Evaluation of antibiotic resistance changes in Acinetobacter baumannii in the era of COVID-19 in Northern Iran
-
Golnar Rahimzadeh
,
Reza Valadan
,
Shaghayegh Rezai
,
Mohammad Khosravi
,
Laleh Vahedi Larijani
,
Somayeh Sheidaei
,
Ebrahim Nemati Hevelaee
,
Faezeh Sadat Movahedi
,
Raha Rezai
,
Mohammad Sadegh Rezai
Abstract
Background and Objectives: During the coronavirus pandemic, the overuse of antibiotics to reduce coinfections and mortality may be contributing to the rise of antimicrobial resistance. In this study, we aim to investigate the antibiotic resistance changes of Acinetobacter baumannii post-COVID-19 pandemic in Northern Iran.
Materials and Methods: The current study is a cross-sectional study. Between 2022 and 2023, 2190 clinical samples were collected from patients with healthcare-associated infections (HAIs) at four hospitals in Sari, which served as corona centers after the COVID-19 pandemic. Antimicrobial sensitivity was determined using standard broth macro-dilution, and resistance genes were detected using multiplex PCR.
Results: Based on the results co-amoxiclav had a resistance rate of 100%, while piperacillin/tazobactam showed the least resistance rate of 29.82%. In terms of GM MIC values, colistin was the most potent against multi-drug resistant isolates. The frequency of blaOXA-51, ampC, aphA6, and blaNDM genes were 100%, 99.12%, 90.35%, and 69.30% respectively.
Conclusion: Our study revealed high multi-drug resistance rates. Piperacillin/tazobactam recommended for treating multidrug resistant Acinetobacter baumannii infections in Northern Iran.
1. Rahimzadeh G, Rezai MS, Farshid F. Genotypic patterns of multidrug-resistant Acinetobacter baumannii: A systematic review. Adv Biomed Res 2023; 12: 56.
2. Rezai MS, Rafiei A, Ahangarkani F, Bagheri-Nesami M, Nikkhah A, Shafahi KH, et al. Emergence of extensively drug resistant Acinetobacter baumannii-encoding integrons and extended-spectrum beta-lactamase genes isolated from ventilator-associated pneumonia patients. Jundishapur J Microbiol 2017; 10 (7): e14377.
3. Alrahmany D, Omar AF, Alreesi A, Harb G, Ghazi IM. Acinetobacter baumannii infection-related mortality in hospitalized patients: Risk factors and potential targets for clinical and antimicrobial stewardship interventions. Antibiotics (Basel) 2022; 11: 1086.
4. Thabit A, Abdulrhman A, Mohammed A, Ahmed A, Almubarak Y, Almasari O. Prevalence of multidrug-resistant Acinetobacter baumannii in a critical care setting: A tertiary teaching hospital experience. SAGE Open Med 2021; 9: 20503121211001144.
5. Nasiri MJ, Zamani S, Fardsanei F, Arshadi M, Bigverdi R, Hajikhani B, et al. Prevalence and mechanisms of carbapenem resistance in Acinetobacter baumannii: a comprehensive systematic review of cross-sectional studies from Iran. Microb Drug Resist 2020; 26: 270-283.
6. Mortazavi SM, Farshadzadeh Z, Janabadi S, Musavi M, Shahi F, Moradi M, et al. Evaluating the frequency of carbapenem and aminoglycoside resistance genes among clinical isolates of Acinetobacter baumannii from Ahvaz, south-west Iran. New Microbes New Infect 2020; 38: 100779.
7. Rizk MA, Abou El-Khier NT. Aminoglycoside resistance genes in Acinetobacter baumannii clinical isolates. Clin Lab 2019; 65: 10.7754/Clin.Lab.2019.190103.
8. Aurilio C, Sansone P, Barbarisi M, Pota V, Giaccari LG, Coppolino F, et al. Mechanisms of action of carbapenem resistance. Antibiotics (Basel) 2022; 11: 421.
9. Clancy CJ, Buehrle DJ, Nguyen MH. PRO: The COVID-19 pandemic will result in increased antimicrobial resistance rates. JAC Antimicrob Resist 2020; 2: dlaa049.
10. Li J, Wang J, Yang Y, Cai P, Cao J, Cai X, et al. Etiology and antimicrobial resistance of secondary bacterial infections in patients hospitalized with COVID-19 in Wuhan, China: A retrospective analysis. Antimicrob Resist Infect Control 2020; 9: 153.
11. Garcia-Vidal C, Sanjuan G, Moreno-García E, Puerta-Alcalde P, Garcia-Pouton N, Chumbita M, et al. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: A retrospective cohort study. Clin Microbiol Infect 2021; 27: 83-88.
12. Lob SH, Hoban DJ, Sahm DF, Badal RE. Regional differences and trends in antimicrobial susceptibility of Acinetobacter baumannii. Int J Antimicrob Agents 2016; 47: 317-323.
13. Rezai MS, Bagheri-Nesami, M, Nikkhah A. Catheter-related urinary nosocomial infections in intensive care units: An epidemiologic study in North of Iran. Caspian J Intern Med 2017; 8: 76-82.
14. Wagenlehner FME, Dittmar F. Re: Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Eur Urol 2022; 82: 658.
15. Clinical and Laboratory Standards Institute (CLSI). M100 Performance Standards for Antimicrobial Susceptibility Testing. 30th ed. Pennsylvania: CLSI; 2020.https://www.nih.org.pk/wp-content/uploads/2021/02/CLSI-2020.pdf
16. Konca C, Tekin M, Geyik M. Susceptibility patterns of multidrug-resistant Acinetobacter baumannii. Indian J Pediatr 2021; 88: 120-126.
17. Bengoechea JA, Bamford CG. SARS-CoV-2, bacterial co-infections, and AMR: The deadly trio in COVID-19? EMBO Mol Med 2020; 12(7): e12560.
18. Maes M, Higginson E, Pereira-Dias J, Curran MD, Parmar S, Khokhar F, et al. Ventilator-associated pneumonia in critically ill patients with COVID-19. Crit Care 2021; 25: 25.
19. Sreenath K, Batra P, Vinayaraj E, Bhatia R, SaiKiran K, Singh V, et al. Coinfections with other respiratory pathogens among patients with COVID-19. Microbiol Spectr 2021; 9(1): e0016321.
20. Grochowalska A, Kozioł-Montewka M, Sobieszczańska A. Analysis of Acinetobacter baumannii resistance patterns in patients with chronic obstructive pulmonary disease (COPD) in terms of choice of effective empiric antibiotic therapy. Ann Agric Environ Med 2017; 24: 307-311.
21. Bagheri-Nesami M, Rezai MS, Ahangarkani F, Rafiei A, Nikkhah A, Eslami G, et al. Multidrug and co-resistance patterns of non-fermenting Gram-negative bacilli involved in ventilator-associated pneumonia carrying class 1 integron in the North of Iran. Germs 2017; 7: 123-131.
22. Musuuza JS, Watson L, Parmasad V, Putman-Buehler N, Christensen L, Safdar N. Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: a systematic review and meta-analysis. PLoS One 2021; 16(5): e0251170.
23. Pettit NN, Nguyen CT, Mutlu GM, Wu D, Kimmig L, Pitrak D, et al. Late onset infectious complications and safety of tocilizumab in the management of COVID-19. J Med Virol 2021; 93: 1459-1464.
24. Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, et al. Bacterial co-infection and secondary infection in patients with COVID-19: A living rapid review and meta-analysis. Clin Microbiol Infect 2020; 26: 1622-1629.
25. Chaudhary M, Payasi A. Molecular characterization and antimicrobial susceptibility study of Acinetobacter baumannii clinical isolates from Middle East, African and Indian patients. J Proteom Bioinform 2012; 5: 11.
26. Boorgula SY, Yelamanchili S, Kottapalli P, Naga MD. An update on secondary bacterial and fungal infections and their antimicrobial resistance pattern (AMR) in COVID-19 confrmed patients. J Lab Physicians 2022; 14: 260-264.
27. Tiri B, Sensi E, Marsiliani V, Cantarini M, Priante G, Vernelli C, et al. antimicrobial stewardship program, COVID-19, and infection control: spread of carbapenem-resistant Klebsiella pneumoniae colonization in ICU COVID19 patients. What did not work? J Clin Med 2020; 9: 2744.
28. Azimi L, Talebi M, Pourshafie MR, Owlia P, Rastegar Lari A. Characterization of carbapenemases in extensively drug resistance Acinetobacter baumannii in a burn care center in Iran. Int J Mol Cell Med 2015; 4: 46-53.
2. Rezai MS, Rafiei A, Ahangarkani F, Bagheri-Nesami M, Nikkhah A, Shafahi KH, et al. Emergence of extensively drug resistant Acinetobacter baumannii-encoding integrons and extended-spectrum beta-lactamase genes isolated from ventilator-associated pneumonia patients. Jundishapur J Microbiol 2017; 10 (7): e14377.
3. Alrahmany D, Omar AF, Alreesi A, Harb G, Ghazi IM. Acinetobacter baumannii infection-related mortality in hospitalized patients: Risk factors and potential targets for clinical and antimicrobial stewardship interventions. Antibiotics (Basel) 2022; 11: 1086.
4. Thabit A, Abdulrhman A, Mohammed A, Ahmed A, Almubarak Y, Almasari O. Prevalence of multidrug-resistant Acinetobacter baumannii in a critical care setting: A tertiary teaching hospital experience. SAGE Open Med 2021; 9: 20503121211001144.
5. Nasiri MJ, Zamani S, Fardsanei F, Arshadi M, Bigverdi R, Hajikhani B, et al. Prevalence and mechanisms of carbapenem resistance in Acinetobacter baumannii: a comprehensive systematic review of cross-sectional studies from Iran. Microb Drug Resist 2020; 26: 270-283.
6. Mortazavi SM, Farshadzadeh Z, Janabadi S, Musavi M, Shahi F, Moradi M, et al. Evaluating the frequency of carbapenem and aminoglycoside resistance genes among clinical isolates of Acinetobacter baumannii from Ahvaz, south-west Iran. New Microbes New Infect 2020; 38: 100779.
7. Rizk MA, Abou El-Khier NT. Aminoglycoside resistance genes in Acinetobacter baumannii clinical isolates. Clin Lab 2019; 65: 10.7754/Clin.Lab.2019.190103.
8. Aurilio C, Sansone P, Barbarisi M, Pota V, Giaccari LG, Coppolino F, et al. Mechanisms of action of carbapenem resistance. Antibiotics (Basel) 2022; 11: 421.
9. Clancy CJ, Buehrle DJ, Nguyen MH. PRO: The COVID-19 pandemic will result in increased antimicrobial resistance rates. JAC Antimicrob Resist 2020; 2: dlaa049.
10. Li J, Wang J, Yang Y, Cai P, Cao J, Cai X, et al. Etiology and antimicrobial resistance of secondary bacterial infections in patients hospitalized with COVID-19 in Wuhan, China: A retrospective analysis. Antimicrob Resist Infect Control 2020; 9: 153.
11. Garcia-Vidal C, Sanjuan G, Moreno-García E, Puerta-Alcalde P, Garcia-Pouton N, Chumbita M, et al. Incidence of co-infections and superinfections in hospitalized patients with COVID-19: A retrospective cohort study. Clin Microbiol Infect 2021; 27: 83-88.
12. Lob SH, Hoban DJ, Sahm DF, Badal RE. Regional differences and trends in antimicrobial susceptibility of Acinetobacter baumannii. Int J Antimicrob Agents 2016; 47: 317-323.
13. Rezai MS, Bagheri-Nesami, M, Nikkhah A. Catheter-related urinary nosocomial infections in intensive care units: An epidemiologic study in North of Iran. Caspian J Intern Med 2017; 8: 76-82.
14. Wagenlehner FME, Dittmar F. Re: Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Eur Urol 2022; 82: 658.
15. Clinical and Laboratory Standards Institute (CLSI). M100 Performance Standards for Antimicrobial Susceptibility Testing. 30th ed. Pennsylvania: CLSI; 2020.https://www.nih.org.pk/wp-content/uploads/2021/02/CLSI-2020.pdf
16. Konca C, Tekin M, Geyik M. Susceptibility patterns of multidrug-resistant Acinetobacter baumannii. Indian J Pediatr 2021; 88: 120-126.
17. Bengoechea JA, Bamford CG. SARS-CoV-2, bacterial co-infections, and AMR: The deadly trio in COVID-19? EMBO Mol Med 2020; 12(7): e12560.
18. Maes M, Higginson E, Pereira-Dias J, Curran MD, Parmar S, Khokhar F, et al. Ventilator-associated pneumonia in critically ill patients with COVID-19. Crit Care 2021; 25: 25.
19. Sreenath K, Batra P, Vinayaraj E, Bhatia R, SaiKiran K, Singh V, et al. Coinfections with other respiratory pathogens among patients with COVID-19. Microbiol Spectr 2021; 9(1): e0016321.
20. Grochowalska A, Kozioł-Montewka M, Sobieszczańska A. Analysis of Acinetobacter baumannii resistance patterns in patients with chronic obstructive pulmonary disease (COPD) in terms of choice of effective empiric antibiotic therapy. Ann Agric Environ Med 2017; 24: 307-311.
21. Bagheri-Nesami M, Rezai MS, Ahangarkani F, Rafiei A, Nikkhah A, Eslami G, et al. Multidrug and co-resistance patterns of non-fermenting Gram-negative bacilli involved in ventilator-associated pneumonia carrying class 1 integron in the North of Iran. Germs 2017; 7: 123-131.
22. Musuuza JS, Watson L, Parmasad V, Putman-Buehler N, Christensen L, Safdar N. Prevalence and outcomes of co-infection and superinfection with SARS-CoV-2 and other pathogens: a systematic review and meta-analysis. PLoS One 2021; 16(5): e0251170.
23. Pettit NN, Nguyen CT, Mutlu GM, Wu D, Kimmig L, Pitrak D, et al. Late onset infectious complications and safety of tocilizumab in the management of COVID-19. J Med Virol 2021; 93: 1459-1464.
24. Langford BJ, So M, Raybardhan S, Leung V, Westwood D, MacFadden DR, et al. Bacterial co-infection and secondary infection in patients with COVID-19: A living rapid review and meta-analysis. Clin Microbiol Infect 2020; 26: 1622-1629.
25. Chaudhary M, Payasi A. Molecular characterization and antimicrobial susceptibility study of Acinetobacter baumannii clinical isolates from Middle East, African and Indian patients. J Proteom Bioinform 2012; 5: 11.
26. Boorgula SY, Yelamanchili S, Kottapalli P, Naga MD. An update on secondary bacterial and fungal infections and their antimicrobial resistance pattern (AMR) in COVID-19 confrmed patients. J Lab Physicians 2022; 14: 260-264.
27. Tiri B, Sensi E, Marsiliani V, Cantarini M, Priante G, Vernelli C, et al. antimicrobial stewardship program, COVID-19, and infection control: spread of carbapenem-resistant Klebsiella pneumoniae colonization in ICU COVID19 patients. What did not work? J Clin Med 2020; 9: 2744.
28. Azimi L, Talebi M, Pourshafie MR, Owlia P, Rastegar Lari A. Characterization of carbapenemases in extensively drug resistance Acinetobacter baumannii in a burn care center in Iran. Int J Mol Cell Med 2015; 4: 46-53.
| Files | ||
| Issue | Vol 16 No 3 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v16i3.15762 | |
| Keywords | ||
| COVID-19; Drug resistance; Acinetobacter baumannii; Healthcare associated infections; Multiplex polymerase chain reaction | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Rahimzadeh G, Valadan R, Rezai S, Khosravi M, Vahedi Larijani L, Sheidaei S, Nemati Hevelaee E, Movahedi FS, Rezai R, Rezai MS. Evaluation of antibiotic resistance changes in Acinetobacter baumannii in the era of COVID-19 in Northern Iran. Iran J Microbiol. 2024;16(3):314-322.
