Antibiotic Resistance Patterns and Distribution of Extended- Spectrum Beta-Lactamases and Different Classes of Integrons Among Pseudomonas aeruginosa strains recovered from various clinical samples
DOI:
https://doi.org/10.35516/jmj.v59i1.2546Keywords:
Pseudomonas aeruginosa, class A ESBL, multi-drug resistant, integronsAbstract
Background: Treatment of infections caused by Pseudomonas
aeruginosa (P. aeruginosa) is becoming more difficult with each passing
year. Class A extended-spectrum beta-lactamases (ESBLs) and integrons
play a vital role in antibiotic treatment failure and ensuing poor patient
outcomes. We aimed to determine the prevalence of antibiotic resistance
patterns, class A ESBLs genes, as well as different classes of integrons
among P. aeruginosa strains obtained from clinical specimens.
methods: In total, 90 non-repetitive isolates of P.
aeruginosa were collected from clinical specimens. Standard
microbiology laboratory tests were used to identify P. aeruginosa.
Antibiotic resistance patterns were ascertained using the disc diffusion
method based on clinical and laboratory standard institute guidelines. The
PCR (polymerase chain reaction) was applied to detect ESBLs (blaCTXM,
blaSHV, and blaTEM) genes and different classes of integrons (I, II, and III).
Results: In this study, isolates were mostly resistant to ceftazidime 41
(45.6%) and gentamicin 39 (43.3%). Out of 90 investigated isolates, 25
(27.8%) were multi-drug resistant (MDR). ESBLs genes including
blaCTXM, blaTEM, and blaSHV were detected in 22.2% (20 of 90), 28.9% (26
of 90), and 31.1% (28 of 90) of the isolates, respectively. The prevalence
of class I and II integrons was 61.1% and 4.4%, respectively. Class III
integrons were not detected.
Conclusion: Based on this study's results, the prescription of ceftazidime
and gentamicin should be restricted. In addition, ESBLs genes and
integrons seem to play a significant role in the emergence and spread of
MDR infections. It is of pivotal importance that microbiology laboratory
remains vigilant about identifying ESBLs and integrons-positive isolates
through surveillance systems.
References
Qin S, Xiao W, Zhou C, Pu Q, Deng X, Lan L, et
al. Pseudomonas aeruginosa: pathogenesis,
virulence factors, antibiotic resistance, interaction
with host, technology advances and emerging
therapeutics. Signal Transduct Target Ther. 2022;
(1): 199.
Reyes J, Komarow L, Chen L, Ge L, Hanson BM,
Cober E, et al. Global epidemiology and clinical
outcomes of carbapenem-resistant Pseudomonas
aeruginosa and associated carbapenemases (POP):
a prospective cohort study. Lancet Microbe. 2023;
(3): e159-e170.
Vaez H, Salehi-Abargouei A, Ghalehnoo ZR,
Khademi F. Multidrug Resistant Pseudomonas
aeruginosa in Iran: A Systematic Review and
Metaanalysis. J Glob Infect Dis. 2018; 10(4): 212-
WHO. Media Center. WHO publishes list of
bacteria for which new antibiotics are urgently
needed. World Health Organization: Feb 27, 2017.
Vaez H, Faghri J, Isfahani BN, Moghim S,
Yadegari S, Fazeli H, Moghofeei M, Safaei HG.
Efflux pump regulatory genes mutations in
multidrug resistance Pseudomonas aeruginosa
isolated from wound infections in Isfahan
hospitals. Adv Biomed Res. 2014
Namaki M, Habibzadeh S, Vaez H, Arzanlou M,
Safarirad S, Bazghandi SA, Sahebkar A, Khademi
F. Prevalence of resistance genes to biocides in
antibiotic-resistant Pseudomonas aeruginosa
clinical isolates. Mol Biol Rep. 2022; 49(3): 2149-
Castanheira M, Simner PJ, Bradford PA.
Extended-spectrum β-lactamases: An update on
their characteristics, epidemiology and detection.
JAC-antimicrobial resistance. 2021; 3(3)
Liu M, Ma J, Jia W, Li W. Antimicrobial
Resistance and Molecular Characterization of
Gene Cassettes from Class 1 Integrons
in Pseudomonas aeruginosa Strains. Microb Drug
Resist. 2020 Jun; 26(6): 670-676.
Mahon C, Lehman, D, Manuselis G. Text Book of
Diagnostic Microbiology. 7th Ed. New York, NY,
USA: Elsevier, 2022.
Clinical and Laboratory Standards Institute
(CLSI). Performance Standards for Antimicrobial
Susceptibility Testing. 28th ed. CLSI supplement
M100. Wayne, PA: Clinical and Laboratory
Standards Institute; 2018.
Delarampour A, Ghalehnoo ZR, Khademi F, Vaez
H. Antibiotic resistance patterns and prevalence of
class I, II and III Integrons among clinical isolates
of Klebsiella pneumoniae. Le infezioni in
medicina. 2020; 28(1): 64-9
Kiratisin P, Apisarnthanarak A, Laesripa C, Saifon
P. Molecular characterization and epidemiology of
extended-spectrum-β-lactamase-producing
Escherichia coli and Klebsiella pneumoniae
isolates causing health care-associated infection in
Thailand, where the CTX-M family is endemic.
Antimicrobial agents and chemotherapy. 2008;
(8): 2818-24.
Colom K, Pérez J, Alonso R, Fernández-Aranguiz
A, Lariño E, Cisterna R. Simple and reliable
multiplex PCR assay for detection of bla TEM, bla
SHV and bla OXA–1 genes in Enterobacteriaceae.
FEMS microbiology letters. 2003; 223(2): 147-51
Pang Z, Raudonis R, Glick BR, Lin TJ, Cheng Z.
Antibiotic resistance in Pseudomonas aeruginosa:
mechanisms and alternative therapeutic strategies.
Biotechnol Adv. 2019; 37(1): 177-192.
Subedi D, Vijay AK, Willcox M. Overview of
mechanisms of antibiotic resistance in
Pseudomonas aeruginosa: an ocular perspective.
Clin Exp Optom. 2018; 101(2): 162-171.
Vaez H, Khademi F, Salehi-Abargouei A, Sahebkar
A. Metallo- beta- Lactamase-producing
Pseudomonas aeruginosa in Iran: a systematic
review and meta-analysis. Infez Med. 2018 Sep 1;
(3): 216-225.
European Centre for Disease Prevention and
Control. Surveillance of antimicrobial resistance in
Europe 2018. Stockholm: ECDC; 2019.
Saeid M, Yazdanpour Z, Khademi F, Vaez H
prevalence of extended-spectrum beta lactamase
blaCTXM,blaSHV and blaTEM genes in
Escherichia coli strains isolated from clinical
samples of patients with urinary tract infections.
Int J Basic SciMed. 2022; 7(2): 89-93.
Nazari Alam A, Sarvari J, Motamedifar M,
Khoshkharam H, Yousefi M, Moniri R, et al. The
occurrence of blaTEM, blaSHV and blaOXA
genotypes in Extended-Spectrum β-Lactamase
(ESBL)-producing Pseudomonas aeruginosa
strains in Southwest of Iran. Gene Rep. 2018; 13:
-23.
Hasanpour F, Ataei N, Sahebkar A, Khademi F.
Distribution of Class A Extended-Spectrum β-
Lactamases Among Pseudomonas aeruginosa
Clinical Strains Isolated from Ardabil Hospitals.
Jundishapur J Microbiol. 2023; 16(4): e135726.
Hakemi Vala M, Hallajzadeh M, Hashemi A,
Goudarzi H, Tarhani M, Sattarzadeh Tabrizi M,
Bazmi F. Detection of Ambler class A, B and D ßlactamases
among Pseudomonas aeruginosa and
Acinetobacter baumannii clinical isolates from
burn patients. Ann Burns Fire Disasters. 2014;
(1): 8-13.
Tilahun M, Gedefie A, Bisetegn H, Debash H.
Emergence of High Prevalence of Extended-
Spectrum Beta-Lactamase and Carbapenemase
Producing Acinetobacter Species and Pseudomonas aeruginosa Among Hospitalized
Patients at Dessie Comprehensive Specialized
Hospital, North-East Ethiopia. Infection and Drug
Resistance. 2022: 895-911
Ouedraogo A-S, Sanou M, Kissou A. High
prevalence of extended-spectrum ß-lactamase
producing Enterobacteriaceae among clinical
isolates in Burkina Faso. BMC Infect Dis. 2016;
(1): 1–9.
Ghafourian S, Sadeghifard N, Soheili S, Sekawi Z.
Extended Spectrum Beta-lactamases: Definition,
Classification and Epidemiology. Curr Issues Mol
Biol. 2015; 17: 11-21.
Shaikh S, Fatima J, Shakil S, Rizvi SM, Kamal
MA. Risk factors for acquisition of extended
spectrum beta lactamase producing Escherichia
coli and Klebsiella pneumoniae in North-Indian
hospitals. Saudi Journal of Biological Sciences.
; 22(1): 37-41.
Rezai M S, Ahangarkani F, Rafiei A, Hajalibeig A,
Bagheri-Nesami M. Extended-Spectrum Beta-
Lactamases Producing Pseudomonas
aeruginosa Isolated From Patients With Ventilator
Associated Nosocomial Infection. Arch Clin Infect
Dis. 2018; 13(4): e13974.
Bokaeian M, Shahraki Zahedani S, Soltanian
Bajgiran M, Ansari Moghaddam A. Frequency of
PER, VEB, SHV, TEM and CTX-M Genes in
Resistant Strains of Pseudomonas aeruginosa
Producing Extended Spectrum β-Lactamases.
Jundishapur J Microbiol. 2014; 8(1): e13783.
Potron A, Poirel L, Nordmann P. Emerging broadspectrum
resistance in Pseudomonas aeruginosa
and Acinetobacter baumannii: mechanisms and
epidemiology. International journal of
antimicrobial agents. 2015; 45(6): 568-85.
Sabbagh P, Rajabnia M, Maali A, Ferdosi-
Shahandashti E. Integron and its role in
antimicrobial resistance: A literature review on
some bacterial pathogens. Iran J Basic Med Sci.
; 24(2): 136-142.
Khosravi AD, Motahar M, Abbasi Montazeri E.
The frequency of class1 and 2 integrons in
Pseudomonas aeruginosa strains isolated from
burn patients in a burn center of Ahvaz, Iran. PloS
one. 2017; 12(8): e0183061.
Khademi F, Ashrafi SS, Neyestani Z, Vaez H,
Sahebkar A. Prevalence of class I, II and III
integrons in multidrug-resistant and carbapenemresistant
Pseudomonas aeruginosa clinical isolates.
Gene Reports. 2021; 25: 101407.
Elfadadny A, Ragab RF, AlHarbi M, Badshah F,
Ibáñez-Arancibia E, Farag A, Hendawy AO, De los
Ríos-Escalante PR, Aboubakr M, Zakai SA,
Nageeb WM. Antimicrobial resistance of
Pseudomonas aeruginosa: navigating clinical
impacts, current resistance trends, and innovations
in breaking therapies. Frontiers in Microbiology.
Apr 5; 15: 1374466.
Kang CI, Kim SH, Kim HB, Park SW, Choe YJ,
Oh MD, Kim EC, Choe KW. Pseudomonas
aeruginosa bacteremia: risk factors for mortality
and influence of delayed receipt of effective
antimicrobial therapy on clinical outcome. Clinical
infectious diseases. 2003 Sep 15; 37(6): 745-51.
Folic MM, Djordjevic Z, Folic N, Radojevic MZ,
Jankovic SM. Epidemiology and risk factors for
healthcare-associated infections caused by
Pseudomonas aeruginosa. Journal of
Chemotherapy. 2021 Sep 7; 33(5): 294-301.