Susceptibility patterns and cross-resistance of antibiotics against Pseudomonas aeruginosa isolated from burn patients in the South of Iran

Japoni, Aziz; Alborzi, Abdolvahab; Kalani, Mehdi; Nasiri, Jalil; Hayati, Masoumeh; Farshad, Shohreh

doi:10.1016/j.burns.2005.10.017

Cited by 59 publications

(40 citation statements)

References 27 publications

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“…The presence of populations of MDR strains among clinical isolates is a cause for concern for physicians applying empirical treatment, especially in serious cases of P. aeruginosa infections in Asian countries such as Japan (Sekiguchi et al, 2007), Taiwan (Leung et al, 2008), India (Navaneeth et al, 2002) and Iran (Japoni et al, 2006).…”

Section: Discussionmentioning

confidence: 99%

Analysis of integrons and associated gene cassettes of metallo-β-lactamase-positive Pseudomonas aeruginosa in Malaysia

Khosravi

Tay

Vadivelu

2011

Journal of Medical Microbiology

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In this study, 90 non-replicate imipenem-resistant Pseudomonas aeruginosa (IRPA) Malaysian isolates collected between October 2005 and March 2008 were subjected to a screening test for detection of the integron and the gene cassette. Class 1 integrons were detected in 54 IRPA clinical isolates, whilst three isolates contained class 2 integrons. Analysis of the gene cassettes associated with the class 1 integrons showed the detection of accC1 in isolates carrying bla and aacA7 in isolates carrying bla VIM-2 . aadA6 was detected in two isolates carrying bla . Using random amplification of polymorphic DNA analysis, 14 PCR fingerprint patterns were generated from the 32 isolates carrying metallo-b-lactamase (MBL) genes (35.5 %), whilst 20 patterns were generated from the 58 non-MBL gene isolates (64.4 %). Based on the differences in the fingerprinting patterns, two clusters (A and B) were identified among the MBL-producing isolates. Cluster A comprised 18 isolates (56 %) carrying the bla VIM gene, whereas cluster B comprised 14 (44 %) isolates carrying the bla IMP gene. The non-MBL isolates were divided into clusters C and D. Cluster C comprised 22 non-MBL isolates harbouring class 1 integrons, whilst cluster D consisted of three isolates carrying class 2 integrons. These findings suggest that the class 1 integron is widespread among P. aeruginosa isolated in Malaysia and that characterization of cassette arrays of integrons will be a useful epidemiological tool to study the evolution of multidrug resistance and the dissemination of antibiotic resistance genes. INTRODUCTIONThe recent emergence of multidrug-resistant (MDR) Pseudomonas aeruginosa has become a serious problem in healthcare settings worldwide, including in Asian countries (Leung et al., 2008;Raja & Singh, 2007;Sekiguchi et al., 2007). The rapid emergence of antibiotic resistance among clinical isolates of bacteria is due to dissemination of antibiotic resistance genes by horizontal transfer (Leverstein-van Hall et al., 2003). Carbapenems, including imipenem and meropenem, are the most potent antimicrobial agents for the treatment of P. aeruginosa infections (Lee et al., 2011). However, carbapenem resistance due to metallo-b-lactamase (MBL) production of P. aeruginosa has been reported (Varaiya et al., 2008). Several families of MBLs have been documented in P. aeruginosa, including IMP, VIM, SPM, GIM, SIM, KHM, AIM and NDM (Toleman & Walsh, 2008). The genes of both IMP-and VIM-type MBLs (bla IMP and bla VIM ) in clinical isolates of P. aeruginosa are often encoded on mobile gene cassettes inserted into class 1 integrons (Pasteran et al., 2005;Peleg et al., 2004;Yong et al., 2009;Zhao et al., 2009). Integrons have been identified as a primary source of resistance genes and are suspected to serve as reservoirs of antimicrobial resistance genes within microbial populations (Xu et al., 2009). They are able to capture one or more gene cassettes from the environment and incorporate them using site-specific recombination. To date, there are more than nine cla...

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Section: Discussionmentioning

confidence: 99%

Analysis of integrons and associated gene cassettes of metallo-β-lactamase-positive Pseudomonas aeruginosa in Malaysia

Khosravi

Tay

Vadivelu

2011

Journal of Medical Microbiology

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“…Furthermore, the resistance rates of P. aeruginosa to ticarcillin containing additional β-lactamase inhibitors such as tazobactam or clavulanate have been reported to be as high as 77% and the MIC 50 and MIC 90 were >128 and >128 μg/ml, respectively [37,[43][44][45][46][47]. The resistance rates of P. aeruginosa to piperacillin have been reported in different surveillance studies from different regions to be as low as 3.9% to as high as 50% with MIC 50 and MIC 90 values of >256 and >256 μg/ ml, respectively [48][49][50][51].…”

Section: Literature Searchmentioning

confidence: 98%

Pseudomonas Aeruginosa : Arsenal of Resistance Mechanisms, Decades of Changing Resistance Profiles, and Future Antimicrobial Therapies

et al. 2015

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Antimicrobial resistance is one of the most serious public health issues facing humans since the discovery of antimicrobial agents. The frequent, prolonged, and uncontrolled use of antimicrobial agents are major factors in the emergence of antimicrobial-resistant bacterial strains, including multidrug-resistant variants. Pseudomonas aeruginosa is a leading cause of nosocomial infections. The abundant data on the increased resistance to antipseudomonal agents support the need for global action. There is a paucity of new classes of antibiotics active against P. aeruginosa. Here, we discuss recent antibacterial resistance profiles and mechanisms of resistance by P. aeruginosa. We also review future potential methods for controlling antibiotic-resistant bacteria, such as phage therapy, nanotechnology and antipseudomonal vaccines.

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“…to ceftazidime and ciprofloxacin, has developed [19]. Meropenem has been identified as an important reserve antibiotic to which most P. aeruginosa and Acinetobacter are susceptible [19], but resistance to the carbapenems has developed [37][38][39]. A study at eight centers in the United States found that 15% of P. aeruginosa isolates recovered from burn ICUs were resistant to ceftazidime and 20% were resistant to imipenem [40].…”

Section: Treatment Of Multi-resistant Pathogensmentioning

confidence: 99%

Emerging Infections in Burns

Branski

Al-Mousawi

Rivero

et al. 2009

Surgical Infections

294

174

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Background: Patients who suffer severe burns are at higher risk for local and systemic infections. In recent years, emerging resistant pathogens have forced burn care providers world wide to search for alternative forms of treatment. Multidrug-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter spp., and various fungal strains have been the major contributors to the increase in morbidity and mortality rates. Multi-drugresistant S. aureus remains the major cause of gram-positive burn wound infections world wide. Treatment strategies include rigorous isolation protocols and new types of antibiotics where necessary. Methods: We reviewed 398 severely burned patients (burns >40% total body surface area [TBSA]) admitted to our hospital between 2000 and 2006. Patients who did not contract multi-drug-resistant gram-negative organisms during their hospital course and received our standard antibiotic regimen-vancomycin and piperacillin= tazobactam-served as controls (piperacillin=tazobactam; n ¼ 280). The treatment group consisted of patients who, during their acute hospital stay, developed infections with multi-drug-resistant gram-negative pathogens and were treated with vancomycin and colistin for at least three days (colistin; n ¼ 118). Results: Gram-negative organisms continue to cause the most severe infections in burn patients. Colistin has reemerged as a highly effective antibiotic against multiresistant Pseudomonas and Acinetobacter infections of burns. Patients who required colistin therapy had a significantly larger average total and full-thickness burn than patients treated with piperacillin=tazobactam and vancomycin, and the mortality rate was significantly higher in the colistin group (p < 0.05). However, there was no significant difference between the colistin and piperacillin= tazobactam groups in the incidence of neurotoxicity, hepatic toxicity, or nephrotoxicity. The main fungal pathogens in burn patients are Candida spp., Aspergillus spp., and Fusarium spp. A definitive diagnosis is more difficult to obtain than in bacterial infections. Amphotericin B and voriconazole remain the two most important anti-fungal substances in our practice. Conclusions: Innovations in fluid management, ventilatory support, surgical care, and antimicrobial therapy have contributed to a significant reduction in morbidity and mortality rates in burn patients. Vancomycin and clindamycin are the two most important reserve antibiotics for methicillin-resistant Staphylococcus aureus infection. Oxazolidinones and streptogramins have showed high effectiveness against gram-positive infections. Colistin has re-emerged as a highly effective antibiotic against multiresistant Pseudomonas and Acinetobacter infections. Current challenges include Candida, Aspergillus, and molds. The development of new agents, prudent and appropriate use of antibiotics, and better infection control protocols are paramount in the ongoing battle against multi-resistant organisms.

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Susceptibility patterns and cross-resistance of antibiotics against Pseudomonas aeruginosa isolated from burn patients in the South of Iran

Cited by 59 publications

References 27 publications

Analysis of integrons and associated gene cassettes of metallo-β-lactamase-positive Pseudomonas aeruginosa in Malaysia

Analysis of integrons and associated gene cassettes of metallo-β-lactamase-positive Pseudomonas aeruginosa in Malaysia

Pseudomonas Aeruginosa : Arsenal of Resistance Mechanisms, Decades of Changing Resistance Profiles, and Future Antimicrobial Therapies

Emerging Infections in Burns

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