Intestinal colonization of infants with multidrug resistant Pseudomonas aeruginos in tertiary care center in Jordan

Background: Pseudomonas aeruginosa is among the most common opportunistic hospital pathogens, which exhibit an innate resistance and has developed increasing resistance to many useful antimicrobial agents over the last decades. This study investigated the occurrence of important types of ESBLs and MBLs in association with potential important virulence factors among P. aeruginosa isolates from feces of Jordanian infants. Methods: A total of 302 feces samples were obtained randamely from neonates and infants admitted to Pediatric Clinic and the Neonate Intensive Care Unit (NICU)/Jordan University Hospital (JUH), over a 9-month period of 2016-2017. Fecal samples were cultured for P. aeruginosa and their growth was identified and tested using microbiological and antibiotic susceptibility methods. Additionly, virulence factors, antimicrobial resistance genes and genotypes were detected using Polymerase Chain Reaction (PCR). Results: A total of 16/302 (5.3%) of P. aeruginosa isolates were recovered from feces samples of only hospitalized infants. Antimicrobial susceptibility of the isolates ranged between the lowest 18.7% to meropenem and highest of 87.5% to azetreonam among 9 tested drugs. The percentage of specific genes of ESBLs and MBLs in 16 P. aeruginosa isolates were the following: blaOXA-50, blaTEM, blaCTXM, blaVIM, blaKPC, blaSHV, blaGES, and blaVEB were detected at the rate of 13 (81.2%), 13 (81.2%), 12 (75%), 12 (75%), 11 (68.7%), 10 (62.5%), 2 (12.5), 1 (6.2%), respectively. The percentage of the potential virulence genes in the same isolates were detected as follow: lasB, algD, toxA, exoS and exoU at the rate of 100%, 87.5%, 81.2%, Intestinal colonization of infants with multidrug resistant Pseudomonas aeruginos in tertiary care center in Jordan Noor Issam Shishtawi1, Manar Al-lawama2, Asem A. Shehabi1 1 Department of Pathology-Microbiology and Forensic Medicine, The University of Jordan, Amman, Jordan. 2 Department of pediatrics, Jordan University Hospital, Amman, Jordan. Contact information: Professor Asem A. Shehabi. asashehabi2@gmail.com The InTernaTIonal arabIc Journal of anTImIcrobIal agenTs ISSN: 2174-9094 2019 Vol. 9 No. 2:4 doi: 10.3823/834 This article is available at: www.iajaa.org / www.medbrary.com 2 Introduction Pseudomonas aeruginosa is a major cause of nosocomial infections in children and adults, and its responsible for about 10% of all hospital-acquired infections worldwide [1, 2]. P. aeruginosa causes severe infections especially in immune-compromised patients, and it continues to pose a therapeutic challenge resulting in high rate of morbidity and mortality due to development of drug resistance during antibiotic treatment of patients [3-4]. P. aeruginosa infections are becoming more difficult to treat, and the number of multidrug drug resistant isolates from clinical and hospital environment sources is increasing worldwide including Arab Middle East countries [1, 5-7]. Recently, the most important issue is the emergence of carbapnemases in P. aeruginosa which considered as the last-line agents against Gram-negative bacteria infections [8]. P. aeruginosa infections are especially difficult to prevent and to treat because of its common occurrence in hospital environment and water sources, and for both intrinsic resistance to many antibiotics as well as rapid development of antibiotic resistance [9-11]. These features facilitate P. aeruginosa infections to become a serious health care issue in hospitals worldwide [12]. P. aeruginosa is associated with presence and execration of large virulence factors that are involved in various stages of the infection process allowing the organism to colonize any part of the infected host. These virulence factors include flagellum, type IV pili, lipopolysaccharide, a type III secretion system, and alginate which are involved in the adhesion, motility and colonization [13-14]. In particular, P. aeruginosa is possessing cell-associated and extracellular virulence factors controlled by a complex regulatory circuit involving cell-to-cell signaling (quorum sensing) system, allowing hostpathogen interactions during infections [15]. The organism also releases several metabolites including mainly, exotoxins, exoproteases, heamolysins and pyocyanin or pyoverdin-fluorescein pigments. All these virulence factors are causing extensive tissue damage as well as facilitate bacterial multiplication and the spread in host tissues [5, 16]. The emergence of extended-spectrum-βlactamases (ESBLs) and metallo-β-lactamases (MBLs) compromised the effect of most β-lactam antibio81.2%, 31.2%, respectively. All P. aeruginosa isolates observed to develop beta-hemolysis on both human and sheep blood agar, and to produce either pyoverdin (56.3%) or pyocyanin (43.7%). Conclusions: The present study demonstrates high occurrence of multidrug resistant P. aeruginosa isolates from only hospitalized infant feces which also carried high rates of important genes of ESBLs and MBLs and potential virulence factors.