American Journal of Infectious Diseases and Microbiology
ISSN (Print): 2328-4056 ISSN (Online): 2328-4064 Website: https://www.sciepub.com/journal/ajidm Editor-in-chief: Maysaa El Sayed Zaki
Open Access
Journal Browser
Go
American Journal of Infectious Diseases and Microbiology. 2023, 11(1), 1-7
DOI: 10.12691/ajidm-11-1-1
Open AccessArticle

Prevalence of Multidrug-Resistant, Extensively Drug-Resistant and Pandrug-Resistant Pseudomonas aeruginosa Clinical Isolates in Khartoum State, Sudan

Sara E Mohammed1, , Omnia M Hamid2, Sababil S Ali1, Mushal Allam3 and A M Elhussein4

1Faculty of Medical Laboratory Sciences, National University, Khartoum, Sudan

2Medical Microbiology-Faculty of Medical Laboratory Sciences, University of Medical Sciences& Technology-UMST, Khartoum, Sudan

3Departments of Genetics and Genomics, College of Medicine and Health Sciences, United Arab Emirates University, Alain, United Arab Emirates

4Central laboratory, Ministry of Science and Higher Education, Khartoum, Sudan

Pub. Date: January 09, 2023

Cite this paper:
Sara E Mohammed, Omnia M Hamid, Sababil S Ali, Mushal Allam and A M Elhussein. Prevalence of Multidrug-Resistant, Extensively Drug-Resistant and Pandrug-Resistant Pseudomonas aeruginosa Clinical Isolates in Khartoum State, Sudan. American Journal of Infectious Diseases and Microbiology. 2023; 11(1):1-7. doi: 10.12691/ajidm-11-1-1

Abstract

Background. Pseudomonas aeruginosa is a common opportunistic Gram-negative pathogen responsible for a wide range of hospital acquired infections that may present high rates of antimicrobial resistance. It could also become multidrug-resistant (MDR), extensively drug-resistant (XDR), and pan drug-resistant (PDR) during a short period. The aim of the present study is to determine the prevalence of MDR, XDR and PDR-P. aeruginosa clinical isolates in Khartoum State-Sudan. Materials and Methods. A multihospital laboratory-based study was conducted to collect P. aeruginosa clinical isolates from various clinical specimen’s culture during eighteen-month period from March 2020 to December 2021. The P. aeruginosa strains were reidentified by conventional biochemical methods and genotypically by amplification of 16S rRNA gene by Polymerase chain reaction (PCR) assay. Antimicrobial susceptibility testing was done by Kirby-Bauer disc diffusion method. MDR, XDR and PDR were determined according to new recommendation of the Clinical and Laboratory Standards Institute and the European Committee for Antimicrobial Susceptibility Testing. Results. Of 512 P. aeruginosa clinical isolates were recovered from various clinical specimen’s culture, only 289 (66.4%) of the isolates were confirmed as P. aeruginosa strains genotypically, out of those P. aeruginosa strains were categorized regarding antimicrobial resistance to 98 (33.9%) MDR, 61 (21.1%) XDR and 2 (0.7%) PDR. The XDR strains were exhibited significant overall resistance to all used antibiotic classes, whereas MDR strains were insignificant resistant to fluoroquinolones and polymyxins. Patients prior of hospitalized for 1-2weeks, uses of companied antibiotics therapy with duration of one week and source of isolation from wound swab and blood specimen (P <0.05), remained independently associated with an increased likelihood of antimicrobial resistant in clinical P. aeruginosa isolates. Conclusion. The study highlights the increase prevalence of MDR and XDR P. aeruginosa clinical isolates in both hospital and community settings, along with emerged two pandrug resistant strains. Thus, continuous antimicrobial resistance surveillance for this bacterium is necessary for guiding antimicrobial treatment and stewardship as well as based knowledge for future comparative studies.

Keywords:
pseudomonas aeruginosa clinical isolates multidrug-resistant extensively drug-resistant pan drug-resistant Khartoum

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]  Fujitani S, Moffett KS, Yu V. Pseudomonas aeruginosa. Antimicrobe, Pittsburgh, PA. 2017; 15219.
 
[2]  Araos R, D’Agata E. Pseudomonas aeruginosa and Other Pseudomonas Species. Mandell, Douglas, and Benett's principles and practice of infectious diseases: Churchill Livingstone Elsevier Philadelphia; 2019. p. 2686-99.
 
[3]  YAGOUP MA, TAHA AA, MUBARAK AK, ELGAILI A, ALAMEEN HE. Drugs-Resistant Pseudomonas aeruginosa Isolated from Various Clinical Specimens in Khartoum, Sudan. Children. 8: 22.
 
[4]  Pang Z, Raudonis R, Glick BR, Lin T-J, Cheng Z. Antibiotic resistance in Pseudomonas aeruginosa: mechanisms and alternative therapeutic strategies. Biotechnology advances. 2019; 37(1): 177-92.
 
[5]  Souli M, Galani I, Giamarellou H. Emergence of extensively drug-resistant and pandrug-resistant Gram-negative bacilli in Europe. Eurosurveillance. 2008; 13(47): 19045.
 
[6]  Kakoullis L, Papachristodoulou E, Chra P, Panos G. Mechanisms of antibiotic resistance in important gram-positive and gram-negative pathogens and novel antibiotic solutions. Antibiotics. 2021; 10(4): 415.
 
[7]  Law N, Logan C, Yung G, Furr C-LL, Lehman SM, Morales S, et al. Successful adjunctive use of bacteriophage therapy for treatment of multidrug-resistant Pseudomonas aeruginosa infection in a cystic fibrosis patient. Infection. 2019; 47(4): 665-8.
 
[8]  Cerceo E, Deitelzweig SB, Sherman BM, Amin AN. Multidrug-resistant gram-negative bacterial infections in the hospital setting: overview, implications for clinical practice, and emerging treatment options. Microbial Drug Resistance. 2016; 22(5): 412-31.
 
[9]  Babour IA, Mohamed MB, Shehabi AA. Molecular characterization of Pseudomonas aeruginosa isolates from various clinical specimens in Khartoum/Sudan: Antimicrobial resistance and virulence genes. The International Arabic Journal of Antimicrobial Agents. 2020; 10(1).
 
[10]  Babiker R, Elsharief U, Mohammed N. Pseudomonas aeruginosa in Diabetic Foot Infections, Gadarif Diabetic Center, Sudan (2017-2018). J Trop Med Health. 2019; 3: 140.
 
[11]  Omer THS, Mustafa SAM, Mohamed SOO. Extended Spectrum β-Lactamase-Mediated Resistance and Antibiogram of Pseudomonas aeruginosa Isolates from Patients Attending Two Public Hospitals in Khartoum, Sudan. International journal of microbiology. 2020; 2020.
 
[12]  Mansour DH, Ali MA. Detection of Drug Resistant Strains of Pseudomonas aeruginosa isolated from Patients attending Kosti Hospitals (White Nile State). African Journal of Medical Sciences. 2018; 3(4).
 
[13]  M Tille P. Bailey & Scott’s Diagnostic Microbiology Fourteenth Edition. Elsevier; 2017.
 
[14]  Clinical and Laboratory Standards Institute .Performance Standards for Antimicrobial Susceptibility Testing. 31th ed CLSI supplement M1002021.
 
[15]  Magiorakos A-P, Srinivasan A, Carey RB, Carmeli Y, Falagas M, Giske C, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clinical microbiology and infection. 2012; 18(3): 268-81.
 
[16]  O'Neill J. Tackling drug-resistant infections globally: final report and recommendations. 2016.
 
[17]  World Health Organization (WHO) Global Priority List of Antibiotic-Resistant Bacteria. 2017.
 
[18]  Altaai ME, Aziz IH, Marhoon AA. Identification Pseudomonas aeruginosa by 16s rRNA gene for Differentiation from Other Pseudomonas Species that isolated from Patients and environment. Baghdad Sci J. 2014; 11(2): 1028-34.
 
[19]  Othman HE. Molecular Identification and Genotyping of Pseudomonas aeruginosa Isolates Using Double-Locus Sequence Typing (DLST) Analysis. Zanco Journal of Pure and Applied Sciences. 2018; 30(6): 118-29.
 
[20]  Nurain AM, Bilal NE, Ibrahim ME. The frequency and antimicrobial resistance patterns of nosocomial pathogens recovered from cancer patients and hospital environments. Asian Pacific Journal of Tropical Biomedicine. 2015; 5(12): 1055-9.
 
[21]  Mirzaei B, Bazgir ZN, Goli HR, Iranpour F, Mohammadi F, Babaei R. Prevalence of multi-drug resistant (MDR) and extensively drug-resistant (XDR) phenotypes of Pseudomonas aeruginosa and Acinetobacter baumannii isolated in clinical samples from Northeast of Iran. BMC research notes. 2020; 13(1): 1-6.
 
[22]  Wahab WFA, Bakhiet MA, Mahadi SEI, Mahmoud SM, Widataa AH, Ahmed ME. Diabetic foot infections with Pseudomonas: jabir Abueliz diabetic center Khartoum experience. Clinical Research on Foot & Ankle. 2013: 1-4.
 
[23]  Elsaid RE, Eldeen S, Abdelkhalek HS, Eisa EA. Antimicrobial Susceptibility Patterns of Nosocomial Pseudomonas aeruginosa Strains Isolated from Clinical Specimens in Tanta University Hospitals. Egyptian Journal of Medical Microbiology. 2022; 31(2): 57-62.
 
[24]  Sebola D, Eliasi UL, Oguttu JW, Qekwana DN. Antimicrobial resistance patterns of Pseudomonas aeruginosa isolated from canine clinical cases at a veterinary academic hospital in South Africa. Journal of the South African Veterinary Association. 2020; 91(1): 1-6.
 
[25]  Hosu MC, Vasaikar SD, Okuthe GE, Apalata T. Detection of extended spectrum beta-lactamase genes in Pseudomonas aeruginosa isolated from patients in rural Eastern Cape Province, South Africa. Scientific reports. 2021; 11(1): 1-8.
 
[26]  Pérez A, Gato E, Pérez-Llarena J, Fernández-Cuenca F, Gude MJ, Oviaño M, et al. High incidence of MDR and XDR Pseudomonas aeruginosa isolates obtained from patients with ventilator-associated pneumonia in Greece, Italy and Spain as part of the MagicBullet clinical trial. Journal of Antimicrobial Chemotherapy. 2019; 74(5): 1244-52.
 
[27]  Hamze M, Mallat H, Dabboussi F, Achkar M. Antibiotic susceptibility and serotyping of clinical Pseudomonas aeruginosa isolates in northern Lebanon. Int Arabic J Antimicrob Agents. 2012; 2: 1-6.
 
[28]  Al Dawodeyah HY, Obeidat N, Abu-Qatouseh LF, Shehabi AA. Antimicrobial resistance and putative virulence genes of Pseudomonas aeruginosa isolates from patients with respiratory tract infection. Germs. 2018; 8(1): 31.
 
[29]  Hatami R. The frequency of multidrug-resistance and extensively drug-resistant Acinetobacter baumannii in west of Iran. J Clin Microbiol Infect Dis. 2018; 1(1): 4-8.
 
[30]  Ahmed MS, Hassan A, Jarir SA, Hadi HA, Bansal D, Wahab AA, et al. Emergence of multidrug-and pandrug-resistant Pseudomonas aeruginosa from five hospitals in Qatar. Infection Prevention in Practice. 2019; 1(3-4): 100027.
 
[31]  Peng Y, Shi J, Bu T, Li Y, Ye X, Chen X, et al. Alarming and increasing prevalence of multidrug-resistant Pseudomonas aeruginosa among healthcare-associated infections in China: A meta-analysis of cross-sectional studies. Journal of Global Antimicrobial Resistance. 2015; 3(3): 155-60.
 
[32]  Palavutitotai N, Jitmuang A, Tongsai S, Kiratisin P, Angkasekwinai N. Epidemiology and risk factors of extensively drug-resistant Pseudomonas aeruginosa infections. PloS one. 2018; 13(2): e0193431.
 
[33]  Kang C-I, Kim S-H, Park WB, Lee K-D, Kim H-B, Kim E-C, et al. Risk factors for antimicrobial resistance and influence of resistance on mortality in patients with bloodstream infection caused by Pseudomonas aeruginosa. Microbial Drug Resistance. 2005; 11(1): 68-74.
 
[34]  van Bijnen EM, den Heijer CD, Paget WJ, Stobberingh EE, Verheij RA, Bruggeman CA, et al. The appropriateness of prescribing antibiotics in the community in Europe: study design. BMC infectious diseases. 2011; 11(1): 1-5.
 
[35]  Omer THS, Mustafa SAM, Mohamed SOO. Antibiogram of Pseudomonas Aeruginosa Isolates from Patients with Diabetic Septic Wounds Attending Two Public Hospitals in Khartoum, Sudan. 2020.
 
[36]  Al-Orphaly M, Hadi HA, Eltayeb FK, Al-Hail H, Samuel BG, Sultan AA, et al. Epidemiology of multidrug-resistant Pseudomonas aeruginosa in the Middle East and North Africa Region. Msphere. 2021; 6(3): e00202-21.