PME and Other ESBL-Positive Multiresistant Pseudomonas aeruginosa Isolated from Hospitalized Patients in the Region of Kurdistan, Iraq

Abstract

Nosocomial infections occur worldwide and also in the Kurdistan region. Frequently patients colonized with multiresistant Pseudomonas aeruginosa isolates are encountered in many hospitals. As information is lacking with respect to the mechanisms of resistance responsible for the multiresistant character of the P. aeruginosa isolates and their genetic relationship, isolates were prospectively collected and characterized with respect to their mechanism of resistance. During 2012 and 2013, 81 P. aeruginosa isolates were collected from three teaching hospitals in the city of Erbil, Iraq. Susceptibility testing was performed using the VITEK-2 system. Isolates were screened for the presence of extended-spectrum β-lactamases (ESBLs) and for the presence of metallo β-lactamases (MBLs). The presence of serine carbapenemases was detected by PCR. The genetic relationship of the isolates was demonstrated by amplified fragment length polymorphism (AFLP). Susceptibility results revealed high rates of resistance against all classes of antibiotics except polymyxins. Genetic characterization demonstrated the presence of ESBL-genes, that is, bla (30%) and bla (17%), also ESBL bla was detected in four isolates. AFLP typing revealed clonal spread of bla, bla, and three clusters of bla-positive isolates. Only one isolate was MBL (bla) positive. Of a selected number of isolates (n = 11), whole-genome sequencing analysis revealed that these isolates belonged to "high-risk" MLSTs ST244, ST235, ST308, and ST654. This study reveals the presence and clonal spread of widely resistant high-risk clones of P. aeruginosa in Iraqi Kurdistan. As far as we are aware, this is the first report of multiple, polyclonal, PME producing P. aeruginosa outside the Arabian Peninsula.

Retrospective Analysis on Antimicrobial Resistance Trends and Prevalence of β-lactamases in Escherichia coli and ESKAPE Pathogens Isolated from Arabian Patients during 2000–2020

“…The results shown in Table 1 indicate that in Iraq during 2000 through 2020, resistance to 3rd- and 4th-generation standalone cephalosprins; ceftazidime, and cefepime was higher than that of β-lactam/β-lactamase inhibitor combination, amoxicillin-clavulanic acid. Curiously, resistance to piperacillin-tazobactam combination, aminoglycosides (gentamicin and amikacin) was higher than carbapenems such as; imipenem and meropenem [ 70 , 71 , 72 , 73 ]. These increases in antibiotic resistance in these isolates were correlated with the identification of β-lactamases phenotypically.…”

“…Isolates expressing various ESBLs were verified by using a double-disk potentiation method. Studies based on the 402 clinical samples have revealed that the incidence of ESBLs pathogens was comparatively low (13.5%) in 2000, but significantly increased to 61.5% over time [ 70 , 72 , 73 ]. The results shown in Table 2 represent molecular characterization of the ESBL trait with PCR analysis.…”

“…Table 2 shows that bla SHV , bla TEM and bla CTX-M were the most predominant ESBLs among E. coli and ESKAPE pathogens, and an increasing trend was also observed for bla OXA , bla PER , and bla VEB ESBL traits. bla NDM was the most prevalent metallo-β-lactamase encoding gene, with fewer isolates demonstrating expression of the bla VIM and bla IMP ESBL trait [ 71 , 72 , 73 , 74 ].…”

Detection of Carbapenemase-Producing Klebsiella pneumoniae and Escherichia coli Recovered from Clinical Specimens in Erbil City Kurdistan Region of Iraq

“…Results presented in Figure 4 provide evidence for the effects of IMP-resistance on MBLproduction, the study assessed that 19 (82.6%) of the IMP-resistant isolates were MBLproducers while only 4 of the IMP-resistant isolates were non MBL-producers. [17][18][19] In the current study, the frequency of Escherichia coli isolates were (75.5%) while Klebsiella pneumoniae was (24.5%) of the isolates, most of them were isolated from urine samples (66.0%), this result is in conformity with another study conducted by Romero and coworkers [20]. The highest level of antibiotic resistance among Escherichia coli isolates was presented against ampicillin (91.8%) which is shown in (Figure 1).…”

An outbreak of ST307 extended-spectrum beta-lactamase (ESBL)–producingKlebsiella pneumoniaein a rehabilitation center: An unusual source and route of transmission

“…We performed MLVA according to the method of Brink et al (2014) 12 with minor modifications, and we performed AFLP according to the method of van Burgh et al 13 with minor modifications. We used HpyCHIV4 and MseI restriction enzymes in combination with a selective G residue for HpyCHIV4 and GG for MseI.…”