Prevalence Of Carbapenem Resistant Pseudomonas Aeruginosa Isolated from Wound Infection and The Genes Responsible for Carbapenemase Production in Najaf Hospitals

Abstract

 Background: Pseudomonas aeruginosa is one of the most prevalent opportunistic human pathogens among Gram-negative bacteria, it is linked to nosocomial infections such as burn and wound infections. The rise of carbapenem-resistant P. aeruginosa (CRPA) is a major therapeutic challenge. The objective of the current study is to specify the frequency carbapenem resistant P. aeruginosa and the associated carbapenemase genes in P. aeruginosa isolated from wound infection

 Methods: During the study period, 300 swabs were collected from patients who had wound infections. P. aeruginosa were identified using standard bacteriological and biochemical methods. The Kirby-Bauer disk diffusion method was utilized to investigate the antibiotic susceptibility of using 17 antimicrobial drugs. Multi-druge resistance(MDR) and Extensive-druge resistance (XDR) were identified using international guideline. Extended-spectrum-beta-lactamase (ESBL) production were screened using ceftazidime, ceftriaxone, cefotaxime and aztreonam antibiotics by disk diffusion method. Carbapenem resistance isolates were characterized using imipenem and/or meropenem antibiotics resistance and the double disk diffusion test was used to confirm its production. PCR analysis was conducted to identify ESBL and carbapenem resistance genes (bla_CTX-M, bla_TEM, bla_SHV, bla_OXA, bla_KPC, bla_IMP, bla _VIM, bla_SIM, bla _NDM, bla _GIM, bla _SPM, bla _OXA-48).

 Results: from 300 swabs specimen P. aeruginosa isolates were identified in 40 (13.3%) specimens. Antibiotic susceptibility test revealed 13(32.5%) isolates were carbapenem resistant P. aeruginosa, and the highest resistant was to β-lactam class and cephalosporin antibiotics. The results showed 17(42.5%) of isolates were MDR and 23(57.5%) were XDR. PCR assay revealed that bla_CTX-M was found in 22(55%) and bla_OXA was noticed in 27 (67.5%) of P. aeruginosa isolates. Among 13 CRPA isolates, 1(7.6%) isolate had bla_OXA-48,  2(15.3%) isolates had bla_IMP, bla_SIM and bla_VIM for each, 3(23%) carry bla_GIM, and 4 (30.7%) had bla_NDM. While bla_SPM and bla_KPC were not found in any isolate.  

Conclusion: wound infections showed high rate of XDR and CRPA driven by diverse carbapenem resistance genes, indicating dangerous public health concern

Keywords:

Pseudomonas aeruginosa, Carbapenem Resistant genes, ESBL

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