Prevalence of metallo-β-lactamases as a correlate of multidrug resistance among clinical Pseudomonas aeruginosa isolates in Nepal

Prabin Dawadi; Christina Khadka; Manita Shyaula; Gopiram Syangtan; Tista Prasai Joshi; Samantha H Pepper; Sushil R Kanel; Lok R Pokhrel

doi:10.1016/j.scitotenv.2022.157975

Prevalence of metallo-β-lactamases as a correlate of multidrug resistance among clinical Pseudomonas aeruginosa isolates in Nepal

Sci Total Environ. 2022 Dec 1:850:157975. doi: 10.1016/j.scitotenv.2022.157975. Epub 2022 Aug 11.

Authors

Prabin Dawadi¹, Christina Khadka², Manita Shyaula², Gopiram Syangtan², Tista Prasai Joshi³, Samantha H Pepper⁴, Sushil R Kanel⁵, Lok R Pokhrel⁶

Affiliations

¹ Faculty of Science, Nepal Academy of Science and Technology, Khumaltar, Lalitpur 44700, Bagmati, Nepal; Central Department of Microbiology, Tribhuvan University, Kathmandu 44618, Bagmati, Nepal.
² Central Department of Microbiology, Tribhuvan University, Kathmandu 44618, Bagmati, Nepal.
³ Faculty of Science, Nepal Academy of Science and Technology, Khumaltar, Lalitpur 44700, Bagmati, Nepal.
⁴ Department of Heath Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC 27858, USA.
⁵ Department of Chemistry, Wright State University, Dayton, OH 45435, USA.
⁶ Department of Public Health, The Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA. Electronic address: POKHRELL18@ecu.edu.

PMID: 35964754
DOI: 10.1016/j.scitotenv.2022.157975

Abstract

Pseudomonas aeruginosa is an opportunistic human pathogen that has developed antibiotic resistance (AR) and causes a range of illnesses, including respiratory pneumonia, gastrointestinal infections, keratitis, otitis media and bacteremia in patients with compromised immune system. The production of metallo-β-lactamases (MBLs) is one of the major mechanisms of AR in this bacterium with ensuing infections difficult to treat. The main goal of this study was to provide a quantitative estimate of MBLs producing clinical P. aeruginosa isolates among the Nepalese patients and determine if MBL correlates with multi-drug resistance (MDR). Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline was followed for meta-analysis of relevant literature using PubMed, Research4Life, and Google Scholar. The prevalence of MBLs in P. aeruginosa from clinical samples was determined using R 4.1.2 for data pooled from studies published until 2021. The meta-analysis of a total of 19 studies selected (of 6038 studies for which titles and abstracts were reviewed) revealed the prevalence of MBLs producing P. aeruginosa (MBL-PA) was 14 % (95 % CI: 0.10-0.19) while MDR isolates among P. aeruginosa was 42 % (95 % CI: 0.30-0.55) in Nepal. Combined Disc Test was predominantly used phenotypic method for confirming MBLs phenotypes among the studies. Sputum was the most common specimen from which MBL-PA was recovered. A significant positive correlation was observed between MDR and MBL production in P. aeruginosa. We conclude that MBL producing strains are widespread among the clinical isolates of P. aeruginosa in Nepal and responsible for emerging MDR strains. It is paramount that antibiotics prescription against the bacterium should be monitored closely and alternative therapeutic modalities against MBL-PA explored.

Keywords: Clinical isolates; Metallo-β-lactamases; Multidrug-resistance; Nepal; Pseudomonas aeruginosa.

Publication types

Meta-Analysis
Review

MeSH terms

Anti-Bacterial Agents / pharmacology
Drug Resistance, Multiple
Humans
Microbial Sensitivity Tests
Nepal / epidemiology
Prevalence
Pseudomonas Infections* / drug therapy
Pseudomonas Infections* / epidemiology
Pseudomonas Infections* / microbiology
Pseudomonas aeruginosa*
beta-Lactamases / genetics

Substances

Anti-Bacterial Agents
beta-Lactamases