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Antibiotic resistance, biofilm production ability and genetic diversity of carbapenem-resistant Pseudomonas aeruginosa strains isolated from nosocomial infections in southwestern Iran

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Abstract

Background

This study was aimed to evaluate the antibiotic resistance, biofilm formation, and genetic diversity of carbapenem-resistant Pseudomonas aeruginosa (CRPA) strains isolated from four types of nosocomial infections (NIs) including urinary tract infection (UTI), ventilator-associated pneumonia (VAP), surgical site infection (SSI), and bloodstream infection (BSI).

Methods and results

In total, 115 isolates of NIs-causing P. aeruginosa were collected from NIs. Antibiotic susceptibility testing (AST) was performed using disk diffusion method and minimum inhibitory concentrations. Biofilm formation was tested on 96-well polystyrene microtiter plates (MTP). CRPA isolates were genotyped using multiple-locus variable number of tandem repeat analysis (MLVA). The most resistance and susceptibility rates were observed to amikacin (70.6%) and colistin (96.1%), respectively. Colistin and meropenem were the most active antimicrobial agents in VAP, SSI, and BSI. While, colistin and cefepime were the most active in UTIs. In total, 52.2% (n = 60/115) of P. aeruginosa isolates were carbapenem resistant, of which 95.0%, 55.0%, and 5.0% were multidrug-resistant, extensively drug-resistant, and pandrug-resistant, respectively. There was a significant association between resistance to carbapenem and resistance to other antibiotics except for piperacillin/tazobactam. The biofilm production of CRPA isolates was 95.0%, of which 23.3% were strong biofilm producers. Based on MLVA, there were 34 different types of CRPA isolates classified into three main clusters and 5 sub clusters.

Conclusion

The association of CRPA with other antibiotic resistance, the high rates of biofilm production, and the high genetic diversity of the isolates may be a warning of the need for a careful surveillance program.

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Data availability

All analyzed data within this study can be obtained from the corresponding author on request.

Code availability

Not applicable.

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Acknowledgements

This study was a part of the Ph.D. thesis of Reza Heidari. The cooperation of the Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences is acknowledged. Our appreciation also goes to the Vice Chancellor for Research affairs, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, and Tropical and Infectious Diseases Research Center of the University for their financial (Grant No. OG-9940) and executive support.

Funding

This work was supported by the Vice Chancellor for Research affairs, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, and Tropical and Infectious Diseases Research Center of the University (Grant No. OG-9940).

Author information

Authors and Affiliations

  1. Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    Reza Heidari, Ahmad Farajzadeh Sheikh, Mohammad Hashemzadeh, Zahra Farshadzadeh & Morteza Saki

  2. Department of Microbiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    Reza Heidari, Ahmad Farajzadeh Sheikh, Mohammad Hashemzadeh, Zahra Farshadzadeh, Shokrollah Salmanzadeh & Morteza Saki

  3. Tropical Medicine Ward, Razi Teaching Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    Shokrollah Salmanzadeh

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  1. Reza Heidari
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Contributions

RH and AFS: conceptualization, methodology, writing- original draft preparation, writing-reviewing and editing, formal analysis. MH: methodology, data curation, formal analysis, writing- original draft preparation. ZF: conceptualization, data curation, formal analysis, writing-reviewing and editing. SS: conceptualization, supervision, writing-reviewing and editing. Writing- original draft preparation. MS: writing-reviewing and editing, formal analysis. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Ahmad Farajzadeh Sheikh.

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Ethical approval was obtained from the Ethics Committee of the Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran (IR.AJUMS.REC.1399.530). Written informed consent was obtained from all patients.

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All patients provided written informed consent.

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Heidari, R., Farajzadeh Sheikh, A., Hashemzadeh, M. et al. Antibiotic resistance, biofilm production ability and genetic diversity of carbapenem-resistant Pseudomonas aeruginosa strains isolated from nosocomial infections in southwestern Iran. Mol Biol Rep 49, 3811–3822 (2022). https://doi.org/10.1007/s11033-022-07225-3

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