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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 5  |  Issue : 4  |  Page : 148-152

Prevalence of meropenem and imipenem resistance in gram-negative uropathogens in ibn sina clinic in Benghazi-Libya


1 Departments of Pharmacology, Benghazi University, Benghazi, Libya
2 ICU HIV Centre, Benghazi, Libya
3 Department of Microbiology, Ibn-sena Clinic, Benghazi, Libya
4 Medicine, Benghazi University, Benghazi, Libya

Date of Submission09-Sep-2021
Date of Acceptance15-Sep-2021
Date of Web Publication28-Feb-2022

Correspondence Address:
Dr. Huda Mohammed Gargoum
Department of Pharmacology, Benghazi University, Benghazi
Libya
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ljms.ljms_55_21

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  Abstract 


Background/Aims: The carbapenem resistance is increasing worldwide. Although there are a number of studies on carbapenem resistance available in western Libya, there is no adequate information in eastern Libya. The aim of the present work was to study the prevalence of both imipenem and meropenem in uropathogens in one hospital in Benghazi, a city in Libya, to know the magnitude of resistance caused by these groups of bacteria. Subjects and Methods: A total of 1011 samples of patients with urinary tract infection were collected from August 1, 2019, to April 30, 2020. Identification of the isolates was done and the antibiotic susceptibility of different uropathogens was tested for their imipenem and meropenem susceptibility. Results: The prevalence of Escherichia coli was 68.8%, followed by Klebsiella pneumonia and Proteus mirabilis (12.4% and 4.8%, respectively). The prevalence of Pseudomonas aeruginosa was also (12.4%), and the Acinetobacter baumannii comes next by 1.6%. Conclusions: Compared to different results done in different parts of Libya, the prevalence of carbapenem was increased and this expanded to other Enterobacteriaceae as P. mirabilis that has not declared in previous data in different regions in Libya.

Keywords: Carbapenem resistance, Enterobacteriaceae, Pseudomonas aeruginosa


How to cite this article:
Gargoum HM, Muftah M M, Zinab M A, Khadija E. Prevalence of meropenem and imipenem resistance in gram-negative uropathogens in ibn sina clinic in Benghazi-Libya. Libyan J Med Sci 2021;5:148-52

How to cite this URL:
Gargoum HM, Muftah M M, Zinab M A, Khadija E. Prevalence of meropenem and imipenem resistance in gram-negative uropathogens in ibn sina clinic in Benghazi-Libya. Libyan J Med Sci [serial online] 2021 [cited 2022 May 23];5:148-52. Available from: https://www.ljmsonline.com/text.asp?2021/5/4/148/338632




  Introduction Top


Antimicrobial resistance (AMR) is an ongoing public health problem of the universe. It affects the management of broad spectrum of bacterial infections by limiting antibiotic prescription options and leads to the development of serious and hard to treat complications.[1] Over the past decade, different studies have witnessed the problem of AMR in Libya with various bacteria.[2],[3] One of the significant causes of rapid transmission of AMR is that the genes with resistance are carried on the genetic material or plasmid. These are replicated and transferred horizontally between various pathogens.[4] The concern of multidrug-resistant and extended-spectrum beta-lactamase (ESBL) was prevalent.[5],[6] ESBL extended to cause a resistance to the newer beta-lactam as well as nonbeta-lactam antibiotics.[7]

Carbapenems are new and potent beta-lactam antibiotics, they are usually preserved for the treatment of serious infections caused by a wide spectrum of Gram-negative bacteria.[8] At beginning of the current century, the resistance of different strains to carbapenems did not exist.[9] Spreading of infections with carbapenem-resistant Enterobacteriaceae (CRE) and other negative uropathogens such as carbapenem-resistant Acinetobacter baumannii (CRAB) and carbapenem-resistant Pseudomonas aeruginosa isolates (CRPA) are considered a challenge in health-care situations and it is an increasing concern globally.[9],[10],[11] In addition to efflux pumps and porin-mediated resistance, another major reason for the development of carbapenem resistance is mediated by carrying of carbapenemase genes and production of carbapenemase enzymes.[4] There are different classes of carbapenemase: Klebsiella pneumoniae carbapenemase, metalloenzymes, and enzymes (OXA-48 type) 10. The presence of carbapenemase genes such as the blaVIM-2, bla NDM, and OXA-genes is one of the most common mechanisms for these bacteria to get a resistant to the carbapenem antibiotics in several countries.[12],[13],[14],[15]

Different studies in the western part of Libya showed that the blaOXA-48 was the most prevalent gene, followed by bla NDM in CRE.[16],[17] While in CRAB, the blaOXA-23, bla-OXA24, blaOXA-48, and bla NDM-1 genes were identified, and in CRPA, the blaVIM-2 gene was the most predominant.[14],[18] The investigations on carbapenem-resistant pathogens in Benghazi city remain inadequate and limited. The aim of the present work was to study the prevalence of both imipenem and meropenem in uropathogens in one hospital in Benghazi, a city in Libya, to know the magnitude of resistance caused by these groups of bacteria.


  Subjects and Methods Top


Study design

A descriptive study conducted at Ibn Sina Clinic in Benghazi-Libya was done after approval from the ethical committees. A total of 1011 samples of patients with urinary tract infection were collected from August 1, 2019, to April 30, 2020. The midstream urine samples were collected in a sterile containers at early morning and sent to the laboratory within 30 minutes.

Bacterial isolates and antibiotic susceptibility testing

Urine samples were placed on cysteine lactose electrolyte deficient (CLED) agar incubated at 37°C for 24 h. A growth of >105 colony-forming units per mL of one type of organism was considered significant bacteriuria. Identification of the isolates was done by observing colonial morphology on the CLED medium.[19] The antibiotic susceptibility of different uropathogens was tested for their imipenem and meropenem susceptibility by the Clinical and Laboratory Standards Institute's disk diffusion method.[20]


  Results Top


In the present study, a total of 186 resistant strains of different Gram-negative isolates include Enterobacteriaceae ( Escherichia More Details coli, K. pneumonia and Proteus mirabilis), P. aeruginosa, and A. baumannii were isolated. The prevalence of Enterobacteriaceae bacteria was the most predominant (86%). E. coli, K. pneumonia, and P. mirabilis accounted for 68.8%, 12.4%, and 4.8%, respectively. It was followed by P. aeruginosa (12.4%), followed by A. baumannii 1.6% [Figure 1].
Figure 1: The prevalence of uropathogens in the collected growth samples. in Ibn Sina Clinic

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A total of 19 (10.2%) different isolates were resistant to carbapenem [Figure 2]. Imipenem resistance constituted 5.4% while the prevalence of meropenem resistance was 4.8% [Figure 2]. The prevalence of carbapenem resistance in males (57.9%) was higher than in females (42.1%) [Figure 3]a. While the percentages of male resistance of imipenem and meropenem were 26.3% and 31.6%, respectively, the percentages of female resistance of both medicines were 26.3% and 15.8% [Figure 3]b, respectively. As shown in the same figure, meropenem resistance is more predominant in males than in females.
Figure 2: The prevalence of imipenem and meropenem in Ibn Sina Clinic

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Figure 3: Gender differences in resistant bacteria. (a) Shows different sex in total carbapenem (imipenem and meropenem)-resistant pathogens. (b) Shows different sex in each imipenem and meropenem resistant pathogens

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Eight isolates of 160 Enterobacteriaceae-resistant bacteria were resistant to imipenem (5%) [Figure 4]. The prevalence of imipenem resistance in K. pneumonia was 8.7% (2 of 23), while in E. coli was 3.9% (5 of 128) and in P. mirabilis was 11.1% (1 of 9). Eight isolates of 160 (5%) Enterobacteriaceae-resistant bacteria were resistant to meropenem [Figure 4]. The prevalence of meropenem resistance in K. pneumonia was 17.4% (4 of 23) and in E. coli was 3.1% (4 of 128). P. mirabilis bacteria were susceptible to meropenem [Figure 4]. Only 8.7% of P. aeruginosa pathogens showed resistance to imipenem, while 33% of A. baumannii were resistant to meropenem.
Figure 4: The prevalence of carbapenem-resistant Gram-negative uropathogen. (a) Shows imipenem and meropenem reistance in Enterobacteriaceae and Pseudomonas aeruginosa

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  Discussion Top


Carbapenem-resistant GNB (such as A. baumannii, P. aeruginosa, and members of the family Enterobacteriaceae) has spread in the past decade and led to a serious health problem that continues to grow worldwide.[21] In the current study, the prevalence of carbapenem-resistant bacteria was 10.2%. This was nearly similar to a recent study performed in Libya in which 11 of 83 (13.3%) of Gram-negative bacteria were carbapenem-resistant strains.[22] WHO has warned of disassembly of carbapenem resistance. At the beginning of the new millennium, a few studies reported on carbapenem resistance in Libya. A review study from 1970 to 2011 reported that all detected strains were susceptible to imipenem.[3] However, in subsequent year, the prevalence of carbapenem resistance is progressively increased. A study was done in 2016 showed that the prevalence of resistance of imipenem and meropenem was 0.6% and 2.5%, respectively,[23] a higher prevalence was recorded in the present study. It has been found that the imipenem resistance accounted for 5.4% and meropenem resistance was 4.8%.

It has been noticed that in this study, there was a gender difference in carbapenem-resistance strains. Although the GNB infection is more predominant in female patients because of their anatomical structure,[24],[25] it has been found that males have a higher rate of infections with antibiotic-resistance bacteria.[26],[27],[28] This study is also consistent with previous records in which 57.9% of carbapenem resistance was found in male gender. The AMR in male patients has been explained by several factors in different studies such as age, variation in prescribing the medicine, poorer compliance, and hand hygiene, which may cause a higher rate of hospitalization.[29],[30],[31],[32]

According to different studies done in 2013 and 2015 in western regions of Libya, the prevalence of CRE isolates ranged from 6.8% to 29.2%, with blaOXA-48 being the most prevalent gene, followed by bla NDM.[16],[17] While in the present study, the total prevalence of CRE isolates was within the range of other previous studies in the western part (about 10%). The prevalence of carbapenem-resistant K. pneumonia CRK was 26% and the prevalence of carbapenem-resistant E. coli was 7%. While there were no data in Libya about carbapenem resistant in P. mirabilis, we found in this study that 11% of the pathogens were resistant to imipenem but not to meropenem. This was consistence with some recent studies that were done in different countries. In Sudan, the prevalence of carbapenem resistant in P. mirabilis was 3%, while in Turkey, it was about 17% and it was higher in eastern Asia.[33],[34],[35]

In the current study, 33% of A. baumannii isolates were only resistant to meropenem and P. aeruginosa pathogens only showed a resistance to imipenem 8.7%. Comparatively to other studies that showed 88% and 85.5% of A. baumannii isolates and P. aeruginosa were resistant to imipenem, our results were much lower. This variation between eastern and western parts of the country may be own to different genes and points of mutations in the isolated pathogens recovered from the two regions. The blaOXA-23 was detected in 86% of A. baumannii isolates recovered from Benghazi and Tripoli hospitals and the blaOXA-48 gene was detected in one pathogen isolated from Benghazi hospital. Although the blaVIM-2 gene was detected in 90% of P. aeruginosa at different regions, the presence of OprD mutations was variable in Benghazi and Tripoli hospitals.[14] Groups (G) of mutations 1, 11, and 12 were present on the detected gene of pathogens isolated from Benghazi, while G2–G10 and G13 were found in genes in pathogens isolated from Tripoli hospitals.[14]


  Conclusions Top


In this study, we found that the prevalence of carbapenem resistance is increased as compared to previous studies tha were done in Libya. We also found that the prevalence of K. pneumonia carbapenem resistant was predominant among CRE isolates and this consistence with several studies. Comparing to western parts of the country, this study also showed that there was a variation in the prevalence of resistance of CRAB and CRPA, and we reported for the first time the development of resistance in P. mirabilis in one of the Benghazi hospitals.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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