ANTIBIOTIC RESISTANCE PATTERN OF ACINETOBACTER BAUMANNII ISOLATED FROM BACTEREMIA PATIENTS IN PAKISTAN
AbstractBackground: Acinetobacter baumannii causes a number of life threatening infections in Hospitalized patients attributed to its ability to develop resistance against multiple antibiotics. The current scrutinisation is aimed to observe the prevalence and antibiotic resistance profile of A. baumannii strains isolated from blood of tertiary care Hospitalized patients in Lahore, Pakistan. Methods: This research is a retrospective study conducted over a period of one year where 1864 blood samples were collected from both male and female patients with septicaemia. Total 156 A. baumannii species were identified by conventional method and their antimicrobial resistance pattern against 22 antimicrobials (representing all known classes of antibiotics) was evaluated by Kirby Bauer disc diffusion method. MICs of colistin, polymyxin B and vancomycin against A. baumannii were calculated by E test and broth dilution method. Results: More males (n=97, 62%) were found infected than females (n=59, 38%). The spreading rate of A. baumannii was highest (n=101, 65%) in patients of age ≤20 years, and lowest (n=12, 7%) in the patients with the age of 41–60 years. Most of the strains of A. baumannii (n=118, 75.6%) were found to be MDR (multi drug resistant), 37 (23.7%) strains were XDR (Extensively drug-resistant) and only 1 (0.05%) strain was PDR (pandrug resistant). All the strains were sensitive to minocycline and tigecycline whereas highest non-susceptibility (n=144, 92%) was seen against Ampicillin-Sulbactam. Most of the strains demonstrated resistance against carbapenem and cephalosporin beckoning that A. baumannii can no longer be considered for salvage therapy by carbapenem. MICs of colistin, polymyxin B and vancomycin against A. baumannii divulged polymixin B as the most effective drug. Conclusion: Use of wide range of drugs has made A. baumannii multidrug resistant. Colistin, polymyxin B and vancomycin are the preferable drugs for the treatment of A. baumannii infections.
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.
Uwingabiye J, Lemnouer A, Roca I, Alouane T, Frikh M, Belefquih B, et al. Clonal Diversity and Detection of Carbapenem Resistance Encoding Genes among Multidrug-Resistant Acinetobacter Baumannii Isolates Recovered from Patients and Environment in Two Intensive Care Units in a Moroccan Hospital. Antimicrob Resist Infect Control 2017;6(1):99–106.
Sieniawski K, Kaczka K, Rucińska M, Gagis L, Pomorski L. Acinetobacter Baumannii Nosocomial Infections. Pol J Surg 2013;85(9):483–90.
Longo F, Vuotto C, Donelli G. Biofilm Formation in Acinetobacter Baumannii. New Microbiol 2014;37(2):119–27.
Rodríguez‐Baño J, Marti S, Soto S, Fernández‐Cuenca F, Cisneros JM, Pachón J, et al. Biofilm Formation in Acinetobacter Baumannii: Associated Features and Clinical Implications. Clin Microbiol Infect 2008;14(3):76–278.
Kirkgöz E, Zer Y. Clonal Comparison of Acinetobacter Strains Isolated from Intensive Care Patients and the Intensive Care Unit Environment. Turk J Med Sci 2014;44(4):643–8.
Guckan R, Kilinc C, Demir A, Capraz A, Yanik K. Antimicrobial Susceptibility of Acinetobacter Baumannii Complex Isolated from Different Clinical Samples in a Tertiary Care Hospital. J Antibiot Res 2015;1(1):1–5.
Howard A, O’Donoghue M, Feeney A, Sleator RD. Acinetobacter Baumannii: An Emerging Opportunistic Pathogen. Virulence 2012;3(3):243–50.
Islahi S, Ahmad F, Khare V, Mishra N, Yaqoob S, Shukla P, et al. Prevalence and Resistance Pattern of Acinetobacter Species in Hospitalized Patients in a Tertiary Care Centre. J Evol Med Dent Sci 2014;3(17):4629–35.
Fishbain J and Peleg AY. Treatment of Acinetobacter Infections. Clin Infect Dis 2010;51(1):79–84.
Joly-Guillou ML. Nosocomial and Community-Acquired Acinetobacter Infections. Acinetobacter Biology and Pathogenesis. Springer, 2008; p.155–65.
Farshadzadeh Z, Hashemi FB, Rahimi S, Pourakbari B, Esmaeili D, Haghighi MA, et al. Wide Distribution of Carbapenem Resistant Acinetobacter Baumannii in Burns Patients in Iran. Front Microbiol 2015;6:1146–56.
Magiorakos AP, Srinivasan A, Carey R, Carmeli Y, Falagas M, Giske C, 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.
Kwon KT, Oh WS, Song JH, Chang HH, Jung SI, Kim SW, et al. Impact of Imipenem Resistance on Mortality in Patients with Acinetobacter Bacteraemia. J Antimicrob Chemother 2007;59(3):525–30.
Wasihun AG, Wlekidan LN, Gebremariam SA, Dejene TA, Welderufael AL, Haile TD, et al. Bacteriological Profile and Antimicrobial Susceptibility Patterns of Blood Culture Isolates among Febrile Patients in Mekelle Hospital, Northern Ethiopia. Springerplus 2015;4(1):314–9.
Furuno JP, Hebden JN, Standiford HC, Perencevich EN, Miller RR, Moore AC, et al. Prevalence of Methicillin-Resistant Staphylococcus Aureus and Acinetobacter Baumannii in a Long-Term Acute Care Facility. Am J Infect Control 2008;36(7):468–71.
Rehman S, Ali NM, Pier GB, Liaqat I, Mazhar B. In Vitro Susceptibility of Pseudomonas Aeruginosa Isolated from Acute and Chronic Pulmonary Infection to Antibiotics, Lactobacillus Competition and Metal Nanoparticles. Pak J Zool 2018;50(6):2165–71.
Manoharan A, Pai R, Shankar V, Thomas K, Lalitha M. Comparison of Disc Diffusion & E Test Methods with Agar Dilution for Antimicrobial Susceptibility Testing of Haemophilus Influenzae. Indian J Med Res 2003;117:81–7.
Young LS, Sabel AL, Price CS. Epidemiologic, Clinical, and Economic Evaluation of an Outbreak of Clonal Multidrug-Resistant Acinetobacter Baumannii Infection in a Surgical Intensive Care Unit. Infect Control Hosp Epidemiol 2007;28(11):1247–54.
Davis KA, Moran KA, McAllister CK, Gray PJ. Multidrug-Resistant Acinetobacter Extremity Infections in Soldiers. Emerg Infect Dis 2005;11(8):1218–42.
McConnell MJ, Actis L, Pachón J. Acinetobacter Baumannii: Human Infections, Factors Contributing to Pathogenesis and Animal Models. FEMS Microbiol Rev 2013;37(2):130–55.
Chan MC, Chiu SK, Hsueh PR, Wang NC, Wang CC, Fang CT. Risk Factors for Healthcare-Associated Extensively Drug-Resistant Acinetobacter Baumannii Infections: A Case-Control Study. PLoS One 2014;9(1):85973–80.
Ou HY, Kuang SN, He X, Molgora BM, Ewing PJ, Deng Z, et al. Complete Genome Sequence of Hypervirulent and Outbreak-Associated Acinetobacter Baumannii Strain Lac-4: Epidemiology, Resistance Genetic Determinants and Potential Virulence Factors. Sci Rep 2015;5:8643–56.
Hussein MH, Schneider EK, Elliott AG, Han M, Reyes-Ortega F, Morris F, et al. From Breast Cancer to Antimicrobial: Combating Extremely Resistant Gram-Negative “Superbugs” Using Novel Combinations of Polymyxin B with Selective Estrogen Receptor Modulators. Microb Drug Resist 2017;23(5):640–50.
Villar M, Cano ME, Gato E, Garnacho-Montero J, Cisneros JM, de Alegría CR, et al. Epidemiologic and Clinical Impact of Acinetobacter Baumannii Colonization and Infection: A Reappraisal. Medicine 2014;93(5):202–10.
Timurkaynak F, Can F, Azap ÖK, Demirbilek M, Arslan H, Karaman SÖ. In Vitro Activities of Non-Traditional Antimicrobials Alone or in Combination against Multidrug-Resistant Strains of Pseudomonas Aeruginosa and Acinetobacter Baumannii Isolated from Intensive Care Units. Int J Antimicrob Agents 2006;27(3):224–8.
Kamble R. Acinetobacter Species in Health Care Setting: Clinical Significance and Antimicrobial Sensitivity. Int J Curr Microbiol App Sci 2015;4(4):861–9.
Begum S, Hasan F, Hussain S, Shah AA. Prevalence of multi drug resistant Acinetobacter baumannii in the clinical samples from Tertiary Care Hospital in Islamabad, Pakistan. Pak J Med Sci 2013;29(5):1253–8.
Fernandes R, Amador P, Prudêncio C. Β-Lactams: Chemical Structure, Mode of Action and Mechanisms of Resistance. Rev Med Microbiol 2013;24(1):7–17.
Fernandes R, Vieira M, Ferraz R and Prudêncio C. Bloodstream Infections Caused by Multidrug-Resistant Enterobacteriaceae: Report from Two Portuguese Hospitals. J Hosp Infect 2008;70(1):93–5.
Poirel L, Jayol A, Nordmann P. Polymyxins: Antibacterial Activity, Susceptibility Testing, and Resistance Mechanisms Encoded by Plasmids or Chromosomes. Clin Microbiol Rev 2017;30(2):557–96.
Lin MF, Lan CY. Antimicrobial Resistance in Acinetobacter Baumannii: From Bench to Bedside. World J Clin Cases 2014;2(12):787–814.
Peleg AY, Seifert H, Paterson DL. Acinetobacter Baumannii: Emergence of a Successful Pathogen. Clin Microbiol Rev 2008;21(3):538–82.
Nayman SA, Aybey A, Akşit F, Ozgüneş I, Kiremitci A, Usluer G. In Vitro Tigecycline and Carbapenem Susceptibilities of Clinical Acinetobacter Baumannii Isolates. Mikrobiyol Bul 2010;44(4):641–5.
Dijkshoorn L, Nemec A, Seifert H. An Increasing Threat in Hospitals: Multidrug-Resistant Acinetobacter Baumannii. Nat Rev Microbiol 2007;5(12):939–51.
Zavascki AP, Goldani LZ, Li J, Nation RL. Polymyxin B for the Treatment of Multidrug-Resistant Pathogens: A Critical Review. J Antimicrob Chemother 2007;60(6):1206–15.
Karaiskos I, Giamarellou H. Multidrug-Resistant and Extensively Drug-Resistant Gram-Negative Pathogens: Current and Emerging Therapeutic Approaches. Expert Opin Pharmacother 2014;15(10):1351–70.
Ko KS, Suh JY, Kwon KT, Jung SI, Park KH, Kang CI, et al. High Rates of Resistance to Colistin and Polymyxin B in Subgroups of Acinetobacter Baumannii Isolates from Korea. J Antimicrob Chemother 2007;60(5):1163–7.
Navon-Venezia S, Leavitt A, Carmeli Y. High Tigecycline Resistance in Multidrug-Resistant Acinetobacter Baumannii. J Antimicrob Chemother 2007;59(4):772–4.