Systematic review and meta-analysis of imipenem-resistant Pseudomonas aeruginosa prevalence in Iran.

INTRODUCTION: Imipenem-resistant Pseudomonas aeruginosa (IRPA), due to resistance to different classes of antibiotics and its remarkable capacity to survive in harsh and adverse conditions such as those in the hospital environment, is considered a serious threat to the healthcare system. Given the great impact of IRPA on patients' outcome and in order to possibly improve antibiotic prescription, this study was conducted to determine the prevalence of clinical isolates of IRPA in different parts of Iran. METHODS: A systematic literature search was performed in PubMed, Web of Science, Google Scholar and Scopus, as well as in two Iranian domestic search engines, i.e., Iranian Scientific Information Database and Magiran. Finally, after applying exclusion and inclusion criteria 37 articles with full-texts describing the prevalence of imipenem-resistant P. aeruginosa were selected for meta-analysis and systematic review. RESULTS: The pooled estimation of 5227 P. aeruginosa isolates in this analysis showed that the percentage of imipenem-resistant P. aeruginosa is about 54% in the Iranian population (95%CI: 0.47-0.62, logit event rate=0.19, 95%CI: -0.12,0.49). CONCLUSION: The findings of this analysis show that in the majority of Iranian hospitals the relative frequency of IRPA is high, therefore, in order to prevent further dissemination of IRPA, more appropriate antibiotic prescription and infection control policies must be implemented by decision-makers.

Imipenem Resistant Pseudomonas aeruginosa: The fall of the final quarterback.

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.

Epidemiology of VIM-1-imipenem resistant Pseudomonas aeruginosa in Iran: A systematic review and meta-analysis.

BACKGROUND: Pseudomonas aeruginosa is an opportunistic human pathogen which causes serious problems, especially in people who have immunodeficiency. Metallo beta-lactamase (MBL) resistance in this bacterium has led some difficulties in treating bacterial infections. MBLs are being reported with increasing frequency worldwide. The aim of the present systematic review and meta-analysis was to collect data about the relative frequency (RF) of VIM-1-imipenem resistant P. aeruginosa (VIM-1-IRPA) in different regions of Iran and report an overall prevalence if possible. MATERIALS AND METHODS: PubMed, ISI web of science, Scopus and Google Scholar were searched using following key terms: "P. aeruginosa," "imipenem," "VIM-1" and "Iran" were. Articles/abstracts, which used clinical specimens and had done polymerase chain reaction to detect the VIM-1 gene of MBL genes, were included in this review. STATA SE version 11.2 (StataCorp, College Station, TX, USA) was used for statistical analysis. RESULTS: Out of 5457 results found, 10 articles were eligible to be included in our systematic review and meta-analysis. These studies were carried out in Tehran, Isfahan, Kurdistan, Ahvaz, Markazi and Northwest of Iran (Orumieh and Tabriz). Pooled estimation of 1972 P. aeruginosa samples showed that 13% (95% confidence interval = 10.5-16.5%]) of strains were VIM-1 positive. VIM-1-IRPA RF in different studies varied from 0% to 19.5% in Isfahan and Markazi provinces, respectively. We found a moderate heterogeneity (Chochran Q-test, P = 0.032, I-squared = 50.7%) of VIM-1-IRPA RF among studies. CONCLUSION: According to the results of this study VIM-1-IRPA RF in Iran is in low-level Prevention strategies to reduce the prevalence rates of VIM-1 positive strains in Iran are needed.

Investigation on drug resistance status quo of imipenem-resistant Pseudomonas aeruginosa in Xi′an area and carbapenemase genes / 国际检验医学杂志

Objective To investigate the drug resistance status quo of imipenem-resistant Pseudomonas aeruginosa and carbap-enemase gene carrying in Xi′an area for guiding the clinical rational use of antibacterial drugs.Methods 151 strains of imipenem-re-sistant Pseudomonas aeruginosa isolated from clinical samples in 4 hospitals from August 2012 to July 2013 were continuously col-lected.Then the drug resistance characteristics of imipenem-resistant Pseudomonas aeruginosa were investigated by the antimicrobi-al drug sensitivity test.The PCR technique was adopted to detect the carrying situation of carbapenemase drug-resistance genes in imipenem-resistant Pseudomonas aeruginosa.Results Totally isolated 151 strains of imipenem-resistant Pseudomonas aeruginosa were mainly distributed in the neurosurgery ICU (37.1%),neurology ICU (27.1%)and the burn department (19.9%);the detec-ted strains were sensitive to polymyxin B and resistant to other 9 kinds of antibacterial drugs in different degrees;94 strains carried VIM gene,32 strains carried IMP gene,5 strains carried SPM gene and 3 strains carried SIM gene.Conclusion The multidrug re-sistance and pan-drug resistance phenomenon of imipenem-resistant Pseudomonas aeruginosa is serious,its cause might be related with the carbapenemases-producing drug resistant gene expression,the drug resistance genes are dominated by VIM and IMP.Clinic should strengthen the bacterial drug resistance monitoring and use antibacterial drugs rationally and effectively for preventing the spreading of imipenem-resistant Pseudomonas aeruginosa.

Neutropenic Hematological Malignancy Patients with Imipenem-resistant Pseudomonas aeruginosa Sepsis:Analysis of 3 Cases / 中华医院感染学杂志

OBJECTIVE To investigate the clinical characteristics of imipenem-resistant Pseudomonas aeruginosa sepsis in neutropenic hematological malignancy patients. METHODS A retrospective review of the medical records of 3 cases in neutropenic hematological malignancy patients with P.aeruginosa sepsis in June 2008 were taken. RESULTS All they died within 3 days,2 times blood culture results indicated.With imipenem-resistant P.aeruginosa growth. CONCLUSIONS Neutropenic hematological malignancy patients with imipenem-resistant P.aeruginosa sepsis have rapid progress of the disease and high mortality rates,we should step up surveillance.

Risk of Transmission of Imipenem-Resistant \it{Pseudomonas aeruginosa} through Use of Mobile Bathing Service

Objectives: The demand for mobile bathing service (MBS) is increasing in the Japanese society. Therefore, we assessed the risk of MBS-associated infection in MBS clients and their caregivers by examining the bacterial colonization of MBS equipment and utensils. Methods: Bacterial isolates collected by the stamp agar culture method were examined by disk diffusion assay for their susceptibility to the following drugs: imipenem, ciprofloxacin, amikacin, azutreonam, ceftazidim, meropenem, piperacillin, tobramycin, ofloxacin and cefoperazone. Furthermore, these isolates were subtyped by SpeI-pulsed field gel electrophoresis (SpeI-PFGE). Results: Fifty-four P. aeruginosa isolates were recovered from different sampling sites, and of these, 26 (47.3%) were isolated from pillows. Eighteen isolates (33.3%) were imipenem (IPM) resistant. The minimum inhibitory concentrations (MICs) of 17 isolates were between 16 and 32 μg/ml, and the MIC of one isolate was greater than 32 μg/ml. The SpeI-PFGE typing of IPM-resistant isolates revealed that 13 of the 18 isolates were closely related (F=1.0−0.87). Conclusion: Our findings suggest that MBS equipment and utensils, particularly pillows, are the primary sources of bacterial contamination and transmission and that there is a risk of MBS-mediated infection among MBS clients and their caregivers.

Imipenem-resistant Pseudomonas aeruginosa:Clinical Status and Resistance Investigation / 中华医院感染学杂志

OBJECTIVE To investigate the nosocomial status and drug resistance of imipenem-resistant Pseudomonas aeruginosa(IRPA) to provide the reference for doctor′s use of the antibiotics.METHODS Totally 178 strains of imipenem-resistant P.aeruginosa were identified by the routine methods.And drug sensitivity was determined by Kirby-Bauer method.RESULTS All strains of IRPA were mainly from departments of respiratory diseases,tumor and geriatrics,most of them were isolated from sputum(62.4%).The susceptibility test showed that 100.0% IRPA were resistant to imipenem.Drug resistance rates to piperacillin,cefotaxim,gentamicin,ciprofloxacin and SMZ-TMP were all over 50.0%.CONCLUSIONS The status of nosocomial infection caused by IRPA is very serious.To detect and control the infection is very important.