Abstract
Background: Burn is still an important global public health challenge. Wound colonization of antibiotic resistant bacteria such as Acinetobacter baumannii can lead to high morbidity and mortality in burn patients. The aim of this study was to evaluate the inhibitory effect of tazobactam on efflux pump, which can cause aminoglycoside resistant in A. baumannii isolated from burn patients.
Methods: In this study, 47 aminoglycoside resistant A. baumannii spp. were obtained from burn patients, admitted to the Shahid Motahari Burns Hospital in Tehran, Iran, during June-August 2018. The inhibitory effect of tazobactam against adeB such as efflux pump was evaluated by Minimum Inhibitory Concentration (MIC) determination of amikacin alone and in combination with tazobactam. Fractional Inhibitory Concentration index (FIC) was used to determine the efficacy of tazobactam/ amikacin combination. Further, semi-quantitative Real- Time PCR was performed to quantify the expression rates of the adeB gene before and after addition of tazobactam/amikacin.
Results: The MIC values were significantly reduced when a combined amikacin and tazobactam was utilized. The most common interaction observed was synergistic (78.2%), followed by additive effects (21.8%), as per FIC results. The adeB mRNA expression levels were found to be downregulated in 60.7% of isolates treated with tazobactam.
Conclusion: Tazobactam can have impact on resistance to aminoglycoside by inhibiting efflux pump. Thus, the combination of tazobactam with amikacin can be used as an alternative treatment approach in multidrug resistant A. baumannii infections.
Keywords: Acinetobacter baumannii, antibiotic resistant, aminoglycoside, tazobactam, synergism effect, minimum inhibition concentration.
Graphical Abstract
[1]
Azimi, L.; Talebi, M.; Khodaei, F.; Najafi, M.; Lari, A.R. Comparison of multiple-locus variable-number tandem-repeat analysis with pulsed-field gel electrophoresis typing of carbapenemases producing Acinetobacter baumannii isolated from burn patients. Burns, 2016, 42(2), 441-445.
[http://dx.doi.org/10.1016/j.burns.2015.08.024]
[http://dx.doi.org/10.1016/j.burns.2015.08.024]
[2]
Shariati, A.; Asadian, E.; Fallah, F.; Azimi, T.; Hashemi, A.; Sharahi, J.Y.; Moghadam, M.T. Resistance, d. Evaluation of Nano-curcumin effects on expression levels of virulence genes and biofilm production of multidrug-resistant Pseudomonas aeruginosa isolated from burn wound infection in Tehran, Iran. Infect. Drug Resist., 2019, 12, 2223.
[3]
Nasser, A.; Jazireian, P.; Safari, H.; Alizade-Sani, M.; Pourmand, M.R.; Azimi, T. Staphylococcus aureus versus neutrophil: Scrutiny of ancient combat. Microb. Pathog., 2019, 131, 259-269.
[http://dx.doi.org/10.1016/j.micpath.2019.04.026]
[http://dx.doi.org/10.1016/j.micpath.2019.04.026]
[4]
Fallah, F.; Shams Borhan, R.; Gholinejad, Z.; Zahirnia, Z.; Adabiyan, S.; Sattarzadeh Tabrizi, M.; Hashemi, A. Detection of blaIMP and blaVIM metallo-beta-lactamases genes in Pseudomonas aeruginosa strains isolated from wound of burnt patients in Tehran Shahid Motahari Hospital during 2011, Iran. Qom Univ Med. Sci. J., 2013, 7(5), 21-27.
[5]
Azimi, L.; Motevallian, A.; Ebrahimzadeh, N.A.; Asghari, B.; Lari, A.R. Nosocomial infections in burned patients in Motahari hospital, Tehran, Iran. Dermatol. Res. Pract., 2011, 2011, 436952.
[6]
Alaghehbandan, R.; Azimi, L.; Lari, A.R. Nosocomial infections among burn patients in Teheran, Iran: A decade later. Ann. Burns Fire Disasters, 2012, 25(1), 3-7.
[7]
Alizadeh-Sani, M.; Hamishehkar, H.; Khezerlou, A.; Maleki, M.; Azizi-Lalabadi, M.; Bagheri, V.; Safaei, P.; Azimi, T.; Hashemi, M.; Ehsani, A. Kinetics analysis and susceptibility coefficient of the pathogenic bacteria by titanium dioxide and zinc oxide nanoparticles. Adv. Pharm. Bull., 2020, 10(1), 56-64.
[8]
Ardehali, S.H.; Azimi, T.; Fallah, F.; Owrang, M.; Aghamohammadi, N.; Azimi, L. Role of efflux pumps in reduced susceptibility to tigecycline in Acinetobacter baumannii. New Microbes New Infect., 2019, 30, 100547.
[9]
Hashemi, A.; Fallah, F.; Taherpour, A.; Goudarzi, H.; Erfanimanesh, S.; Taki, E. Evaluation of genetic pattern and determination of oqxA gene expression levels among clinical isolates of Klebsiella pneumoniae strains. Majallahi Danishgahi Ulumi Pizishkii Mazandaran, 2014, 24(119), 48-61.
[10]
Seyedjavadi, S.; Eslami, G.; Goudarzi, M.; Goudarzi, H.; Fallah, F. Integrons and multidrug resistance among E. coli and Klebsiella pneumoniae isolated from children with urinary tract infections. Health Med., 2013, 7(1), 243.
[11]
Lari, A.R.; Azimi, L.; Rahbar, M.; Fallah, F.; Alaghehbandan, R.J.B. Phenotypic detection of Klebsiella pneumoniae carbapenemase among burns patients: First report from Iran. Burns, 2013, 39(1), 174-176.
[12]
Azimi, T.; Maham, S.; Fallah, F.; Azimi, L.; Gholinejad, Z. Evaluating the antimicrobial resistance patterns among major bacterial pathogens isolated from clinical specimens taken from patients in Mofid Children’s Hospital, Tehran, Iran: 2013-2018. Infect. Drug Resist., 2019, 12, 2089.
[13]
Sharahi, J.Y.; Azimi, T.; Shariati, A.; Safari, H.; Tehrani, M.K.; Hashemi, A. Advanced strategies for combating bacterial biofilms. J. Cell. Physiol., 2019, 234(9), 14689-14708.
[http://dx.doi.org/10.1002/jcp.28225]
[http://dx.doi.org/10.1002/jcp.28225]
[14]
Pormohammad, A.; Mehdinejadiani, K.; Gholizadeh, P.; Nasiri, M.J.; Mohtavinejad, N.; Dadashi, M.; Karimaei, S.; Safari, H.; Azimi, T. Global prevalence of colistin resistance in clinical isolates of Acinetobacter baumannii: A systematic review and meta-analysis. Microb. Pathog., 2020, 139, 103887.
[http://dx.doi.org/10.1016/j.micpath.2019.103887]
[http://dx.doi.org/10.1016/j.micpath.2019.103887]
[15]
Pormohammad, A.; Nasiri, M.J.; Azimi, T. Prevalence of antibiotic resistance in Escherichia coli strains simultaneously isolated from humans, animals, food, and the environment: A systematic review and meta-analysis. Infect. Drug Resist., 2019, 12, 1181.
[16]
Pormohammad, A.; Azimi, T.; Shiadeh, S.M.J.; Talebi, G.; Hashemi, A.; Abbasi, E.; Fallah, F. Molecular detection and genotyping of bacterial and viral meningitis common causative agents by multiplex real-time PCR in Iran. J. Microbiol. Methods, 2019.105715
[http://dx.doi.org/10.1016/j.mimet.2019.105715]
[http://dx.doi.org/10.1016/j.mimet.2019.105715]
[17]
Shariati, A.; Moradabadi, A.; Azimi, T.; Ghaznavi-Rad, E. Wound healing properties and antimicrobial activity of platelet-derived biomaterials. Scientif. Rep., 2020, 10(1), 1-9.
[http://dx.doi.org/10.1038/s41598-020-57559-w]
[http://dx.doi.org/10.1038/s41598-020-57559-w]
[18]
Shiva, F.; Ghanaie, R.; Shirvani, F.; Armin, S.; Tabatabaei, S.R.; Fahimzad, S.A.; Fallah, F.; PourMoshtagh, H.; Karimi, A. Pattern of antibiotic usage in children hospitalized for common infectious diseases. arch pediatr. infect. dis, 2018, 6(1)
[19]
Owrang, M.; Eslami, G.; Fallah, F.; Irani, S.; Rahbar, M. Molecular detection of Isaba2 among carbapenem hydrolyzing class d β-lactamasese. Acinetobacter baumannii strains isolated from patients in Tehran Hospitals. Irant. J. Med. Microbiol., 2017, 11(3), 19-26.
[20]
Owrang, M.; Fallah, F.; Irani, S.; Rahbar, M.; Eslami, G. identification and isolation of insertion sequences, isaba1 and isaba2, in carbapenem resistant clinical isolates of Acinetobacter baumannii from Hospitals in Tehran, Iran. Jundishapur J. Microbiol., 2017, 11(6), e58251.
[21]
Erfani, Y.; Yaghuobi, S.; Fallah, F.; Rahbar, M.; Rasti, A.; Ghanati, K. Detection of bla NDM-1, bla VIM, and bla IMP genes in multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa from clinical isolates in Tehran hospitals. Int. J. Adv. Biotechnol. Res., 2017, 8, 500-506.
[22]
Owlia, P.; Azimi, L.; Gholami, A.; Asghari, B.; Lari, A.R. ESBLand MBL-mediated resistance in Acinetobacter baumannii: A global threat to burn patients. Infezioni in medicina , 2012, 20(3), 182-7.
[23]
Asif, M.; Alvi, I.A.; Rehman, S. Insight into Acinetobacter baumannii: Pathogenesis, global resistance, mechanisms of resistance, treatment options, and alternative modalities. Infect. Drug Resist., 2018, 11, 1249.
[24]
Pormohammad, A.; Lashkarbolouki, S.; Azimi, T.; Gholizadeh, P.; Bostanghadiri, N.; Safari, H.; Armin, S.; Mohtavinejad, N.; Fallah, F. Clinical characteristics and molecular epidemiology of children with meningitis in Tehran, Iran: a prospective study. New Microbes New Infect., 2019, 32, 100594.
[25]
Maham, S.; Fallah, F.; Gholinejad, Z.; Seifi, A.; Hoseini-Alfatemi, S. Bacterial etiology and antibiotic resistance pattern of pediatric bloodstream infections: A multicenter based study in Tehran, Iran. Ann. Ig., 2018, 30(4), 337-345.
[26]
Bahramian, A.; Khoshnood, S.; Shariati, A.; Doustdar, F.; Chirani, A.S.; Heidary, M. Molecular characterization of the pilS2 gene and its association with the frequency of Pseudomonas aeruginosa plasmid pKLC102 and PAPI-1 pathogenicity island. Infect. Drug Resist., 2019, 12, 221.
[27]
Chiang, C-H.; Pan, S-C.; Yang, T-S.; Matsuda, K.; Kim, H.B.; Choi, Y.H.; Hori, S.; Wang, J-T.; Sheng, W-H.; Chen, Y-C. Healthcare-associated infections in intensive care units in Taiwan, South Korea, and Japan: Recent trends based on national surveillance reports. Antimicrob. Resist. Infect. Control, 2018, 7(1), 129.
[28]
Owrang, M.; Fallah, F.; Irani, S.; Rahbar, M.; Eslami, G. Distribution of ISAba1 and ISAba2 among OXA-type carbapenemase-producing clinical isolates of Acinetobacter baumannii from Hospitals in Tehran, Iran. J. Pure Appl. Microbiol., 2016, 10(2), 959-967.
[29]
Khalilzadegan, S.; Sade, M.; Godarzi, H.; Eslami, G.; Hallajzade, M.; Fallah, F.; Yadegarnia, D. Beta-lactamase encoded genes blaTEM and blaCTX among Acinetobacter baumannii species isolated from medical devices of intensive care units in Tehran hospitals. Jundishapur J. Microbiol., 2016, 9(5)
[http://dx.doi.org/10.5812/jjm.14990]
[http://dx.doi.org/10.5812/jjm.14990]
[30]
Fallah, F.; Noori, M.; Hashemi, A.; Goudarzi, H.; Karimi, A.; Erfanimanesh, S.; Alimehr, S. Prevalence of blaNDM, blaPER, blaVEB, blaIMP, and blaVIM genes among Acinetobacter baumannii isolated from two hospitals of Tehran, Iran. Scientifica (Cairo), 2014, 2014, 245162.
[31]
Peymani, A.; Nahaei, M-R.; Farajnia, S.; Hasani, A.; Mirsalehian, A.; Sohrabi, N.; Abbasi, L. High prevalence of metallo-b-lactamase-producing Acinetobacter baumannii in a teaching hospital in Tabriz, Iran. Jpn. J. Infect. Dis., 2011, 64(1), 69-71.
[32]
Noori, M.; Karimi, A.; Fallah, F.; Hashemi, A.; Alimehr, S.; Goudarzi, H.; Aghamohammad, S. high prevalence of metallo-betalactamase producing acinetobacter baumannii isolated from two hospitals of tehran, iran. arch. pediatr. infect. dis 2014, 2(3)
[33]
Kim, U.J.; Kim, H.K.; An, J.H.; Cho, S.K.; Park, K-H.; Jang, H-C. Update on the epidemiology, treatment, and outcomes of carbapenem-resistant Acinetobacter infections. Chonnam Med. J., 2014, 50(2), 37-44.
[34]
Santajit, S.; Indrawattana, N. Mechanisms of antimicrobial resistance in ESKAPE pathogens. BioMed Res. Int., 2016, 2016, 2475067.
[35]
Bahramian, A.; Shariati, A.; Azimi, T.; Sharahi, J.Y.; Bostanghadiri, N.; Gachkar, L.; Ghalavand, Z.; Chirani, A.S.; Erfanimanesh, S.; Hashemi, A. First report of New Delhi metallo-β-lactamase-6 (NDM-6) among Klebsiella pneumoniae ST147 strains isolated from dialysis patients in Iran. Infect. Genet. Evol., 2019, 69, 142-145.
[36]
Shariati, A.; Azimi, T.; Ardebili, A.; Chirani, A.; Bahramian, A.; Pormohammad, A.; Sadredinamin, M.; Erfanimanesh, S.; Bostanghadiri, N.; Shams, S. Insertional inactivation of oprD in carbapenem-resistant Pseudomonas aeruginosa strains isolated from burn patients in Tehran, Iran. New Microbes New Infect., 2018, 21, 75-80.
[37]
Dadashi, M.; Hashemi, A.; Eslami, G.; Fallah, F.; Goudarzi, H.; Erfanimanesh, S.; Taherpour, A. Evaluation of antibacterial effects of Zataria multiflora Boiss extracts against ESBL-producing Klebsiella pneumoniae strains. Avicenna J. Phytomed., 2016, 6(3), 336.
[38]
Azimi, L.; Talebi, M.; Pourshafie, M-R.; Owlia, P.; Lari, A.R. Characterization of carbapenemases in extensively drug resistance Acinetobacter baumannii in a burn care center in Iran. Int. J. Mol. Cell. Med., 2015, 4(1), 46.
[39]
Armin, S.; Fallah, F.; Hoseini-Alfatemi, S.M. Antimicrobial susceptibility pattern of six threatening pathogens at Mofid Children’s Hospital, Tehran, Iran. Arch. Pediatr. Infect. Dis., 2018, 13(4)
[40]
Kim, W-Y.; Moon, J-Y.; Huh, J.W.; Choi, S-H.; Lim, C-M.; Koh, Y.; Chong, Y.P.; Hong, S-B. Comparable efficacy of tigecycline versus colistin therapy for multidrug-resistant and extensively drug-resistant Acinetobacter baumannii pneumonia in critically ill patients. PLoS One, 2016, 11(3)
[http://dx.doi.org/10.1371/journal.pone.0150642]
[http://dx.doi.org/10.1371/journal.pone.0150642]
[41]
Chuang, Y-C.; Cheng, C-Y.; Sheng, W-H.; Sun, H-Y.; Wang, J-T.; Chen, Y-C.; Chang, S-C. Effectiveness of tigecycline-based versus colistin-based therapy for treatment of pneumonia caused by multidrug-resistant Acinetobacter baumannii in a critical setting: A matched cohort analysis. BMC Infect. Dis., 2014, 14(1), 102.
[http://dx.doi.org/10.1186/1471-2334-14-102]
[http://dx.doi.org/10.1186/1471-2334-14-102]
[42]
Marie, M.A.M.; Krishnappa, L.G.; Alzahrani, A.J.; Mubaraki, M.A.; Alyousef, A. A prospective evaluation of synergistic effect of sulbactam and tazobactam combination with meropenem or colistin against multidrug resistant Acinetobacter baumannii. Bosn. J. Basic Med. Sci., 2015, 15(4), 24.
[43]
Cetin, E.S.; Tekeli, A.; Ozseven, A.G.; Us, E.; Aridogan, B.C. Determination of in vitro activities of polymyxin B and rifampin in combination with ampicillin/sulbactam or cefoperazone/sulbactam against multidrug-resistant Acinetobacter baumannii by the E-test and checkerboard methods. Jpn. J. Infect. Dis., 2013, 66(6), 463-468.
[44]
Spellberg, B.; Bonomo, R. Combination therapy for Extreme Drug Resistant (XDR) Acinetobacter baumannii: Ready for prime-time? Crit. Care Med., 2015, 43(6), 1332.
[45]
Temocin, F.; Erdinc, F.S.; Tulek, N.; Demirelli, M.; Ertem, G.; Kinikli, S.; Koksal, E. Synergistic effects of sulbactam in multi-drug-resistant Acinetobacter baumannii. Braz. J. Microbiol., 2015, 46(4), 1119-1124.
[http://dx.doi.org/10.1590/S1517-838246420140101]
[http://dx.doi.org/10.1590/S1517-838246420140101]
[46]
Tuon, F.F.; Rocha, J.L.; Merlini, A.B. Combined therapy for multi-drug-resistant Acinetobacter baumannii infection-is there evidence outside the laboratory? J. Med. Microbiol., 2015, 64(9), 951-959.
[http://dx.doi.org/10.1099/jmm.0.000144]
[http://dx.doi.org/10.1099/jmm.0.000144]
[47]
Savov, E.; Chankova, D.; Vatcheva, R.; Dinev, N. In vitro investigation of the susceptibility of Acinetobacter baumannii strains isolated from clinical specimens to ampicillin/sulbactam alone and in combination with amikacin. Int. J. Antimicrob. Agents, 2002, 20(5), 390-392.
[48]
Wang, Y-C.; Kuo, S-C.; Yang, Y-S.; Lee, Y-T.; Chiu, C-H.; Chuang, M-F.; Lin, J-C.; Chang, F-Y.; Chen, T-L. Individual or combined effects of meropenem, imipenem, sulbactam, colistin, and tigecycline on biofilm-embedded Acinetobacter baumannii and biofilm architecture. Antimicrob. Agents Chemother., 2016, 60(8), 4670-4676.
[49]
Mobasseri, P.; Azimi, L.; Salehi, M.; Hosseini, F.; Fallah, F. Distribution and expression of efflux pump gene and antibiotic resistance in Acinetobacter baumannii. Arch. Clin. Infect. Dis., 2018, 13(5)
[http://dx.doi.org/10.5812/archcid.67143]
[http://dx.doi.org/10.5812/archcid.67143]
[50]
Meletiadis, J.; Pournaras, S.; Roilides, E.; Walsh, T. Defining fractional inhibitory concentration index cutoffs for additive interactions based on self-drug additive combinations, Monte Carlo simulation analysis, and in vitro-in vivo correlation data for antifungal drug combinations against Aspergillus fumigatus. Antimicrob. Agents Chemother., 2010, 54(2), 602-609.
[51]
The Clinical & Laboratory Standards Institute, Performance standards for antimicrobial susceptibility testing: Nineteenth informational supplement M100-S21; CLSI,: Wayne, PA, USA, 2018.
[52]
Azimi, L.; Ghanaiee, R.M.; Shirdust, M.; Karimi, A.M.; Armin, S.; Tabatabaei, S.R.; Shiva, F.; Fallah, F.; Rezaei, M.; Fahimzad, S. Molecular identification of gram-negative bacteria in respiratory samples of cystic fibrosis patients from a children referral hospital in Tehran. arch. pediatr. infect. dis.,, 2019, 7(3)
[http://dx.doi.org/10.5812/pedinfect.64834]
[http://dx.doi.org/10.5812/pedinfect.64834]
[53]
Ahmed, A.; Azim, A.; Gurjar, M.; Baronia, A. Current concepts in combination antibiotic therapy for critically ill patients. Ind. J. Crit. Care Med., 2014, 1(5), 310.
[54]
Shiadeh, S.M.J.; Hashemi, A.; Fallah, F.; Lak, P.; Azimi, L.; Rashidan, M. First detection of efrAB, an ABC multidrug efflux pump in Enterococcus faecalis in Tehran, Iran. Acta Microbiol. Immunol. Hung., 2019, 66(1), 57-68.
[55]
Haeili, M.; Ghodousi, A.; Nomanpour, B.; Omrani, M.; Feizabadi, M. Drug resistance patterns of bacteria isolated from patients with nosocomial pneumonia at Tehran hospitals during 2009-2011. J. Infect. Dev. Ctries., 2013, 7(4), 312-317.
[56]
Tängdén, T. Combination antibiotic therapy for multidrug-resistant Gram-negative bacteria. Ups. J. Med. Sci., 2014, 119(2), 149-153.
[57]
Purmohamad, A.; Abasi, E.; Azimi, T.; Hosseini, S.; Safari, H.; Nasiri, M.J.; Fooladi, A.A.I. Global estimate of Neisseria meningitidis serogroups proportion in invasive meningococcal disease: A systematic review and meta-analysis. Microb. Pathog., 2019, •••103571
[http://dx.doi.org/10.1016/j.micpath.2019.103571]
[http://dx.doi.org/10.1016/j.micpath.2019.103571]
[58]
Fischbach, M. Combination therapies for combating antimicrobial resistance. Curr. Opin. Microbiol., 2011, 14(5), 519-523.
[http://dx.doi.org/10.1016/j.mib.2011.08.003]
[http://dx.doi.org/10.1016/j.mib.2011.08.003]
[59]
Sobouti, B.; Ghavami, Y.; Fallah, S. Educational case: Pseudomonas and Acinetobacter sepsis due to thermal injury. Arch. Pediatr. Infect. Dis., 2013, 1(3), 147-150.
[60]
Yang, B.; Lei, Z.; Zhao, Y.; Ahmed, S.; Wang, C.; Zhang, S.; Fu, S.; Cao, J.; Qiu, Y. Combination susceptibility testing of common antimicrobials in vitro and the effects of sub-MIC of antimicrobials on Staphylococcus aureus biofilm formation. Front. Microbiol., 2017, 8, 2125.
[http://dx.doi.org/10.3389/fmicb.2017.02125]
[http://dx.doi.org/10.3389/fmicb.2017.02125]
[61]
Chu, H.; Zhao, L.; Wang, M.; Liu, Y.; Gui, T.; Zhang, J. Sulbactam-based therapy for Acinetobacter baumannii infection: A systematic review and meta-analysis. Braz. J. Infect. Dis., 2013, 17(4), 389-394.
[http://dx.doi.org/10.1016/j.bjid.2012.10.029]
[http://dx.doi.org/10.1016/j.bjid.2012.10.029]
[62]
Peck, K.R.; Kim, M.J.; Choi, J.Y.; Kim, H.S.; Kang, C-I.; Cho, Y.K.; Park, D.W.; Lee, H.J.; Lee, M.S.; Ko, K.S. In vitro time-kill studies of antimicrobial agents against blood isolates of imipenem-resistant Acinetobacter baumannii, including colistin-or tigecycline-resistant isolates. J. Med. Microbiol., 2012, 61(3), 353-360.
[http://dx.doi.org/10.1099/jmm.0.036939-0]
[http://dx.doi.org/10.1099/jmm.0.036939-0]
[63]
Fernando, D.M.; Kumar, A.J. Resistance-nodulation-division multidrug efflux pumps in gram-negative bacteria: Role in virulence. Antibiotics (Basel), 2013, 2(1), 163-181.
[http://dx.doi.org/10.3390/antibiotics2010163]
[http://dx.doi.org/10.3390/antibiotics2010163]
Related Books
Industrial Applications of Soil Microbes
Industrial Applications of Soil Microbes
Algal Biotechnology for Fuel Applications
Biopolymers Towards Green and Sustainable Development
Terpenoids: Recent Advances in Extraction, Biochemistry and Biotechnology
Environmental Microbiology: Advanced Research and Multidisciplinary Applications
Biomarkers in Medicine
Industrial Applications of Soil Microbes
Recent Advances in Biotechnology
Sustainable Utilization of Fungi in Agriculture and Industry
Article Metrics
5