Pseudomonas aeruginosa-producing Metallo-β-lactamases (VIM, IMP, SME, and AIM) in the Clinical Isolates of Intensive Care Units, a University Hospital in Isfahan, Iran

Khorvash, Farzin; Yazdani, Mohammadreza; Shabani, Shiva; Soudi, Aliasghar

Pseudomonas aeruginosa-producing Metallo-β-lactamases (VIM, IMP, SME, and AIM) in the Clinical Isolates of Intensive Care Units, a University Hospital in Isfahan, Iran

Authors

¹ Department of Infectious Diseases, Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

² Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Pseudomonas aeruginosa is a severe challenge for antimicrobial therapy, due to the chromosomal mutations or exhibition of intrinsic resistance to various antimicrobial agents such as most β-lactams. We undertook this study to evaluate the existence of SME, IMP, AIM, and VIM metallo-β-lactamases (MBL) encoding genes among P. aeruginosa strains isolated from Intensive Care Unit (ICU) patients in Al-Zahra Hospital in Isfahan, Iran. Materials and Methods: In a retrospective cross-sectional study that was conducted between March 2012 and April 2013, a total of 48 strains of P. aeruginosa were collected from clinical specimens of bedridden patients in ICU wards. Susceptibility test was performed by disc diffusion method. All of the meropenem-resistant strains were subjected to modified Hodge test for detection of carbapenemases. Multiplex polymerase chain reaction was performed for detection of blaVIM, blaIMP, blaAIM, and blaSME genes. Results: In disk diffusion method, imipenem and meropenem showed the most and colistin the least resistant antimicrobial agents against P. aeruginosa strains. Of the 48 isolates, 36 (75%) were multidrug resistant (MDR). Amplification of β-lactamase genes showed the presence of blaVIM genes in 7 (%14.6) strains and blaIMP genes in 15 (31.3%) strains. All of the isolates were negative for blaSME and blaAIM genes. We could not find any statistically significant difference among the presence of this gene and MDR positive, age, or source of the specimen. Conclusion: As patients with infections caused by MBL-producing bacteria are at an intensified risk of treatment failure, fast determination of these organisms is necessary. Our findings may provide useful insights in replace of the appropriate antibiotics and may also prevent MBLs mediated resistance problem.

Keywords

References

1.	Wolter DJ, Khalaf N, Robledo IE, Vázquez GJ, Santé MI, Aquino EE, et al. Surveillance of carbapenem-resistant Pseudomonas aeruginosa isolates from Puerto Rican Medical Center Hospitals: Dissemination of KPC and IMP-18 beta-lactamases. Antimicrob Agents Chemother 2009;53:1660-4.
2.	Doosti M, Ramazani A, Garshasbi M. Identification and characterization of metallo-ß-lactamases producing Pseudomonas aeruginosa clinical isolates in University Hospital from Zanjan Province, Iran. Iran Biomed J 2013;17:129-33. [PUBMED]
3.	Mataseje LF, Bryce E, Roscoe D, Boyd DA, Embree J, Gravel D, et al. Carbapenem-resistant gram-negative bacilli in Canada 2009-10: Results from the Canadian Nosocomial Infection Surveillance Program (CNISP). J Antimicrob Chemother 2012;67:1359-67. [PUBMED]
4.	Baumgart AM, Molinari MA, Silveira AC. Prevalence of carbapenem resistant Pseudomonas aeruginosa and Acinetobacter baumannii in high complexity hospital. Braz J Infect Dis 2010;14:433-6. [PUBMED]
5.	Dortet L, Boulanger A, Poirel L, Nordmann P. Bloodstream infections caused by Pseudomonas spp.: How to detect carbapenemase producers directly from blood cultures. J Clin Microbiol 2014;52:1269-73. [PUBMED]
6.	Saderi H, Karimi Z, Owlia P, Bahar MA, Akhavi Rad SM. Phenotypic detection of metallo-beta-lactamase producing pseudomonas aeruginosa strains isolated from burned patients. Iran J Pathol 2008;3:20-4.
7.	Dortet L, Poirel L, Nordmann P. Rapid detection of carbapenemase-producing Pseudomonas spp. J Clin Microbiol 2012;50:3773-6. [PUBMED]
8.	Pasteran F, Veliz O, Rapoport M, Guerriero L, Corso A. Sensitive and specific modified Hodge test for KPC and metallo-beta- lactamase detection in Pseudomonas aeruginosa by use of a novel indicator strain, Klebsiella pneumoniae ATCC 700603. J Clin Microbiol 2011;49:4301-3. [PUBMED]
9.	Braun SD, Monecke S, Thürmer A, Ruppelt A, Makarewicz O, Pletz M, et al. Rapid identification of carbapenemase genes in Gram-negative bacteria with an oligonucleotide microarray-based assay. PLoS One 2014;9:e102232.
10.	Dally S, Lemuth K, Kaase M, Rupp S, Knabbe C, Weile J. DNA microarray for genotyping antibiotic resistance determinants in Acinetobacter baumannii clinical isolates. Antimicrob Agents Chemother 2013;57:4761-8. [PUBMED]
11.	Safari M, Alikhani MY, Arabestani MR, Kamali Kakhki R, Jafari R. Prevalence of metallo-ß-lactamases encoding genes among aeruginosa strains isolated from the bedridden patients in the Intensive Care Units. Avicenna J Clin Microbiol Infect 2014;1:e19216.
12.	Bashir D, Thokar MA, Fomda BA, Bashir G, Zahoor D, Ahmad S, et al. Detection of metallo-beta-lactamase (MBL) producing Pseudomonas aeruginosa at a tertiary care hospital in Kashmir. Afr J Microbiol Res 2011;5:164-72.
13.	Cockerill FR. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing. Twenty Second International Supplement M100-S22. USA: Clinical and Laboratory Standards Institute; 2012.
14.	Lin KY, Lauderdale TL, Wang JT, Chang SC. Carbapenem-resistant Pseudomonas aeruginosa in Taiwan: Prevalence, risk factors, and impact on outcome of infections. J Microbiol Immunol Infect 2016;49:52-9. [PUBMED]
15.	Kaase M, Szabados F, Wassill L, Gatermann SG. Detection of carbapenemases in Enterobacteriaceae by a commercial multiplex PCR. J Clin Microbiol 2012;50:3115-8. [PUBMED]
16.	Noyal MJ, Menezes GA, Harish BN, Sujatha S, Parija SC. Simple screening tests for detection of carbapenemases in clinical isolates of nonfermentative Gram-negative bacteria. Indian J Med Res 2009;129:707-12. [PUBMED] [Full text]
17.	Kato H, Kato N, Watanabe K, Iwai N, Nakamura H, Yamamoto T, et al. Identification of toxin A-negative, toxin B-positive Clostridium difficile by PCR. J Clin Microbiol 1998;36:2178-82. [PUBMED]
18.	Poirel L, Walsh TR, Cuvillier V, Nordmann P. Multiplex PCR for detection of acquired carbapenemase genes. Diagn Microbiol Infect Dis 2011;70:119-23. [PUBMED]
19.	Pitout JD, Gregson DB, Poirel L, McClure JA, Le P, Church DL. Detection of Pseudomonas aeruginosa producing metallo-beta-lactamases in a large centralized laboratory. J Clin Microbiol 2005;43:3129-35. [PUBMED]
20.	Morrow BJ, Pillar CM, Deane J, Sahm DF, Lynch AS, Flamm RK, et al. Activities of carbapenem and comparator agents against contemporary US Pseudomonas aeruginosa isolates from the CAPITAL surveillance program. Diagn Microbiol Infect Dis 2013;75:412-6. [PUBMED]
21.	Shahcheraghi F, Nikbin VS, Feizabadi MM. Identification and genetic characterization of metallo-beta-lactamase-producing strains of Pseudomonas aeruginosa in Tehran, Iran. New Microbiol 2010;33:243-8. [PUBMED]
22.	Strateva T, Yordanov D. Pseudomonas aeruginosa – A phenomenon of bacterial resistance. J Med Microbiol 2009;58(Pt 9):1133-48.
23.	Khosravi Y, Tay ST, Vadivelu J. Analysis of integrons and associated gene cassettes of metallo-ß-lactamase-positive Pseudomonas aeruginosa in Malaysia. J Med Microbiol 2011;60(Pt 7):988-94.
24.	Walther-Rasmussen J, Høiby N. OXA-type carbapenemases. J Antimicrob Chemother 2006;57:373-83.
25.	Queenan AM, Bush K. Carbapenemases: The versatile beta-lactamases. Clin Microbiol Rev 2007;20:440-58. [PUBMED]
26.	Chen IL, Lee CH, Su LH, Tang YF, Chang SJ, Liu JW. Antibiotic consumption and healthcare-associated infections caused by multidrug-resistant Gram-negative bacilli at a large medical center in Taiwan from 2002 to 2009: Implicating the importance of antibiotic stewardship. PLoS One 2013;8:e65621. [PUBMED]
27.	Rosenthal VD, Maki DG, Jamulitrat S, Medeiros EA, Todi SK, Gomez DY, et al. International Nosocomial Infection Control Consortium (INICC) report, data summary for 2003-2008, issued June 2009. Am J Infect Control 2010;38:95-104.e2.
28.	Amjad A, Mirza IA, Abbasi S, Farwa U, Malik N, Zia F. Modified Hodge test: A simple and effective test for detection of carbapenemase production. Iran J Microbiol 2011;3:189-93. [PUBMED]

Advanced Biomedical Research