Abstract
The rise in multiple-drug-resistant (MDR) phenotypes in Gram-negative pathogens is a major public health crisis. Pseudomonas aeruginosa is one of the leading causes of nosocomial infections in clinics. Treatment options for P. aeruginosa have become increasingly difficult due tdo its remarkable capacity to resist multiple antibiotics. The presence of intrinsic resistance factors and the ability to quickly adapt to antibiotic monotherapy warrant us to look for alternative strategies like combinatorial antibiotic therapy. Here, we report the frequency of P. aeruginosa multidrug-resistant and extensively drug-resistance (XDR) phenotypes in a super-specialty tertiary care hospital in north India. Approximately 60 percent of all isolated P. aeruginosa strains displayed the MDR phenotype. We found highest antibiotic resistance frequency in the emergency department (EMR), as 20 percent of isolates were resistant to 15 antipseudomonal antibiotics. Presence of plasmids with quinolone-resistance determinants were major drivers for resistance against fluoroquinolone. Additionally, we explored the possible combinatorial therapeutic options with four antipseudomonal antibiotics—colistin, ciprofloxacin, tobramycin, and meropenem. We uncovered an association between different antibiotic interactions. Our data show that the combination of colistin and ciprofloxacin could be an effective combinatorial regimen to treat infections caused by MDR and XDR P. aeruginosa.
Highlights
A High Level of Antibiotic Resistance Is Observed among P. aeruginosa
We observed the highest rates of resistance for the fluoroquinolones, with resistance to ciprofloxacin, ranging from 50 to
P. aeruginosa isolates from the emergency department (EMR) department showed higher resistance rates for fluoroquinolones, β-lactams, aminoglycosides, co-trimoxazole, and colistin than general trends for hospitalized patients
Summary
The expanding frequency of multidrug-0resistant pathogens and the virtually dry pipeline of new antibiotics have created a formidable challenge for our public health settings [1,2]. Infections due to Gram-negative pathogens, especially Pseudomonas aeruginosa, are responsible for high mortality around the globe [3,4,5]. P. aeruginosa is responsible for blood infections, respiratory tract infections, skin infections, urinary tract infections, and surgical site infections [6,7,8]. The presence of high-level intrinsic and acquired resistance determinants in this pathogen often results in poor clinical outcomes. Frequent reports of Pharmaceuticals 2022, 15, 243.
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