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Inducible Amp C Beta-lactamase producing Pseudomonas aeruginosa: Predominant Resistance Mechanism and a Threat in a Tertiary Care Teaching Hospital.

Background
Antibiotic resistance to multiple antibiotics among P aeruginosa are on rise due to acquisition of various beta-lactamase enzymes. P aeruginosa possessing such enzymes can cause major break down in therapy and are responsible for substantial clinical challenges.


Objectives
To know the antibiotic susceptibility pattern, common resistance mechanisms of P aeruginosa and document baseline antibiotic resistance data to implement effective infection control program.


Methods
A total of 200 P aeruginosa was isolated between January - June 2015 from various clinical samples of both hospitalized and outpatients. Antibiotic susceptibility testing was done by Kirby-Bauer disc diffusion method to ceftazidime, cefepime, cefpirome, piperacillin -tazobactam, cefoperazonesulbactum, ciprofloxacin, gentamicin, amikacin, imipenem and piperacillin. ESBLs, inducible chromosomal and non-inducible plasmid Amp C beta-lactamase and metallo-beta-lactamase presence was investigated.


Results
Twenty five percent isolates were from the intensive care unit, 41.5% from in patients and 33.5% from outpatients. Inducible, non-inducible Amp C betalactamase, ESBLs and MBLs producers was 47.5%, 4%, 26% and 19% respectively. Highest resistance was recorded to cephalosporins (44% - 56.5%). Least resistance to colistin (2%), imipenem (19.5%) and amikacin (21.5%). Resistance to piperacillin-tazobactam, ciprofloxacin, gentamicin and cefoperazone-sulbactam was 24%, 31.5%, 32%, and 36.5% respectively. Multi-drug resistance were 37.5%. Overall resistance pattern were higher among ICU and inpatient than outpatient isolates.


Conclusion
Inducible Amp C beta-lactamases was found to be predominant resistance mechanism followed by ESBL and MBL among P aeruginosa. Resistance was high to cephalosporins and among hospitalized patients. Usage of cephalosporins could be risk factor for inducible resistance. Colistin, imipenem and amikacin as first line with piperacillin-tazobactam as alternative may be preferred antibiotics in treating P aeruginosa infections. Calls for screening, monitoring and infection control measures.