Tamer Essawi, Mohammad A Farraj, Israr Sabri

Extended Spectrum B-lactamases and antimicrobial susceptibility among clinical isolates of Pseudomonas aeruginosa in the West Bank, Palestine

Amaç: D sınıfı oksasilinazlar gram negatif basiller içinde ve de özellikle P. aeruginosa kökenlerinde yaygındır. P. aeruginosa hastane enfeksiyonlarının sık nedenlerinden biridir. P. aeruginosa kökenlerinde antibiyotik direncinin ve blaOXA genlerinin kazanılması tedavi başarısını etkiler. Bu çalışmada P. aeruginosa kökenlerinde antibiyotik direnci ve blaOXA gen varlığının tedavi başarısı üzerine etkileri araştırıldı.Yöntemler: Toplam 49 klinik P. aeruginosa izolatı Filistin’de bulunan Rafidia Hastanesinden elde edildi. Antimikrobiyal duyarlılık testleri standart disk difüzyon metodu ile CLSI standartlarına göre yapıldı. D grubu β-lactamaz (OXA grop I, II ve III) sıklığı ve pseudomonasa özgün enzimlerin (CARB-3) varlığı PCR yöntemiyle araştırıldı.Bulgular: P. aeruginosa kökenlerinde en yüksek duyarlılık karbapenemlere (%89) ve en düşük duyarlılık ise tikarsilin/klavulanik aside (%70) karşı saptandı. Bu çalışmanın sonuçlarına göre; P. aeruginosa kökenlerinde OXA-10 oranı %40,8, OXA-2 %20,4 ve OXA-1 %18,4. Seftazidime dirençli kökenlerin hepsi OXA-1 taşırken %18,4’ü OXA-11 taşıyorlardı. PSE grubu salgılanması ise %10,2 idi.Sonuç: Bu çalışma Filistin’deki P. aeruginosa izolatları üzerinde yapılan ve OXA genleriyle (blaOXA-1, blaOXA-2 ve blaOXA-10 ) antimikrobiyal direnç arasındaki ilişkiyi araştıran ilk çalışmadır. Sonuçlarımız dirençli kökenlerdeki tedavi prensiplerini anlamaya yardımcı oldu ve D grubu β-laktamazların coğrafi dağılımı hakkında bilgi sahibi olmamızı sağladı

Anahtar Kelimeler:

P. aeruginosa, β-laktamaz, Duyarlılık, Oksasilinaz, blaOXA genleri

Extended Spectrum B-lactamases and antimicrobial susceptibility among clinical isolates of Pseudomonas aeruginosa in the West Bank, Palestine

Objectives: Class D oxacillinases are frequently acquired by gram negative bacteria in general and P.aeruginosa in particular. P.aeruginosa is commonly implicated in causing nosocomial infections. The evolution of antibiotic resistance in P.aeruginosa and the acquisition of blaOXA genes interfere with successful treatment. Methods: A total of 49 clinical isolates of P.aeruginosa were obtained from Rafidia Hospital, West Bank, Palestine. Antimicrobial susceptibility testing of the isolates was performed by the standard disc diffusion method following the guidelines of CLSI. The prevalence of class D β-lactamases (OXA groups I, II and III) as well as the pseudomonas specific enzymes (CARB-3) were determined by PCR. Results: Susceptibility of P.aeruginosa to carbapenems was the highest 89%, and lowest to ticarcillin/clavulanic acid 70%. This study revealed that P.aeruginosa produced oxacillinase enzymes at rates of: OXA-10 (40.8%), OXA-2 (20.4%) and OXA-1 (18.4%). All ceftazidime resistant strains expressed OXA-1 and OXA-11, 18.4%. PSE group was expressed in 10.2%. Conclusions: This is the first research conducted to investigate the correlation between OXA genes (blaOXA-1, blaOXA-2 and blaOXA-10) and antimicrobial resistance among P.aeruginosa clinical isolates in Palestine. The results obtained could contribute to better treatment and reduction of the evolution of resistant strains. In addition, it will provide important information regarding the geographical distribution of class D β-lactamases.

Keywords:

P.aeruginosa,

PDF

___

Giamarellou H, Kanellakopoulou K. Current therapies for Pseudomonas aeruginosa. Crit Care Clin 2008;24:261-278.
Souli M, Galani I, Giamarellou H. Emergence of extensively drug-resistant and pandrug resistant Gram negative bacilli in Europe. Eurosurveillance 2008;13:1-11.
Wirth FW, Picoli SU, Cantarelli VV, et al. Metallo-β-lactamase- producing Pseudomonas aeruginosa in two hospitals from Southern Brazil. Braz J Infect Dis 2009;13:170-172.
Mahmood F, Hakimiyan A, Jayaraman V, et al. A novel hu- man antimicrobial factor targets Pseudomonas aerugi- nosa through its type III secretion system. J Med Microbiol 2013;62,531-539.
Hancock EWR, Speert DP. Antibiotic resistance in Pseudomo- nas aeruginosa: mechanisms and impact on treatment. Drug Resistance Updates 2000;3:247-255.
Mesaros N, Nordmann P, Plesiat P, et al. Pseudomonas aeru- ginosa: resistance and therapeutic options at the turn of the new millennium. Clin Microbiol Infect 2007;13:560-578.
Lister PD, Wolter DJ, Hanson ND. Antibacterial-Resistant Pseudomonas aeruginosa: Clinical impact and complex reg- ulation of chromosomally encoded resistance mechanisms. Clin Microbiol Rev 2009;22:582-610.
Hirsch EB, Tam VH. Impact of multidrug-resistant Pseudomo- nas aeruginosa infection on patient outcomes. Expert Rev Pharmacoecon Outcomes Res 2010,10:441-451.
Cholley P, Thouverez M, Hocquet D, van der Mee-Marquet N, Talon D, Bertrand X. Most multidrug-resistant Pseudomonas aeruginosa isolates from hospitals in Eastern France belong to a few clonal types. J Clin Microbiol 2011;49:2578-2583.
Khosravi Y, Tay ST, Vadivelu J. Analysis of integrons and associated gene cassettes of metallo-β-lactamase-positive Pseudomonas aeruginosa in Malaysia. J Med Microbiol 2011; 60:988-994
Lee S, Park YJ, Kim M, et al. Prevalence of Ambler class A and D β-lactamases among clinical isolates of Pseudomonas aeruginosa in Korea. J Antimicrob Chemother 2005;56:122- 127.
Strateva T, Ouzounova-Raykova V, Markova B, Todorova A, Marteva-Proevska Y, Mitov I. Problematic clinical isolates of Pseudomonas aeruginosa from the university hospitals in Sofia, Bulgaria: current status of antimicrobial resistance and prevailing resistance mechanisms. J Med Microbiol 2007;56:956-963.
Strateva T, Yordanov D. Pseudomonas aeruginosa - a phenomenon of bacterial resistance. J Med Microbiol 2009;58:1133-1148.
Doi Y, Poirel L, David L, Paterson DL, Nordmann P. Char- acterization of a Naturally Occurring Class D β-Lactamase from Achromobacter xylosoxidans. Antimicrobial agents and chemotherapy 2008;52:1952-1956.
Clinical Laboratory Standards Institute (CLSI). Performance standards for antimicrobial disk susceptibility tests; Approved standard - 8th edition 2009; MO2-A10,29:4-27.
Clinical Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing; 20th infor- mation supplement 2010; M100-S20,30:52-53.
Didier H, Dehecq B, Bertrand X, Plesiat P. Strain-Tailored Double-Disk Synergy Test Detects Extended-Spectrum Oxacillinases in Pseudomonas aeruginosa. J Clin Microbiol 2011;49:2262-2265.
Bert Frederic, Branger Catherine, Lambert-Zechovsky Ni- cole. Identification of PSE and OXA β-lactamase genes in Pseudomonas aeruginosa using PCR-restriction fragment length polymorphism J Antimicrob Chemother 2002;50:11- 18.
Church D, Elsayed S, Reid O, Winston B, Lindsay R. Burn Wound Infections. Clin Microb Rev 2006;19:403-434.
Venet F, Lepape A, Monneret G. Clinical review: flow cytom- etry perspectives in the ICU - from diagnosis of infection to monitoring of injury-induced immune dysfunctions. Crit Care 2011;15:231.
Heintz BH, Halilovic J. Lessons learned from surveillance of antimicrobial susceptibilities of Pseudomonas aerugi- nosa at a large academic medical center. Pharmaceuticals 2010;3:1070-1083.