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Antimicrobial Susceptibility Patterns of Pseudomonas aeruginosa from Diabetes Patients with Foot Ulcers


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Pseudomonas aeruginosa is an invasive organism that frequently causes severe tissue damage in diabetic foot ulcers. A major problem in P. aeruginosa infection may be that this pathogen exhibits a high degree of resistance to a broad spectrum of antibiotics. The study aimed to isolate and determine the antimicrobial susceptibility patterns of the P. aeruginosa population from diabetes patients with foot ulcers attending tertiary care hospitals in and around Coimbatore and their antimicrobial susceptibility pattern. The study was carried out at the Department of Microbiology, Dr. N.G.P. Arts and Science College, Coimbatore, for a period of one year (June 2006 to April 2007). The present study comprised 270 pus specimens collected from diabetic patients with foot ulcers. All pus samples were subjected to gram staining; bacterial culture and subsequently the antibiotic sensitivity to 15 different antibiotics for the confirmed P. aeruginosa were performed as per the standard procedures. Eighteen strains (14.28%) of P. aeruginosa from 270 diabetic foot ulcers were detected. Almost all the strains exhibited a varying degree of resistance to the antibiotics tested. Multidrug resistance for about 8 to 11 antibiotics was observed among the 55.5% of the isolates. Disk diffusion results show 100% resistance to ampicillin, cefoperazone, erythromycin, norfloxacin, and only cefotaxime, ciprofloxacin exhibited greater activity against Pseudomonas aeruginosa.
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Hindawi Publishing Corporation
International Journal of Microbiology
Volume 2011, Article ID 605195, 4pages
Research Article
Antimicrobial Susceptibility Patterns of
Pseudomonas aeruginosa
from Diabetes Patients with Foot Ulcers
Tamil Selvi Sivanmaliappan1and Murugan Sevanan2
1Department of Microbiology, Dr. N.G.P. Arts and Science College, Coimbatore, Tamil Nadu 641048, India
2Department of Biotechnology, School of Biotechnology and Health Sciences, Karunya University, Karunya Nagar,
Coimbatore, Tamil Nadu 641 114, India
Correspondence should be addressed to Murugan Sevanan,
Received 13 July 2011; Accepted 23 August 2011
Academic Editor: Toni L. Poole
Copyright © 2011 T. S. Sivanmaliappan and M. Sevanan. This is an open access article distributed under the Creative Commons
Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is
properly cited.
Pseudomonas aeruginosa is an invasive organism that frequently causes severe tissue damage in diabetic foot ulcers. A major
problem in P. a er u g i n o s a infection may be that this pathogen exhibits a high degree of resistance to a broad spectrum of antibiotics.
The study aimed to isolate and determine the antimicrobial susceptibility patterns of the P. a e r u g in o s a population from diabetes
patients with foot ulcers attending tertiary care hospitals in and around Coimbatore and their antimicrobial susceptibility pattern.
The study was carried out at the Department of Microbiology, Dr. N.G.P. Arts and Science College, Coimbatore, for a period
of one year (June 2006 to April 2007). The present study comprised 270 pus specimens collected from diabetic patients with
foot ulcers. All pus samples were subjected to gram staining; bacterial culture and subsequently the antibiotic sensitivity to 15
dierent antibiotics for the confirmed P. a e r u g i n o sa were performed as per the standard procedures. Eighteen strains (14.28%)
of P. a e r u g i no s a from 270 diabetic foot ulcers were detected. Almost all the strains exhibited a varying degree of resistance to the
antibiotics tested. Multidrug resistance for about 8 to 11 antibiotics was observed among the 55.5% of the isolates. Disk diusion
results show 100% resistance to ampicillin, cefoperazone, erythromycin, norfloxacin, and only cefotaxime, ciprofloxacin exhibited
greater activity against Pseudomonas aeruginosa.
1. Introduction
Diabetes is a chronic disorder that aects a large segment of
population and is a major public health problem. Diabetes
and foot problems are almost synonymous [1]. A recent
WHO report indicates that India has the largest diabetic
population (19 million in 1995) that is expected to rise to 57
million by 2025 [2]. A commonly accepted definition of foot
infection is the presence of systemic signs of infection (e.g.,
fever and leucocytosis) or purulent secretions or two or more
local symptoms or signs (redness, warmth, indurations, pain,
or tenderness) [3]. Viswanathan et al. [4] reported that 25%
of diabetic individuals are anticipated to develop severe foot
problems at some point in their lifetime that often end
with amputation. Diabetic foot infections are more severe
and more dicult to treat than infections in nondiabetics.
Polymicrobial etiology has been implicated in the infected
diabetic foot. Gram-negative infections are three-times more
frequent in the diabetic than in non-diabetic individuals [5].
Most infections with Pseudomonas species occur in
compromised hosts. The pathogenicity of these organisms
is based on its ability to produce a variety of toxins and
proteases and also on its ability to resist phagocytosis [6].
Pseudomonas aeruginosa is commonly resistant to antibiotics,
and because of this it is a dangerous and dreaded pathogen.
The only antibiotic agents to which strains are regularly
sensitive are cephalosporins, carbenicillin, colistin, gentam-
icin, polymyxin, quinolones, and streptomycin; however
degrees of cross-resistance between these agents have been
reported [7]. P. a e r ug i n o s a is one of the most important
microorganisms that cause clinical problems resulting from
high-resistance to antimicrobial agents. Though it is rarely
2International Journal of Microbiology
found in the normal flora of humans, it is frequently isolated
from patients with burns, cystic fibrosis, and neutropenia
[8]. P. a e r u g in o s a may cause severe tissue damage in diabetics
and should never be ignored as insignificant in diabetic
foot ulcers. Moreover, it should never be considered a
contaminants or normal flora, and it should clearly be
considered a pathogen, because it may result in sepsis and
amputation [9].
One of the challenges in managing P. a e r u g in o s a infec-
tions is an inherent resistance mechanism, referred to as
intrinsic resistance. Its multiplicity of resistance mecha-
nisms may render this microbe less amenable to control
by antibiotic cycling [10]. P.aeruginosa is noted for its
metabolic versatility and its exceptional ability to colonize
a wide variety of environments and also for its intrinsic
resistance to a wide variety of antimicrobial agents. The
bacillus almost never causes infections in healthy individuals
and often infects the immunocompromised. Because of its
virulence and the limited choices of eective antimicrobial
agents, treatments of infections by P. a e r u g i n os a are often
dicult [11]. Though a lot of work has been carried out
elsewhere pertaining to P. a e r ug i n o s a , the prevalence and
the antimicrobial susceptibility patterns of P. a e r u g i n os a
from diabetes patients with foot ulcers have rarely been
documented in this part of South India. Therefore, the
present study has been carried out to study the prevalence
of P. ae r u g i n os a and their antimicrobial susceptibility by the
Kirby Bauer-Disk Diusion method.
2. Materials and Methods
2.1. Sample. The study was based on 270 pus specimens
received for the screening of P. ae r u g i n o sa from diabetes
patients with foot ulcers attending tertiary care hospitals
in and around Coimbatore. Specimens included in the
study were from “Soft tissue infection” which includes foot
wound and “limb threatening infections” specimens were
included in the study. Specimens were obtained using aseptic
techniques to avoid contamination and were promptly
transported to the laboratory in a sterile swab in ice-cold
2.2. Isolation and Identification of Pseudomonas aeruginosa.
The isolation and identification of test organisms was carried
out by the procedures suggested by Valentina and Lalitha
[12]. Identification analysis like Gram staining, motility,
catalase, oxidase, pigment production, growth on cetrimide
agar, ability to grow at 42C, gelatin hydrolysis, arginine
dihydrolase, acid from Hugh-Leifson’s glucose, and nitrate
reduction tests were carried out.
2.3. Antibiotic Sensitivity Testing (Kirby Bauer-Disk Dif-
fusion Method). Antibiogram was performed using com-
mercially available antibiotic discs (Hi-Media, Mumbai)
with a standard P. a e r u g in o s a ATCC 27853 as a positive
control. Kirby-Bauer, recommended by the CLSI [13], was
used for antimicrobial susceptibility testing. The identi-
fied 18 P. a e r u g i n os a strains were tested against ampi-
cillin (10 µg), amikacin (30 µg), ceftazidime (30 µg), cefo-
taxime (30 µg), ciprofloxacin (5 µg), cefoperozone (75 µg),
co-trimoxazole (25 µg), erythromycin (10 µg), gentamicin
(10 µg), imipenem (10 µg), norfloxacin (10 µg), piperacillin
(100 µg), tobramycin (30 µg), ticarcillin (75 µg), and tetracy-
cline (30 µg).
3. Results and Discussion
3.1. Patients. Of the total 270 diabetic patients suering from
foot infections, 180 were male and 90 were female. The
male-to-female ratio was 2 : 1 and the age of the patients
ranged between 36 to 75 years. Very few of these patients
have undergone amputation. Studies conducted in Chennai
have shown that males were more susceptible than females
in the ratio of 8 : 3 [14]. Previous studies have shown that
males were more susceptible than females in the ratio of 2 : 1,
which is in accordance with the current study. Predominance
of male over female patients as shown in the study can be
explained by the fact that in our country males are exposed
more to the outside environment because of their mobility as
compared to females.
3.2. Isolation Rate. Of the 270 pus specimens of diabetic
patients with foot infections, 180 (66.6%) specimens were
culture positive and the other 90 (33.3%) were negative.
Among the strains, aerobic gram-negative Pseudomonas
species were 126 (70.0%) and other aerobic organisms
comprised 54 (30.0%). From the 126 Pseudomonas species,
18 (14.30%) were found to be P. ae r u g i n o sa . Dhanasekaran
et al.[5] reported the prevalence of Pseudomonas species to
be 18.79% from a diabetic centre in Chennai. In a similar
study conducted in a private hospital in Chennai, 29.8%
strains among diabetic foot ulcer patients were P. a e r u g i no s a
[15]. This finding shows the high prevalence of Pseudomonas
species and P. ae r u g i n o sa among diabetes patients with foot
3.3. Antibiogram Pattern of Pseudomonas aeruginosa. The
Mueller Hinton agar-based antibiogram-resistogram pattern
study of P. a e r ug i n o s a isolated from foot ulcers of diabetes
patients is shown in Figure 1. Almost all of the eighteen
P. a e ru g i n o s a strains screened showed 100% resistance to
ampicillin, erythromycin, and norfloxacin, similarly 83.3%
resistance to piperacillin, ticarcillin, and tetracycline, 66.6%
resistance to ceftazidime, imipenem, gentamicin, amikacin,
tobramycin, and cotrimoxazole and 50.0% resistance to cef-
operazone. However, 15 (83.3%) P. a e ru g i n o s a strains were
susceptible to cefotaxime. Multidrug resistance for about 8
to 11 antibiotics was observed among 55.5% of the strains
(Tab l e 1 ). No single antibiotic showed 100% sensitivity to all
P. a e r u g i n o sa strains. Resistance was least with cefotaxime
(16.6%), followed by an intermediate resistance of 66.7%
observed for ciprofloxacin.
India has the largest number of diabetic individuals
and appreciably poor economic conditions; the study on
International Journal of Microbiology 3
Resistance (%)
Antimicrobial agents
Resistant Sensitivity
Te t
Figure 1: Antimicrobial susceptibility patterns of Pseudomonas
aeruginosa among diabetes patients with foot ulcers.
Tab l e 1: Multidrug resistance patterns of P. a e r u g in o s a of diabetic
foot ulcers.
No. of drugs resistant No. of isolates
(n=18) Resistance (%)
8 18 100
9 15 83.3
10 13 72.2
11 10 55.5
12 7 38.8
13 5 27.7
14 2 11.1
15 0 0
this intrinsic resistant organism in diabetic foot infections
assumes significance. The present study has shown the
incidence of P. a e r u g i n os a to be 14.3% in diabetic foot
ulcers, which is significant when compared to previous
studies. In accordance with earlier observations [16], the
current study has demonstrated that P. ae r u g i n o s a strains
isolated from foot ulcers are more resistant to antimicrobial
agents. This may be due to the fact that the strains
isolated from clinical specimens have been subjected to
the selective actions of both disinfectants and antibiotics
[16]. As expected, the strains were resistant to imipenem,
piperacillin, erythromycin, ticarcillin, tetracycline, gentam-
icin, co-trimoxazole, and amikacin indicating the emergence
of multidrug-resistant strains. Antibiogram also revealed
that cefotaxime and ciprofloxacin retained high levels of
antipseudomonal activity and cefoperazone, gentamicin,
ceftazidime, amikacin, imipenem, and tobramycin had the
least activity. Ciprofloxacin and cefotaxime were found to be
better choices for diabetes patients with foot ulcers in this
part of the region when compared to gentamicin, imipenem,
piperacillin, and other third-generation cephalosporins. The
present study thus revealed the importance of P. ae r u g i n os a
from diabetes patients with foot ulcers, which is necessary for
proper management of diabetes patients.
The second author is grateful to the Chancellor (Dr. Paul
Dhinakaran), Vice Chancellor (Dr. Paul P. Appasamy), and
Registrar (Dr. Anne Mary Fernandez) of Karunya University,
Coimbatore, India, for their constant encouragement and
support to carry out this research publication.
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... P. aeruginosa is a Gram-negative opportunistic pathogen that can cause community and hospital-acquired infections with harmful effects ranging from cosmetic to life-threatening infections [1]. It produces widespread and often overwhelming infections such as skin/soft tissue infections, ulcerative keratitis, diabetic wound and foot infection [2,3], infection of burn wounds, urinary tract infections, bacteraemia, and pneumonia [4,5]. PA is accountable for [11][12][13].8% of all hospital-acquired infections with a high prevalence of exotoxin production along with antimicrobial resistance. ...
... Since PA is an opportunistic organism, we used a diabetic rat model to test for the vaccine efficacy. It is well-reported that PA is problematic in diabetic patients especially those with diabetic foot infections [2,3]. Alloxan-induced diabetic rats were immunized thrice via the oral route and the immune response was examined. ...
Full-text available
Abstract: Infections with Pseudomonas aeruginosa (PA) pose a major clinical threat worldwide especially to immunocompromised patients. As a novel vaccine network for many kinds of bacteria, bacterial ghosts (BGs) have recently been introduced. In the present research, using Sponge-Like Reduced Protocol, P. aeruginosa ghosts (PAGs) were prepared to maintain surface antigens and immunogenicity. This is the first study, to our knowledge, on the production of chemically induced well-structured bacterial ghosts for PA using concentrations of different chemicals. The research was carried out using diabetic rats who were orally immunized at two-week intervals with three doses of PAGs. Rats were subsequently challenged either by the oral route or by the model of ulcer infection with PA. In challenged rats, in addition to other immunological parameters, organ bioburden and wound healing were determined, respectively. Examination of the scanning electron microscope (EM) proved that PAGs with a proper three-dimensional structure was obtained. In contrast, to control groups, oral PAGs promoted the generation of agglutinating antibodies, the development of IFN-γ, and the increase in phagocytic activity in vaccinated groups. Antibodies of the elicited PAGs were reactive to PA proteins and lipopolysaccharides. The defense against the PA challenge was observed in PAGs-immunized diabetic rats. The resulting PAGs in orally vaccinated diabetic rats evoked unique humoral and cell-mediated immune responses and defended them from the threat of skin wound infection. These results have positive implications for future studies on the PA vaccine
... P. aeruginosa is notorious for being a multidrug resistant organism, part of its resistance being because of its innate resistance to some antimicrobials and rest, because of injudicious use of antimicrobials. The percentage of multidrug resistance in P. aeruginosa has been reported to be as low as 11.36% by Idris S et al. to as high as 91.6% as reported by Paranjothi S et al. (21,22) In the current study, 56.02% (23) strains were found to be multidrug resistant which falls in the above range. Our results are also concordant with the study conducted by Sivanmaliappan et al. who reported 55.5% MDR in P. aeruginosa. ...
... Our results are also concordant with the study conducted by Sivanmaliappan et al. who reported 55.5% MDR in P. aeruginosa. (23) The emergence of multidrug resistant strains of P. aeruginosa warns of unlimited use of antimicrobials. ...
Full-text available
Introduction: Pseudomonas aeruginosa is an important pathogen causing healthcare-associated infections especially in immunocompromised patients. It poses a threat to public health due to its inherent resistance to various antimicrobial agents and its ability to acquire new resistance through multiple mechanisms. Infections due to extended spectrum β-lactamase (ESBL) producing isolates of P. aeruginosa continue to be a challenge for clinicians as these result in high mortality and morbidity due to antimicrobial resistance. The aim of this study was to determine the prevalence of Cefotaximase-Munich (CTX-M) producing strains of P. aeruginosa in Sharda hospital, Greater Noida. Methods: Strains of P. aeruginosa isolated from various clinical samples were subjected to phenotypic detection for ESBL production by disc combination method. Positive strains were then subjected to polymerase chain reaction (PCR) for detection of blaCTX-M gene. Results: Out of 166 isolates of P. aeruginosa, 54 (32.53%) were phenotypically confirmed to produce ESBL. Out of these 54 isolates, 39 (72.22%) were positive for blaCTX-M gene. Multidrug resistance was found in 70 (42.17%) isolates. Imipenem was the most effective drug with a sensitivity of 64.86% whereas aztreonam was found to be least effective with sensitivity of only 36.74%. Conclusion: Current study highlights the phenotypic and molecular characterization of CTX-M gene in P.aeruginosa in our hospital set-up. With judicious use of antimicrobials and strict infection control practices, it might be possible to limit the effect of these drug destroying enzymes. Keywords: CTX-M gene, Extended spectrum beta lactamases, Hospital acquired infections, multidrug resistance, Pseudomonas aeruginosa.
... The resistance for piperacillin in this study was 14.0%. This was higher than the results obtained by (Henwood et al. 2001) where it was (5.0%) and lower than results obtained by Sivanmaliappan et al, (Sivanmaliappan and Sevanan 2011) as the resistance rate was (83.3%). The increase or decrease in the resistance is attributed to the rate of piperacillin usage. ...
Objectives: To evaluate the clinical and environmental ability of P. aeruginosa isolates to make biofilms and to determine their antimicrobial susceptibility patterns. Methods: Environmental swabs (144), air (28) and water samples (12) were collected from various wards of Gaza strip hospitals. Additionally, 158 clinical P. aeruginosa isolates were obtained from the microbiology laboratories of the same hospitals between July 21, 2019 and January 21, 2020. Samples were cultured and bacterial identification was performed using standard microbiological procedures. PCR was used to confirm the identity of P. aeruginosa. P. aeruginosa isolates were tested for their antimicrobial susceptibility patterns by the agar disk diffusion method. Both qualitative and quantitative methods assessed the biofilm formation by crystal violet and safranin stains. Results: Among the P. aeruginosa isolates (N=150), 90.0% were resistant for ceftazidime, (36.7%) aztreonam, (29.3%) gentamicin, (27.3%) levofloxacin, (22.0%) meropenem, (14.0%) piperacillin, (10.0%) amikacin and (9.3%) imipenem. The results for biofilm formation by tube method showed that 78.0% and 71.3% of the isolates were biofilm producer by crystal violet and safranin methods, respectively. Microtiter plate method demonstrated that 94.0% and 96.0% were biofilm producers by crystal violet and safranin, respectively. In addition, there was a statistical significance between the meropenem resistance and biofilm-forming ability of the isolates. Conclusions: High resistance rates were detected among P. aeruginosa isolates. The lowest rate of resistance was to imipenem and amikacin. As for the biofilm assessment, the tissue culture plate method showed higher detection rates than the tube method.
... and E. coli as the most common isolate. On the other hand, S. aureus was reported as the most common isolate by Alavi et al. [28] and Citron et al. [29] who also reported that E. coli was the second highest producer of ESBL. ...
Background This study aimed to assess the bacterial profile of diabetes patients with an infected foot and their antimicrobial susceptibility pattern in a tertiary care hospital. Methodology We conducted a six-month prospective study at a hospital in Peshawar, Pakistan. Demographics and clinical characteristics such as age, sex, type and duration of diabetes, glycemic control, presence of retinopathy, nephropathy, neuropathy, peripheral vascular disease, ulcer size, outcomes, and the number of admitted days at the facility were collected. Pus or discharges from the ulcer base and debrided necrotic tissue were obtained. Gram staining was performed on the samples which were isolated on chocolate agar and MacConkey agar. Incubation was done for 24 hours at a temperature of 37°C, and isolates were identified using standard bacteriological methods. The Kirby-Bauer testing method was used to assess antibiotic susceptibility. Results A total of 200 patients received a diagnosis of diabetic foot ulcer at the hospital during the study period. The age of the patients ranged from 24 to 92 years, with a mean age of 58.12 years (standard deviation (SD) = 12.494). The mean HbA1c level was 9.33% (SD = 2.050). The mean duration of diabetes mellitus was 12.3 years (SD = 6.181). In total, 96 (66.2%) isolates were gram-negative bacteria, while 49 (33.8%) were gram-positive bacteria. Among the gram-negative bacteria, Pseudomonas spp. was the most reported (15.9%), whereas methicillin-resistant Staphylococcus aureus was the most reported gram-positive bacteria (20.7%). Amikacin was found to be the most effective (45%) in treating diabetic foot ulcers, followed by tineam and meropenem being equally effective at a susceptibility of 44%. The highest resistance of the microbes was to the drug trimethoprim (44.5%). Conclusions The pathogens causing diabetic foot ulcers show sensitivity to many of the routinely used medications. However, resistance is being developed to some of the antibiotics such as trimethoprim. Therefore, the culture of the specimen to identify the causative agent and adequate knowledge of the susceptibility pattern are critical for the appropriate management of diabetic foot ulcers.
... 5,10-12 It was mostly isolated from patients with burns injuries, cystic fibrosis, and neutropenia. 5,12 The use of old antibiotics resembled the antibiotic rotation scheme where some antibiotics were intentionally withheld from use to reduce chances of developing resistance to certain pathogens. 7 Old antibiotics have a major advantage to the currently used antibiotics by the fact that their use had been greatly limited in recent years. ...
Full-text available
Background Antimicrobial resistance to current novel antibiotics is posing a major threat to both human and zoonotic life. This poses a serious potential of rolling back to pre-antibiotic era clinical settings. Antimicrobial discovery pipeline has dried up as major pharmaceutical brands have shifted to long term chronic illness drugs production. In the absence of new novel antibiotics molecules, clinicians have resorted into a desperate last resort to review and re-introduce prior discarded antibiotics as their new weaponry in the fight against multi-resistant Gram-negative bacteria. Case presentation We report a case of a 77 years old bed ridden diabetic and hypertensive with renal impairment diagnosed with bilateral lower limbs wet gangrene. She underwent transfemoral on her right and transtibial amputation on her left lower limb. She developed Surgical site infection on her right stump and wet gangrene on her left stump. Surgical toilet, debridement and stump revision was done on her right stump and a transfemoral amputation on her left lower limb. Pus swab on her right stump revealed carbapenem resistant strains of Pseudomonas aeruginosa. She was instituted on parenteral colistin and showed no bacterial growth 7 days post treatment. She suffered an ischaemic cerebral vaso-occlusive stroke during her hospital stay. CT angiography revealed distal infra-renal abdominal aorta multiple calcified plaques, multiple calcified plaques and completely obstructing thrombus both on common and external iliac arteries, seen downstream to both superficial femoral arteries with multiple collaterals in both thighs. The included portion of the lower lung fields showed a large filling defect in the right main pulmonary artery extending to the lower lobe branches suggestive of right-sided pulmonary embolism. She developed hypostatic pneumonia, bed sores and her condition deteriorated and she unfortunately succumbed from her comorbidities. Despite our patient succumbing to her multiple co-morbidities we report this case to highlight the isolation of carbapenem resistant strains of Pseudomonas aeruginosa and the efficacy and safety of colistin as a salvage antibiotic in renal impaired patients. Conclusions Colistin can be safely used as a last reserve antibiotic for multi-resistant strains of Pseudomonas aeruginosa infection even in patients with renal impairment.
... Earlier studies conducted have reported a lower rate of isolation from wound samples. Investigations by Sivanmaliappan et al. 31 and Qayoom et al. 32 have revealed 37.5%, 14.30% and 9.1% respectively. Similarly, the recovery from sputum samples was also less as shown in a study by Boyer et al. 33 who reported an isolation rate of 6.2%. ...
Full-text available
Infections with P. aeruginosa are three times more common in people with diabetes than in non-diabetic individuals. Investigations disclosing the distinguishing traits of P. aeruginosa strains to cause respiratory and wound infection in diabetics is limited. Wound swab and sputum from infected diabetic patients were used for the isolation of P. aeruginosa. The confirmed isolates were evaluated for their virulence factor production, antibiotic susceptibility, and clonal relationship. The study confirmed the increased virulence of sputum isolates characterized by their multidrug resistant nature, strong biofilm formation at 72h [(p<0.05) =0.003)] and 96h [(p<0.05) =0.002)] and elaboration of proteolytic enzymes (40.0%). Albeit the fact that wound isolates were less virulent than the sputum isolates, there was an increased siderophore production (77.0%). Nearly 90.0% of the isolates including sputum and wound were resistant to colistin. Random Amplified Polymorphic DNA analysis showed no distinct lineages of wound and sputum isolates. The study disclosed the higher prevalence of virulent P. aeruginosa in causing infection in the diabetics. No distinct lineages of the wound and sputum isolates indicated their ability to adapt to different host environments. To the best of our knowledge, this is the first study to show the difference in virulence traits among the P. aeruginosa strains isolated from sputum and wound of diabetic patients. Our study distinctly reveals the significance of periodic examination of antibiotic resistance and virulence factors of P. aeruginosa in order to recognize the possible co-regulatory mechanism involved in their expression.
... [4][5][6] Nevertheless, 1 pathogen seems to have an exceptional role in the clinical management decisions of many clinicians: Pseudomonas aeruginosa. On the basis of many published microbiological surveys, this organism is significantly less frequent as a pathogen in DFIs in temperate geographic areas than in DFIs in subtropical regions such as South-(Eastern) Asia [12][13][14] or the Middle East. 1,15,16 Moreover, P aeruginosa is naturally resistant to many standard antibiotics commonly used for mild and moderate DFIs, 17,18 such as aminopenicillins 7 or firstand second-generation cephalosporins. ...
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Objective To assess the outcomes of diabetic foot infections (DFIs) due to Pseudomonas aeruginosa. Patients and Methods From April 24, 2013 to July 31, 2016, we analyzed data from patients prospectively enrolled in our clinical pathway of DFIs, comparing those with infection due to Pseudomonas with those without infection due to Pseudomonas. Results Overall, we assessed 1018 cases of DFIs: 392 with osteomyelitis and 626 with only soft tissue infections. The prevalence of P aeruginosa in deep wound cultures was 10% (104/1018); of the 1018 cultures, 22 were monomicrobial, 82 were polymicrobial, and 46 were with osteomyelitis. Overall, the patients were treated with a median of 1 surgical debridement and a total of 20 days of antibiotic therapy. In a comparison of crude groups, the proportion of clinical failures was significantly higher with Pseudomonas than with other pathogens (36/104 [35%] vs 218/914 [24%], respectively; P=.02). A multivariate analysis showed that pseudomonal DFIs did not recur more often than nonpseudomonal DFIs (hazard ratio, 1.0; 95% confidence interval, 0.6-1.7). Among the 104 cases of pseudomonal DFIs, there was no association between failure of treatment and the total duration of antibiotic therapy, duration of intravenous therapy, duration of combined antibiotic therapy with more than 1 agent, or duration of oral (fluoroquinolone) therapy. Among 15 cases of pseudomonal recurrence, 2 (13%) developed resistance to the antibiotic agent used for the index episode. Conclusion For DFIs caused by P aeruginosa, other than choosing an antibiotic agent that is active against the organism, it does not appear necessary to treat with a different therapeutic regimen compared with the treatment of nonpseudomonal DFIs. There is no difference!
... The study of Shah DA et al. has reported resistance to Co-trimoxazole 99.2%.17 Sivanmaliappan TS et al. has reported resistance of Pseudomonas aeruginosa to Co-trimoxazole 66.6%.18 In the study by Senthamarai S. et al.14 had found resistance of Ceftazidime (65.38%), ...
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Infections caused by resistant organisms are increasing in hospitalised patients. Pseudomonas aeruginosa is one the important pathogen which is resistant to many antimicrobials and associated with infections in intensive care units with higher rates of morbidity and mortality. It can cause wide range of infection in ICU patients like, wound infections, septicaemia, urinary tract infection, cystitis, and rarely pneumonia. The study was carried out with an aim to study prevalence, clinical and antimicrobial profile of ICU infections caused by P. aeruginosa. Bacteriological study of total 589 clinical specimens from different ICU s was done. Prevalence of P. aeruginosa infection was 13.66 %. Age group 21- 40 and 41 to 60 was most affected (36.25 %). Maximum isolates were from medicine ICU (51.25 %) and from urine specimen (37.5 %). Piperacillin (48.75 %) and Amikacin (47.5 %) showed most susceptibility pattern. To conclude it is very important to have routine surveillance of ICU infections to prevent pan drug resistant Pseudomonas aeruginosa infection.
Introduction Pseudomonas aeruginosa (PA) possesses several virulence genes that enable them to evade the immune system and to cause injury in the host tissue. However, the number of studies that characterized the virulence genes profile in PA sepsis is limited. Aim The main objective of this study was to identify and characterize virulence genes in PA causing sepsis, as well as investigate the relationship between virulence genes, antimicrobial susceptibility patterns, and infection outcomes. Methodology A prospective study, conducted between October 2020–October 2021, isolates were recovered from blood samples and identified using standard microbiological procedures. Phenotypic techniques were used to screen for capsule, siderophore production, biofilm formation, serum resistance, hemolysin production, and protease. Molecular techniques were performed to screen for alginate D (alg D), exoenzyme S (Exo S), exotoxin A (tox A), phospholipase H (plc H), phospholipase N (plc N), and elastase B (las B). Kirby-Bauer disc diffusion method was used to determine the antimicrobial susceptibility pattern of isolates, which was then interpreted according to the CLSI 2021 guidelines. Results Out of the n = 215 Gram-negative bacteria recovered from sepsis patients during our study, n = 20 were Pseudomonas aeruginosa. PA isolates were susceptible to all antibiotics tested except for 3 of the isolates that were resistant to gentamycin, 2 to imipenem, and 1 to ceftazidime, cefepime, meropenem, tobramycin, and amikacin. The most prevalent virulence genes present were capsule (100%), siderophore production (100%), alg D (100%), Las B (100%), and Tox A (100%). Conclusion Our study found that PA causing sepsis harbours a high level of virulence genes. However, the high presence of virulence factors was not statistically associated with antimicrobial susceptibility, as most isolates in our study were susceptible to the antibiotics tested.
Diabetes mellitus is a major health problem, rapidly expanding worldwide. In India, it is projected that around 80 million will be affected by DM. Asia contributes to >60% of the world's population with diabetes, of which two nations; India and China contribute the largest. In developing countries like India, diabetic foot ulcerations and infections are one of the most common causes of hospitalization and often resulting in amputation, osteomyelitis, mortality and morbidity. Infection is most often a consequence of foot ulceration, which typically follows trauma to a neuropathic foot. The present study was conducted to know the prevalence and sensitivity pattern of P. aeruginosa from diabetic foot infections and to assess their susceptibility to the commonly used antibiotics. This was a retrospective study conducted at a tertiary care hospital in South India conducted from January 2013 to August 2013. Culture materials from all the wounds were obtained, either by washing the wound with sterile physiological saline and then making a puncture-aspiration from the base of the wound or by applying a sterile cotton swab to the wound. A total of 77 patients were included in the study. 104 bacteria were isolated from 77 patients. Out of 104 bacteria, 39 (37.5%) were P. aeruginosa. Infection was polymicrobial is some cases and Gram negative bacteria were the most common organisms isolated. P. aeruginosa showed resistnce to most commonly used antibiotics, highest resistance was seen with Ciprofloxacin and Ofloxacin and least with Aztreonam an Imipenem. Other studies have reported similar findings. The major concern is emergence of resistance to third and fourth generation of Cephalosporins and even more alarming is Carbapenem resistance surfacing nowadays. The increasing prevalence of multi drug resistance in P. aeruginosa is a cause for concern. The selection of the antibiotic treatment should be based on the predominant organisms which are isolated and their antimicrobial susceptibility patterns.
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In order to assess the current level of resistance to widely used antipseudomonal antibiotics in clinical isolates of Pseudomonas aeruginosa, a national survey was undertaken. Fifteen hospitals throughout Italy participated in the study. The University of Catania tested the antibiotic susceptibility of 1005 consecutive clinically significant P. aeruginosa collected from March to June 1995. Lack of susceptibility, according to NCCLS breakpoints, was at the following rates: meropenem, 9.1%; imipenem, 19.3%; ceftazidime, 13.4%; carbenicillin, 27.3%; piperacillin, 12%; ticarcillin/clavulanic acid, 22.8%; amikacin, 10.6%; and ciprofloxacin, 31.9%. About half of the isolates (44.4%) were not susceptible to at least one of the antibiotics tested.
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Enterobacter species were studied longitudinally in a children’s hospital. In total, 287 Enterobacter isolates were obtained from 171 children in 15 different wards (from March 1995 through April 1997). Strains were typed by random amplified polymorphic DNA and pulsed-field gel electrophoresis, which were concordant in outcome. In total, 97 DNA types and 199 colonization events were identified. A predominant clone was isolated 111 times from 62 children; another clone was isolated 19 times from 10 patients. These clones caused 36% of all colonizations. In 34% of the children, Enterobacter clones were found in 2–4 patients. The remaining colonizations were due to unique Enterobacter isolates. A large proportion of the Enterobacter strains was acquired through cross-transmission. This finding contrasts with the prevailing opinion that resistant Enterobacter strains are selected primarily from the patient’s own gut flora
Historically, the trend toward automation in clinical pathology laboratories has largely bypassed the clinical microbiology laboratory. In this article, we review the historical impediments to automation in the microbiology laboratory and offer insight into the reasons why we believe that we are on the cusp of a dramatic change that will sweep a wave of automation into clinical microbiology laboratories. We review the currently available specimen-processing instruments as well as the total laboratory automation solutions. Lastly, we outline the types of studies that will need to be performed to fully assess the benefits of automation in microbiology laboratories.
Extracts of black tea, green tea, pu-erh tea or coffee inhibited the growth of various bacteria known to cause diarrhoeal diseases. Tea or coffee also showed bactericidal activity against Staphylococcus aureus and Vibrio parahaemolyticus.
Foot ulcerations and their sequelae remain a major source of morbidity for patients with diabetes mellitus. Often leading to infection, osteomyelitis, or gangrene, these lesions have consistently been ascertained as significant risk factors for subsequent lower extremity amputation. Hence education, appropriate foot care, and early intervention have assumed important roles in programs focused on amputation prevention. Multidisciplinary cooperation has been demonstrated as the most successful approach to the management and prevention of foot lesions in patients with diabetes. This article reviews the epidemiology, current understanding of the underlying pathophysiology, and treatment rationale for diabetic foot ulcerations. Such knowledge is essential in the overall management of these complicated patients and, when incorporated into daily practice, can significantly reduce the incidence and morbidity of foot disease in diabetes.
A number of effective, low-cost strategies are available to identify and treat the person at risk for diabetic foot ulcers and lower-extremity amputation. These strategies must be more widely adopted by all diabetic care providers to maintain the integrity and function of the lower limb, and thus improve the quality of life for people with diabetes.