ANTIBIOTIC RESISTANCE PATTERNS OF MBL-PRODUCING PSEUDOMONAS AERUGINOSA ISOLATED FROM HOSPITAL SETTINGS IN QUETTA, BALOCHISTAN
Main Article Content
Keywords
P. aeruginosa, MBL antibiotics, Balochistan.
Abstract
Objective: This study aimed to examine the variety of clinical specimens collected from admitted patients, perform isolation and identification of metallo-β-lactamase (MBL)-producing Pseudomonas aeruginosa and their antibiotic resistance patterns.
Methods: The cross-sectional study was conducted at Microbiology Laboratory of BMCH Quetta from June 2022 to June 2023. A total of 93 strain of P. aeruginosa were isolated from pus, urine, wounds, sputum and pleural fluid. All bacterial isolates were identified through established standard methods, and their antibiotic susceptibility was assessed using the Kirby-Bauer disc diffusion technique. This testing adhered strictly to the guidelines set forth by the Clinical and Laboratory Standards Institute (CLSI). Furthermore, imipenem-resistant strains were assessed for metallo-beta-lactamase (MBL) activity using the double-disk synergy assay.
Results: Among the 93 tested P. aeruginosa isolates, 24 exhibited resistances to Imipenem (IMP), with 18 (75%) of them being metallo-β-lactamase (MBL) producers. All MBL-positive isolates (100%) showed resistance to Cefotaxime, Ceftazidime, and Imipenem. Additionally, MBL-positive strains exhibited varying resistance patterns: Polymyxin B demonstrated a sensitivity of 6.67%, Piperacillin-tazobactam showed 66.66%, Amikacin exhibited 83.33%, Tobramycin reached 83.33%, and Ciprofloxacin displayed a sensitivity of 72.22%. In terms of ward distribution, the majority of samples, 43 (12.53%) were from the surgical unit, followed by 34 (9.91%) from medical wards, and 16 (4.66%) from the ICU.
Conclusion: Timely identification of P. aeruginosa that produces MBLs helps healthcare professionals choose appropriate antibiotics, implement infection control, and adapt treatment strategies to improve patient outcomes while controlling antibiotic resistance.
References
2. Allegranzi B, Nejad SB, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. The Lancet. 2011 Jan 15;377(9761):228-41.
3. Reynolds D, Kollef M. The epidemiology and pathogenesis and treatment of Pseudomonas aeruginosa infections: an update. Drugs. 2021 Dec;81(18):2117-31.
4. Mesaros N, Nordmann P, Plésiat P, Roussel-Delvallez M, Van Eldere J, Glupczynski Y, Van Laethem Y, Jacobs F, Lebecque P, Malfroot A, Tulkens PM. Pseudomonas aeruginosa: resistance and therapeutic options at the turn of the new millennium. Clinical microbiology and infection. 2007 Jun 1;13(6):560-78.
5. Kapoor G, Saigal S, Elongavan A. Action and resistance mechanisms of antibiotics: A guide for clinicians. Journal of Anesthesiology Clinical Pharmacology. 2017 Jul 1;33(3):300-5.
6. Lee K, Chong Y, Shin HB, Kim YA, Yong D, Yum JH. Modified Hodge and EDTA-disk synergy tests to screen metallo-β-lactamase-producing strains of Pseudomonas and Acinetobacter species. Clinical microbiology and infection. 2001 Feb 1;7(2):88-91.
7. Lee K, Lim YS, Yong D, Yum JH, Chong Y. Evaluation of the Hodge test and the imipenem-EDTA double-disk synergy test for differentiating metallo-β-lactamase-producing isolates of Pseudomonas spp. and Acinetobacter spp. Journal of clinical microbiology. 2003 Oct;41(10):4623-9.
8. Hancock RE. The bacterial outer membrane as a drug barrier. Trends in microbiology. 1997 Jan 1;5(1):37-42.
9. Collee JG, Marmion BP, Simmons A. Mackie and McCartney, practical Medical Microbiology, 14th editi Churchil living stone. New York. 1996.
10. Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a standardized single disk method. American journal of clinical pathology. 1966 Apr 1;45(4_ts):493-6.
11. PA W. Clinical and Laboratory Standards Institute: Performance standards for antimicrobial susceptibility testing: 20th informational supplement. CLSI document M100-S20. 2010.
12. Yong D, Lee K, Yum JH, Shin HB, Rossolini GM, Chong Y. Imipenem-EDTA disk method for differentiation of metallo-β-lactamase-producing clinical isolates of Pseudomonas spp. and Acinetobacter spp. Journal of clinical microbiology. 2002 Oct;40(10):3798-801.
13. Radhika A, Lakshmi JT, Ariyanachi K, Sakthivadivel V. Detection of Metallo Beta-Lactamase (MBL) producing pseudomonas aeruginosa in a tertiary care hospital, Ghanpur, Medchal, India. Maedica. 2022 Mar;17(1):134.
14. Srinivas B, Devi DL, Rao BN. A prospective study of Pseudomonas aeruginosa and its Antibiogram in a teaching hospital of rural setup. J Pharm Biomed Sci. 2012;22(18):1-5.
15. Javiya A, Somsuvra B., Kamlesh R., Pateland A., Patel. Antibiotic susceptibility patterns of Pseudomonas aeruginosa at a tertiary care hospital in Gujarat, India. Indian J Pharmacol. 2008 October; 40(5): 230–234.
16. Alkhudhairy MK, Al-Shammari MM. Prevalence of metallo-β-lactamase–producing Pseudomonas aeruginosa isolated from diabetic foot infections in Iraq. New microbes and new infections. 2020 May 1;35: 100661.
17. Angadi KM, Kadam M, Modak MS, Bhatavdekar SM, Dalal BA, Jadhavvar SR, Tolpadi AG, Thakkar V, Shah SR. Detection of antibiotic resistance in Pseudomonas aeruginosaisolates with special reference to metallo β-lactamases from a tertiary care hospital in Western India. International Journal of Microbiology Research. 2012 Sep 26;4(7):295-8.
18. Anupurba S, Bhattacharjee A, Garg A, Sen MR. Antimicrobial susceptibility of Pseudomonas aeruginosa isolated from wound infections. Indian journal of dermatology. 2006 Oct 1;51(4):286-8.
19. Arora D, Jindal N, Kumar R, Romit M. Emerging antibiotic resistance in Pseudomonas-A challenge. Int J Pharm Sci. 2011;3(2):82-84.
20. Dwivedi M, Mishra A, Singh RK, Azim A, Baronia AK, Prasad KN. Nosocomial cross-transmission of Pseudomonas aeruginosa between patients in a tertiary intensive care unit. Indian journal of Pathology and microbiology. 2009 Oct 1;52(4):509-13.
21. Ameen N, Memon Z, Shaheen S, Fatima G, Ahmed F. Imipenem Resistant Pseudomonas aeruginosa: The fall of the final quarterback. Pakistan journal of medical sciences. 2015 May;31(3):561.
22. Nagaveni S, Rajeshwari H, Oli AK, Patil SA, Chandrakanth RK. Widespread emergence of multidrug resistant Pseudomonas aeruginosa isolated from CSF samples. Indian journal of microbiology. 2011 Jan; 51:2-7.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Ashiq Hussain
Associate Professor Pathology Bolan Medical College Quetta
Yasmeen Lashari
Associate Professor Pathology Bolan Medical College Quetta
Asmatullah
Assistant Professor ENT Bolan Medical College Quetta
Habib Ullah
Assistant Professor ENT Bolan Medical College Quetta
Bezan Baloch
\Assistant Professor Surgery Bolan Medical College Quetta
Shahid Ali
Assistant Professor Pharmacology Jhalawan Medical College Khuzdar