Susceptibility of multidrug-resistant nosocomial pathogens for the new antimicrobial agents in Jordan

Authors

  • Jamal Wadi Al Ramahi M.D, FIDSA Office 11, The Medical Center, Jordan Hospital and medical Center. 29 Adeeb Wahbeh StreetAmman - Jordan 11118
  • MaramAbu Said Department of laboratory, Jordan Hospital, Jordan Hospital, Amman. Jordan.
  • Rasmieh Abu Kwaik Department of laboratory, Jordan Hospital, Jordan Hospital, Amman. Jordan.
  • Walid Jamal Department of laboratory, Al KhalidiMedical Center, Amman. Jordan.
  • Deema Al Jammal Department of laboratory, the Specialty (Al Takhassusi) Hospital, Amman. Jordan.
  • Nisreen Al Radaidah Department of laboratory, the Specialty (Al Takhassusi) Hospital, Amman. Jordan.
  • Amin A. Aqel Department of Microbiology and Pathology, Faculty of Medicine, Mutah University, Al-Karak, Jordan.

DOI:

https://doi.org/10.3823/852

Keywords:

MDR-Bacteria, Ceftazidime-Avibactam, Ceftolozane-Tazobactam, Ceftobiprole Medocaril, Nosocomial Pathogens

Abstract

Background

To study resistance rates of multidrug-resistant bacteria (MDR) for new Cephalosporines before their widespread use in Jordan.

Methods

During September 2019 - May 2020, MDR-bacteria were prospectively collected from microbiology laboratories of three hospitals, susceptibility of the extended-spectrum β-lactamases-producing Enterobacteriaceae (ESBL), K. pneumoniae-carbapenemases strains (KPC), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant P. aeruginosa (CRPa), carbapenem-resistant A. baumannii (CRAb), and Methicillin-resistant Staphylococcus aureus (MRSA) were tested. Demographic details for patients were identified. Antimicrobials evaluated were ceftazidime-avibactam, ceftolozane-tazobactam, and ceftobiprole medocaril.

Results

Non-duplicate 263 MDR clinical isolates were collected from sterile sites; ESBL (128), P. aeruginosa (57), MRSA (37), KPC (22), A. baumannii (11), and CRE (n = 8). The age was dominated by the older age group (Age > 64, Pearson R = 0.985, R2 = 0.969, P = 0.000). Males were 143 and females 107 (P < 0.000). There were (194) isolate from the wards and (55) were from the ICUs. Sources were urine (96), blood (36), soft tissues (49), abdomen (24), URT (14), and osteo-skeletal (12). Clinical diagnoses were: UTI (90). Bacteremia (36), SSTI (45), IAI (23), pneumonia (17), URTI (13), osteomyelitis (11), and diabetic foot (6). The susceptibility of the ESBL-producing bacteria was 100% for meropenem, 99% for ceftazidime-avibactam, and 90% for ceftolozane/tazobactam. P. aeruginosa was, 73% for ceftazidime-avibactam, 62% susceptible to ceftolozane/tazobactam, 62% for meropenem, and 45% to ceftobiprole. CRE was 38% susceptible to ceftazidime-avibactam and KPC 15%, while ceftolozane-tazobactam susceptibility was zero, and 14% for CRE, and 0% for Ceftobiprole Medocaril. A. baumannii was 13% susceptible to ceftazidime-avibactam, meropenem 9%, and 2% for ceftolozane/tazobactam

Conclusion

Ceftazidime-avibactam and ceftolozane/tazobactam may be useful alternatives for the treatment of ESBL-producers and P. aeruginosa, though the MDR-bacteria demonstrated some resistance to the newly introduced agents before their widespread use in the country.

 

Author Biographies

Jamal Wadi Al Ramahi M.D, FIDSA, Office 11, The Medical Center, Jordan Hospital and medical Center. 29 Adeeb Wahbeh StreetAmman - Jordan 11118

Adjunct, Assistant Professor of Infectious Diseases, School of Medicine. University of Jordan.

Chairman, The Infection Prevention and Control Committee. Al Khalidi Hospital and Medical Center.

School of Medicine, University of Jordan. Amman, Jordan.

Department of laboratory, Jordan Hospital, Jordan Hospital, Amman. Jordan.

Department of laboratory, Al KhalidiMedical Center, Amman. Jordan.

Department of laboratory, the Specialty (Al Takhassusi) Hospital, Amman. Jordan.

The Infection Prevention and Control department, The Specialty Hospital. Amman. Jordan.

The Infection Prevention and Control department. Al Khalidi Hospital. Amman. Jordan.

MaramAbu Said, Department of laboratory, Jordan Hospital, Jordan Hospital, Amman. Jordan.

Department of laboratory, Jordan Hospital, Jordan Hospital, Amman. Jordan.

Rasmieh Abu Kwaik, Department of laboratory, Jordan Hospital, Jordan Hospital, Amman. Jordan.

Department of laboratory, Jordan Hospital, Jordan Hospital, Amman. Jordan.

Walid Jamal, Department of laboratory, Al KhalidiMedical Center, Amman. Jordan.

Department of laboratory, Al KhalidiMedical Center, Amman. Jordan.

Deema Al Jammal, Department of laboratory, the Specialty (Al Takhassusi) Hospital, Amman. Jordan.

Department of laboratory, the Specialty (Al Takhassusi) Hospital, Amman. Jordan.

Nisreen Al Radaidah, Department of laboratory, the Specialty (Al Takhassusi) Hospital, Amman. Jordan.

Department of laboratory, the Specialty (Al Takhassusi) Hospital, Amman. Jordan.

Amin A. Aqel, Department of Microbiology and Pathology, Faculty of Medicine, Mutah University, Al-Karak, Jordan.

Department of Microbiology and Pathology, Faculty of Medicine, Mutah University, Al-Karak, Jordan.

References

- Silva DM, Menezes EM, Silva EV, Lamounier TA. Prevalence and antimicrobial susceptibility profile of ESKAPE pathogens from the Federal District, Brazil. Jornal Brasileiro de Patologia e Medicina Laboratorial. 2017 Aug;53(4):240-5.

- Ziglam H, Elahmer O, Amri S, Shareef F, Grera A, Labeeb M, Zorgani A. Antimicrobial resistance patterns among Acinetobacter baumannii isolated from burn intensive care unit in Tripoli, Libya. The International Arabic Journal of Antimicrobial Agents. 2012 Oct 22;2(3).

- Zorgani A, Franka RA, Zaidi MM, Alshweref UM, Elgmati M. Trends in nosocomial bloodstream infections in a burn intensive care unit: an eight-year survey. Annals of burns and fire disasters. 2010 Jun 30;23(2):88.

- Liddawi R, Siryani I, Ghneim R, Al-Dawodi R, Abu-Diab A, Ghneim R, Zoughbi M, Al Qass R, Turkuman S, Corradin L, Marzouqa H. Emergence of Klebsiella pneumoniae Carbapenemase (blaKPC-2) in members of the Enterobacteriaceae family in Palestine. The International Arabic Journal of Antimicrobial Agents. 2012 Aug 10;2(2).

- Pfaller MA, Flamm RK, Mendes RE, Streit JM, Smart JI, Hamed KA, Duncan LR, Sader HS. Ceftobiprole activity against Gram-positive and-negative pathogens collected from the United States in 2006 and 2016. Antimicrobial agents and chemotherapy. 2019 Jan 1;63(1).

- Sahm DF, Thornsberry C, Mayfield DC, Jones ME, Karlowsky JA. Multidrug-Resistant Urinary Tract Isolates ofEscherichia coli: Prevalence and Patient Demographics in the United States in 2000. Antimicrobial agents and chemotherapy. 2001 May 1;45(5):1402-6.

- O'Connell KM, Hodgkinson JT, Sore HF, Welch M, Salmond GP, Spring DR. Combating multidrugâ€resistant bacteria: current strategies for the discovery of novel antibacterials. Angewandte Chemie International Edition. 2013 Oct 4;52(41):10706-33.

- van Duin D, Bonomo RA. Ceftazidime/avibactam and ceftolozane/tazobactam: second-generation β-lactam/β-lactamase inhibitor combinations. Clinical Infectious Diseases. 2016 Jul 15;63(2):234-41.

- Kuti JL, Maglio D, Nightingale CH, Nicolau DP. Economic benefit of a meropenem dosage strategy based on pharmacodynamic concepts. American journal of health-system pharmacy. 2003 Mar 15;60(6):565-8.

- Liao CH, Lee NY, Tang HJ, Lee SS, Lin CF, Lu PL, Wu JJ, Ko WC, Lee WS, Hsueh PR. Antimicrobial activities of ceftazidime–avibactam, ceftolozane–tazobactam, and other agents against Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa isolated from intensive care units in Taiwan: results from the Surveillance of Multicenter Antimicrobial Resistance in Taiwan in 2016. Infection and Drug Resistance. 2019;12:545.

- King M, Heil E, Kuriakose S, Bias T, Huang V, El-Beyrouty C, McCoy D, Hiles J, Richards L, Gardner J, Harrington N. Multicenter study of outcomes with ceftazidime-avibactam in patients with carbapenem-resistant Enterobacteriaceae infections. Antimicrobial agents and chemotherapy. 2017 Jul 1;61(7)

- Van Duin D, Lok JJ, Earley M, Cober E, Richter SS, Perez F, Salata RA, Kalayjian RC, Watkins RR, Doi Y, Kaye KS. Colistin versus ceftazidime-avibactam in the treatment of infections due to carbapenem-resistant Enterobacteriaceae. Clinical Infectious Diseases. 2018 Jan 6;66(2):163-71.

- Hsueh SC, Lee YJ, Huang YT, Liao CH, Tsuji M, Hsueh PR. In vitro activities of cefiderocol, ceftolozane/tazobactam, ceftazidime/avibactam and other comparative drugs against imipenem-resistant Pseudomonas aeruginosa and Acinetobacter baumannii, and Stenotrophomonas maltophilia, all associated with bloodstream infections in Taiwan. Journal of Antimicrobial Chemotherapy. 2019 Feb 1;74(2):380-6.

- Schaumburg F, Peters G, Alabi A, Becker K, Idelevich EA. Missense mutations of PBP2a are associated with reduced susceptibility to ceftaroline and ceftobiprole in African MRSA. Journal of Antimicrobial Chemotherapy. 2016 Jan 1;71(1):41-4.

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Published

2021-01-18

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