Incidence of Dominant Metallo-β-Lactamase Resistance Genes Produced in Pseudomonas aeruginosa Burn Infections in Iran: A Systemic Review and Meta-Analysis

Document Type : Systematic Review

Authors
L. Shamkhali
M. Shahriari
Bcteriology department, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran
10.52547/iem.7.2.173
Abstract
Backgrounds: Metallo-β-Lactamase (MBL) enzymes-producing Pseudomonas aeruginosa strains are one of the most important causes of nosocomial infections and are very difficult to treat, leading to high mortality rate. Therefore, control of these cases is very important, especially in burns. This study aimed to systematically review published data on MBL genes prevalence among P. aeruginosa strains isolated from burn patients.

Materials & Methods: ISI Web of Science, Scopus, PubMed, and Google Scholar were searched using appropriate key terms as follows: P. aeruginosa, metallo-β-lactamase, burn patients, imipenem resistant, and Iran. Antibiotic susceptibility tests were conducted by Kirby-Bauer disc diffusion and broth microdilution methods according to the CLSI guidelines. The MBL producers was evaluated by the combination disk diffusion test (CDDT), and detection of genes such as blaIMP, blaVIM, blaSPM and blaNDM was performed with polymerase chain reaction (PCR). In this review statistical analyses were performed using STATA statistical software Ver.13.

Results: Out of 410 retrieved articles, 18 articles were eligible to be included in this systematic review and meta-analysis. These studies were carried out in Tehran, Shiraz, Yazd, Zahedan, and other locations. Pooled estimation of all P. aeruginosa strains included in 18 studies showed that the prevalence of MBL-producing P. aeruginosa strains in Iranian population was about 49% (95% CI: 33-65). The present study findings also revealed that in Iranian population, the most prevalent MBL genes were blaIMP with 17% (95% CI) and blaVIM with 13% (95% CI), respectively.

Conclusion: Detection of these bacterial resistance genes should be performed nationally, and strict control measures should be put on the agenda to reduce the incidence of these cases.

Keywords

Subjects

1. Jabalameli F, Taki E, Emaneini M, RJRdSBdMT. B. Prevalence of metallo-β-lactamase-encoding genes among carbapenem-resistant Pseudomonas aeruginosa strains isolated from burn patients in Iran. 2018;51(3):270-6.
2. Faghri J, Nouri S, Jalalifar S, Zalipoor M, MJBrn. H. Investigation of antimicrobial susceptibility, class I and II integrons among Pseudomonas aeruginosa isolates from hospitalized patients in Isfahan, Iran. 2018;11(1):806.
3. Morita Y, Tomida J, YJFim. K. Responses of Pseudomonas aeruginosa to antimicrobials. 2014;4:422.
4. Rostami S, Sheikh AF, Shoja S, Farahani A, Tabatabaiefar MA, Jolodar A, et al. Investigating of four main carbapenem-resistance mechanisms in high-level carbapenem resistant Pseudomonas aeruginosa isolated from burn patients. 2018;81(2):127-32.
5. El-Domany RA, Emara M, El-Magd MA, Moustafa WH, NMJMDR. A. Emergence of imipenem-resistant Pseudomonas aeruginosa clinical isolates from Egypt Coharboring VIM and IMP carbapenemases. 2017;23(6):682-6.
6. Caporaso JG KJ, Stombaugh J, Bittinger K, Bushman FD, Costello EK, et al. QIIME allows analysis of high-throughput community sequencing data. 2010;7(5):335.
7. Fallah F, Taherpour A, Hakemi Vala M, AJIJCID. H. Global spread of New Delhi metallo-beta-lactamase-1 (NDM-1).. 2011;6(4):171-77.
8. Meimani F, Nazari R, MNJZJoRiMS. R. Detection of Metallo-Beta-Lactamase-Encoding Genes Among Clinical Isolates of Pseudomonas aeruginosa in Qom Province. . 2018;20(9).
9. Wirth FW, Picoli SU, Cantarelli VV, Gonçalves AL, Brust FR, Santos LM, et al. Metallo-β-lactamase-producing Pseudomonas aeruginosa in two hospitals from Southern Brazil. 2009;13(3):170-2.
10. Hong DJ, Bae IK, Jang I-H, Jeong SH, Kang H-K, Lee KJI, et al. Epidemiology and characteristics of metallo-β-lactamase-producing Pseudomonas aeruginosa. 2015;47(2):81-97.
11. Ramakrishnan K, Rajagopalan S, Nair S, Kenchappa P, Chandrakesan SDJIJoP, Microbiology. Molecular characterization of metallo β-lactamase producing multidrug resistant Pseudomonas aeruginosa from various clinical samples. 2014;57(4):579.
12. Diene SM, Rolain J-MJCM, Infection. Carbapenemase genes and genetic platforms in Gram-negative bacilli: Enterobacteriaceae, Pseudomonas and Acinetobacter species. 2014;20(9):831-8.
13. Yong D TM, Giske CG, Cho HS, Sundman K, Lee K, et al. . Characterization of a new metallo-β-lactamase gene, blaNDM-1, and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. 2009;53(12):5046-54.
14. Fiett J, Baraniak A, Mrówka A, Fleischer M, Drulis-Kawa Z, Naumiuk Ł, et al. Molecular epidemiology of acquired-metallo-β-lactamase-producing bacteria in Poland. 2006;50(3):880-6.
15. Franklin C, Liolios L, AYJJocm. P. Phenotypic detection of carbapenem-susceptible metallo-β-lactamase-producing gram-negative bacilli in the clinical laboratory. 2006;44(9):3139-44.
16. Gupta V, Datta P, JJJoI. C. Prevalence of metallo-β lactamase (MBL) producing Pseudomonas spp. and Acinetobacter spp. . in a tertiary care hospital in India. 2006;52(5):311-4.
17. Liu Q., Li X, Li W., Du X., He J.Q., C. T. Influence of carbapenem resistance on mortality of patients with Pseudomonas aeruginosa infection: a meta-analysis. . SciRep 5. 2015:1-10.
18. Lautenbach E., Synnestvedt M., Weiner M.G., BilkerW.B., J. S. Imipenem resistance in Pseudomonas aeruginosa: emergence, epidemiology, and impact on clinical and economic outcomes. Infect. . Control HospEpidemiol. 2010;31:47-53.
19. Willmann M., Kuebart I., Marschal M., Schroppel K., Vogel W., I. F. Effect of metallo-beta-lactamase production and multidrug resistance on clinical outcomesin patients with Pseudomonas aeruginosa bloodstream infection: a retrospective cohort study. . BMC InfectDis. 2013(13):1-9.
20. Patel H, R. G. Antibiotic susceptibility pattern of Pseudomonas aeruginosa isolated at SSG hospital Baroda. . J Res Med Dent Sci. 2014;2:84‑7.
21. Ozkurt Z, Ertek M, Erol S, Altoparlak U, MN. A. The risk factors for acquisition of imipenem‑resistant Pseudomonas aeruginosa in the burn unit. . Burns. 2005;31:870‑3.
22. Hakemi‑Vala M, Eslamzadeh A, Bejestany FB, Asgarpanah J, Heidary M, S. K. Preliminary evaluation of the antimicrobial activity of total extract and fractions of chloroform, methanol, and aqueous from the aerial parts of Salvia aegyptiaca. . Avicenna J Clin Microbiol Infect [In Press]. 2017.
23. Anvarinejad M, Japoni A, Rafaatpour N, Mardaneh J, Abbasi P, Amin Shahidi M, et al. Burn patients infected with metallo‑beta‑lactamase‑producing Pseudomonas aeruginosa: Multidrug‑resistant strains. . Arch Trauma Res. 2014;3:181-82.
24. Sadredinamin M, Hashemi A, Goudarzi H, Tarashi S, Yousefi Nojookambari N, E. T. Detection of blaIMP, blaVIM and OprD genes among Pseudomonas aeruginosa isolated from burn patients. . J Mazandaran Univ Med Sci 2016;26:181‑6.
25. W.H.O. A WHO Plan for Burn Prevention and Care. Geneva: World Health Organization. 2008.
26. Sadredinamin M, Hashemi A, Goudarzi H, Tarashi S, Nojookambari NY, S. E. Detection of ISPa1328 and ISPpu21, two novel insertion sequences in the OprD porin and bla IMP‑1 gene among metallo‑beta‑lactamase‑producing Pseudomonas aeruginosa isolated from burn patients. . Arch Trauma Res. 2016;6:1-7.
27. Weber J, McManus A. Nursing Committee of the International Society for Burn Injuries. Infection control in burn patients. . Burns. 2004;30(A):16‑24.
28. Ducel G, Fabry J, L. N. Prevention of Hospital Acquired Infections:A Practical Guide. . 2002.;2nd ed.
29. Arslan E, Dalay C, Yavuz M, Göcenler L, S. A. Gram‑negative bacterial surveillance in burn patients. . Proteus. 1999;95:53.
30. Samuelsen O, Toleman MA, Sundsfjord A, Rydberg J, Leegaard TM, Walder M, et al. Molecular epidemiology of metallo-beta-lactamase-producing Pseudomonas aeruginosa isolates from Norway and Sweden shows import of international clones and local clonal expansion. Antimicrob Agents Chemother. 2010;1(54):346-52.
31. Erlandsson M., Gill H., Nordlinder D., Giske C.G., Jonas D., L.E. N, et al. Antibiotic susceptibility patterns and clones of Pseudomonas aeruginosa in Swedish ICUs. Scand J Infect Dis. 2008.( 40):487-94,.
32. Liakopoulos A., Mavroidi A., Katsifas E.A., Theodosiou, A. KAD, V. M. Carbapenemase-producing Pseudomonas aeruginosa from central Greece: molecular epidemiology and genetic analysis of class I integrons. . BMC Infect Dis,. 2013(13): 1-7.
33. Kaleem F., Usman J., Hassan A., . KA. Frequency and susceptibility pattern of metallo-beta-lactamase producers in a hospital in Pakistan. J Infect Dev Ctries. 2010(4):810-3, .
34. Hashem H., Hanora A., Abdalla S., Shaeky A., A. S. Dissemination of metallo-beta-lactamase in Pseudomonas aeruginosa isolates in Egypt: mutation in blaVIM-4. APMIS. 2017(125):499-505.
35. Vaez H., Moghim S., Nasr Esfahani B., Ghasemian, H. S. Clonal relatedness among imipenem-resistant Pseudomonas aeruginosa isolated from ICU-Hospitalized Patients. . Crit Care Res Pract. 2015:1-5.
36. Alp E, N. D. Healthcare-associated infections in intensive care units: epidemiology and infection control in low-to-middle income countries. J Infect Dev Ctries. 2015;9(10):1040-5.
37. Emaneini M, Hosseinkhani F, Jabalameli F, Nasiri MJ DM, Pouriran R, al. e. Prevalence of vancomycin-resistant Enterococcus in Iran: a systematic review and meta-analysis. . Eur J Clin Microbiol Infect Dis. 2016;35(9):1387-92.
38. Alp E, Leblebicioglu H, Doganay M, A. V. Infection control practice in countries with limited resources. . Ann Clin Microbiol Antimicrob. 2011;10:36.
39. Esfandiari A, Rashidian A, Masoumi Asl H, Rahimi Foroushani A, Salari H, A. AS. Prevention and control of health care-associated infections in Iran: A qualitative study to explore challenges and barriers. . Am J Infect Control 2016;44(10):1149-53.
40. Hakemi Vala M., Hallajzadeh M., Hashemi A., Goudarzi H., Tarhani M., Sattarzadeh Tabrizi M., et al. DETECTION OF AMBLER CLASS A, B AND D ß-LACTAMASES AMONG PSEUDOMONAS AERUGINOSA AND ACINETOBACTER BAUMANNII CLINICAL ISOLATES FROM BURN PATIENTS. Annals of Burns and Fire Disasters. 2014;XXVII.
41. Mehrzad Sadredinamin, Ali Hashemi, Hossein Goudarzi, Samira Tarashi, Neda Yousefi Nojookambari, Taki E. Detection of blaIMP, blaVIM and OprD Genes among Pseudomonas aeruginosa Isolated from Burn Patients. J Mazandaran Univ Med Sci. 2016;138(26):181-6 (Persian).
42. Ali Hashemi, Fatemeh Fallah, Soroor Erfanimanesh, Alireza Salimi Chirani, Dadashi M. Detection of Antibiotic Resistance Genes among Pseudomonas aeruginosa Strains Isolated from Burn Patients in Iran. British Microbiology Research Journal. 2016;4(12):1-6.
43. Mohsen Radan, Rezvan Moniri, Ahmad Khorshidi, Hamidreza Gilasi, Zohreh Norouzi, FahimehBeigi, et al. Emerging Carbapenem-Resistant Pseudomonas aeruginosa Isolates Carrying blaIMP Among Burn Patients in Isfahan, Iran. Arch Trauma Res. 2016;3(5).
44. Mahmood Saffari, Farzaneh Firoozeh, Mohammad Pourbabaee, Zibaei M. Evaluation of Metallo--Lactamase-Production and Carriage of bla-VIM Genes in Pseudomonas aeruginosa Isolated from BurnWound Infections in Isfahan. Arch Trauma Res. 2016;4(5).
45. Samira Tarashi, Hossein Goudarzi, Soroor Erfanimanesh, Ali Pormohammad, Hashemi A. Phenotypic and Molecular Detection of Metallo-Beta-Lactamase Genes Among Imipenem Resistant Pseudomonas aeruginosa and Acinetobacter baumannii Strains Isolated From Patients with Burn Injuries. Arch Clin Infect Dis. 2016.
46. Soodabeh Rostami, Ahmad Farajzadeh Sheikh, Saeed Shoja, Farahani A, Mohammad Amin Tabatabaiefar, Abbas Jolodar, et al. Investigating of four main carbapenem-resistance mechanisms in high-level carbapenem resistant Pseudomonas aeruginosa isolated from burn patients. Journal of the Chinese Medical Association. 2018:127-32.
47. Azimi.A, Peyman.Ai, pour.P K. Phenotypic and molecular detection of metallo-β-lactamase-producing Pseudomonas aeruginosa isolates from patients with burns in Tehran, Iran. Rev Soc Bras Med Trop. 2018;5(51):610-5.
48. Emami.A, Pirbonyeh.N, Keshavarzi.A, Bazargani.A, Hassanpour.S, Javanmardi.F. Evaluation of the Saliva of Burn ICU Patients for Resistant Bacteria Harbor Metallo-β-Lactamase Genes. Journal of Burn Care & Research 2020;3(41):647-51.
49. Ahmad FARAJZADEH SHEIKH, Mojtaba SHAHIN, Leili SHOKOOHIZADEH, Fahimeh GHANBARI, Hamid SOLGI, SHAHCHERAGHI F. Emerge of NDM-1-Producing Multidrug-Resistant Pseudomo-nas aeruginosa and Co-Harboring of Carbapenemase Genes in South of Iran. Iran J Public Health. 2020;49(5):959-67.
Infection Epidemiology and Microbiology
Volume 7, Issue 2
May 2021
Pages 173-185