High prevalence of carbapenem resistant Acinetobacter baumannii associated respiratory tract infections in Pakistani hospitals

Khalid, Fizza; Saleem, Sidrah; Ahmad, Irfan

doi:10.5455/jpma.35384

Cited by 7 publications

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“…In addition, 84% (126/150) of the isolates were resistant to imipenem, 9,3% (14/150) to minocycline and doxycycline, and 7,3% (11/150) to colistin and polymyxin B (Table 1). Except for the findings on colistin resistance, data were in line with previous studies describing extensive occurrence of multidrug-resistant strains of A. baumannii in Pakistan (Begum et al, 2013;Khalid et al, 2020). More alarmingly, there were two isolates resistant to all tested 2 nd line and 3 rd line antibiotics including colistin, moxifloxacin and doxycycline.…”

Section: High Frequency Of Colistin Resistance In Extreme Drug Resist...supporting

confidence: 89%

“…Bacteremia and acute respiratory distress syndrome associated with A. baumannii infections are often fatal (Mcconnell et al, 2013). Over the last 2 decades, a tremendous rise in antimicrobial resistance of A. baumannii has been reported throughout the world (Antunes et al, 2014;Ayoub Moubareck and Hammoudi Halat, 2020;Karah et al, 2020;Khalid et al, 2020;Ibrahim et al, 2021). In contrast, new additions to the arsenal of useful antimicrobial drugs are remarkably low.…”

Section: Introductionmentioning

confidence: 99%

“…Pakistan stands among countries where carbapenem resistant A. baumannii are reported at very high frequency (Begum et al, 2013;Evans et al, 2011;Hasan et al, 2014;Hsu et al, 2017;Karah et al, 2020;Khalid et al, 2020). Carbapenem resistant A. baumannii infections are challenging to treat due to limited available options.…”

Section: Introductionmentioning

confidence: 99%

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Emergence of high colistin resistance in carbapenem resistant Acinetobacter baumannii in Pakistan and its potential management through immunomodulatory effect of an extract from Saussurea lappa

et al. 2022

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Carbapenem resistant Acinetobacter baumannii has emerged as one of the most difficult to treat nosocomial bacterial infections in recent years. It was one of the major causes of secondary infections in Covid-19 patients in developing countries. The polycationic polypeptide antibiotic colistin is used as a last resort drug to treat carbapenem resistant A. baumannii infections. Therefore, resistance to colistin is considered as a serious medical threat. The purpose of this study was to assess the current status of colistin resistance in Pakistan, a country where carbapenem resistant A. bumannii infections are endemic, to understand the impact of colistin resistance on virulence in mice and to assess alternative strategies to treat such infections. Out of 150 isolates collected from five hospitals in Pakistan during 2019-20, 84% were carbapenem resistant and 7.3% were additionally resistant to colistin. There were two isolates resistant to all tested antibiotics and 83% of colistin resistant isolates were susceptible to only tetracycline family drugs doxycycline and minocycline. Doxycycline exhibited a synergetic bactericidal effect with colistin even in colistin resistant isolates. Exposure of A. baumannii 17978 to sub inhibitory concentrations of colistin identified novel point mutations associated with colistin resistance. Colistin tolerance acquired independent of mutations in lpxA, lpxB, lpxC, lpxD, and pmrAB supressed the proinflammatory immune response in epithelial cells and the virulence in a mouse infection model. Moreover, the oral administration of water extract of Saussuria lappa, although not showing antimicrobial activity against A. baumannii in vitro, lowered the number of colonizing bacteria in liver, spleen and lung of the mouse model and also lowered the levels of neutrophils and interleukin 8 in mice. Our findings suggest that the S. lappa extract exhibits an

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Section: High Frequency Of Colistin Resistance In Extreme Drug Resist...supporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

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Emergence of high colistin resistance in carbapenem resistant Acinetobacter baumannii in Pakistan and its potential management through immunomodulatory effect of an extract from Saussurea lappa

et al. 2022

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“…A study from Teheran, Iran, also showed 100% resistance to imipenem and meropenem in intensive care patients [ 20 ]. Several studies have reported the high resistance of A. baumannii to β-lactams, including carbapenems, in a variety of clinical settings in Pakistan [ 10 , 21 , 22 , 23 ]. In addition, in Bulgaria, A. baumannii isolates were 98.2% and 100% resistant to imipenem and meropenem, respectively [ 24 ].…”

Section: Discussionmentioning

confidence: 99%

The Molecular Detection of Class B and Class D Carbapenemases in Clinical Strains of Acinetobacter calcoaceticus-baumannii Complex: The High Burden of Antibiotic Resistance and the Co-Existence of Carbapenemase Genes

et al. 2022

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The emergence of carbapenem-resistant Acinetobacter calcoaceticus-baumannii complex (CRACB) in clinical environments is a significant global concern. These critical pathogens have shown resistance to a broad spectrum of antibacterial drugs, including carbapenems, mostly due to the acquisition of various β-lactamase genes. Clinical samples (n = 1985) were collected aseptically from multiple sources and grown on blood and MacConkey agar. Isolates and antimicrobial susceptibility were confirmed with the VITEK-2 system. The modified Hodge test confirmed the CRACB phenotype, and specific PCR primers were used for the molecular identification of blaOXA and blaNDM genes. Of the 1985 samples, 1250 (62.9%) were culture-positive and 200 (43.9%) were CRACB isolates. Of these isolates, 35.4% were recovered from pus samples and 23.5% from tracheal secretions obtained from patients in intensive care units (49.3%) and medical wards (20.2%). An antibiogram indicated that 100% of the CRACB isolates were resistant to β-lactam antibiotics and β-lactam inhibitors, 86.5% to ciprofloxacin, and 83.5% to amikacin, while the most effective antibiotics were tigecycline and colistin. The CRACB isolates displayed resistance to eight different AWaRe classes of antibiotics. All isolates exhibited the blaOXA-51 gene, while blaOXA-23 was present in 94.5%, blaVIM in 37%, and blaNDM in 14% of the isolates. The blaOXA-51, blaOXA-23, and blaOXA-24 genes co-existed in 13 (6.5%) isolates. CRACB isolates with co-existing blaOXA-23, blaOXA-24, blaNDM, blaOXA-51 and blaVIM genes were highly prevalent in clinical samples from Pakistan. CRACB strains were highly critical pathogens and presented resistance to virtually all antibacterial drugs, except tigecycline and colistin.

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“…Both HAP and VAP are associated with the increasing prevalence of resistant nosocomial pathogens. The resistance rate of A. baumannii isolated from hospitals to antibiotics has risen rapidly, including carbapenem resistance 33 – 35 . Carbapenems constitute an important class of antibiotics for the treatment of nosocomial infections caused by gram-negative bacteria 36 .…”

Section: Discussionmentioning

confidence: 99%

Enhanced antibacterial effect of a novel Friunavirus phage vWU2001 in combination with colistin against carbapenem-resistant Acinetobacter baumannii

Wintachai

Phaonakrop

Roytrakul

et al. 2022

Sci Rep

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The emergence of carbapenem-resistant Acinetobacter baumannii (CRAB) has been increasingly reported, leading to greater challenges in treating infections. With the development of phage therapy and phage-antibiotic combinations, it is promising to improve the treatment of bacterial infections. In the present study, a novel vB_AbaP_WU2001 (vWU2001) phage-specific CRAB with a genome of 40,792 bp was isolated. Genomic analysis disclosed that it belongs to the Autographiviridae family of the order Caudovirales. Phage vWU2001 had a broad host range with a high adsorption rate, short latent period, large burst size and good stability. The phage could reduce preformed biofilms and inhibit biofilm formation. The combination of phage vWU2001 and colistin had significantly higher bacterial growth inhibition activity than that of phage, or colistin alone. The efficacy of the combined treatment was also evaluated in Galleria mellonella. Evaluation of its therapeutic potential showed that the combination of phage and colistin resulted in a significantly greater increase in G. mellonella survival and in bacterial clearance, as compared with that of phage or colistin alone, indicating that the combination was synergistic against CRAB. The results demonstrated that phage vWU2001 has the potential to be developed as an antibacterial agent.

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High prevalence of carbapenem resistant Acinetobacter baumannii associated respiratory tract infections in Pakistani hospitals

Cited by 7 publications

References 0 publications

Emergence of high colistin resistance in carbapenem resistant Acinetobacter baumannii in Pakistan and its potential management through immunomodulatory effect of an extract from Saussurea lappa

Emergence of high colistin resistance in carbapenem resistant Acinetobacter baumannii in Pakistan and its potential management through immunomodulatory effect of an extract from Saussurea lappa

The Molecular Detection of Class B and Class D Carbapenemases in Clinical Strains of Acinetobacter calcoaceticus-baumannii Complex: The High Burden of Antibiotic Resistance and the Co-Existence of Carbapenemase Genes

Enhanced antibacterial effect of a novel Friunavirus phage vWU2001 in combination with colistin against carbapenem-resistant Acinetobacter baumannii

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