An Update on Antimicrobial Resistance and the Role of Newer Antimicrobial Agents for Pseudomonas aeruginosa

Abstract Background: Pseudomonas aeruginosa is a common pathogen causing healthcare-associated infections most especially in critically ill and immunocompromised patients. This pathogen poses a public health threat due to its innate resistance to many antimicrobial agents and its ability to acquire new resistance mechanisms under pressure. Infections with Extended spectrum β-lactamases (ESBL)‑producing isolates result into outbreaks that lead to serious antibiotic management concerns with higher mortality and morbidity and significant economic causatives. In this study, we evaluated the antimicrobial resistance patterns and characterized genetically the ESBLs and Metallo- β-lactamases (MBL) produced by this pathogen. Methods: Isolates of P. aeruginosa cultured from patients who attended Nelson Mandela Academic Hospital and other clinics in the four district municipalities of the Eastern Cape between August 2017 and May 2019 were identified; and their antibiotic resistance patterns were tested against amikacin, aztreonam, cefepime, ceftazidime, ciprofloxacin, doripenem, gentamicin, imipenem, levofloxacin, meropenem, piperacillin, piperacillin/tazobactam and tobramycin using the bioMérieux VITEK® 2 and confirmed by Beckman autoSCAN-4 System. Real-time PCR was done using Roche Light Cycler 2.0 to detect the presence of ESBLs; blaSHV, blaTEM and blaCTX-M genes; and MBLs; blaIMP, blaVIM. Results: High antibiotic resistance in decreasing order was observed in piperacillin (64.2%), aztreonam (57.8%), cefepime (51.5%), ceftazidime (51.0%), piperacillin/tazobactam (50.5%), and imipenem (46.6%). A total of 75 (36.8%) multidrug resistant (MDR) isolates were observed of the total pool of isolates. The blaTEM, blaSHV and blaCTX-M was detected in 79.3%, 69.5% and 31.7% isolates (n=82), respectively. The blaIMP was detected in 1.25% while no blaVIM was detected in any of the isolates tested. Conclusions: The study showed a high rate of MDR P. aeruginosa in our setting. The vast majority of these resistant isolates carried blaTEM and blaSHV genes. Continuous monitoring of antimicrobial resistance and strict compliance towards infection prevention and control practices are the best defence against spread of MDR P. aeruginosa.

Download Full-text

Inducible, but Not Constitutive, Resistance of Gonococci to Hydrophobic Agents Due to the MtrC-MtrD-MtrE Efflux Pump Requires TonB-ExbB-ExbD Proteins

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.46.2.561-565.2002 ◽

2002 ◽

Vol 46 (2) ◽

pp. 561-565 ◽

Cited By ~ 23

Author(s):

Corinne Rouquette-Loughlin ◽

Igor Stojiljkovic ◽

Tara Hrobowski ◽

Jacqueline T. Balthazar ◽

William M. Shafer

Keyword(s):

Pseudomonas Aeruginosa ◽

Antimicrobial Resistance ◽

Antimicrobial Agents ◽

Efflux Pump ◽

Energy Requirement ◽

Constitutive Resistance ◽

Absolute Requirement ◽

Pump Activity ◽

Tonb Protein ◽

Triton X

ABSTRACT The MtrC-MtrD-MtrE efflux pump possessed by Neisseria gonorrhoeae is very similar to the MexA-MexB-OprM efflux pump of Pseudomonas aeruginosa. Because the antimicrobial resistance property afforded by the MexA-MexB-OprM efflux pump also requires the TonB protein, we asked whether a similar requirement exists for the gonococcal efflux pump. Unlike earlier studies with P. aeruginosa, we found that constitutive levels of gonococcal resistance to hydrophobic antimicrobial agents (i.e., Triton X-100 [TX-100]) did not require the TonB, ExbB, or ExbD protein. However, inducible levels of TX-100 resistance in gonococci had an absolute requirement for the TonB-ExbB-ExbD system, suggesting that such resistance in gonococci has an energy requirement above and beyond that required for constitutive pump activity.

Download Full-text

Pseudomonas aeruginosa in Nepali hospitals: poor outcomes amid 10 years of increasing antimicrobial resistance

Public Health Action ◽

10.5588/pha.21.0048 ◽

2021 ◽

Vol 11 (1) ◽

pp. 58-63

Author(s):

M. Mahto ◽

A. Shah ◽

K. L. Show ◽

F. L. Moses ◽

A. G. Stewart

Keyword(s):

Pseudomonas Aeruginosa ◽

Antimicrobial Resistance ◽

Antimicrobial Agents ◽

Significant Risk ◽

Cross Sectional Study ◽

Cross Sectional ◽

Microbiological Methods ◽

Resistance Patterns ◽

Resistant Strains ◽

Poor Outcomes

OBJECTIVE: To determine antimicrobial resistance patterns and prevalence of multi- (MDR, i.e., resistant to 3 classes of antimicrobial agents) and extensively (XDR, i.e., resistant to 3, susceptible to 2 groups of antibiotics) drug-resistant strains of Pseudomonas aeruginosa.METHODS: This was a cross-sectional study conducted in Nepal Mediciti Hospital, Lalitpur, Nepal, using standard microbiological methods with Kirby Bauer disc diffusion to identify antimicrobial susceptibility.RESULTS: P. aeruginosa (n = 447) were most frequently isolated in respiratory (n = 203, 45.4%) and urinary samples (n = 120, 26.8%). AWaRe Access antibiotics showed 25–30% resistance, Watch antibiotics 30–55%. Susceptibility to AWaRe Reserve antibiotics remains high; however, 32.8% were resistant to aztreonam. Overall, 190 (42.5%) were MDR and 99 (22.1%) XDR (first Nepali report) based on mainly non-respiratory samples. The majority of infected patients were >40 years (n = 229, 63.2%) or inpatients (n = 181, 50.0%); 36 (15.2%) had an unfavourable outcome, including death (n = 25, 10.5%). Our larger study showed a failure of improvement over eight previous studies covering 10 years.CONCLUSION: Antibiotic resistance in P. aeruginosa occurred to all 19 AWaRe group antibiotics tested. Vulnerable patients are at significant risk from such resistant strains, with a high death rate. Sustainable and acceptable antibiotic surveillance and control are urgently needed across Nepal, as antimicrobial resistance has deteriorated over the last decade.

Download Full-text

2477. Antimicrobial Resistance patterns of Enterobacteriaceae and Pseudomonas aeruginosa from Colombian clinical isolates. 2017–2018

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2155 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S858-S858

Author(s):

Monica Maria Rojas Rojas ◽

Catalina López ◽

Jaime Ruiz ◽

Jacquleine Pavía ◽

Jose Oñate ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Antimicrobial Resistance ◽

Antimicrobial Agents ◽

Clinical Isolates ◽

In Vitro Susceptibility ◽

Gram Negative ◽

Guidelines Development ◽

Resistance Patterns ◽

Tract Infections

Abstract Background The Study for Monitoring Antimicrobial Resistance Trends (SMART) is a worldwide initiative to monitor in vitro susceptibility of clinical Gram-negative isolates to several antimicrobial agents. Surveillance initiatives are essential to provide real-world evidence to support local guidelines development. Colombia has participated since 2012 with isolates from complicated intrabdominal infections (cIAI), complicated urinary tract infections (cUTI) and respiratory tract infections (RTI). This study describes resistant patterns of Escherichia coli (Eco), Klebsiella pneumoniae (Kpn) and Pseudomonas aeruginosa (Pae) clinical isolates collected in Colombian hospitals in a 2 years period (2017–2018). Methods Isolates from patients with cIAI, cUTI and RTI were collected. Identification confirmation was done in central laboratory. Minimum inhibitory concentrations (MIC) were performed by broth microdilution and interpreted according to 2018 CLSI guidelines, same criteria for Extended-spectrum β-lactamase (ESBL) classification. The antimicrobial activity was evaluated for aztreonam (ATM), ceftolozane/tazobactam (C/T), ceftazidime (CAZ), colistin (COL), ertapenem (ETP), cefepime (FEP), imipenem (IMP), meropenem (MEM) and piperacillin–tazobactam (TZP). Results During 2017–2018, 1492 isolates were collected. The main organism was Eco (51%) followed by Kpn (29%) and Pae (20%). In vitro susceptibility activity is presented in Table 1. COL, C/T, ETP, MEM and IPM exhibited over 95% susceptibility in Eco. ESBL prevalence was 18% for Eco (53/314) and 22% for Kpn (36/165). COL and C/T were the most active agents against Pae isolates. For Kpn, MIC50/90 values were: MEM (0.12 / 8), C/T (0.5 / 8) and for TZP (8 / > 64), meanwhile for Pae were MEM (0.5 / 32), C/T (0.5 / 32) and for TZP (8 / > 64). Conclusion Continued antimicrobial resistance surveillance initiatives are critical to guide the empiric treatments decision in a multidrug resistance era. This study shows that Ceftolozane/Tazobactam, MEM and COL have the best susceptibility profile against Eco, Kpn and Pae of cIAI, cUTI and RTI cases in Colombia. The C/T susceptibility rates and low MIC distribution provide evidence to support its use as a non-carbapenem therapeutic alternative for Gram-negative infections. Disclosures All authors: No reported disclosures.

Download Full-text

Role of Artificial Intelligence in Fighting Antimicrobial Resistance in Pediatrics

Antibiotics ◽

10.3390/antibiotics9110767 ◽

2020 ◽

Vol 9 (11) ◽

pp. 767 ◽

Cited By ~ 1

Author(s):

Umberto Fanelli ◽

Marco Pappalardo ◽

Vincenzo Chinè ◽

Pierpacifico Gismondi ◽

Cosimo Neglia ◽

...

Keyword(s):

Artificial Intelligence ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Potential Role ◽

Antimicrobial Agents ◽

Primary Role ◽

Science And Engineering ◽

Intelligent Behavior ◽

Applications Of Ai

Artificial intelligence (AI) is a field of science and engineering concerned with the computational understanding of what is commonly called intelligent behavior. AI is extremely useful in many human activities including medicine. The aim of our narrative review is to show the potential role of AI in fighting antimicrobial resistance in pediatric patients. We searched for PubMed articles published from April 2010 to April 2020 containing the keywords “artificial intelligence”, “machine learning”, “antimicrobial resistance”, “antimicrobial stewardship”, “pediatric”, and “children”, and we described the different strategies for the application of AI in these fields. Literature analysis showed that the applications of AI in health care are potentially endless, contributing to a reduction in the development time of new antimicrobial agents, greater diagnostic and therapeutic appropriateness, and, simultaneously, a reduction in costs. Most of the proposed AI solutions for medicine are not intended to replace the doctor’s opinion or expertise, but to provide a useful tool for easing their work. Considering pediatric infectious diseases, AI could play a primary role in fighting antibiotic resistance. In the pediatric field, a greater willingness to invest in this field could help antimicrobial stewardship reach levels of effectiveness that were unthinkable a few years ago.

Download Full-text

Pseudomonas aeruginosa: the history of one of the most successful nosocomial pathogens in Russian hospitals

Clinical Microbiology and Antimicrobial Chemotherapy ◽

10.36488/cmac.2018.3.164-171 ◽

2018 ◽

Vol 20 (3) ◽

pp. 164-171 ◽

Cited By ~ 3

Author(s):

E.Yu Skleenova ◽

I.S. Azizov ◽

Е.А. Shek ◽

M.V. Edelstein ◽

R.S. Kozlov ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Antimicrobial Resistance ◽

Antimicrobial Agents ◽

Bacterial Pathogen ◽

Nosocomial Pathogens ◽

History Of ◽

Resistance Rates ◽

Eskape Pathogens ◽

Klebsiella Spp

Pseudomonas aeruginosa is recognized as one of the six most important pathogens in terms of antimicrobial resistance («ESKAPE» pathogens), and included by WHO in the group of microorganisms for which the need for development of new antimicrobial agents is crucial. In 2015, P. aeruginosa was the second (after Klebsiella spp.) most common nosocomial bacterial pathogen in Russia with the following resistance rates: amikacin – 45.2%, imipenem – 51.5%, meropenem – 53.3%, colistin – 2.2%, piperacillin/tazobactam – 61.4%, ceftazidime – 56.8%, ciprofloxacin – 61.2%. The majority of carbapenemase-producing isolates in Russia belong to the two epidemic lineages – CC235 and CC654.

Download Full-text

Diversity of Antimicrobial Resistance and Virulence Determinants inPseudomonas aeruginosaAssociated with Fresh Vegetables

International Journal of Microbiology ◽

10.1155/2012/426241 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 16

Author(s):

Kashina Allydice-Francis ◽

Paul D. Brown

Keyword(s):

Pseudomonas Aeruginosa ◽

Antimicrobial Resistance ◽

Healthy Eating ◽

Antimicrobial Agents ◽

Virulence Determinants ◽

Retail Markets ◽

Source Of Infection ◽

Fresh Vegetables ◽

The Difference ◽

Susceptibility Profiles

With the increased focus on healthy eating and consuming raw vegetables, this study assessed the extent of contamination of fresh vegetables byPseudomonas aeruginosain Jamaica and examined the antibiotic susceptibility profiles and the presence of various virulence associated determinants ofP. aeruginosa. Analyses indicated that vegetables from retail markets and supermarkets were widely contaminated byP. aeruginosa; produce from markets were more frequently contaminated, but the difference was not significant. Lettuce and carrots were the most frequently contaminated vegetables, while tomatoes were the least. Pigment production (Pyoverdine, pyocyanin, pyomelanin and pyorubin), fluorescein and alginate were common in these isolates. Imipenem, gentamicin and ciprofloxacin were the most inhibitory antimicrobial agents. However, isolates were resistant or showed reduced susceptibility to ampicillin, chloramphenicol, sulphamethoxazole/trimethoprim and aztreonam, and up to 35% of the isolates were resistant to four antimicrobial agents. As many as 30% of the isolates were positive for thefpv1gene, and 13% had multiple genes. Sixty-four percent of the isolates harboured an exoenzyme gene (exoS,exoT,exoUorexoY), and multiple exo genes were common. We conclude thatP. aeruginosais a major contaminant of fresh vegetables, which might be a source of infection for susceptible persons within the community.

Download Full-text

The role of efflux pump systems and OprD porine in antimicrobial resistance of Pseudomonas aeruginosa strains isolated from patients with bronchiectasis

10.1183/13993003.congress-2021.pa2359 ◽

2021 ◽

Author(s):

Roberto Cabrera ◽

Laia Fernández-Barat ◽

Nil Vázquez ◽

Victoria Alcaráz ◽

Rubén López-Aladid ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Antimicrobial Resistance ◽

Efflux Pump

Download Full-text