IN-VITRO ASSESSMENT OF THE THERAPEUTIC POTENTIAL OF POLYMYXINS AND TIGECYCLINE AGAINST MULTIDRUG-RESISTANT ACINETOBACTER ISOLATES FROM INFECTED WOUNDS
AbstractBackground: The incidence of multidrug-resistant (MDR), extreme drug resistant (XDR), and pan drug-resistant (PDR) Acinetobacter are increasing throughout the world. The therapeutic management and control of Acinetobacter are difficult due to the emergence of drug resistance and its enduring capacity to survive in the environment. The present study was designed to appraise the efficacy of Polymyxins and Tigecycline against multidrug-resistant Acinetobacter isolates from surgical and burn wounds. Methods: During the study, the specimens were collected from various types of wounds from inpatients and outpatients of the tertiary care hospitals of Lahore, Pakistan in 2017 and 2018. The bacterial pathogens were isolated and identified using standard microbiological procedures and molecular confirmation of Acinetobacter species was examined by PCR using specific primers. The antibiotic susceptibility profiling of Acinetobacter isolates was studied against 18 antibiotics as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: The Acinetobacter isolates demonstrated extreme resistance especially to ampicillin/sulbactam, piperacillin/tazobactam, cephalosporins, carbapenems, fluoroquinolones, and aminoglycosides. However, the colistin, polymyxin, and tigecycline remained the most effective antimicrobial agents against Acinetobacter isolates. Conclusion: The results highlight the extent of drug resistance and therapeutic potential of Polymyxins and Tigecycline for wound infections caused by MDR and XDR Acinetobacter species. The wiser use of antimicrobials, incessant surveillance of antimicrobial resistance, and stringent adherence to infection control guidelines are critical to reducing major outbreaks in the future.Keywords: Acinetobacter; Wounds; Antimicrobial resistance; Polymyxins; Tigecycline
Fournier PE, Richet H. The epidemiology and control of Acinetobacter baumannii in health care facilities. Clin Infect Dis 2006;42(5):692–9.
Lee K, Yong D, Jeong SH, Chong Y. Multidrug-resistant Acinetobacter spp.: increasingly problematic nosocomial pathogens. Yonsei Med J 2011;52(6):879–91.
Maragakis LL, Perl TM. Acinetobacter baumannii: epidemiology, antimicrobial resistance, and treatment options. Clin Infect Dis 2008;46(8):1254–63.
Sohail M, Rashid A, Aslam B, Waseem M, Shahid M, Akram M, et al. Antimicrobial susceptibility of Acinetobacter clinical isolates and emerging antibiogram trends for nosocomial infection management. Rev Soc Bras Med Trop 2016;49(3):300–4.
Durante-Mangoni E, Zarrilli R. Global spread of drug-resistant Acinetobacter baumannii: molecular epidemiology and management of antimicrobial resistance. Future Microbiol 2011;6(4):407–22.
Peng C, Zong Z, Fan H. Acinetobacter baumannii isolates associated with community-acquired pneumonia in West China. Clin Microbiol Infect 2012;18(12):E491–3.
Falagas ME, Rafailidis PI. Attributable mortality of Acinetobacter baumannii: no longer a controversial issue. Critical Care 2007;11(3):134.
Falagas ME, Kopterides P, Siempos, II. Attributable mortality of Acinetobacter baumannii infection among critically ill patients. Clin Infect Dis 2006;43(3):389–90.
Collier M. Understanding wound inflammation. Nurs Times 2003;99(25):63–4.
MacFaddin JF. Biochemical tests for Identification of Medical Bacteria. 3rd ed. Baltimore: Lippincott Williams & Wilkins; 2000.
Chen TL, Siu LK, Wu RC, Shaio MF, Huang LY, Fung CP, et al. Comparison of one-tube multiplex PCR, automated ribotyping and intergenic spacer (ITS) sequencing for rapid identification of Acinetobacter baumannii. Clin Microbiol Infect 2007;13(8):801–6.
CLSI. Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Fourth Informational Supplement. M100-S24. Wayne, PA, USA; 2014.
Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18(3):268–81.
Chastre J. Infections due to Acinetobacter baumannii in the ICU. Semin Respir Crit Care Med 2003;24(1):69–78.
Manchanda V, Sanchaita S, Singh N. Multidrug resistant acinetobacter. J Glob Infect Dis 2010;2(3):291–304.
Villers D, Espaze E, Coste-Burel M, Giauffret F, Ninin E, Nicolas F, et al. Nosocomial Acinetobacter baumannii infections: microbiological and clinical epidemiology. Ann Intern Med 1998;129(3):182–9.
Lahiri KK, Mani NS, Purai SS. Acinetobacter spp as nosocomial pathogen: Clinical significance and antimicrobial sensitivity. Med J Armed Forces India 2004;60(1):7–10.
Shoja S, Moosavian M, Peymani A, Tabatabaiefar MA, Rostami S, Ebrahimi N. Genotyping of carbapenem resistant Acinetobacter baumannii isolated from tracheal tube discharge of hospitalized patients in intensive care units, Ahvaz, Iran. Iran J Microbiol 2013;5(4):315–22.
Bouchillon SK, Hoban DJ, Johnson BM, Stevens TM, Dowzicky MJ, Wu DH, et al. In vitro evaluation of tigecycline and comparative agents in 3049 clinical isolates: 2001 to 2002. Diagn Microbiol Infect Dis 2005;51(4):291–5.
Gales AC, Jones RN. Antimicrobial activity and spectrum of the new glycylcycline, GAR-936 tested against 1,203 recent clinical bacterial isolates. Diagn Microbiol Infect Dis 2000;36(1):19–36.
Ruiz J, Nunez ML, Perez J, Simarro E, Martinez-Campos L, Gomez J. Evolution of resistance among clinical isolates of Acinetobacter over a 6-year period. Eur J Clin Microbiol Infect Dis 1999;18(4):292–5.
Wu CJ, Lee HC, Lee NY, Shih HI, Ko NY, Wang LR, et al. Predominance of Gram-negative bacilli and increasing antimicrobial resistance in nosocomial bloodstream infections at a university hospital in southern Taiwan, 1996-2003. J Microbiol Immunol Infect 2006;39(2):135–43.
Ishii Y, Alba J, Kimura S, Shiroto K, Yamaguchi K. Evaluation of antimicrobial activity of beta-lactam antibiotics using Etest against clinical isolates from 60 medical centres in Japan. Int J Antimicrob Agents 2005;25(4):296–301.
Turner PJ, Greenhalgh JM, Group MS. The activity of meropenem and comparators against Acinetobacter strains isolated from European hospitals, 1997-2000. Clin Microbiol Infect 2003;9(6):563–7.
Turner PJ. Meropenem activity against European isolates: report on the MYSTIC (Meropenem Yearly Susceptibility Test Information Collection) 2006 results. Diagn Microbiol Infect Dis 2008;60(2):185–92.
McDonald LC. Trends in antimicrobial resistance in health care-associated pathogens and effect on treatment. Clin Infect Dis 2006;42(Suppl 2):S65–71.
Falagas ME, Mourtzoukou EG, Polemis M, Vatopoulos AC. Trends in antimicrobial resistance of Acinetobacter baumannii clinical isolates from hospitalised patients in Greece and treatment implications. Clin Microbiol Infect 2007;13(8):816–9.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.