Investigation of Carbapenemase Production Among Carbapenem-Resistant Pseudomonas aeruginosa Isolates

Harran Üniversitesi Tıp Fakültesi Dergisi Pub Date : 2024-02-23 DOI:10.35440/hutfd.1404926

Shirwan Hussein Darweesh, Umut Safiye Şay Coşkun

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Abstract

Background: Pseudomonas aeruginosa is an opportunist organism that causes potentially life threatening nosocomial infections, particularly in immunocompromised patients. Carbapenems are regarded to be the last line of treatment against severe infections caused by multi drug resistant P. aeruginosa isolates. isolates. Production of the carbapenemase enzyme is the primary mechanism of carbapenem resistance and has become a serious health concern worldwide as these enzymes are highly transferable and limit therapeutic alternatives. Rapid detection of carbapenemase production is important for prompt planning the treatment of car-bapenemase-producing isolates and preventing the spread of these strains. This study aimed to investigate carbapenemase produc-tion in carbapenem resistant Pseudomonas aeruginosa isolates by the Carbapenem inactivation method. Materials and Methods: In this retrospective study a total of 172 Pseudomonas aeruginosa isolates were obtained from different samples sent from various clinics to Tokat Gaziosmanpaşa University Research and Application Hospital Microbiology Laboratory between 2016-2019 and were evaluated. Of the 172 isolates, 51 (29.7%) were found to be carbapenem- resistant and included in this investigation. Identification and antibiotic susceptibility tests of the isolates were performed with the Vitek 2 (Biomerieux, France) automated system. Carbapenem sensitivities were also determined by the disc diffusion method. Carbapenemase production in isolates was investigated by the Carbapenem inactivation method. Results: These samples were sent from clinical units, such as neurology (n =10), general surgery (n =8), internal medicine (n =7), and pediatric (n =6). The isolates were identified from wounds (n = 17), sputum (n = 15), blood (n = 11), urine (n = 5), and cerebrospinal fluid (n = 3) samples. Of all the carbapenem –resistant samples 32 (62.8%) were obtained from male, and 19 (37.3%) from female patients. Of the 51 carbapenem resistant isolates, 38 (74.5%) were found to be resistant to both imipenem and meropenem. Eight (15.7%) isolates were found to be resistant to imipenem only, and five (9.8%) isolates were resistant to meropenem. Carbapenemase production was detected in 31 (60.8%) isolates by using using the Carbapenem inactivation method. The antibiotic resistance rates of the carbapenem-resistant isolates were as follows: piperacillin-tazobactam 65%, amikacin 6.8%, gentamicin 15.2%, ceftazidime 34.6%, cefepime 38.3%, ciprofloxacin 26.7%, levofloxacin 24.2%. Conclusions: Rapid identification of carbapenemase enzymes among carbapenem resistant Pseudomonas aeruginosa isolates using phenotypic and genotypic approaches is important to control the transmission of infection caused by carbapenem-resistant isolates and to control the morbidity and mortality associated with them. In this study, the carbapenem inactivation test was seen as a method that can be preferred in the laboratory in terms of its easy and fast application in the detection of carbapenemase production. Key Words: Pseudomonas aeruginosa, Carbapenem inactivation method, Antimicrobial resistance

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耐碳青霉烯类药物铜绿假单胞菌分离物中碳青霉烯酶产量的研究

背景：铜绿假单胞菌是一种机会致病菌，可引起潜在的危及生命的院内感染，尤其是在免疫力低下的患者中。碳青霉烯类被认为是治疗由多重耐药铜绿假单胞菌引起的严重感染的最后一线药物。碳青霉烯酶的产生是对碳青霉烯类产生耐药性的主要机制，由于这些酶具有很强的转移性，限制了替代疗法，因此已成为全球严重的健康问题。快速检测碳青霉烯酶的产生对于及时规划对产碳青霉烯酶分离菌株的治疗和防止这些菌株的传播非常重要。本研究旨在通过碳青霉烯灭活法调查耐碳青霉烯类的铜绿假单胞菌分离株中碳青霉烯酶的产生情况：在这项回顾性研究中，共对172株铜绿假单胞菌分离物进行了评估，这些分离物来自2016-2019年间托卡特加齐奥斯曼帕萨大学研究与应用医院微生物实验室从不同诊所采集的不同样本。在 172 个分离株中，发现 51 个（29.7%）具有碳青霉烯耐药性，并被纳入本次调查。分离菌株的鉴定和抗生素药敏试验采用 Vitek 2（法国 Biomerieux 公司）自动系统进行。碳青霉烯敏感性也是通过盘扩散法测定的。用碳青霉烯灭活法研究了分离物中碳青霉烯酶的产生情况：这些样本来自临床科室，如神经内科（10 例）、普外科（8 例）、内科（7 例）和儿科（6 例）。从伤口（17 例）、痰（15 例）、血液（11 例）、尿液（5 例）和脑脊液（3 例）样本中鉴定出了分离株。在所有对碳青霉烯类耐药的样本中，32 份（62.8%）来自男性患者，19 份（37.3%）来自女性患者。在 51 个对碳青霉烯类耐药的分离物中，发现 38 个（74.5%）对亚胺培南和美罗培南都耐药。8个（15.7%）分离株仅对亚胺培南耐药，5个（9.8%）分离株对美罗培南耐药。使用碳青霉烯灭活法检测到 31 个（60.8%）分离物产生碳青霉烯酶。对碳青霉烯类耐药菌株的抗生素耐药率如下：哌拉西林-他唑巴坦 65%、阿米卡星 6.8%、庆大霉素 15.2%、头孢他啶 34.6%、头孢吡肟 38.3%、环丙沙星 26.7%、左氧氟沙星 24.2%：利用表型和基因型方法快速鉴定耐碳青霉烯酶铜绿假单胞菌分离株中的碳青霉烯酶，对于控制耐碳青霉烯酶分离株引起的感染传播以及与之相关的发病率和死亡率非常重要。在本研究中，碳青霉烯灭活试验被认为是实验室检测碳青霉烯酶产生的一种简便、快速的方法：铜绿假单胞菌碳青霉烯灭活法抗菌药耐药性

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