Abstract
Infections with Pseudomonas aeruginosa (P. aeruginosa) have become a real fear in hospital-acquired infections, especially in critically ill and immunocompromised patients. Thus, advance of novel anti-infectives is currently pursued. The aim of the present study was to evaluate the antibacterial effect of each of citrus honey and fosfomycin in comparison to the combined effect of both of them on multidrug resistant (MDR) P. aeruginosa. 50 MDR P. aeruginosa isolates were tested for the antibacterial effect of citrus honey. Screening for potential synergistic activity of fosfomycin and honey combinations by E test. Molecular detection of the virulent exoenzyme U (exoU) genotype by conventional PCR was done. The present study found that 50 % (v/v) concentration of citrus honey was sufficient to inhibit the growth of most isolates (33/50, 66%). Minimal inhibitory concentration (MIC) for fosfomycin tested by E test was found to be >128 µg/mL in 50(100%) of MDR P. aeruginosa isolates but after repeating E test with Mueller-Hinton agar (MHA) containing sublethal concentration of citrus honey (29/50,58%) isolates were sensitive. Also, there was a significant correlation between the presence of exoU gene and positive synergy of citrus honey-fosfomycin combination. This study showed that citrus honey has antibacterial effect and synergy with fosfomycin antibiotic against MDR P. aeruginosa isolates. Also, exoU positive genotype is associated with MDR phenotype. In conclusion, our results revealed that the citrus honey-fosfomycin combination showed highly statistically significant effect on MDR P. aeruginosa fosfomycin susceptibility pattern. exoU positive P. aeruginosa isolates were detected mostly in burn unit and ICUs. Also, there was a statistically significant correlation between the presence of exoU gene and positive result of honey-fosfomycin combination E test.
Highlights
Non-S. epidermidis isolates from serious infections with minimal inhibitory concentration (MIC) in this range may be tested for mecA or for penicillin-binding protein 2a (PBP2a)
Isolates that test mecA or PBP2a negative should be reported as oxacillin susceptible
The zone margin should be considered the area showing no obvious, visible growth that can be detected with the unaided eye
Summary
Institutional infection control procedures or epidemiological investigations may necessitate identification of carbapenemase-producing Enterobacteriaceae and P. aeruginosa Such testing is not currently recommended for routine use. Carbapenemase-producing isolates of Enterobacteriaceae usually test intermediate or resistant to one or more carbapenems using the current breakpoints as listed in Table 2A (NOTE: Ertapenem nonsusceptibility is the most sensitive indicator of carbapenemase production) and usually test resistant to one or more agents in cephalosporin subclass III (eg, cefoperazone, cefotaxime, ceftazidime, ceftizoxime, and ceftriaxone). Laboratories using Enterobacteriaceae MIC breakpoints for carbapenems described in M100-S20 (January 2010) should perform mCIM with or without eCIM, the CarbaNP test, and/or a molecular assay as described below when isolates of Enterobacteriaceae are suspicious for carbapenemase production based on imipenem or meropenem MICs of 2–4 μg/mL or ertapenem MIC of 2 μg/mL. No special reagents or Determines type of necessary media necessary carbapenemase in addition to absence or presence of the enzyme
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