International Journal of Medical Laboratory Research (IJMLR)

TWENTY-YEAR TRENDS IN ANTIMICROBIAL RESISTANCES AMONG PSEUDOMONAS AERUGINOSA CLINICAL ISOLATES

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Jari Intra, Claudia Siracusa, Maria Roberta Sala, Valerio Leoni, Paolo Brambilla, Davide Carcione

 

ABSTRACT: We retrospectively analyzed the antimicrobial data of P. aeruginosa strains isolated from hospitalized subjects and outpatients over a 20-year period (2000-2019). A total of 2,588 unique P. aeruginosa strains, 588 from outpatients (23 %) and 2,000 from hospitalized subjects (77 %), were retrieved. Except gentamicin and ciprofloxacin, which showed significant antibiotic decreasing trends, all the antimicrobial agents tested did not show significantly changes in both groups (p < 0.01). There were significant increasing resistance trends for all antibiotics, except gentamicin and ciprofloxacin in P. aeruginosa strains isolated from respiratory tract samples (p < 0.05), and for meropenem and piperacillin-tazobactam in urine samples from subjects with and without urinary catheter (p < 0.05). Moreover, there was a significant increase in multidrug resistant isolates (p < 0.05). Monitoring antibiotic resistances at local and regional levels are required in order to reduce inappropriate antimicrobial consumption, to increase the focus on antimicrobial stewardship.

 

KEY WORDS: Antibiotic resistance, Pseudomonas aeruginosa, Epidemiology, Carbapenem resistance, Surveillance

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REFERENCES:

1. Rossolini GM, Arena F, Pecile P, Pollini S. Update on the antibiotic resistance crisis. Curr Opin Pharmacol. 2014; 18:56-60.

2. Munita JM, Arias CA. Mechanisms of Antibiotic Resistance. Microbiol Spectr. 2016;4(2): 10.1128/microbiolspec.VMBF-0016-2015.

3. Dodds DR. Antibiotic resistance: A current epilogue. Biochem Pharmacol. 2017 Jun 15; 134:139-146.

4. Botelho J, Grosso F, Peixe L. Antibiotic resistance in Pseudomonas aeruginosa - Mechanisms, epidemiology and evolution. Drug Resist Updat. 2019; 44:100640.

5. Feng W, Huang Q, Wang Y, Yuan Q, Li X, Xia P, Sun F. Changes in the resistance and epidemiological characteristics of Pseudomonas aeruginosa during a ten-year period. J Microbiol Immunol Infect. 2021 ;54,2:261-266.

6. Brzozowski M, Krukowska Ż, Galant K, Jursa-Kulesza J, Kosik-Bogacka D. Genotypic characterisation and antimicrobial resistance of Pseudomonas aeruginosa strains isolated from patients of different hospitals and medical centres in Poland. BMC Infect Dis. 2020 ;20,1:693.

7. Tacconelli E, Carrara E, Savoldi A, Harbarth S, Mendelson M, Monnet DL, Pulcini C, Kahlmeter G, Kluytmans J, Carmeli Y, Ouellette M, Outterson K, Patel J, Cavaleri M, Cox EM, Houchens CR, Grayson ML, Hansen P, Singh N, Theuretzbacher U, Magrini N; WHO Pathogens Priority List Working Group.

8. Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. Lancet Infect Dis. 2018 ;18,3:318-327.

9. CLSI. 2021. Performance Standards for Antimicrobial Susceptibility Testing.31st ed. CLSI supplement M100.

10. The European Committee on Antimicrobial Susceptibility Testing (EUCAST). 2021. Breakpoint tables for interpretation of MICs and zone diameters. Version 11.0 http://www.eucast.org.

11. Magiorakos AP, Srinivasan A, Carey RB, Carmeli Y, Falagas ME, Giske CG, Harbarth S, Hindler JF, Kahlmeter G, Olsson-Liljequist B, Paterson DL, Rice LB, Stelling J, Struelens MJ, Vatopoulos A, Weber JT, Monnet DL. 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.

12. StataCorp. 2019. Stata Statistical Software: Release 16. College Station, TX: StataCorp LLC.

13. Sánchez-Bautista A, Coy J, García-Shimizu P, Rodríguez JC. From CLSI to EUCAST guidelines in the interpretation of antimicrobial susceptibility: What is the effect in our setting? Enferm Infecc Microbiol Clin (Engl Ed). 2018 ;36,4:229-232. English, Spanish.

14. Bellino S, Iacchini S, Monaco M, Del Grosso M, Camilli R, Errico G, D'Ancona F, Pantosti A, Pezzotti P, Maraglino F, Iannazzo S. AR-ISS: sorveglianza nazionale dell’Antibiotico-Resistenza. Dati 2019. Roma: Istituto Superiore di Sanità; 2020. (Rapporti ISS Sorveglianza RIS-1/2020).

15. European Centre for Disease Prevention and Control. 2020. Antimicrobial resistance in the EU/EEA (EARS-Net) -Annual Epidemiological Report 2019.

16. Osservatorio Nazionale sull’impiego dei Medicinali. 2019. L’uso degli antibiotici in Italia. Rapporto Nazionale 2017.

17. European Medicine Agency. 2019. Disabling and potentially permanent side effects lead to suspension or restrictions of quinolone and fluoroquinolone antibiotics. EMA/175398/2019

18. European Commission. 2017. Commission Notice - EU Guidelines for the prudent use of antimicrobials in human health (2017/C 212/01)

19. Telling K, Laht M, Brauer A, Remm M, Kisand V, Maimets M, Tenson T, Lutsar I. Multidrug resistant Pseudomonas aeruginosa in Estonian hospitals. BMC Infect Dis. 2018; 11;18,1:513.

20. Ijaz M, Siddique AB, Rasool MH, Shafique M. Frequency of multi drug resistant Pseudomonas aeruginosa in different wound types of hospitalized patients. Pak J Pharm Sci. 2019 ;32,2:865-870.

21. Moussally M, Zahreddine N, Kazma J, Ahmadieh R, Kan SS, Kanafan ZA. Prevalence of antibiotic-resistant organisms among hospitalized patients at a tertiary care center in Lebanon, 2010-2018. J Infect Public Health. 2021 ;14,1:12-16.

22. D'Atri F, Arthur J, Blix HS, Hicks LA, Plachouras D, Monnet DL; The European Survey on Transatlantic Task Force On Antimicrobial Resistance Tatfar Action Group. Targets for the reduction of antibiotic use in humans in the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) partner countries. Euro Surveill. 2019 ;24,28)\:1800339.

23. European Centre for Disease Prevention and Control. 2019. Surveillance of antimicrobial resistance in Europe 2018.

24. Doyle JS, Buising KL, Thursky KA, Worth LJ, Richards MJ. Epidemiology of infections acquired in intensive care units. Semin Respir Crit Care Med. 2011 ;32,2:115-38.

25. Cavallazzi R, Ramirez J. Community-acquired pneumonia in chronic obstructive pulmonary disease. Curr Opin Infect Dis. 2020 ;33,2:173-181.