Emergence of Multidrug- and Pandrug- Resistant Pseudomonas aeruginosa from Five Hospitals in Qatar

Abstract

Summary Background A global rise in multidrug-resistant (MDR) nosocomial infections has led to a significant increase in morbidity and mortality. MDR Gram-negative bacteria (GNB) are recognised for rapidly developing drug resistance. Despite Pseudomonas aeruginosa being the second most common GNB isolated from healthcare associated infections, the magnitude of MDR P. aeruginosa (MDR-PA) has not been evaluated in Qatar. Aim To assess the prevalence and antimicrobial susceptibility patterns of MDR-PA from 5 major hospitals in Qatar. Methods A total of 2533 P. aeruginosa clinical isolates were collected over a one-year period. MDR-PA was defined as resistance to at least one agent of ≥ 3 antibiotic classes. Clinical and demographic data were collected prospectively. Findings The overall prevalence of MDR-PA isolates was 8.1% (205/2533); the majority of isolates were from patients exposed to antibiotics during 90 days prior to isolation (85.4 %, 177/205), and the infections were mainly hospital-acquired (95.1%, 195/205) with only 4.9% from the community. The majority of MDR-PA isolates were resistant to cefepime (96.6%, 198/205), ciprofloxacin, piperacillin/tazobactam (91%, 186/205), and meropenem (90%, 184/205). Patient comorbidities with MDR-PA were diabetes mellitus (47.3%, n=97), malignancy (17.1%, n=35), end-stage renal disease (13.7%, n=28) and heart failure (10.7%, n=22). Conclusion There was a significant prevalence of MDR-PA in Qatar, primarily from healthcare facilities and associated with prior antibiotic treatment. There was an alarming level of antimicrobial resistance to carbapenems. Our results are part of a national surveillance of MDR to establish effective containment plans.

Antimicrobial Resistance Pattern of Pseudomonas aeruginosa from Different Clinical Specimens: Survey Article

“…A total of fifteen articles published in English, between the period of 2010 and 2020 were identified and reviewed, nine articles were prospective studies (Siddiqua et al, 2018;Farooq et al, 2019;Ahmadi et al, 2016;Rustini et al, 2017;Senthamarai, 2014;Farhan et al, 2019;Ahmed et al, 2019;Al-Marzoqi and Al Taee, 2013;Khan and Faiz, 2016), four were descriptive cross sectional studies (Pokharel et al, 2019;Karami et al, 2020;Mahfoud et al, 2015;Alhusseini et al, 2019), one systemic review and meta-analysis study (Acar et al, 2019) and one retrospective study (Al-Tawfiq et al, 2020).…”

“…This study focused mainly on the resistance pattern of P. aeruginosa against different drugs in different countries. It was observed that the highest resistance rate was against Cefuroxime in Bangladesh (Siddiqua et al, 2018), Ceftriaxone in Indonesia (Rustini et al, 2017), Imipenem in Pakistan (Farooq et al, 2019), Ampicillin (Ahmadi et al, 2016) and Ticarcillin/Clavulanic Acid (Karami et al, 2020) in Iran, Co-Trimoxazole in Nepal (Pokharel et al, 2019), Ceftazidime in India and Egypt (Senthamarai, 2014;Farhan et al, 2019), Cefepime in Qatar (Ahmed et al, 2019), Amoxicillin/Clavulanic Acid in Syria (Mahfoud et al, 2015), Penicillin and Amoxicillin/Clavulanic Acid in Iraq (Alhusseini et al, 2019), Aztreonam in Turkey (Acar et al, 2019) and Meropenem (Khan and Faiz, 2016), Ciprofloxacin followed by Meropenem and Imipenem (Al-Tawfiq et al, 2020) then both Carbapenems (Al-Tawfiq et al, 2020) in Saudi Arabia.…”

“…This represents a challenge for antimicrobial therapy patients and might be caused by the indiscriminate use of third generation Cephalosporin as broad spectrum empirical therapy and the secretion of Extended Spectrum Beta-Lactamases enzymes )ESBL( mediate the resistance by hydrolysis of β-lactam ring of β-lactam antibiotics (Richards and Brogden, 1985). Cefepime is a fourth generation Cephalosporin that has an antipseudomonal activity and was found to be the least effective drug against P. aeruginosa in Qatar with a resistance rate of (96.6%), which might be due to higher consumption of this drug compared to others (Ahmed et al, 2019).…”

“…In Nepal MDRPA prevalence was reported according to the type of specimen where it found to be the highest in tracheal aspirate specimens (100%) and the lowest in pleural fluid samples (0%) (Pokharel et al, 2019). Female to male ratio for MDRPA prevalence was reported in two of the included articles as it was (1.17:1) in Pakistan (Farooq et al, 2019) and (1:3) in Qatar (Ahmed et al, 2019). Further information was reported in Pakistan regarding distribution of MDRPA according to medical ward as it was the highest in surgical ward (27.1%) and the lowest in the gynecology ward (4.1%) (Farooq et al, 2019).…”

“…MDRPA prevalence was reported in seven of the collected articles. The distribution of MDRPA among the specimens was found to be as follows: Pakistan, (55%) (Farooq et al, 2019); Indonesia, (36%) (Rustini et al, 2017); India (41.35%) (Senthamarai, 2014); Egypt (66.6%) (Farhan et al, 2019); Qatar (8.1%) (Ahmed et al, 2019); Saudi Arabia (10.7%) (Khan and Faiz, 2016). In Nepal MDRPA prevalence was reported according to the type of specimen where it found to be the highest in tracheal aspirate specimens (100%) and the lowest in pleural fluid samples (0%) (Pokharel et al, 2019).…”