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      Imipenem Resistant Pseudomonas aeruginosa: The fall of the final quarterback

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          Abstract

          Objective:

          To isolate, determine the frequency, and study the demographic trends of MBL positive Pseudomonas aeruginosa from imipenem resistant isolates collected from clinical samples in a tertiary care hospital of Pakistan.

          Methods:

          In this cross sectional study a total of 230 strains of Pseudomonas were isolated from various clinical specimens on the basis of culture and biochemical tests. Imipenem resistant isolates were selected by Kirby Bauer Diffusion technique, followed by screening for MBL production by Imipenem EDTA Combined Disk Test. Demographic details of each patient were recorded on a separate questionnaire. Chi-Square goodness-of-fit test was computed to review the isolation of MBL positive isolates (P-value ≤ 0.05) in different specimen.

          Results:

          Out of 230 strains of P. aeruginosa 49.5% were imipenem resistant; MBL production was confirmed in 64.9% of the resistant isolates. Resistance to polymyxin B (12.5%) was notable. Majority of the MBL positive strains were isolated from patients aged between 20-39 years (45.9%) and the predominant source was pus (43.24%) which was found to be statistically significant (P-value=0.04). Outpatient departments (24.3%) and burn unit (21.6%) were the major places for resistant isolates.

          Conclusion:

          MBL production is one of the major causes of IRPA. Increasing resistance to polymyxin B is grave. Due to acquisition of MBL strains MDR P. aeruginosa has become endemic in tertiary setups.

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          Most cited references37

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          Carbapenemases: the versatile beta-lactamases.

          Carbapenemases are beta-lactamases with versatile hydrolytic capacities. They have the ability to hydrolyze penicillins, cephalosporins, monobactams, and carbapenems. Bacteria producing these beta-lactamases may cause serious infections in which the carbapenemase activity renders many beta-lactams ineffective. Carbapenemases are members of the molecular class A, B, and D beta-lactamases. Class A and D enzymes have a serine-based hydrolytic mechanism, while class B enzymes are metallo-beta-lactamases that contain zinc in the active site. The class A carbapenemase group includes members of the SME, IMI, NMC, GES, and KPC families. Of these, the KPC carbapenemases are the most prevalent, found mostly on plasmids in Klebsiella pneumoniae. The class D carbapenemases consist of OXA-type beta-lactamases frequently detected in Acinetobacter baumannii. The metallo-beta-lactamases belong to the IMP, VIM, SPM, GIM, and SIM families and have been detected primarily in Pseudomonas aeruginosa; however, there are increasing numbers of reports worldwide of this group of beta-lactamases in the Enterobacteriaceae. This review updates the characteristics, epidemiology, and detection of the carbapenemases found in pathogenic bacteria.
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            Multiple mechanisms of antimicrobial resistance in Pseudomonas aeruginosa: our worst nightmare?

            Pseudomonas aeruginosa carries multiresistance plasmids less often than does Klebsiella pneumoniae, develops mutational resistance to cephalosporins less readily than Enterobacter species, and has less inherent resistance than Stenotrophomonas maltophilia. What nevertheless makes P. aeruginosa uniquely problematic is a combination of the following: the species' inherent resistance to many drug classes; its ability to acquire resistance, via mutations, to all relevant treatments; its high and increasing rates of resistance locally; and its frequent role in serious infections. A few isolates of P. aeruginosa are resistant to all reliable antibiotics, and this problem seems likely to grow with the emergence of integrins that carry gene cassettes encoding both carbapenemases and amikacin acetyltransferases.
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              Imipenem-EDTA disk method for differentiation of metallo-beta-lactamase-producing clinical isolates of Pseudomonas spp. and Acinetobacter spp.

              Rapid detection of metallo-beta-lactamase (MBL)-producing gram-negative bacilli is necessary to prevent their dissemination. The method using a disk with imipenem plus 750 micro g of EDTA differentiated all MBL-producing pseudomonads, and the sensitivity and specificity for acinetobacters were 95.7 and 91.0%, respectively. The imipenem-EDTA disks were stable for 12 and 16 weeks at 4 and -20 degrees C, respectively.
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                Author and article information

                Journal
                Pak J Med Sci
                PJMS
                Pakistan Journal of Medical Sciences
                Professional Medical Publications (Pakistan )
                1682-024X
                1681-715X
                2015
                : 31
                : 3
                : 561-565
                Affiliations
                [1 ]Nadya Ameen, MBBS. Department of Pharmacology, Ziauddin University, St-4B, Sharah-e-Ghalib Block6, Karachi-75600, Pakistan
                [2 ]Zahida Memon, MBBS, M.Phil, PhD. Department of Pharmacology, Ziauddin University, St-4B, Sharah-e-Ghalib Block6, Karachi-75600, Pakistan
                [3 ]Shehla Shaheen, MBBS, M.Phil. Department of Pharmacology, Ziauddin University, St-4B, Sharah-e-Ghalib Block6, Karachi-75600, Pakistan
                [4 ]Ghulam Fatima, MBBS, MCPS, M.Phil Central Lab, Civil Hospital, Karachi, Pakistan
                [5 ]Farah Ahmed, MBBS, MPH. Department of Community Health Sciences, Ziauddin University, Karachi, Pakistan
                Author notes
                Correspondence: Dr. Nadya Ameen, Department of Pharmacology, Ziauddin University, St-4B, Sharah-e-Ghalib Block6, Karachi-75600, Pakistan. E-mail: nadya.ameen@ 123456gmail.com
                Article
                PJMS-31-561
                10.12669/pjms.313.7372
                4485271
                a3b2effc-d6f2-46bf-90bb-7a865c01b28c
                Copyright: © Pakistan Journal of Medical Sciences

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 January 2015
                : 21 March 2015
                : 24 March 2015
                Categories
                Original Article

                imipenem-resistant pseudomonas aeruginosa (irpa),metallo-beta-lactamases (mbl),combined disk test

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