Emergence of blaVEB and blaGES among VIM-producing Pseudomonas aeruginosa clinical isolates in Alexandria, Egypt

Gaballah, Ahmed; ElBaradei, Amira; Elsheredy, Amel; Kader, Ola

doi:10.1556/030.65.2018.044

Cited by 14 publications

(12 citation statements)

References 20 publications

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“…It is reasonable to explain that this may be correlated with the extent use of carbapenems in recent years as well as a selective pressure from increased prescriptions of carbapenem. As anticipated, similar high rates of resistance have been recorded in Egypt (Gaballah et al 2018;Abaza et al 2017). The frequency of carbapenem resistance P. aeruginosa was also recognized in our Middle East (Castanheira et al 2014).…”

Section: Discussionsupporting

confidence: 85%

Phenotypic characterization of the Egyptian isolates “extensively drug-resistant Pseudomonas aeruginosa” and detection of their metallo-β-lactamases encoding genes

2020

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Background: Carbapenem antibiotics consider the primary treatment choice for serious Pseudomonas aeruginosa infection. Hence, the evolution of carbapenem resistance mediated by acquiring genes encoding class b enzymes is of global concern. The purpose of this article research is to explore the prevalence, drug resistance profiles, and metallo-βlactamases (MβLs) production in extensively drug-resistant carbapenem-resistant P. aeruginosa (XDR-CRPA). Methods: P. aeruginosa isolates were collected and identified according to conventional methods. Antibiotic resistance patterns were determined by single disk diffusion. Minimum inhibitory concentrations (MICs) of (imipenem, meropenem, ceftazidime, piperacillin/tazobactam, levofloxacin, and gentamicin) were determined for CRPA. A subset of the isolates collection consisting of the XDR-CRPA with the highest MICs to imipenem and meropenem were selected for the phenotypic screening of carbapenemases and MβLs production capability using the modified carbapenem inactivation (mCIM) and imipenem-EDTA combined disk (MβL-CD) methods, respectively. Then, molecular analysis, including identification by the specific primer of 16S rRNA and detection of MβL genes using polymerase chain reaction (PCR) was performed to the XDR selected isolates. Results: Among 100 P. aeruginosa isolated throughout this period, 59% exhibited reduced susceptibility rates to carbapenems. A total of 20.3% and 57% of CRPA isolates were MDR and XDR, respectively. MIC values of the CRPA revealed that these isolates exhibited high MIC 50 and MIC 90 to the six selected antibiotics. The findings of the (mCIM) assay displayed identical concordance results with the MβL-CD. Molecular investigation technique assured that 10 (90.9%) and 2 (18.1%) of the 11 XDR selected isolates are positive for bla NDM-1 and bla VIM-1 genes, respectively. Polymyxin B and colistin followed by aztreonam were the most effective antibiotics used for curing infections caused by XDR Pseudomonas aeruginosa. Conclusion: The prevalence of high XDR-CRPA in our study is a critical problem. Our present study found that the bla NDM-1 was present at a significant frequency among the selected XDR isolates, highlighting the need for establishing strict antimicrobial policies to avoid the prompt spread of these isolates.

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Section: Discussionsupporting

confidence: 85%

Phenotypic characterization of the Egyptian isolates “extensively drug-resistant Pseudomonas aeruginosa” and detection of their metallo-β-lactamases encoding genes

2020

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“…35 However, our results show a dominance of blaVIM-1, which is not in agreement with earlier studies carried out in Egypt showing a dissemination of bla-VIM-2 instead or the universal bla-VIM genes. 34,36 Interestingly, we report here for the first time in Upper Egypt the emergence of New Delhi metallo-beta-lactamase −1 gene (bla-NDM) harboring isolates, which possessed bla-VIM-1 as well and showed high-level resistance. There are no previous reports of bla-NDM in Egypt, except a case report of two isolates recovered from a tertiary hospital in 2012.…”

Section: Discussionmentioning

confidence: 86%

<p>Molecular Epidemiology and Mechanisms of High-Level Resistance to Meropenem and Imipenem in <em>Pseudomonas aeruginosa</em></p>

Hassuna¹,

Darwish²,

Sayed³

et al. 2020

IDR

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Purpose: Pseudomonas aeruginosa possesses a large number of resistance mechanisms to different antimicrobials with carbapenems being the most powerful in treating resistant P. aeruginosa. Hence, it is imperative to explore different mechanisms of carbapenemsresistance in P. aeruginosa to achieve successful treatment through the design of new drugs acting on this interaction to combat against antimicrobial resistance. Strains and Methods: A total of 634 P. aeruginosa clinical isolates were collected from various patient sources and their MIC levels were measured. Molecular evaluation of carbapenem resistance was assessed by investigating the presence of bla IMP1 , bla IMP2 , bla VIM1 , bla VIM2 , bla SPM and bla NDM genes and the gene expression of the following multidrug efflux pump systems: MexAB-OprM, MexCD-OprJ, MexEF-OprN and MexXY-OprM and its correlation with MIC. Isolates were typed by Random Amplified Polymorphic DNA (RAPD)-typing. Results: Carbapenem resistance was detected in 32 (5%) isolates, which were all imipenem resistant (of which 29 were meropenem resistant). High-level resistance (≥64mg/mL) to imipenem was found in 27 (84.3%) isolates, and to meropenem in 28 (96.5%) isolates. The carbapenemase bla VIM-1 was found in 31 isolates, while bla NDM was detected in 4 isolates. None of the isolates possessed either bla-VIM-2 , bla IMP-1 , bla IMP-2 or bla SPM. The majority of the isolates displayed over-expression of MexCD-OprJ (75%) followed by MexXY-OprM efflux pump (62%), while MexAB-OprM and MexEF-OprN efflux pumps were overexpressed in 21.8% and 18.7% of the isolates, respectively, with no down-regulation of oprD in any of the isolates. A strong correlation was found between CDJ efflux pump expression and meropenem, imipenem resistance (r=0.532, 0.654, p<0.001, <0.001) respectively. Four major clusters were detected by RAPD-typing: group 1(10 isolates), group 3 (9 isolates), group 2 (8 isolates) while the fourth group (4) included 4 isolates (12.5% polymorphism). Conclusion: High-level carbapenem resistance reported in this study was allied to multiple mechanisms including carbapenemase production and efflux-pump over-expression. Threatening cross-infection is possible inside the hospital and stringent infection control measures are crucial.

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“…The results shown in Table 1 indicate that in Egypt from 2000 through 2020, resistance to various cephalosporins, such as cefuroxime, cefotaxime, ceftazidime, and cefepime, was higher than that to b-lactam/b-lactamase inhibitor combinations, e.g., amoxicillin-clavulanic acid and piperacillin-tazobactam. A rise in resistance was reported against aminoglycosides; gentamcin/amikacin, ciprofloxacin (a quinolone drug) and carbapenems, i.e., imipenem and meropenem [ 84 , 85 , 86 , 87 , 88 , 89 ]. The increase in antibiotic resistance in these isolates has also been demonstrated by β-lactamase detection.…”

Section: Resultsmentioning

confidence: 99%

“…The increase in antibiotic resistance in these isolates has also been demonstrated by β-lactamase detection. These studies from Egypt reported the phenotypic prevalence of ESBLs in E. coli and ESKAPE pathogens with ESBL rate of 7.4%, which increased to 48.9% [ 84 , 89 , 90 , 91 , 92 ]. Molecular characterization of the ESBL trait with PCR showed that bla SHV , bla TEM and bla CTX-M were the most predominant traits among E. coli and ESKAPE pathogens.…”

Section: Resultsmentioning

confidence: 99%

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Retrospective Analysis on Antimicrobial Resistance Trends and Prevalence of β-lactamases in Escherichia coli and ESKAPE Pathogens Isolated from Arabian Patients during 2000–2020

Nasser

Palwe²,

Bhargava

et al. 2020

Microorganisms

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The production of diverse and extended spectrum β-lactamases among Escherichia coli and ESKAPE pathogens is a growing threat to clinicians and public health. We aim to provide a comprehensive analysis of evolving trends of antimicrobial resistance and β-lactamases among E. coli and ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acine to bacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) in the Arabian region. A systematic review was conducted in Medline PubMed on papers published between January 2000 and February 2020 on countries in the Arab region showing different antibiotic resistance among E. coli and ESKAPE pathogens. A total of n = 119,144 clinical isolates were evaluated for antimicrobial resistance in 19 Arab countries. Among these clinical isolates, 74,039 belonged to E. coli and ESKAPE pathogen. Distribution of antibiotic resistance among E. coli and ESKAPE pathogens indicated that E. coli (n = 32,038) was the predominant pathogen followed by K. pneumoniae (n = 17,128), P. aeruginosa (n = 11,074), methicillin-resistant S. aureus (MRSA, n = 4370), A. baumannii (n = 3485) and Enterobacter spp. (n = 1574). There were no reports demonstrating Enterococcus faecium producing β-lactamase. Analyses revealed 19 out of 22 countries reported occurrence of ESBL (Extended-Spectrum β-Lactamase) producing E. coli and ESKAPE pathogens. The present study showed significantly increased resistance rates to various antimicrobial agents over the last 20 years; for instance, cephalosporin resistance increased from 37 to 89.5%, fluoroquinolones from 46.8 to 70.3%, aminoglycosides from 40.2 to 64.4%, mono-bactams from 30.6 to 73.6% and carbapenems from 30.5 to 64.4%. An average of 36.9% of the total isolates were reported to have ESBL phenotype during 2000 to 2020. Molecular analyses showed that among ESBLs and Class A and Class D β-lactamases, blaCTX-M and blaOXA have higher prevalence rates of 57% and 52.7%, respectively. Among Class B β-lactamases, few incidences of blaVIM 27.7% and blaNDM 26.3% were encountered in the Arab region. Conclusion: This review highlights a significant increase in resistance to various classes of antibiotics, including cephalosporins, β-lactam and β-lactamase inhibitor combinations, carbapenems, aminoglycosides and quinolones among E. coli and ESKAPE pathogens in the Arab region.

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Emergence of blaVEB and blaGES among VIM-producing Pseudomonas aeruginosa clinical isolates in Alexandria, Egypt

Cited by 14 publications

References 20 publications

Phenotypic characterization of the Egyptian isolates “extensively drug-resistant Pseudomonas aeruginosa” and detection of their metallo-β-lactamases encoding genes

Phenotypic characterization of the Egyptian isolates “extensively drug-resistant Pseudomonas aeruginosa” and detection of their metallo-β-lactamases encoding genes

<p>Molecular Epidemiology and Mechanisms of High-Level Resistance to Meropenem and Imipenem in <em>Pseudomonas aeruginosa</em></p>

Retrospective Analysis on Antimicrobial Resistance Trends and Prevalence of β-lactamases in Escherichia coli and ESKAPE Pathogens Isolated from Arabian Patients during 2000–2020

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