Evaluation of antibiotics resistance including fosfomycin in Pseudomonas aeruginosa isolates from cystic fibrosis patients in Palestinian Hospital over 5 years
Date
2021-06-07
Authors
Bayan Asad “Mohammad Rajab” Subb Laban
بيان أسعد محمد رجب صب لبن
Journal Title
Journal ISSN
Volume Title
Publisher
Al-Quds University
Abstract
Background: Antipseudomonal agents, like other antibiotics, will develop a resistance
when taken continuously for many years. In diseases like cystic fibrosis (CF),the most
dangerous pathogen colonizing the lungs is Pseudomonas aeruginosa and antibiotic
resistance has a high chance to occur. In Palestine, there is no accurate data about
resistance in these bacteria among CF patients.
The increased prevalence of multi-drug resistant strains, allergic reactions,
nephrotoxicity and other side effects of antibiotic used among patients with CF limits the
number of antibiotics available to treat pulmonary exacerbations. Fosfomycin, a unique
broad spectrum bactericidal antibiotic, might offer an alternative therapeutic option in
such cases.
Objectives: The aim of this study was to determine the level and change in the rates of
resistance over the years for mostly commonly used antibiotics in Pseudomonal infection
in CF patients. In addition, the study evaluated the effect of fosfomycin on this bacteria.
Methods: To study antibiotics resistance tested in sputum samples over the past 5 years,
a retrospective study was carried out in the Department of Microbiology at Caritas Baby
Hospital. Clinical and microbiological data were extracted from medical database for
pediatric CF patients. The results were analyzed using Microsoft Excel Software 2010
and Statistical Package for Social Sciences (SPSS) program version 20.
In addition, 129Pseudomonas aeruginosa sputum samples from CF patients were tested
for fosfomycin sensitivity by using two different methods minimum inhibitor
concentration (MIC) and disc diffusion(DD).
Results: The sensitivity to commonly used antibiotics in treatment P.aeruginosa
infection in CF pediatric patients in Palestine was92.3%, 91.9%, 89.1%, 87.7%, 76.5%
and 73.5% for ciprofloxacin, ceftazidime, piperacillin-tazobactam, meropenem, amikacin
and gentamicin; respectively. Over the past 5 years, the sensitivity was oscillating slightly
with no deterioration in sensitivity toward these antibiotics.
The vast majority of patients are from the south of the west bank (70.1%), and also the
resistance in this area is higher for all antibiotics. Males are slightly more sensitive than
females. Regarding ages, as the age increased, resistance to antibiotics increased.
In vitro, due to the lack of susceptibility breakpoint of fosfomycin for P.aeruginosa in
CLSI and EUCAST, sensitivity to fosfomycin according to MIC results was determined
based on the existing CLSI breakpoints for the Enterobacteriaceae; ≤64 is sensitive. MIC
method showed good activity for fosfomycin toward P.aeruginosa isolates from CF
patients; nearly 40% sensitive, the most sensitivity was in mucoid type (57.5%). DD
method showed a strong correlation with MIC method, Pearson Correlation between MIC
and DD 200 μg was -0.889, between MIC and DD 50 μg was -0.768, and also 0.932
between DD 200μg and DD 50μg.
Conclusions: In Palestine, the sensitivity to commonly used antibiotics in treatment
P.aeruginosa infection in CF pediatric patients was stable, and there was no deterioration
in sensitivity toward these antibiotics over the past 5 years. Fosfomycin showed a good
sensitivity towards Palestinian P.aeruginosa isolates in CF patients, so it can be
considered as a choice in the antibiotics used in treating P.aeruginosa infection
(particularly the mucoid type) in CF patients in the future, but it still needs more research.
Keywords: Cystic Fibrosis, Pseudomonas Aeruginosa , Fosfomycin, Bacterial
Resistance.