Prevalence of Pseudomonas aeruginosa isolates and their antibiotic susceptibility among patients and healthcare workers in three Hospitals of Duhok city/ Iraq
Keywords:Pseudomonas aeruginosa, patients, healthcare, equipment, antibiotic susceptibility. Corresponding Author: Haval Mohammed Khalid, email: Haval.firstname.lastname@example.org
Objective Pseudomonas aeruginosa is opportunistic gram-negative bacillus and a major human pathogen belongs to family Pseudomonadaceae, it causes several nosocomial infections including pneumonia, urinary tract, surgical sites, otitis externa, and soft tissues.
Methods: The study was conducted from April 2021 to January 2022 and involved the prevalence of Pseudomonas aeruginosa isolates and their susceptibility to different antimicrobial agents among patients and healthcare workers specimens in three hospitals of Duhok city. The collected specimens were examined and cultured on different media in the Advanced Microbiology Laboratory, Azadi teaching hospital. The isolated bacteria were identified according to their morphological and biochemical properties.
Results: Out of 324 specimens, 29.32% (95/324) of the isolates were identified as Pseudomonas aeruginosa, isolated from 26.89% patients and 40% healthcare workers. Regarding isolate rates among specimens, the highest rate (48.78%) was from sputum, with a highly significant (P<0.001) difference from other sources. Females had a non-significantly higher isolate rate than males (28.19% vs 25.22%), ages, >50 years had the highest isolate rate (72.88%), while the lowest rate 6.25% was among ages >10-20 years, with highly significant (P< 0.001) differences among them. Specimens from Hevii hospital showed a non-significantly higher isolate rate (28.57%) than other hospitals. Isolates highest susceptibility was to Colistin (88.7%) followed by Imipenem (78.9%), while they were 98.6 % resistant to ampicillin and 100% resistant to Amoxicillin, Erythromycin and Trimethoprim/Sulfamethoxazole. A high rate of extensively drug-resistant (19.72%) Pseudomonas aeruginosa isolates was documented among patients who attended these hospitals with the highest (31.25%) from wounds.
Conclusion these findings will be helpful to advise treatment with appropriate antibiotic strategy against multi- and extensively drug -resistant P. aeruginosa to cope with the chances of evolving resistant pathogens.
Diggle SP, Whiteley M (2021). Microbe Profile: Pseudomonas aeruginosa: opportunistic pathogen and lab rat. Microbiology (Reading).166(1): 30-33.
Neamah AA (2017). Molecular Detection of virulence factor genes in Pseudomonas aeruginosa isolated from humans and animals in Diwaniya province. Kufa J Vet Med Sci. 8(1):218-230.
Rasmussen BS, Christensen N, Sørensen J, Rosenvinge FS, Kolmos HJ, Skov MN (2015). Outbreak of Pseudomonas aeruginosa bacteremia in a Haematology Department. Dan Med J. 62(4): A5040.
Buhl M, Peter S, Willmann M (2015). Prevalence and risk factors associated with colonization and infection of extensively drug-resistant Pseudomonas aeruginosa: A systematic review. Expert Rev Anti Infect Ther. 13(9):1159–1170.
Del Barrio-Tofiño E, López-Causapé C, Oliver A (2020). Pseudomonas aeruginosa epidemic high-risk clones and their association with horizontally acquired β-lactamases: 2020 update. Int J Antimicrob Agents. 56(6):106-196.
Lister PD, Wolter DJ, Hanson ND (2009). Antibacterial-resistant Pseudomonas aeruginosa: clinical impact and complex regulation of chromosomally encoded resistance mechanisms. Clin Microbiol Rev. 22(4):582-610.
Pang Z, Raudonis R, Glick BR, Lin TJ, Cheng Z (2019). Antibiotic resistance in Pseudomonas aeruginosa: mechanisms and alternative therapeutic strategies. Biotechnol adv. 37(1):177-192.
Idris SN, Desa MN, Aziz MN, Taib NM (2012). Antimicrobial susceptibility pattern and distribution of exoU and exoS in clinical isolates of Pseudomonas aeruginosa at a Malaysian hospital. Southeast Asian J Trop Med Public Health. 43(1):116-123.
Al-Daraghi WA, Abdullah ZH (2013). Detection of Exotoxin A gene in Pseudomonas aeruginosa from Clinical and Environmental samples. ANJS. 16(2):167- 172.
Khattab MA, Nour MS, El-Sheshtawy NM (2015). Genetic Identification of Pseudomonas aeruginosa Virulence Genes among Different Isolates. J Microb Biochem Technol.7(5): 274-277.
Percival SL, Suleman L, Vuotto C, Donelli G (2015). Healthcare-associated infections, medical devices and biofilms: risk, tolerance and control. J Med Microbiol. 64(4):323-334.
Skariyachan S, Sridhar VS, Packirisamy S, Kumargowda ST, Challapilli SB (2018). Recent perspectives on the molecular basis of biofilm formation by Pseudomonas aeruginosa and approaches for treatment and biofilm dispersal. Folia Microbiol (Praha). 63(4):413-432.
Ciofu O, Tolker-Nielsen T (2019). Tolerance and Resistance of Pseudomonas aeruginosa Biofilms to Antimicrobial Agents- How P. aeruginosa Can Escape Antibiotics. Front Microbiol. 10:913.
Pachori P, Gothalwal R, Gandhi P (2019). Emergence of antibiotic resistance Pseudomonas aeruginosa in intensive care unit; a critical review. Genes Dis. 6(2):109-119.
Rocca DM, Aiassa V, Zoppi A, Silvero Compagnucci J, Becerra MC (2020). Nanostructured Gold Coating for Prevention of Biofilm Development in Medical Devices. J Endourol. 34(3):345-351.
Neu HC (1992). The crisis in antibiotic resistance. Science. 257(5073):1064-1073.
Oliver A, Mulet X, López-Causapé C, Juan C (2015). The increasing threat of Pseudomonas aeruginosa high-risk clones. Drug Resist Updat.22:41-59.
Llor C, Bjerrum L (2014). Antimicrobial resistance: risk associated with antibiotic overuse and initiatives to reduce the problem. Ther Adv Drug Saf. 5(6):229-241.
Tsao LH, Hsin CY, Liu HY, Chuang HC, Chen LY, Lee YJ (2018). Risk factors for healthcare-associated infection caused by carbapenem-resistant Pseudomonas aeruginosa. J Microbiol Immunol Infect. 51(3):359-366.
López-García A, Rocha-Gracia RDC, Bello-López E, Juárez-Zelocualtecalt C, Sáenz Y, Castañeda-Lucio M, López-Pliego L, González-Vázquez MC, Torres C, Ayala-Nuñez T, Jiménez
Flores G, Arenas-Hernández MMP, Lozano-Zarain P (2018). Characterization of antimicrobial resistance mechanisms in carbapenem-resistant Pseudomonas aeruginosa carrying IMP variants recovered from a Mexican Hospital. Infect Drug Resist. 11:1523-1536.
CLSI (2018). Performance Standards for Antimicrobial Susceptibility Testing. 28th ed. Wayne, PA: Clinical and Laboratory Standards Institute.www.cisi.org.
Cheesbrough, M. (2006). District laboratory practical in tropical countries part 2.
Cambridge University, 13: 511-978.
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, VatopoulosA, Weber JT, Monnet DL (2012). Multidrug-resistant, extensively drug-resistant and pan drug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect.18(3):268-281.
Lanotte P, Watt S, Mereghetti L, Dartiguelongue N, Rastegar-Lari A, Goudeau A, Quentin R (2004). Genetic features of Pseudomonas aeruginosa isolates from cystic fibrosis patients compared with those of isolates from other origins. J Med Microbiol. 53(1):73-81.
Litwin A, Rojek S, Gozdzik W, Duszynska W (2021). Pseudomonas aeruginosa device associated - healthcare associated infections and its multidrug resistance at intensive care unit of University Hospital: polish, 8.5-year, prospective, single-center study. BMC Infect Dis. 21(1):180.
Crivaro V, Di Popolo A, Caprio A, Lambiase A, Di Resta M, Borriello T, Scarcella A, Triassi M, Zarrilli R (2009). Pseudomonas aeruginosa in a neonatal intensive care unit: molecular epidemiology and infection control measures. BMC Infect Dis. 9:70. Pp 7.
Mansour SA, Eldaly O, Jiman-Fatani A, Mohamed ML, Ibrahim EM (2013). Epidemiological characterization of P. aeruginosa isolates of intensive care units in Egypt and Saudi Arabia. East Mediterr Health J. 19(1):71-80.
CDC (2023). Hand hygiene in healthcare settings. CDC 24/7: Saving lives protectingapeople.www.cdc.gov/hand hygiene/index.html.
Al-Zaidi JR (2016). Antibiotic susceptibility patterns of Pseudomonas aeruginosa isolated from clinical and hospital environmental samples in Nasiriyah, Iraq. Afr J Microbiol Res.10: 844-849.
Al-Saffar MF, Jarallah EM (2019). Isolation and characterization of Pseudomonas aeruginosa from Babylon Province. Biochem Cell Arch. 19(1): 203-209.
Hasan SA, Najati AM, Abass KS (2019). Isolation and identification of multi-drug resistant “pseudomonas aeruginosa” from burn wound infection in Kirkuk City, Iraq. Eurasia J Biosci.13: 1045-1050.
Rashid Mahmood A, Mansour Hussein N (2022). Study of Antibiotic Resistant Genes in Pseudomonas aeruginosa Isolated from Burns and Wounds. Arch Razi Inst. 77(1):403-411.
AL-Fridawy RAK, Al-Daraghi WAH, Alkhafaji MH (2020). Isolation and Identification of multidrug resistance among clinical and environmental Pseudomonas aeruginosa isolates. IJB .19(2): 37-45.
Alkhulaifi ZM, Mohammed KA (2023). Prevalence and molecular analysis of antibiotic resistance of Pseudomonas aeruginosa isolated from clinical and environmental specimens in Basra, Iraq. Iran J Microbiol. 15(1):45-54.
Othman N, Babakir-Mina M, Noori CK, Rashid PY (2014). Pseudomonas aeruginosa infection in burn patients in Sulaymaniyah, Iraq: risk factors and antibiotic resistance rates. J Infect Dev Ctries. 8(11) :1498-1502.
Folic MM, Djordjevic Z, Folic N, Radojevic MZ, Jankovic SM (2021). Epidemiology and risk factors for healthcare-associated infections caused by Pseudomonas aeruginosa. J Chemother.33(5):294-301.
Friyah SH, Rasheed MN (2018). Molecular Study of Efflux Mex X Gene in Pseudomonas aeruginosa Isolated from Iraqi Patients. IJB.17(3): 92-99.
Saderi H, Lotfalipour H, Owlia P, Salimi H. 2019. Detection of Metallo-β-Lactamase Producing Pseudomonas aeruginosa Isolated from Burn Patients in Tehran, Iran. Lab. Medicine. 41:609–612.
Bédard E, Prévost M, Déziel E (2016). Pseudomonas aeruginosa in premise plumbing of large buildings. Microbiology open.5(6):937-956.
CDC. 2020. Pseudomonas aeruginosa in healthcare settings. Available at: https://www.cdc.gov/hai/organisms/pseudomonas.html.
Oumeri MMQ, Yassin NA (2021). Molecular characterization of some carbapenem-resistance genes among Pseudomonas aeruginosa isolated from wound and burn infections in Duhok city, Iraq. JDU.24(1):136-144.
Bialvaei AZ, Samadi KH (2015). Colistin, mechanisms and prevalence of resistance. Curr Med Res Opin. 31: 707- 721.
Al-Derzi NA (2012). Pattern of Resistance to Pseudomonas infection in the North of Iraq: Emphasis on the Potential Role of a Combination Antibiogram. IJCM .25(2): 130-135.
Finberg RW, Guharoy R (2021). Monobactam: Aztreonam, in Clinical use of Anti-infective Agents, 2nd edition, Springer Nature, Switzerland.
Yassin N, Khalid HM, Hassan A (2014). Prevalence of metallo-β-lactamase producing Pseudomonas aeruginosa in wound infections in Duhok City, Iraq. IJRMS. 2:1576-1579.
Tam VH, Schilling AN, Melnick DA, Coyle EA (2005). Comparison of beta-lactams in counter-selecting resistance of Pseudomonas aeruginosa. Diagn Microbiol Infect Dis. 52(1):145-151.
Mingeot-Leclercq MP, Glupczynski Y, Tulkens PM (1999). Aminoglycosides: activity and resistance. Antimicrobe Agents Chemother.43(4):727–737.
Ganjo AR (2017). Antimicrobial susceptibility of extensively drug-resistant (XDR) and multidrug-resistant (MDR) Pseudomonas aeruginosa isolated from patients in Erbil city. The Second International Conference College of Medicine, HMU, 22nd - 24th, Divan Hotel - Erbil - Kurdistan, Iraq 238.
WHO (2002) Humans: Reducing risks promoting healthy life. World Health Organization report.
Yoshimura F, Nikaido H (1982). Permeability of Pseudomonas aeruginosa outer membrane to hydrophilic solutes. J Bacteriol. 152(2): 636-642.
How to Cite
Copyright (c) 2023 Journal of Contemporary Medical Sciences
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.