Resistance and heteroresistance to colistin among multidrug-resistant and extensively drug-resistant Gram-negative organisms isolated from patients admitted to Zagazig University Hospitals
Introduction: Nowadays, treating serious infections caused by multi-drug resistant Gram-negative bacteria is best left to the antiquated medication "colistin.". There have been reports of colistin-resistant (Col-R) and heteroresistant (hR) MDR and XDR-GNB strains worldwide. Therefore, we...
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The Journal of Infection in Developing Countries
2025-03-01
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| Series: | Journal of Infection in Developing Countries |
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| Online Access: | https://jidc.org/index.php/journal/article/view/20385 |
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| author | Salah Al-Sayed Ibrahim Ali Aya Ahmed Ghamry Seham K Khirala Asmaa M El-Nasser Fatma M Attia Al-Sayed Fatma Atef Ibrahim |
| author_facet | Salah Al-Sayed Ibrahim Ali Aya Ahmed Ghamry Seham K Khirala Asmaa M El-Nasser Fatma M Attia Al-Sayed Fatma Atef Ibrahim |
| author_sort | Salah Al-Sayed Ibrahim Ali |
| collection | DOAJ |
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Introduction: Nowadays, treating serious infections caused by multi-drug resistant Gram-negative bacteria is best left to the antiquated medication "colistin.". There have been reports of colistin-resistant (Col-R) and heteroresistant (hR) MDR and XDR-GNB strains worldwide. Therefore, we aimed to ascertain the rate of colistin resistance, certain potential resistance mechanisms, and heteroresistance in colistin-susceptible (Col-S) clinical isolates.
Methodology: Identification and Antibiotic susceptibility test (AST) for all isolates were determined by Vitek-2 automated system. The Col-S strains were evaluated for heteroresistance using the population analysis profiling (PAP) method, while the Col-R strains were tested for mcr-1 gene activity by combined disk test (CDT) and colistin minimum inhibitory concentration reduction (CMR) test. The efflux pump mechanism was identified using cyanide 3-chlorophenylhydrazone (CCCP).
Results: Out of 60 isolates enrolled in the study, AST revealed that 60% were MDR-GNB and 40% were XDR-GNB. Ten isolates were colistin resistant (16.6%). The mcr-1 gene was detected in five (5/10) Col-R isolates by PCR. CDT test detected mcr-1 gene activity in four (4/5) of mcr-1 gene positive isolates, while CMR test detected all. Efflux pump inhibition by CCCP showed a reduction of MICs by ≥ 8-folds in four Coli-R isolates. The frequency of carbapenem resistance (CR) within Col-hR strains was 75%, while ESBL was 25%.
Conclusions: The alarmingly high occurrence of colistin resistance and heteroresistance in hospital care settings is of major concern and necessitates a reassessment of recommended AST methods since it can result in colistin therapy failure.
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| format | Article |
| id | doaj-art-67aae92f2b194ad2b6f042e4eee864b4 |
| institution | OA Journals |
| issn | 1972-2680 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | The Journal of Infection in Developing Countries |
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| series | Journal of Infection in Developing Countries |
| spelling | doaj-art-67aae92f2b194ad2b6f042e4eee864b42025-08-20T02:27:14ZengThe Journal of Infection in Developing CountriesJournal of Infection in Developing Countries1972-26802025-03-01190310.3855/jidc.20385Resistance and heteroresistance to colistin among multidrug-resistant and extensively drug-resistant Gram-negative organisms isolated from patients admitted to Zagazig University HospitalsSalah Al-Sayed Ibrahim Ali0Aya Ahmed Ghamry1Seham K Khirala2Asmaa M El-Nasser3Fatma M Attia Al-Sayed4Fatma Atef Ibrahim5Clinical Pathology Department, Faculty of Medicine, Zagazig University, Cairo, EgyptMedical Microbiology and Immunology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, EgyptMedical Microbiology and Immunology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, EgyptMedical Microbiology and Immunology Department, Faculty of Medicine (for Girls), Al-Azhar University, Cairo, EgyptInternal Medicine Department. Faculty of Medicine, Zagazig University, Cairo, EgyptClinical Pathology Department, Faculty of Medicine, Zagazig University, Cairo, Egypt Introduction: Nowadays, treating serious infections caused by multi-drug resistant Gram-negative bacteria is best left to the antiquated medication "colistin.". There have been reports of colistin-resistant (Col-R) and heteroresistant (hR) MDR and XDR-GNB strains worldwide. Therefore, we aimed to ascertain the rate of colistin resistance, certain potential resistance mechanisms, and heteroresistance in colistin-susceptible (Col-S) clinical isolates. Methodology: Identification and Antibiotic susceptibility test (AST) for all isolates were determined by Vitek-2 automated system. The Col-S strains were evaluated for heteroresistance using the population analysis profiling (PAP) method, while the Col-R strains were tested for mcr-1 gene activity by combined disk test (CDT) and colistin minimum inhibitory concentration reduction (CMR) test. The efflux pump mechanism was identified using cyanide 3-chlorophenylhydrazone (CCCP). Results: Out of 60 isolates enrolled in the study, AST revealed that 60% were MDR-GNB and 40% were XDR-GNB. Ten isolates were colistin resistant (16.6%). The mcr-1 gene was detected in five (5/10) Col-R isolates by PCR. CDT test detected mcr-1 gene activity in four (4/5) of mcr-1 gene positive isolates, while CMR test detected all. Efflux pump inhibition by CCCP showed a reduction of MICs by ≥ 8-folds in four Coli-R isolates. The frequency of carbapenem resistance (CR) within Col-hR strains was 75%, while ESBL was 25%. Conclusions: The alarmingly high occurrence of colistin resistance and heteroresistance in hospital care settings is of major concern and necessitates a reassessment of recommended AST methods since it can result in colistin therapy failure. https://jidc.org/index.php/journal/article/view/20385ColistinCREMDRXDRGNB |
| spellingShingle | Salah Al-Sayed Ibrahim Ali Aya Ahmed Ghamry Seham K Khirala Asmaa M El-Nasser Fatma M Attia Al-Sayed Fatma Atef Ibrahim Resistance and heteroresistance to colistin among multidrug-resistant and extensively drug-resistant Gram-negative organisms isolated from patients admitted to Zagazig University Hospitals Journal of Infection in Developing Countries Colistin CRE MDR XDR GNB |
| title | Resistance and heteroresistance to colistin among multidrug-resistant and extensively drug-resistant Gram-negative organisms isolated from patients admitted to Zagazig University Hospitals |
| title_full | Resistance and heteroresistance to colistin among multidrug-resistant and extensively drug-resistant Gram-negative organisms isolated from patients admitted to Zagazig University Hospitals |
| title_fullStr | Resistance and heteroresistance to colistin among multidrug-resistant and extensively drug-resistant Gram-negative organisms isolated from patients admitted to Zagazig University Hospitals |
| title_full_unstemmed | Resistance and heteroresistance to colistin among multidrug-resistant and extensively drug-resistant Gram-negative organisms isolated from patients admitted to Zagazig University Hospitals |
| title_short | Resistance and heteroresistance to colistin among multidrug-resistant and extensively drug-resistant Gram-negative organisms isolated from patients admitted to Zagazig University Hospitals |
| title_sort | resistance and heteroresistance to colistin among multidrug resistant and extensively drug resistant gram negative organisms isolated from patients admitted to zagazig university hospitals |
| topic | Colistin CRE MDR XDR GNB |
| url | https://jidc.org/index.php/journal/article/view/20385 |
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