Phenotypic and genotypic identification of class C and D β-lactamases in clinical isolates of Pseudomonas aeruginosa: a cross-sectional study

Background and Aims

The emergence of Pseudomonas aeruginosa (P. aeruginosa) antibiotic resistance is an important public health problem worldwide that can negatively affect infection control. Therefore, obtaining knowledge about antibiotic resistance mechanisms is necessary for infection control policies. This study aimed to determine the frequency of class C and D β-lactamases in P. aeruginosa strains isolated from patients referred to Ardabil hospitals using phenotypic and genotypic tests.

Methods

Phenotypic detection of β-lactamases including AmpC cephalosporinase, oxacillinase (OXA)-type extended-spectrum β-lactamases (ESBLs), and OXA-type carbapenemases were performed using the disk diffusion-based methods. Amplification of genes encoding classes C (ampC and FOX genes) and D (OXA-1, OXA-2, OXA-10, OXA-23, and OXA-48 genes) β-lactamases was performed using the polymerase chain reaction (PCR) method. A quantitative reverse transcription PCR (qRT-PCR) method was used to determine the expression level of the ampC gene among multiple drug-resistant and imipenem-resistant P. aeruginosa strains.

Results

In phenotypic tests, the prevalence of AmpC cephalosporinase, OXA-type ESBLs, and OXA-type carbapenemases were 52.5%, 7.2%, and 95.8%, respectively. In genotypic tests, the prevalence of ampC, FOX, OXA-1, OXA-2, OXA-10, OXA-23, and OXA-48 genes were 100%, 0%, 4.3%, 60.8%, 42%, 29.7%, and 2.9%, respectively. In addition, the ampC gene overexpression was seen in 16 (33.3%) drug-resistant P. aeruginosa clinical isolates.

Conclusion

Given the presence of class C and D β-lactamases in clinical isolates of P. aeruginosa in Ardabil hospitals, early detection of these strains can help prevent the spread of resistant strains in hospital environments and subsequent treatment failure.

Biofilm Formation and β-Lactamase Production in Burn Isolates of Pseudomonas aeruginosa

Background:

Pseudomonas aeruginosa is an important nosocomial pathogen characterized by its innate resistance to multiple antimicrobial agents. Plasmid-mediated drug resistance also occurs by the production of extended-spectrum β-lactamases (ESBL), metallo β-lactamases (MBL), and AmpC β-lactamases. Another important factor for establishment of chronic infections by P. aeruginosa is biofilm formation mediated by the psl gene cluster.

Objectives:

The aim of this study was to evaluate biofilm formation and presence of the pslA gene in burn isolates of P. aeruginosa as well as the association of antibiotic resistance, MBL, ESBL and AmpC β-lactamase production with biofilm formation among the isolates.

Materials and Methods:

Sixty-two burn isolates of P. aeruginosa were obtained from Shahid Motahari Hospital in Tehran from August to October 2011. Antibiotic susceptibility was determined by the disc diffusion assay. MBL, AmpC and ESBL production were screened using the double disc synergy test, AmpC disc test and combined disc diffusion assay, respectively. The potential to form biofilm was measured using the microtiter plate assay and pslA gene was detected using specific primers and PCR.

Results:

Biofilm formation was observed in 43.5% of the isolates, of which 66.7% produced strong and 33.3% formed weak biofilms. All biofilm-positive and 14.2% of biofilm-negative isolates harbored the pslA gene. MBL, AmpC and ESBL production were significantly higher in the biofilm-positive isolates (70.3%, 62.9% and 33.3%, respectively) compared to the biofilm-negative strains (31.4%, 34.2% and 20%, respectively). Overall, 19 isolates (30.6%) co-produced MBL and AmpC, among which the majority were biofilm-positive (63.1%). Finally, four isolates (6.4%) had all three enzymes, of which 3 (75%) produced biofilm.

Conclusions:

Biofilm formation (both strong and weak) strongly correlated with pslA gene carriage. Biofilm formation also correlated with MBL and AmpC β-lactamase production. More importantly, multiple-β-lactamase phenotype was associated with formation of strong biofilms.