Phenotypic characterization of the Egyptian isolates “extensively drug-resistant Pseudomonas aeruginosa” and detection of their metallo-β-lactamases encoding genes

Abstract

Background: Carbapenem antibiotics consider the primary treatment choice for serious Pseudomonas aeruginosa infection. Hence, the evolution of carbapenem resistance mediated by acquiring genes encoding class b enzymes is of global concern. The purpose of this article research is to explore the prevalence, drug resistance profiles, and metallo-βlactamases (MβLs) production in extensively drug-resistant carbapenem-resistant P. aeruginosa (XDR-CRPA). Methods: P. aeruginosa isolates were collected and identified according to conventional methods. Antibiotic resistance patterns were determined by single disk diffusion. Minimum inhibitory concentrations (MICs) of (imipenem, meropenem, ceftazidime, piperacillin/tazobactam, levofloxacin, and gentamicin) were determined for CRPA. A subset of the isolates collection consisting of the XDR-CRPA with the highest MICs to imipenem and meropenem were selected for the phenotypic screening of carbapenemases and MβLs production capability using the modified carbapenem inactivation (mCIM) and imipenem-EDTA combined disk (MβL-CD) methods, respectively. Then, molecular analysis, including identification by the specific primer of 16S rRNA and detection of MβL genes using polymerase chain reaction (PCR) was performed to the XDR selected isolates. Results: Among 100 P. aeruginosa isolated throughout this period, 59% exhibited reduced susceptibility rates to carbapenems. A total of 20.3% and 57% of CRPA isolates were MDR and XDR, respectively. MIC values of the CRPA revealed that these isolates exhibited high MIC 50 and MIC 90 to the six selected antibiotics. The findings of the (mCIM) assay displayed identical concordance results with the MβL-CD. Molecular investigation technique assured that 10 (90.9%) and 2 (18.1%) of the 11 XDR selected isolates are positive for bla NDM-1 and bla VIM-1 genes, respectively. Polymyxin B and colistin followed by aztreonam were the most effective antibiotics used for curing infections caused by XDR Pseudomonas aeruginosa. Conclusion: The prevalence of high XDR-CRPA in our study is a critical problem. Our present study found that the bla NDM-1 was present at a significant frequency among the selected XDR isolates, highlighting the need for establishing strict antimicrobial policies to avoid the prompt spread of these isolates.

Expression of Mex AB-Opr M efflux pump system and meropenem resistance in Pseudomonas aeruginosa isolated from surgical intensive care unit

“…Concerning meropenem susceptibility in this study, 35 (44.8%) of isolates were meropenem resistant. In a similar study in Egypt by Basha and coworkers [23], it was reported that 57% of their isolated P. aeurginosa were resistant to meropenem. Also 62% of isolates from health care associated infections at Suez Canal University Hospitals were meropenem resistant Kishk et al [1].…”

“…However, a lower resistance rate was detected by Fotouh et al [21] who reported that (22.2%) of P. aeruginosa isolated from surgical site infection of patients admitted at Zagazig University hospitals were meropenem resistant. High meropenem resistance rate detected might be correlated with the selective pressure from increased use of carbapenems for P. aeurginosa infections [23].…”

High Rates of Aminoglycoside Methyltransferases Associated with Metallo-Beta-Lactamases in Multidrug-Resistant and Extensively Drug-Resistant Pseudomonas aeruginosa Clinical Isolates from a Tertiary Care Hospital in Egypt

“…So, the spread of P. aeruginosa with MβL activity could result in a panresistant phenotype, thus resulting in further limitation of therapeutic treatment options for these isolates. 9 In this study, we aimed to evaluate the predominance of aminoglycoside resistance among MDR and XDR P. aeruginosa isolates, and to detect the main mechanisms of resistance and the most prevalent aminoglycoside resistance genes. Since carbapenem resistance represents a crucial problem that further limits therapeutic options in these isolates, bla MβL s were also investigated.…”

“…So, the spread of P. aeruginosa with MβL activity could result in a pan-resistant phenotype, thus resulting in further limitation of therapeutic treatment options for these isolates. 9 …”

Landscape of Multidrug-Resistant Gram-Negative Infections in Egypt: Survey and Literature Review

“…Figure5Summary of the prevalence (%) of carbapenemase genes in P. aeruginosa. Notes: Data from references37,40,[44][45][46][47]49,51,80,[85][86][87][88][89][90][91][92] . a % of MBL-producing P. aeruginosa; b % of P. aeruginosa isolates resistant to one or more β-lactams; c % of XDR-CRPA; d % of imipenem-resistant P. aeruginosa; e % of carbapenemase genes…”