Abstract
BackgroundCarbapenem resistance among Pseudomonas aeruginosa has become a serious life-threatening problem due to the limited therapeutic options. In this study, we investigated the prevalence and the molecular epidemiology of carbapenem resistant Pseudomonas aeruginosa (CRPA) isolated from three hospitals in Annaba city, Algeria.MethodsDuring the study period (January, 2012 to December, 2013), all patients infected by P. aeruginosa were considered as the potential study population. Antibiotic susceptibility testing was performed as recommended by the CLSI. Screening of carbapenemase producer isolates was performed by using imipenem-EDTA double-disk synergy test and modified Hodge test. CRPA isolates were tested for the presence of genes encoding β-lactamases, plasmid mediated quinolone resistance, aminoglycoside resistance and class 1 integrons were investigated by PCR and sequencing. The clonal relatedness among CRPA isolates was analyzed by pulsed-field gel electrophoresis method. The clinical data were collected to identify risk factors for CRPA carriage of P. aeruginosa infection.ResultsThe overall prevalence of CRPA was 18.75 %. The risk factors for carrying CRPA were the length of hospital stay (p = 0.04), co-infections with Staphylococcus aureus (p = 0.01), and the use of urinary catheter (p = 0.03). The in-hospital mortality rate among case patients was 13.33 % compared with 1.53 % for control patients (p = 0.09). All CRPA isolates were multidrug resistance and the most effective antibiotic against CRPA isolates was amikacin and colistin. PFGE revealed an epidemic clonal dissemination of CRPA isolates. None of CRPA isolated were found to be carbapenemase-producers. The blaPSE-1 and aac(3)-II gene was detected in two and five strains respectively. The class1 integrons were detected in 2 isolates with the presence of aadA7 gene cassette in these integrons.ConclusionThe endemic clonal dissemination and multi-drug resistance of CRPA isolates in our institution is highly alarming. Strict measure will be required to control the further spread of these pathogens in hospital setting.
Highlights
Carbapenem resistance among Pseudomonas aeruginosa has become a serious life-threatening problem due to the limited therapeutic options
It is anticipated that an improved understanding of the prevalence, mechanism, and risk factors of carbapenem resistance in P. aeruginosa may guide formulary decisions and the choice of empiric therapy for nosocomial infections in hospitals
The duration of hospitalization was different between the groups, it had a tendency to be prolonged in the carbapenem resistant Pseudomonas aeruginosa (CRPA) group, with a median of 63.44 ± 48.82 days in the carbapenem susceptible P. aeruginosa (CSPA) group and 82.5 ± 45.82 days in the CRPA group
Summary
Carbapenem resistance among Pseudomonas aeruginosa has become a serious life-threatening problem due to the limited therapeutic options. We investigated the prevalence and the molecular epidemiology of carbapenem resistant Pseudomonas aeruginosa (CRPA) isolated from three hospitals in Annaba city, Algeria. The MBL enzymes (IMP, VIM, SPM, GIM, SIM, AIM, FIM, and NDM) are able to hydrolyze carbapenems efficiently and they are considered as the most clinically significant mechanism of carbapenem resistance in P. aeruginosa isolates [4]. At Annaba hospital in Algeria and since December 2010, VIM-2 producing P. aeruginosa has been isolated, mainly in surgery and intensive care unit [7, 8]. It is anticipated that an improved understanding of the prevalence, mechanism, and risk factors of carbapenem resistance in P. aeruginosa may guide formulary decisions and the choice of empiric therapy for nosocomial infections in hospitals
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