Coexistence of AmpC and Extended-Spectrum β-lactamases in Metallo-β-Lactamase Producing Pseudomonas aeruginosa Burn Isolates in Tehran

Abstract

Background: Multi-drug resistant Pseudomonas aeruginosa causes serious complications in burn patients. One of the most important mechanisms of resistance to β-lactam antibiotics is hydrolysis of antibiotics by various β-lactamases. In recent years, Carbapenems have been widely used for treatment of P. aeruginosa infections. However, the organisms have become resistant to Carbapenems mostly by producing metallo β-lactamases. Objectives: The aim of this study was to determine antibiotic susceptibility, production of extended spectrum and AmpC β-lactamases in metallo β-lactamase producing P. aeruginosa burn isolates. Materials and Methods: Antibiotic susceptibility of 135 P. aeruginosa burn isolates was determined by disc diffusion. Metallo β-lactamase production was screened by the double disc synergy test. Metallo β-lactamase producing bacteria were then tested for extended spectrum β-lactamase production by the combined disc diffusion method. AmpC production was carried out using AmpC disc test. Results: There was 99% resistance to Carbenicillin, and Ticarcillin, 98% to Cotrimoxazole, 96% to Ciprofloxacin, and Aztreonam, 95% to Imipenem, and Meropenem, 94% to Pperacillin, 93% to Tobramycin, 92% to Cefepime, 90% to Amikacin, 89% to Ceftazidime, and 87% to Piperacillin-tazobactam. Among the 128 Imipenem resistant isolates, 32 (25%) were capable of producing metallo β-lactamases of which, 4 (12.5%) produced extended spectrum and 26 (81%) produced AmpC β-lactamases. Four isolates (12.5%) produced all 3 types. Conclusions: This study showed that multiple β-lactamases can be produced in burn isolates. This suggests that use of Cephalosporins and Carbapenems should be restricted in burn isolates to minimize the development and spread of these multidrug resistant pathogens.