Multi-Drug Resistant Pseudomonas aeruginosa Isolated from Hospitals in Onitsha, South-Eastern Nigeria
Background: The increasing trend of multi-drug resistant Pseudomonas aeruginosa implicated in most nosocomial infections in Nigeria has necessitated this present study; which investigated the resistance and susceptibility patterns of P. aeruginosa isolated from hospitals in Onitsha, Southeast Nigeria. Methods: A total of 22 clinical and environmental isolates of P. aeruginosa were recovered from 10 hospitals in Onitsha, Southeastern Nigeria and they comprised 3 (13.6%) isolates from hospital sinks, 2 (9.1%) from hospital mops, patients’ table, trolleys, sphygmomanometer, laboratory work bench and cleaning buckets respectively and 1 (4.5%) from theatre bed, wound swab, nasal swab, nurses’ tray, floor, disinfectant and ear swab respectively. Antimicrobial susceptibility testing for 11 antibiotics was performed by agar disk diffusion on Muller-Hinton agar plates and multiple antibiotic resistance index (MARI) was also determined. Results: Antibiogram categorized the 22 P. aeruginosa isolates into 5 different antibiotypes. Results showed that each isolate was resistant to ≥ 3 classes of antibiotics; 3 (13.6%) were resistant to 7 antibiotics; 11 (50%) were resistant to 8 antibiotics; 5 (22.7%) were resistant to 9 antibiotics and 3 (13.6%) were resistant to 10 antibiotics. Susceptibility testing showed that all the 22 isolates were multi-drug resistant being resistant to at least 3 classes of anti-pseudomonal drugs. P. aeruginosa had highest resistance rates to the cephalosporins (ceftazidime, cefuroxime, cefotaxime, cefepime) at 100%, followed by piperacillin (100%), amoxicillin-clavulanic acid (100%) and tetracycline (100%). The multi-drug resistance (MDR) rate was determined at 100%. Highest number of susceptible isolates was recorded for imipenem (100%) and amikacin (86.4%) respectively. Conclusion: The high resistance profiles observed in this study could limit available therapeutic options for infections caused by these multidrug resistant strains if they are not properly detected and reported by hospital laboratories.
2. Carmeli, Y., N. Troillet, G.M. Eliopoulos and M.H. Samore. Emergence of antibiotic resistant Pseudomonas aeruginosa: comparison of risks associated with different antipseudomonal agents. Antimicrobial Agents and Chemotherapy, 1999; 43:1379 - 1382
3. Magiorakos, A. P. Multidrug- Resistant (MDR), Extensively Drug Resistant (XDR) and Pandrug-1 Resistant (PDR) Bacteria in Healthcare Settings. Expert Proposal for a Standardized International Terminology. 2011; Available online at www.escmid.org.
4. Centers for Disease Control and Prevention (CDC). Antibiotic resistance threats in the United States, 2013. Atlanta: CDC, 2013. Available at: http://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf. Accessed 26 November 2014.
5. Tsering, D.C., S. Das, L. Adhiakari, R. Pal and T.S. Singh. Extended spectrum beta-lactamase detection in Gram-negative bacilli of nosocomial origin. Journal of Global Infectious Diseases, 2009; 1(2): 87-92.
6. Ohieku, J.D., M.I. Nnolim and G.B. Galadima. Bacteraemia among inpatient of University of Maiduguri Teaching Hospital: The pathogens involved, their susceptibilities to antibacterial agents and multi-drugs resistant patterns. Journal of Medicine and Applied Bioscience, 2010; 2:1-8.
7. Jombo, G.T., S. Akpan, J. Epoke, P. Denen Akaa and F. Odey. Multi-drug resistant Pseudomonas aeruginosa infections complicating. Asian Pacific Journal of Tropical Medicine, 2010; 2:479-482
8. Cheesbrough, M. Biochemical tests to identify bacteria. In: District Laboratory Practice in Tropical Countries, 2nd edition. Cambridge University Press, UK., 2004; Pp: 178-187.
9. Clinical and Laboratory Standards Institute (CLSI). M100 - S20. Performance standards for Antimicrobial Disk Susceptibility Test. Informal Supplement. 2010.
10. Olayinka, A.T., B.O. Olayinka, and B.A. Onile. Antibiotic susceptibility and plasmid pattern of Pseudomonas aeruginosa from the surgical unit of a university teaching hospital in north central Nigeria. International Journal of Medicine and Medical Sciences, 2009; 1(3):079-083
11. Akingbade, O.A., S.A. Balogun, D.A. Ojo, R.A. Afolabi, B.O. Motayo, P.O. Okerentugba and I.O. Okonko. Plasmid Profile Analysis of Multidrug Resistant Pseudomonas aeruginosa isolated from wound infections in South West, Nigeria. World Applied Science Journal, 2012; 20 (6): 766-775
12. Nworie, O.1., A.U. Nnachi, C. Ukaegbu, M.N. Alo, U.O. Ekuma and E.O. Ogueji. Antibiotic susceptibility and plasmid profile of Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli isolated from wound patients in Abakaliki metropolis, Ebonyi state. American Journal of Bioscience and Bioengineering, 2013; 1(6): 75-82
13. Haleem, H., J. Kadhim and T.I. Abbas. Isolation of Pseudomonas aeruginosa from Clinical Cases and Environmental Samples, and Analysis of its Antibiotic
Resistant Spectrum at Hilla Teaching Hospital. Banyan Medical Journal of Babylon, 2011; 8 (4): 618-624
14. Al-Yasseen, A. H., K.J. Al-Yaqobbi and M. Saleh. Distribution of resistance plasmid among clinical and environmental isolates of Pseudomonas aeruginosa. Kufa Medical Journal, 2012; 15 (2): 11-15
15. Mahmoud, A.B., W.A. Zahran, A.Z. Hindawi Labib, and R. Galal. Prevalence of Multidrug-Resistant Pseudomonas aeruginosa in Patients with Nosocomial Infections at a University Hospital in Egypt, with Special Reference to Typing Methods. Journal of Virology and Microbiology, 2013; 4:1-13.
16. Gad, G. F., R.A. El-Domany, S. Zaki and H.M. Ashour. Characterization of Pseudomonas aeruginosa Isolated from Clinical and Environmental Samples in Minia, Egypt: Prevalence, Antibiogram and Resistance Mechanisms. Journal of Antimicrobial Chemotherapy, 2007; 60: 1010– 1017
17. Odumosu, B.T., B.A. Adeniyi, D.A. Hannah and R. Chandra. Multidrug resistant Pseudomonas aeruginosa from Southwest Nigeria hospitals. International Journal of Pharmaceutical Science Review Research, 2012; 15(2):11-15
18. Ranjbar, R., P. Owlia, H. Saderi, S. Mansouri, M. Jonaidi-Jafari, M. Izadi, M. Farshad and M. Arjomandzadegan. Characterization of Pseudomonas aeruginosa Strains Isolated from Burned Patients Hospitalized in a Major Burn Center in Tehran, Iran. Acta Medica Iranica, 2011; 49(10): 675-679.
19. Hamze M., H. Mallat, F. Dabboussi and M. Achkar. Antibiotic susceptibility and serotyping of clinical Pseudomonas aeruginosa isolates in northern Lebanon. The International Arabic Journal of Antimicrobial Agents, 2012; 2 (4): 1-6
20. Zulfiquar, A.N., H. Khursheed, M.R. Ouazi and S.A. Kharl. Multidrug resistant Pseudomonas aeruginosa: a nosocomial infection threat in burn patients. Pakistan Journal of Pharmacology, 2005; 22(2):170 - 179
21. Odusanya, O.O. Antibiotic susceptibility of microorganisms at a General Hospital in Lagos, Nigeria. Journal of National Medical Association, 2002; 94: 994-998.
22. Nikbin, V.S., A. Abdi-Ali, M.M. Feizabadi and S. Gharavi. Pulsed field gel electrophoresis and plasmid profile of Pseudomonas aeruginosa at two hospitals in Teran, Iran. Indian Journal of Medical Research, 2007; 126:146 -151
23. Ramprasad, B.P., M. Rodrigues and D. Suprama. Role of Pseudomonas in nosocomial infections and biological characterization of local strains. Journal of Bioscience Technology, 2010; 1(14): 170 – 179
24. Zahra, T and R. Moniri. Detection of ESBLs and MDR in Pseudomonas aeruginosa in a Tertiary-Care Teaching Hospital. Iranian Journal of Clinical Infectious Diseases, 2011; 6(1) 18-23.
25. Ejikeugwu C, Duru C, Edeh C, Iroha I. Prevalence of AmpC β-lactamase-producing Pseudomonas aeruginosa Isolates from feacal matter of cow. Journal of Microbiology and Experimentation, 2017; 4(5):1-4.
26. Ejikeugwu C, Esimone C, Iroha I, Ugwu C, Ezeador C, Duru C, Adikwu M. Phenotypic detection of AmpC beta-lactamase among anal Pseudomonas aeruginosa isolates in a Nigerian abattoir. Archives of Clinical Microbiology, 2016; 7(2):1-5.