Multidrug-resistant and extremely drug-resistant Pseudomonas aeruginosa in clinical samples from a tertiary healthcare facility in Nigeria

Abstract Background Multidrug-resistant (MDR) and extensively drug-resistant (XDR) Pseudomonas aeruginosa (PA) have limited therapeutic options for treatment. Ceftolozane/tazobactam is a newer anti-pseudomonal drug effective against resistant PA infections, however resistance against this drug has now also developed and is increasing. In this study, we explored the combination of ceftolozane/tazobactam (CT) and meropenem (MP) as a possible effective regimen against MDR and XDR PA. Methods We obtained 33 non-duplicate isolates of MDR and XDR PA grown from blood, urine and respiratory samples collected from patients admitted between 2015 and 2019 at our two affiliate teaching hospitals. MDR PA was defined as resistance to 3 or more classes of anti-pseudomonal antibiotics, and XDR PA as resistance to all but two or less classes of anti-pseudomonal antibiotics. Antimicrobial preparations of both MP and CT were made according to manufacturer instructions. Susceptibility testing was performed using the checkerboard method in accordance to CLSI guidelines (CLSI M100, 2017). The ATCC 27853 strain of PA used as control. Synergy, additive effect, indifference and antagonism were defined as FIC (fractional inhibitory concentration) indices of ≤0.5, >0.5 to <1, >1 to <4, and >4, respectively. Results Thirteen (39%) of 33 PA isolates were classified as XDR, while 20 (61%) PA isolates were MDR. All isolates were resistant to MP (MIC50 >32 ug/mL), while only 2 (6%) isolates were susceptible to CT (MIC50 64 ug/mL). A synergistic effect was seen in 9 (27.3%) of PA isolates (FIC index range 0.28 to 0.5)— 2 of which were XDR PA, and 7 were MDR PA. An additive effect was seen in 12 (36.4%), with indifference seen in 12 (36.4%) of isolates. In this study, no antagonism was seen when CT and MP were combined. Conclusion When used in combination, CT and MP can exert a synergistic effect against MDR and XDR PA. Additive effect and indifference can also be seen when both antibiotics were used. Moreover, there was no antagonism seen when both antibiotics were combined. This study shows that the use of CT and MP in combination may be an option against XDR and MDR PA infections. Disclosures All Authors: No reported disclosures

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Incidence and Molecular Characterization of Carbapenemase Genes in Association with Multidrug-Resistant Clinical Isolates of Pseudomonas aeruginosa from Tertiary Healthcare Facilities in Southwest Nigeria

Current Microbiology ◽

10.1007/s00284-021-02706-3 ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Oluwatoyin B. Olaniran ◽

Olufemi E. Adeleke ◽

Ahmed Donia ◽

Ramla Shahid ◽

Habib Bokhari

Keyword(s):

Pseudomonas Aeruginosa ◽

Molecular Characterization ◽

Multidrug Resistant ◽

Clinical Isolates ◽

Healthcare Facilities ◽

Southwest Nigeria ◽

Tertiary Healthcare

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Antimicrobial Activity of Ceftazidime-Avibactam Tested against Multidrug-Resistant Enterobacteriaceae and Pseudomonas aeruginosa Isolates from U.S. Medical Centers, 2013 to 2016

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01045-17 ◽

2017 ◽

Vol 61 (11) ◽

Cited By ~ 52

Author(s):

Helio S. Sader ◽

Mariana Castanheira ◽

Dee Shortridge ◽

Rodrigo E. Mendes ◽

Robert K. Flamm

Keyword(s):

Pseudomonas Aeruginosa ◽

Multidrug Resistant ◽

Drug Resistant ◽

Large Collection ◽

Content Type ◽

Negative Results ◽

Medical Centers ◽

Extensively Drug Resistant ◽

Genes Encoding

ABSTRACT The in vitro activity of ceftazidime-avibactam and many comparator agents was determined against various resistant subsets of organisms selected among 36,380 Enterobacteriaceae and 7,868 Pseudomonas aeruginosa isolates. The isolates were consecutively collected from 94 U.S. hospitals, and all isolates were tested for susceptibility by reference broth microdilution methods in a central monitoring laboratory (JMI Laboratories). Enterobacteriaceae isolates resistant to carbapenems (CRE) and/or ceftazidime-avibactam (MIC ≥ 16 μg/ml) were evaluated for the presence of genes encoding extended-spectrum β-lactamases and carbapenemases. Ceftazidime-avibactam inhibited >99.9% of all Enterobacteriaceae at the susceptible breakpoint of ≤8 μg/ml and was active against multidrug-resistant (MDR; n = 2,953; MIC50/90, 0.25/1 μg/ml; 99.2% susceptible), extensively drug-resistant (XDR; n = 448; MIC50/90, 0.5/2 μg/ml; 97.8% susceptible), and CRE (n = 513; MIC50/90, 0.5/2 μg/ml; 97.5% susceptible) isolates. Only 82.2% of MDR Enterobacteriaceae (n = 2,953) and 64.2% of ceftriaxone-nonsusceptible Klebsiella pneumoniae (n = 1,063) isolates were meropenem susceptible. Among Enterobacter cloacae (22.2% ceftazidime nonsusceptible), 99.8% of the isolates, including 99.3% of the ceftazidime-nonsusceptible isolates, were ceftazidime-avibactam susceptible. Only 23 of 36,380 Enterobacteriaceae (0.06%) isolates were ceftazidime-avibactam nonsusceptible, including 9 metallo-β-lactamase producers and 2 KPC-producing strains with porin alteration; the remaining 12 strains showed negative results for all β-lactamases tested. Ceftazidime-avibactam showed potent activity against P. aeruginosa (MIC50/90, 2/4 μg/ml; 97.1% susceptible), including MDR (MIC50/90, 4/16 μg/ml; 86.5% susceptible) isolates, and inhibited 71.8% of isolates nonsusceptible to meropenem, piperacillin-tazobactam, and ceftazidime (n = 628). In summary, ceftazidime-avibactam demonstrated potent activity against a large collection (n = 44,248) of contemporary Gram-negative bacilli isolated from U.S. patients, including organisms resistant to most currently available agents, such as CRE and meropenem-nonsusceptible P. aeruginosa.

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Evaluation of ceftazidime/avibactam for serious infections due to multidrug-resistant and extensively drug-resistant Pseudomonas aeruginosa

Journal of Global Antimicrobial Resistance ◽

10.1016/j.jgar.2018.07.010 ◽

2018 ◽

Vol 15 ◽

pp. 136-139 ◽

Cited By ~ 14

Author(s):

Olga Rodríguez-Núñez ◽

Marco Ripa ◽

Laura Morata ◽

Cristina de la Calle ◽

Celia Cardozo ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Multidrug Resistant ◽

Drug Resistant ◽

Extensively Drug Resistant ◽

Serious Infections

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Susceptibility Profiles of Ceftolazane-Tazobactam (C-T) and Ceftazidime-Avibactam (CZA) Against Isolates of Multidrug-Resistant and Extensively Drug-Resistant Pseudomonas aeruginosa

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.1364 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Christopher Crist ◽

Richard Winn ◽

Kristen Fuhrmann ◽

Alanna Emrick

Keyword(s):

Pseudomonas Aeruginosa ◽

Multidrug Resistant ◽

Drug Resistant ◽

Extensively Drug Resistant ◽

Susceptibility Profiles

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Isolation and Determination of Multidrug Resistant Pseudomonas Aeruginosa from Clinical Samples

International Journal for Research in Applied Science and Engineering Technology ◽

10.22214/ijraset.2018.4731 ◽

2018 ◽

Vol 6 (4) ◽

pp. 4464-4470

Author(s):

Saravanan. K

Keyword(s):

Pseudomonas Aeruginosa ◽

Multidrug Resistant ◽

Clinical Samples

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Antimicrobial Resistance Pattern of Extensively Drug Resistant Carbapenemase Producing Enterobacteriaceae

Bangladesh Journal of Medical Microbiology ◽

10.3329/bjmm.v13i2.51786 ◽

2019 ◽

Vol 13 (2) ◽

pp. 7-10

Author(s):

Fatima Afroz ◽

Shaheda Anwar ◽

Mashrura Quraishi ◽

GM Mohiuddin ◽

SM Ali Ahmed ◽

...

Keyword(s):

Bacterial Infections ◽

Multidrug Resistant ◽

Diffusion Method ◽

Clinical Samples ◽

Resistance Pattern ◽

Drug Resistant ◽

Disk Diffusion Method ◽

Cross Sectional ◽

Extensively Drug Resistant ◽

Broth Microdilution Method

Carbapenems, often agents of last resort for multidrug resistant bacterial infections are now threatened by widespread dissemination of carbapenem-resistant Enterobacteriaceae (CRE). Production of carbapenemases remain the most clinically important mechanism of carbapenem resistance in Enterobacteriaceae. The objective of this study was to determine the antibiogram pattern of carbapenemase producing Enterobacteriaceae. A cross sectional study was conducted at department of Microbiology and Immunology, BSMMU from September 2018 to August 2019. A total of 145 CRE isolates from different clinical samples were studied.Antimicrobial susceptibility was examinedby disk diffusion method and MIC of colistin by broth microdilution method. Resistant carbapenemase genes NDM and OXA-48 were identified by polymerase chain reaction. Out of 145 CRE isolates, 104 were NDM, 73 were OXA-48and 34 isolates were both NDM and OXA-48 co-producers. All the NDM and OXA-48 carbapenemase producing isolates were 100% resistant to meropenem, imipenem, ertapenem, ceftriaxone, ceftazidime, cefotaxime, cefuroxime, amoxicillin + clavulanic acid and piperacillin + tazobactam. Resistance rates of reserved antimicrobials to treat CRE isolates were also alarming. Thirty seven percent, 9.6% and 5.5 % of OXA-48 carbapenemase producers and 26.0%, 10.6% and 2.9% of NDM carbapenemase producers were resistant to colistin, polymyxin B and tigecycline respectively.Among the carbapenemase producing isolates, 16.6% (24) were multidrug resistant (MDR), 82.1% (119) were extensively drug resistant (XDR) and 1.3% (2) isolates were pan drug resistantwhich highlights the emerging therapeutic challenge for these superbugs. Bangladesh J Med Microbiol 2019; 13 (2): 7-10

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A Study of Isolation and Identification of Multidrug Resistant Pseudomonas aeruginosa from Wound Specimen

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2020/v32i3230930 ◽

2020 ◽

pp. 26-31

Author(s):

Maria Muddassir ◽

Sadaf Munir ◽

Almas Raza ◽

Adeel Iqbal ◽

Muddassir Ahmed ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Multidrug Resistance ◽

Antimicrobial Agents ◽

Morphological Characteristics ◽

Multidrug Resistant ◽

Hospitalized Patients ◽

Clinical Samples ◽

Isolation And Identification ◽

Antimicrobial Drugs ◽

Antibiotic Resistant

Background: Pseudomonas aeruginosa is a clinically important pathogenic microbe in hospitalized patients. It is a major cause of mortality and morbidity having a number of mechanisms that make it antibiotic resistant. Considering the dearth of antimicrobial drugs to treat infection with this pathogen, it has become a necessity to open up new arena for treatment with this organism. Recently, there has been an up rise in the number of multidrug resistant pathogenic strains of Pseudomonas aeruginosa. Objective: Isolation and identification of multidrug resistant Pseudomonas aeruginosa from wound specimens and to evaluate the antibiotic resistant strains of this microbe. Methodology: One hundred and fifty clinical samples of wound were taken from hospitalized patients at Jinnah hospital Lahore during the period of October 2019 to April 2020. In total, twenty (20) isolates of Pseudomonas aeruginosa were identified using the cultural features, morphological characteristics and various biochemical tests plus the Vitek 2 system. Blue/green, brown /blue and yellow/green pigment production showed the presence and growth of Pseudomonas aeruginosa. Results: Percentage of Pseudomonas aeruginosa in females came out to be 15% as compared to 11.42% in males. This was followed by testing susceptibility of isolates of Pseudomonas aeruginosa to various antimicrobial drugs. Piperacillin/tazobactam and meropenem showed the highest efficacy against Pseudomonas aeruginosa. Highest resistance was exhibited against trimethoprim/sulfamethoxazole which was 75%. Conclusion: Most isolates showed multidrug resistance to four or more drugs. Development of multidrug resistance has emerged as a global problem with pathogens commonly causing infections becoming increasingly resistant to antimicrobial agents.

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