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Year : 2007  |  Volume : 25  |  Issue : 4  |  Page : 435-436

A report of Pseudomonas aeruginosa antibiotic resistance from a multicenter study in Iran

1 Clinical Laboratory and Pathology Department, Tehran Heart Center, Medical Sciences/University of Tehran, Jalal Al Ahmad and North Kargar Cross, Tehran, Iran
2 Clinical Laboratory and Pathology Department, Reference Laboratories of Iran Research Center, 1411713138 Tehran, Iran

Date of Submission14-Mar-2007
Date of Acceptance28-May-2007

Correspondence Address:
M A Boroumand
Clinical Laboratory and Pathology Department, Tehran Heart Center, Medical Sciences/University of Tehran, Jalal Al Ahmad and North Kargar Cross, Tehran
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0255-0857.37368

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How to cite this article:
Boroumand M A, Esfahanifard P, Saadat S, Sheihkvatan M, Hekmatyazdi S, Saremi M, Nazemi L. A report of Pseudomonas aeruginosa antibiotic resistance from a multicenter study in Iran. Indian J Med Microbiol 2007;25:435-6

How to cite this URL:
Boroumand M A, Esfahanifard P, Saadat S, Sheihkvatan M, Hekmatyazdi S, Saremi M, Nazemi L. A report of Pseudomonas aeruginosa antibiotic resistance from a multicenter study in Iran. Indian J Med Microbiol [serial online] 2007 [cited 2021 Mar 8];25:435-6. Available from:

Dear Editor,

The importance of the microbiology laboratory in hospital-based infection control programmes is well established. The role of the laboratory in infection surveillance, in the management of antimicrobial resistance and in outbreak investigation is also highlighted. Many different methods are available for bacterial susceptibility testing, including disk diffusion, E -test and microdilution procedures. The E -test is a new, continuous gradient diffusion test for MIC determination, [1] which has gained acceptance as a method for MIC determination and is less labour-intensive than the microdilution methodology. [2] Imipenem is a potent agent for the treatment of infections due to multidrug resistant Pseudomonas aeruginosa . Currently, resistance to imipenem is an increasing problem among these bacterial isolates. [3] According to the importance of antibiotic resistance of P. aeruginosa as one of the most important causes of healthcare-associated infection in our country, we tested the activity of imipenem by E -test against P. aeruginosa and compared the outcome with ciprofloxacin and ceftazidime.

In this study, a total of 142 recent clinical isolates from three university hospitals with more than 400 beds each, located in Tehran were tested against a wide a range of imipenem, ciprofloxacin and ceftazidime. The strains were tested for antibiotic susceptibility by three methods: E -test, disk diffusion and microdilution broth technique.

The percentages of P. aeruginosa isolates susceptible to ciprofloxacin and ceftazidime by disc diffusion test were 69 and 58.5%, respectively, compared to 64.8 and 64.1% with E -test and 56.5 and 55.6% with microdilution test, whereas the percentage of bacteria susceptible to imipenem by disk diffusion and E -test were 94.4 and 90.1%, respectively. Fifty percentile MIC (MIC 50 ) for imipenem, ciprofloxacin and ceftazidime in E -test were 2, 0.35 and 3, whereas 90 percentile MIC (MIC 90 ) for these antibiotics in E -test were 5.4, >32 and >256, respectively. A significant relationship between susceptibility of P. aeruginosa and type of antibiotic was seen in E -test (imipenem, 90.1%; ciprofloxacin, 64.8%; ceftazidime, 64.1%; P < 0.0001).

Considering microdilution broth technique as a gold standard test, sensitivity and specificity of E -test were 89.24 and 95.00%, respectively. Interpretation of microdilution and E -test results showed almost perfect agreement, with kappa value of 0.8466 (95% CI: 0.7743-0.9188).

This study has assessed the use of three different tests for determining imipenem, ciprofloxacin and ceftazidime MICs, namely: disk diffusion, microdilution and E -test. In this study, we found a difference between three antibiotics in determining susceptibility of P. aeruginosa in E -test. We found lower susceptibility to ciprofloxacin and ceftazidime than other studies; [4],[5] however, we also showed high susceptibility of P. aeruginosa to imipenem in E -test. In our study, the outcome of E -test as opposed to disk diffusion showed that susceptibility of P. aeruginosa to any selective antibiotic (imipenem, ciprofloxacin or ceftazidime) in E -test was higher than disk diffusion. We also obtained almost perfect agreement between E -test and microdilution. Similar to our study, in the Bonaventura study, overall qualitative agreement between these tests was 81.2% for ceftazidime, 93.7% for ciprofloxacin and 88.7% for imipenem. [5] Kelly et al , found the similar results with 95% agreement for cephalosporin. [1]

P. aeruginosa shows high antimicrobial resistance in this multicentre study; therefore, it is necessary to implement certain policies to prevent antimicrobial resistance and establish a national programme and strategy to gather data centrally and use sensitive and specific tests to detect this bacterium.

This research has supported by a grant from Medical sciences/ University of Tehran.

 ~ References Top

1.Kelly LM, Jacobs MR, Appelbaum PC. Comparison of agar dilution, microdilution, E test and disc diffusion to test the activity of trovafloxacin against Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus and Streptococcus pneumoniae . J Antimicrob Chemother 1999; 43 :707-9.  Back to cited text no. 1    
2.Garner JS, Jarvis WR, Emori TG. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16 :128-40.  Back to cited text no. 2    
3.Kim IS, Lee NY, Ki CS, Oh WS, Peck KR, Song JH. Increasing prevalence of imipenem-resistant Pseudomonas aeruginosa and molecular typing of metallo-beta-lactamase producers in a Korean hospital. Microb Drug Resist 2005; 11 :355-9.  Back to cited text no. 3    
4.Genηer S, Ak , Benzonana N, Batirel A, Ozer S. Susceptibility patterns and cross-resistances of antibiotics against Pseudomonas aeruginosa in a teaching hospital of Turkey. Ann Clin Microbiol Antimicrob 2002; 1 :2.  Back to cited text no. 4    
5.Di Bonaventura G, Ricci E, Della Loggia N, Catamo G, Piccolomini R. Evaluation of the E -test for antimicrobial susceptibility testing of Pseudomonas aeruginosa isolates from patients with long-term bladder catheterization. J Clin Microbiol 1998; 36 :824-6.  Back to cited text no. 5    

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