, with 90% of the isolates being multidrug resistant. Imipenem was considered as the most effective antibiotic against these isolates with a resistant rate of 47%. The genome of all of these isolates were successfully amplified and produced a single band for the 16S rDNA locus with a molecular weight of about 956 base pairs, which was used to confirm, at the molecular level, that all these isolates were indeed P. aeruginosa. The results of the detection of five virulence-related genes including opr1, toxA, exoS, lasB, and nan1 revealed that 10 of these isolates, accounting for 10%, lacked any of the tested virulence markers. The opr1 gene, as a marker for the presence of a pathogenicity island, was the most dominant marker among all the virulence markers and was detected in 90 isolates (90%), followed by the toxA and exoS genes, which were both observed in 86 (86%) isolates, whereas the lasB gene was found in 82 (82%) isolates and the nan1 gene in 35 (35%) of the isolates, respectively.

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Occurrence of NDM-1 and VIM-2 Co-Producing Escherichia coli and OprD Alteration in Pseudomonas aeruginosa Isolated from Hospital Environment Samples in Northwestern Tunisia

Diagnostics ◽

10.3390/diagnostics11091617 ◽

2021 ◽

Vol 11 (9) ◽

pp. 1617

Author(s):

Raouaa Maaroufi ◽

Olfa Dziri ◽

Linda Hadjadj ◽

Seydina M. Diene ◽

Jean-Marc Rolain ◽

...

Keyword(s):

Escherichia Coli ◽

Pseudomonas Aeruginosa ◽

Bacterial Resistance ◽

Carbapenem Resistance ◽

Multidrug Resistant ◽

Hospital Environment ◽

Diffusion Method ◽

Resistant Bacteria ◽

Multidrug Resistant Bacteria ◽

Disk Diffusion Method

Hospital environments constitute the main reservoir of multidrug-resistant bacteria. In this study we aimed to investigate the presence of Gram-negative bacteria in one Northwestern Tunisian hospital environment, and characterize the genes involved in bacterial resistance. A total of 152 environmental isolates were collected from various surfaces and isolated using MacConkey medium supplemented with cefotaxime or imipenem, with 81 fermenter bacteria (27 Escherichia coli, and 54 Enterobacter spp., including 46 Enterobacter cloacae), and 71 non-fermenting bacteria (69 Pseudomonas spp., including 54 Pseudomonas aeruginosa, and 2 Stenotrophomonas maltophilia) being identified by the MALDI-TOF-MS method. Antibiotic susceptibility testing was performed by disk diffusion method and E-Test was used to determine MICs for imipenem. Several genes implicated in beta-lactams resistance were characterized by PCR and sequencing. Carbapenem resistance was detected among 12 isolates; nine E. coli (blaNDM-1 (n = 8); blaNDM-1 + blaVIM-2 (n = 1)) and three P. aeruginosa were carbapenem-resistant by loss of OprD porin. The whole-genome sequencing of P. aeruginosa 97H was determined using Illumina MiSeq sequencer, typed ST285, and harbored blaOXA-494. Other genes were also detected, notably blaTEM (n = 23), blaCTX-M-1 (n = 10) and blaCTX-M-9 (n = 6). These new epidemiological data imposed new surveillance strategies and strict hygiene rules to decrease the spread of multidrug-resistant bacteria in this area.

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Combined Resistance to Ceftolozane-Tazobactam and Ceftazidime-Avibactam in Extensively Drug-Resistant (XDR) and Multidrug-Resistant (MDR) Pseudomonas aeruginosa: Resistance Predictors and Impact on Clinical Outcomes besides Implications for Antimicrobial Stewardship Programs

Antibiotics ◽

10.3390/antibiotics10101224 ◽

2021 ◽

Vol 10 (10) ◽

pp. 1224

Author(s):

Marianna Meschiari ◽

Gabriella Orlando ◽

Shaniko Kaleci ◽

Vincenzo Bianco ◽

Mario Sarti ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Antimicrobial Stewardship ◽

Multivariable Analysis ◽

Multidrug Resistant ◽

University Hospital ◽

Attributable Mortality ◽

Retrospective Case ◽

Comorbidity Score ◽

Charlson Comorbidity Score ◽

Clinical Surveillance

A retrospective case-control study was conducted at Modena University Hospital from December 2017 to January 2019 to identify risk factors and predictors of MDR/XDR Pseudomonas aeruginosa (PA) isolation with resistance to ceftazidime/avibactam (CZA) and ceftolozane/tazobactam (C/T), and of mortality among patients infected/colonized. Among 111 PA isolates from clinical/surveillance samples, 60 (54.1%) were susceptible to both drugs (S-CZA-C/T), while 27 (24.3%) were resistant to both (R-CZA-C/T). Compared to patients colonized/infected with S-CZA-C/T, those with R-C/T+CZA PA had a statistically significantly higher Charlson comorbidity score, greater rate of previous PA colonization, longer time before PA isolation, more frequent presence of CVC, higher exposure to C/T and cephalosporins, longer hospital stay, and higher overall and attributable mortality. In the multivariable analysis, age, prior PA colonization, longer time from admission to PA isolation, diagnosis of urinary tract infection, and exposure to carbapenems were associated with the isolation of a R-C/T+CZA PA strain, while PA-related BSI, a comorbidity score > 7, and ICU stay were significantly associated with attributable mortality. C/T and CZA are important therapeutic resources for hard-to-treat PA-related infections, thus specific antimicrobial stewardship interventions should be prompted in order to avoid the development of this combined resistance, which would jeopardize the chance to treat these infections.

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Post-cataract surgery cluster endophthalmitis due to multidrug-resistant Pseudomonas aeruginosa: A retrospective cohort study of six clusters

Indian Journal of Ophthalmology ◽

10.4103/ijo.ijo_1612_19 ◽

2020 ◽

Vol 68 (7) ◽

pp. 1424

Author(s):

SwapnilM Parchand ◽

Deepanshu Agrawal ◽

Samrat Chatterjee ◽

Anil Gangwe ◽

Mihir Mishra ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Cohort Study ◽

Cataract Surgery ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Multidrug Resistant

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In vitro efficacy of synergistic antibiotic combinations in imipenem resistant Pseudomonas aeruginosa strains

Bangladesh Journal of Medical Microbiology ◽

10.3329/bjmm.v9i1.31332 ◽

2017 ◽

Vol 9 (1) ◽

pp. 3-8

Author(s):

Aleya Farzana ◽

S. M. Shamsuzzaman

Keyword(s):

Pseudomonas Aeruginosa ◽

Carbapenem Resistance ◽

Multidrug Resistant ◽

Diffusion Method ◽

Considerable Proportion ◽

Dilution Method ◽

Agar Dilution Method ◽

Disk Diffusion Method ◽

New Antibiotics

The increase in antibiotic resistance coincided with the decline in production of new antibiotics. Combination antibiotic treatment is preferred in nosocomial infections caused by multidrug resistant Pseudomonas aeruginosa. In vitro synergism test by agar dilution method were used to choose the combinations which might be used in clinic. The aim of this study was to investigate the synergistic efficacy of antibiotic combinations in imipenem resistant P. aeruginosa strains. Carbapenem resistance (imipenem and meropenem) wasdetermined by disk diffusion method. Among isolated P. aeruginosa 44.9% were cabapenem resistant. The MIC of drugs among 25 imipenem resistant isolates ranged from >_ 256 mg/L to <_ 8 mg/L for imipenem, >_ 1024 mg/L to <_ 64 mg/L for ceftriaxone, >_ 256 mg/L to <_ 8 mg/L for amikacin, >_ 16 mg/L to <_ 2 mg/L for colistin, >_ 512 mg/L to <_ 16 mg/L for piperacillin/tazobactam. Among antibiotic combinations, piperacillin /tazobactam- amikacin was most effective with 80% synergism next to which was imipenem-amikacin with 60% synergism, then imipenem-colistin with 50% synergism, imipenem-ceftriaxone with 30% synergism. Only one combination (piperacillin/tazobactum -imipenem showed 20% antagonism. All these combinations had considerable proportion of additive effect which is also desirable for these multi drug resistant isolates.Bangladesh J Med Microbiol 2015; 9 (1): 3-8

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Prevalence and Characteristics of Metallo-beta Lactamase-positive and High-risk Clone ST235 Pseudomonas aeruginosa at Ardabil Hospitals

Jundishapur Journal of Microbiology ◽

10.5812/jjm.115819 ◽

2021 ◽

Vol 14 (3) ◽

Author(s):

Somayeh Safarirad ◽

Mohsen Arzanlou ◽

Jafar Mohammadshahi ◽

Hamid Vaez ◽

Amirhossin Sahebkar ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Continuous Monitoring ◽

Multidrug Resistant ◽

Resistance Rate ◽

Diffusion Method ◽

Disk Diffusion Method ◽

Carbapenem Resistant ◽

Clonal Relatedness ◽

Synergy Test ◽

Highly Virulent

Background: Carbapenems are the most commonly administered drugs for the treatment of multidrug-resistant Pseudomonas aeruginosa (MDR-P. aeruginosa) infections. However, carbapenem-resistant P. aeruginosa is spreading rapidly and has led to a new threat to human health worldwide. Objectives: The current study aimed to determine the prevalence of imipenem-resistant P. aeruginosa, detect metallo-β-lactamase (MBL)-producer isolates, and evaluate their clonal relationships in strains isolated from patients referring to the hospitals of Ardabil city, Iran. Methods: The resistance rate to imipenem was evaluated using the disk diffusion method. Double-disk synergy test and PCR technique were used for phenotypic and genotypic screening of MBL-positive P. aeruginosa, respectively. Ultimately, ERIC-PCR and MLST methods were used for assessing clonal relatedness among the isolates. Results: The prevalence of imipenem-resistant P. aeruginosa strains was estimated at 57.1% (48 out of 84 isolates). In addition, 45 (93.7%) out of 48 imipenem-resistant P. aeruginosa isolates were phenotypically screened as MBL-positive, among which 16 (35.5%) and three (6.6%) isolates harbored blaIMP and blaVIM-1 genes, respectively. However, blaNDM, blaSIM-2, blaSPM, and blaGIM-1 genes were not detected in this study. MBL-producing P. aeruginosa strains were divided into 42 ERIC-PCR types. Based on the results of MLST, P. aeruginosa ST235 was the only identified sequence type. Conclusions: Our results revealed a high and alarming prevalence of imipenem-resistant and blaIMP-positive P. aeruginosa ST235 at Ardabil hospitals. Continuous monitoring is essential to control the further spread of this highly virulent and drug-resistant clone.

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Outbreak of postoperative endophthalmitis caused by Pseudomonas aeruginosa: a case report and brief literature review

Journal of International Medical Research ◽

10.1177/03000605211055394 ◽

2021 ◽

Vol 49 (11) ◽

pp. 030006052110553

Author(s):

Kasra Cheraqpour ◽

Aliasghar Ahmadraji ◽

Seyed Ali Tabatabaei ◽

Bahram Bohrani Sefidan ◽

Mohammad Soleimani ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Visual Acuity ◽

Cataract Surgery ◽

Clinical Findings ◽

Postoperative Endophthalmitis ◽

Causative Pathogen ◽

Light Perception ◽

Strict Adherence ◽

Gram Negative ◽

Source Of Infection

Endophthalmitis is the most serious complication of cataract surgery. A cluster of endophthalmitis is a devastating event for surgeons. Pseudomonas aeruginosa is the main causative pathogen of Gram-negative endophthalmitis, which can be suggestive of the occurrence of an outbreak. Ten patients diagnosed with endophthalmitis after cataract surgery performed by one surgeon were analyzed in this study. At presentation, five patients had obvious clinical findings of endophthalmitis with visual acuity of light perception, two patients had poor light perception/no light perception of vision complicated by concomitant keratitis, and three patients had earlier signs of infection (e.g., a lower degree of anterior chamber and vitreous cells, better presenting visual acuity, and greater visibility of the fundus). Investigations revealed that the source of infection was growth of P. aeruginosa on the phaco probe. All of the surgeries had been performed by the same contaminated probe without sterilization between surgeries. This finding emphasizes the importance of strict adherence to sterility protocols during high-risk surgeries such as intraocular surgeries. Additionally, this report aims to emphasize to surgeons that negligence of simple but vital steps of sterility for any reason, such as limitations in time or equipment, can lead to catastrophic events.

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Clinical Specimens are the Pool of oprL and toxA Virulence Genes Harboring Multidrug-Resistant Pseudomonas aeruginosa: Findings from a Tertiary Hospital of Nepal

Emergency Medicine International ◽

10.1155/2021/4120697 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Yamuna Chand ◽

Sujan Khadka ◽

Sanjeep Sapkota ◽

Suprina Sharma ◽

Santosh Khanal ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Antibiotic Susceptibility ◽

Virulence Genes ◽

Tertiary Hospital ◽

Multidrug Resistant ◽

Diffusion Method ◽

Clinical Settings ◽

Global Public Health ◽

Clinical Specimens ◽

First Time

The multidrug- or extensively drug-resistant (MDR/XDR) Pseudomonas aeruginosa carrying some virulence genes has become a global public health threat. However, in Nepal, there is no existing report showing the prevalence of oprL and toxA virulence genes among the clinical isolates of P. aeruginosa. Therefore, this study was conducted for the first time in the country to detect the virulence genes (oprL and toxA) and antibiotic susceptibility pattern of P. aeruginosa. A total of 7,898 clinical specimens were investigated following the standard microbiological procedures. The antibiotic susceptibility testing was examined by the modified disc diffusion method, and virulence genes oprL and toxA of P. aeruginosa were assessed using multiplex PCR. Among the analyzed specimens, 87 isolates were identified to be P. aeruginosa of which 38 (43.68%) isolates were reported as MDR. A higher ratio of P. aeruginosa was detected from urine samples 40 (45.98%), outpatients’ specimens 63 (72.4%), and in patients of the age group of 60–79 years 36 (41.37%). P. aeruginosa was more prevalent in males 56 (64.36%) than in female patients 31 (35.63%). Polymyxin (83.90%) was the most effective antibiotic. P. aeruginosa (100%) isolates harboured the oprL gene, while 95.4% of isolates were positive for the toxA gene. Identification of virulence genes such as oprL and toxA carrying isolates along with the multidrug resistance warrants the need for strategic interventions to prevent the emergence and spread of antimicrobial resistance (AMR). The findings could assist in increasing awareness about antibiotic resistance and suggest the judicious prescription of antibiotics to treat the patients in clinical settings of Nepal.

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