Share This Article:

Effect of Antibiotic Consumption on Resistance of Pseudomonas aeruginosa Isolated from Lebanese Patients with Emphasis on MBL Production

Full-Text HTML Download Download as PDF (Size:694KB) PP. 382-388
DOI: 10.4236/aim.2013.34052    2,805 Downloads   4,543 Views   Citations


The relationship between antibiotic consumption and resistance has been widely evaluated. Pseudomonas aeruginosa is one of the most important opportunistic pathogens in the nosocomial setting, and its resistance to antibiotics is increaseing. Production of metallo-β-lactamases (MBLs) is currently the most fearful resistance mechanism due to the potential of dissemination. This study aimed to evaluate the correlation between antibiotic consumption (expressed in DDD/100 bed days) and resistance (expressed in % of isolates and patients) in different time periods for P. aeruginosa between 2006 and 2009 at Saint George Hospital University Medical Center (SGH-UMC), Beirut. Pearson correlation coefficients (r) were calculated and linear regression was performed. Detection of MBL-producing Imipenem resistant P. aeruginosa (IRPA) isolates between 2008 and 2009 was performed using three MBL screening methods: MBL Etest?, Imipenem/EDTA combined disk test and EDTA disk potentiation with four cephalosporins. The modified Hodge test was also performed. From 2006 till 2009, there was a trend of increasing resistance of P. aeruginosa to all antibiotics, and the highest % of resistance was for Ofloxacin. Concerning resistance expressed by isolates, high correlation coefficients resulted among Imipenem, Ciprofloxacin and Tazobactam consumption and resistance to these agents in the same year correlation; Ceftazidime and Ofloxacin consumption and resistance in the next year correlation; Gentamicin and Ofloxacin consumption and the change in resistance (ΔR). Concerning resistance expressed by patients, results were similar except for Ceftazidime and Ofloxacin correlation in the next year correlation. In MBL screening, three isolates gave accordance among 4 methods which showed a positive result. The correlation between antibiotic consumption and resistance is highly dependent on the kind of antibiotic, the organism and the time of correlation. Various MBL screening phenotypic methods on one isolate can increase accuracy and eliminate false positive and negative results.

Cite this paper

R. Mouawad, C. Afif, E. Azar, E. Dahdouh, K. Masri, J. Irani and Z. Daoud, "Effect of Antibiotic Consumption on Resistance of Pseudomonas aeruginosa Isolated from Lebanese Patients with Emphasis on MBL Production," Advances in Microbiology, Vol. 3 No. 4, 2013, pp. 382-388. doi: 10.4236/aim.2013.34052.


[1] F. Baquero, G. Baquero-Artigao, R. Canton and C. Garcia-Rey, “Antibiotic Consumption and Resistance Selection in Streptococcus pneumoniae,” Journal of Antimicrobial Chemotherapy, Vol. 50, Suppl. 3, 2002, pp. 27-38. doi:10.1093/jac/dkf504
[2] R. Sharma, C. L. Sharma and B. Kapoor, “Antibacterial Resistance: Current Problems and Possible Solutions,” Indian Journal of Medical Sciences, Vol. 59, No. 3, 2005, pp. 120-129.
[3] J. M. Loeffler, J. Garbino, D. Lew, S. Harbarth and P. Rohner, “Antibiotic Consumption, Bacterial Resistance and Their Correlation in a Swiss University Hospital and its Adult Intensive Care Units,” Scandinavian Journal of Infectious Diseases, Vol. 35, No. 11-12, 2003, pp. 843-850. doi:10.1080/00365540310016646
[4] A. Mutnick, P. Rhomberg, H. Sader and R. Jones, “Antimicrobial Usage and Resistance Trend Relationships from the MYSTIC Programme in North America (1999-2001),” Journal of Antimicrobial Chemotherapy, Vol. 53, No. 2, 2004, pp. 290-296. doi:10.1093/jac/dkh039
[5] T. Slama, “Gram-Negative Antibiotic Resistance: There Is a Price to Pay,” Journal of Critical Care, Vol. 12, Suppl. 4, 2008, p. S4.
[6] S. Pournaras, M. Maniati, N. Spanakis, A. Ikonomidis, P. T. Tassios, A. Tsakris, N. J. Legakis and N. J. Maniatis, “Spread of Efflux Pump-Overexpressing, Non-Metallo-βLactamase Producing, Meropenem-Resistant But Ceftazidime-Susceptible Pseudomonas aeruginosa in a Region with BlaVIM Endemicity,” Journal of Antimicrobial Chemotherapy, Vol. 56, No. 4, 2005, pp. 761-764. doi:10.1093/jac/dki296
[7] C. Lagatolla, E. Edalucci, L. Dolzani, M. L. Riccio, F. Luca, E. Medessi, G. M. Rossolini and E. A. Tonin, “Molecular Evolution of Metallo-β-Lactamase-Producing Pseudomonas aeruginosa in a Nosocomial Setting of HighLevel Endemicity,” Journal of Clinical Microbiology, Vol. 44, No. 7, 2006, pp. 2348-2353. doi:10.1128/JCM.00258-06
[8] P. Onguru, A. Erbay, H. Bodur, G. Baran, E. Akinci, N. Balaban and M. Cevik, “Imipenem-Resistant Pseudomonas aeruginosa: Risk Factors for Nosocomial Infections,” Journal of Korean Medical Sciences, Vol. 23, No. 6, 2008, pp. 982-987. doi:10.3346/jkms.2008.23.6.982
[9] O. Gutiérrez, C. Juan, E. Cercenado, F. Navarro, E. Bouza and P. Coll, “Molecular Epidemiology and Mechanisms of Carbapenem Resistance in Pseudomonas aeruginosa Isolates from Spanish Hospitals,” Antimicrobial Agents and Chemotherapy, Vol. 51, No. 12, 2007, pp. 4329-4335. doi:10.1128/AAC.00810-07
[10] C. Franklin, L. Liolios and A. Y. Peleg, “Phenotypic Detection of Carbapenem-Susceptible Metallo-β-LactamaseProducing Gram-Negative Bacilli in the Clinical Laboratory,” Journal of Clinical Microbiology, Vol. 44, No. 9, 2006, pp. 3139-3144. doi:10.1128/JCM.00879-06
[11] R. C. Picao, S. S. Andrade, A. G. Nicoletti, E. H. Campana, G. C. Moraes, R. E. Mendes and A. C. Gales, “Metallo-β-Lactamase Detection: Comparative Evaluation of Double-Disk Synergy versus Combined Disk Tests for IMP-, GIM-, SIM-, SPM-, or VIM-Producing Isolates,” Journal of Clinical Microbiology, Vol. 46, No. 6, 2008, pp. 2028-2037. doi:10.1128/JCM.00818-07
[12] B. Behera, P. Mathur, A. Das, A. Kapil and V. Sharma, “An Evaluation of Four Different Phenotypic Techniques for Detection of Metallo-β-Lactamase Producing Pseudomonas aeruginosa,” Indian Journal of Medical Microbiology, Vol. 26, No. 3, 200, 233-237. doi:10.4103/0255-0857.39587
[13] I. Galani, P. Rekatsina, D. Hatzaki, D. Plachouras, M. Souli and H. Giamarellou, “Evaluation of Different Laboratory Tests for the Detection of Metallo-β-Lactamase Production in Enterobacteriaceae,” Journal of Antimicrobial Chemotherapy, Vol. 61, No. 3, 2008, pp. 548-553. doi:10.1093/jac/dkm535
[14] P. M. Lepper, E. Grusa, H. Reichl, J. Hogel and M. Trautmann, “Consumption of Imipenem Correlates with β-Lactam Resistance in Pseudomonas aeruginosa,” Antimicrobial Agents and Chemotherapy, Vol. 46, No. 9, 2002, pp. 2920-2925. doi:10.1128/AAC.46.9.2920-2925.2002
[15] M. S. Lapatschek and A. Hartinger, “Antibiotic Usage and Resistance Development in an Intensive Care Unit,” International Journal of Antimicrobial Agents, Vol. 29, 2007, p. S633.
[16] H. Sader, M. Castanheira, R. Mendes, M. Toleman, T. Walsh and R. Jones, “Dissemination and Diversity of Metallo-β-Lactamases in Latin America: Report from the SENTRY Antimicrobial Surveillance Program,” International Journal of Antimicrobial Agents, Vol. 25, No. 1, 2005, pp. 57-61. doi:10.1016/j.ijantimicag.2004.08.013
[17] K. Lee, Y. Chong, H. Shin, Y. Kim, D. Yong and J. Yum, “Modified Hodge and EDTA-Disk Synergy Tests to Screen Metallo-β-Lactamase-Producing Strains of Pseudomonas and Acinetobacter Species,” Clinical Microbiology and Infection, Vol. 7, No. 2, 2001, pp. 88-102. doi:10.1046/j.1469-0691.2001.00204.x
[18] T. Kirikae, Y. Mizuguchi and Y. Arakawa, “Investigation of Isolation Rates of Pseudomonas aeruginosa with and without Multidrug Resistance in Medical Facilities and Clinical Laboratories in Japan,” Journal of Antimicrobial Chemotherapy, Vol. 61, No. 3, 2008, pp. 612-615. doi:10.1093/jac/dkm537
[19] M. A. Borg, P. Zarb, E. A. Scicluna, O. Rasslan, D. Gur, S. B. Redjeb, Z. Elnasser and Z. Daoud, “Antibiotic Consumption as a Driver for Resistance in Staphylococcus aureus and Escherichia coli within a Developing Region,” American Journal of Infection Control, Vol. 38, No. 3, 2010, pp. 212-216. doi:10.1016/j.ajic.2009.07.010
[20] H. Kallel, F. Mahjoubi, H. Dammak, M. Bahloul, C. Hamida, H. Chelly, N. Rekik, A. Hammami and M. Bouaziz, “Correlation between Antibiotic Use and Changes in Susceptibility Patterns of Pseudomonoas aeruginosa in a Medical-Surgical Intensive Care Unit,” Indian Journal of Critical Care Medicine, Vol. 12, No. 1, 2008, pp. 18-23. doi:10.4103/0972-5229.40945
[21] A. Varaiya, N. Kulkarni, M. Kulkarni, P. Bhalekar and J. Dogra, “Incidence of Metallo Beta Lactamase Producing Pseudomonas aeruginosa in ICU Patients,” Indian Journal of Medical Research, Vol. 127, No. 4, 2008, pp. 398-402.
[22] O. Samuelsen, L. Buaro, C. Giske, G. Simonsen, B. Aasnas and A. Sundsfjord, “Evaluation of Phenotypic Tests for the Detection of Metallo-β-Lactamase-Producing Pseudomonas aeruginosa in a Low Prevalence Country,” Journal of Antimicrobial Chemotherapy, Vol. 61, No. 4, 2008, pp. 827-830. doi:10.1093/jac/dkn016
[23] L. Bergès, H. Rodriguez-Villalobos, A. Deplano and M. J. Struelens, “Prospective Evaluation of Imipenem/EDTA Combined Disc and Etest for Detection of Metallo-β-Lactamase-Producing Pseudomonas aeruginosa,” Journal of Antimicrobial Chemotherapy, Vol. 56, No. 4, 2007, pp. 812-813. doi:10.1093/jac/dkm001
[24] T. Qu, J. Zhang, J. Wang, J. Tao, Y. Yu, Y. Chen, C. Zhou and L. Li , “Evaluation of Phenotypic Tests for Detection of Metallo-β-Lactamase-Producing Pseudomonas aeruginosa Strains in China,” Journal of Clinical Microbiology, Vol. 47, No. 4, 2009, pp. 1136-1142. doi:10.1128/JCM.01592-08
[25] K. Lee, D. Yong, J. H. Yum, Y. S. Lim, A. Bolmstrom, A. Qwarnstrom, A. Karlsson and Y. Chong, “Evaluation of Etest MBL for Detection of blaIMP-1 and blaVIM-2 Allele-Positive Clinical Isolates of Pseudomonas spp. and Acinetobacter spp,” Journal of Clinical Microbiology, Vol. 43, No. 2, 2005, pp. 942-944. doi:10.1128/JCM.43.2.942-944.2005

comments powered by Disqus

Copyright © 2018 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.