Prevalence and microbiological and genetic characteristics of multidrug-resistant Pseudomonas aeruginosa over three years in Qatar

Mazen A Sid Ahmed; Hamad Abdel Hadi; Sulieman Abu Jarir; Faisal Ahmad Khan; Mohammed A Arbab; Jemal M Hamid; Mohammed A Alyazidi; Muna A Al-Maslamani; Sini Skariah; Ali A Sultan; Abdul Latif Al Khal; Bo Söderquist; Emad Bashir Ibrahim; Jana Jass; Hisham Ziglam

doi:10.1017/ash.2022.226

Prevalence and microbiological and genetic characteristics of multidrug-resistant Pseudomonas aeruginosa over three years in Qatar

Antimicrob Steward Healthc Epidemiol. 2022 Jun 20;2(1):e96. doi: 10.1017/ash.2022.226. eCollection 2022.

Authors

Mazen A Sid Ahmed^{1

2}, Hamad Abdel Hadi³, Sulieman Abu Jarir³, Faisal Ahmad Khan², Mohammed A Arbab⁴, Jemal M Hamid¹, Mohammed A Alyazidi¹, Muna A Al-Maslamani³, Sini Skariah⁵, Ali A Sultan⁵, Abdul Latif Al Khal³, Bo Söderquist⁶, Emad Bashir Ibrahim^{1

7}, Jana Jass², Hisham Ziglam³

Affiliations

¹ Microbiology Division, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar.
² The Life Science Centre - Biology, School of Science and Technology, Örebro University, Örebro, Sweden.
³ Department of Infectious Diseases, Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar.
⁴ College of Art and Science, Qatar University, Doha, Qatar.
⁵ Department of Microbiology and Immunology, Weill Cornell Medicine - Qatar, Doha, Qatar.
⁶ School of Medical Sciences, Faculty of Medicine and Health, Orebro University, Orebro, Sweden.
⁷ Biomedical Research Centre, Qatar University, Doha, Qatar.

Abstract

Objectives: Antimicrobial resistance (AMR) is a global priority with significant clinical and economic consequences. Multidrug-resistant (MDR) Pseudomonas aeruginosa is one of the major pathogens associated with significant morbidity and mortality. In healthcare settings, the evaluation of prevalence, microbiological characteristics, as well as mechanisms of resistance is of paramount importance to overcome associated challenges.

Methods: Consecutive clinical specimens of P. aeruginosa were collected prospectively from 5 acute-care and specialized hospitals between October 2014 and September 2017, including microbiological, clinical characteristics and outcomes. Identification and antimicrobial susceptibility test were performed using the BD Phoenix identification and susceptibility testing system, matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS), and minimum inhibitory concentration (MIC) test strips. Overall, 78 selected MDR P. aeruginosa isolates were processed for whole-genome sequencing (WGS).

Results: The overall prevalence of MDR P. aeruginosa isolates was 5.9% (525 of 8,892) and showed a decreasing trend; 95% of cases were hospital acquired and 44.8% were from respiratory samples. MDR P. aeruginosa demonstrated >86% resistance to cefepime, ciprofloxacin, meropenem, and piperacillin-tazobactam but 97.5% susceptibility to colistin. WGS revealed 29 different sequence types: 20.5% ST235, 10.3% ST357, 7.7% ST389, and 7.7% ST1284. ST233 was associated with bloodstream infections and increased 30-day mortality. All ST389 isolates were obtained from patients with cystic fibrosis. Encoded exotoxin genes were detected in 96.2% of isolates.

Conclusions: MDR P. aeruginosa isolated from clinical specimens from Qatar has significant resistance to most agents, with a decreasing trend that should be explored further. Genomic analysis revealed the dominance of 5 main clonal clusters associated with mortality and bloodstream infections. Microbiological and genomic monitoring of MDR P. aeruginosa has enhanced our understanding of AMR in Qatar.