Background: Pseudomonas aeruginosa is a pathogenic organism responsible for frequent wound and nosocomial infections worldwide. Its infections are difficult to control since the organism is known to rapidly develop antibiotic resistance and becomes multidrug-resistant (MDR) during treatment of patients. Aim of the study: This study was intended to investigate the occurrence of certain important types of (ESBL) and (MBL) enzymes in association with important specific virulence factors associated with P. aeruginosa clinical isolates from Khartoum, Sudan. Methods: This study investigated 70 P. aeruginosa isolates which were collected from patients admitted to four major hospitals in Khartoum (Fedail, Ribat, Ibn Sina and Soba hospitals). These isolates were recovered from 40 wound swabs (57.1%), 27 urine samples (38.6%), and 3 pleural fluid samples (4.3%) of patients. Higher numbers of isolates were recovered from males 42 (60%) than in females 28 (40%). All P. aeruginosa isolates were first confirmed by conventional biochemical and second using molecular PCR tests. PCR methods were also used for detecting the presence of the virulence genes ToxA, AlgD, LasB, exoS, exoU, CTX, GES-1, and genes of VIM, IMP, KPC, CTX, VEB-1 and SHV-1. Results: Antimicrobial susceptibility testing of P. aeruginosa isolates showed a high resistance to azetronam 49 (70%), followed by ceftazidime 32 (45.7%), 16 ciprofloxacin (22.9%), gentamicin 13 (18.6 %), piperacillin-tazobactam 11 (15.7%), amikacin 9 (12.9 %), and imipenem 6 (8.6%) showed the least resistance. All isolates were positive for algD and lasB (100%), followed by toxA (90%), exoS (34.3), exoU (24.3%), respectively. The rates of detected ESBL genes blaTEM, blaCTX-m, blaSHV-1,GES-1, were 3.3%, 6.6%, 10%, 3.3%,10%, respectively, but all isolates were negative for bla-KPC and bla- VIM and IMP . The percentages of pigment production were 61.4% for pyocyanin, 37.1% for pyoverdin and 1.4% for pyorubin. Conclusion: The study demonstrated high rates of antimicrobial resistance markers to most commonly used antibiotics in treatment of P. aeruginosa infections. The majority of the isolates from urine and wound samples carried at least three potential virulence factor genes of algD, lasB and toxA and without any significant relation to their antimicrobial resistance markers.
Introduction: Antimicrobial resistance (AMR) is an incrrasingly global public health threat. An average of 45% of all patients are prescribed antibiotics. Nearly 50% of these prescribed antibiotics are unnecessary and they may promote the emergence of resistant strains. Antimicrobial stewardship programs have been introduced to tackle this problem. In this study we aim to determine the pattern of antibiotics prescription and resistance profile of common bacterial isolates at Soba university hospital , Sudan. Methods: A retrospective cross sectional study that was conducted at the medicine and surgery wards in a tertiary care hospital . Records of all patients who were admitted during the study period were included. A presented data collection form was used to collect information. Results: Records of 269 inpatients were reviewed. The mean age of patients was 49.5±18.7 years. The most frequently reported diagnoses on admission included cerebrovascular accidents and chronic liver disease, with 10.6% and 7.1% respectively. Je mean duration of stay at the hospital was 6.6 ± 6 days. Almost 81.8% of admitted patients recieved antibiotics. The majority (38.7% and 34.2%) were given one, and two antibiotics, respectively. Most of the antibiotics were administered intravenously (82.1%). Third generation cephalosporin antibiotcs (38%) and metronidazole (21.7%) were the most frequently prescribed. No documented indication for antibiotic prescriptio was found in 40.5% of cases. The main reason for stopping antibitics was the patients discharge (63.6%). Of patients recieving antibiotics, only 5 (1.9%) had undergone culture. Complete blood count (CBC) was requesed in nearly all patients (99.2%). A total of 100 cultures were performed during the study time. Most of them were urine cultures (64%). Escherichia Coli was isolated from 14 (29.2%) cultures. Resistance percentage was highest for erythromycin, and oxacillin (100% for both). Conclusion: The study shows a trend of antibiotic misuse. Most patients recieved antibiotics without documented indication. Antibiotics sensitivity results showed high levels of resistance among isolated organisms. We recommended a wider study and formulation and impementation of clear guidlines to regulate antibiotics use.
Background: Carbapenem family are from the recently synthesized beta-lactam antibiotics which used as last resort antibiotics for treating infections caused by multidrug-resistant Gram-negative bacilli and the resistant to them by Gram-negative bacilli have been developed, due to production of variety of carbapenemase enzymes and other mechanisms that significantly limits treatment options for life-threatening infections.
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