Susceptibility of the multidrug-resistant nosocomial pathogens isolates in Jordan for the new antimicrobial agents

Background: To study resistance rates of the multidrug-resistant bacteria isolates for the new cephalosporines before their widespread use in Jordan. Methods: During September 2019 May 2020, MDR-bacteria isolates were prospectively collected from microbiology laboratories of three hospitals, to investigate their susceptibility to the extended-spectrum β-lactamases-producing Enterobacteriaceae (ESBL), K. pneumoniaecarbapenemases strains (KPC), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant P. aeruginosa (CRPa), carbapenemresistant A. baumannii (CRAb), and Methicillin-resistant Staphylococcus aureus (MRSA) were tested. Demographic details for patients were recorded. Antimicrobials evaluated were ceftazidime-avibactam, ceftolozane-tazobactam, and ceftobiprole medocaril. Results: Non-duplicate 263 MDR clinical isolates were collected from sterile sites; ESBL (128), P. aeruginosa (57), MRSA (37), KPC (22), A. baumannii (11), and CRE (n = 8). The age was dominated by the older age group (Age > 64, Pearson R = 0.985, R2 = 0.969, P = 0.000). Males were 143 and females 107 (P < 0.000). There were (194) isolate from the wards and (55) were from the ICUs. Sources of isolates were urine (96), blood (36), soft tissues (49), abdomen (24), URT (14), and osteo-skeletal (12). Clinical diagnoses were recorded as follow: urinary tract infection (UTI, 90), Bacteremia (36), Skin and soft tissue infections (SSTI, 45), intraabdominal infection (IAI, 23), pneumonia (17), Uper resSusceptibility of the multidrug-resistant nosocomial pathogens isolates in Jordan for the new antimicrobial agents Jamal Wadi Al Ramahi1,2,3,4,5,6, MaramAbu Said2, Rasmieh Abu Kwaik2, Walid Jamal3, Deema Al Jammal4, Nisreen Al Radaidah4, Amin A. Aqel7 1 School of Medicine, University of Jordan. Amman, Jordan 2 Department of laboratory, Jordan Hospital, Jordan Hospital, Amman. Jordan. 3 Department of laboratory, Al KhalidiMedical Center, Amman. Jordan. 4 Department of laboratory, theSpecialty (Al Takhassusi) Hospital, Amman. Jordan. 5 The Infection Prevention and Control department, The Specialty Hospital. Amman. Jordan. 6 The Infection Prevention and Control department. Al Khalidi Hospital. Amman. Jordan. 7 Department of Microbiology and Pathology, Faculty of Medicine, Mutah University, Al-Karak, Jordan. Contact information: Jamal Wadi Al Ramahi MD, FIDSA.  jamalwadimd@yahoo.com The InTernaTIonal arabIc Journal of anTImIcrobIal agenTs ISSN: 2174-9094 2021 Vol. 11 No. 1:1 doi: 10.3823/852 This article is available at: www.iajaa. org 2 Introduction Our region is plagued with multidrug-resistant bacteria (MDR), especially those carrying the acronym “ESKAPE pathogens” including Enterobacter spp. , Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterococci spp. , they comprise the largest burden of the hospitalrelated infections [1]. The treatment of the MDR bacteria entails the use of the advanced generations antimicrobials and complicated regimens, the need for new antimicrobials is advocated as the old ones are becoming ineffective with an unacceptable high rates of resistance [2-4]. In Jordan, few studies addressed the MDR bacteria, but mostly were for a single microorganism and their molecular patterns in the community individuals and Syrian refugees [5, 6]. However, other studies from the Jordan University Hospital addressed a 10-months incidence of the respiratoy MDR Acinetobacter baumannii isolates in hospital; ized patients in ICUs and found that their colonization was rarely associated with blood sepsis and mortality. Another study demonstrated from the same hospital showed high occurrence of MDR P. aeruginosa isolates carrying blaCTX-M genes, but no specific associations were found between antibiotic resistance, virulence genes and genotypes among the isolates [7, 8]. Also, other Studies from Jordan evaluating the resistance pattern of the nosocomial Acinetobater baummannii infections demonstrated high resistant rates (> 94%) for the third and fourth generations cephalosporines, pipracillin-tazobactam, carbapenems and quinolones, reliable antimicrobials pointed at minocycline and colistin. Additionaly, high MRSA rates (31.6%) among S. aureus isolates were reported [9, 10]. piratory tract infection (URTI, 13), osteomyelitis (11), and diabetic foot (6). The susceptibility of the ESBL-producing bacteria was 100% for meropenem, 99% for ceftazidime-avibactam, and 90% for ceftolozane-tazobactam. P. aeruginosa was, 73% for ceftazidime-avibactam, 62% susceptible to ceftolozane-tazobactam, 62% for meropenem, and 45% to ceftobiprole. CRE was 38% susceptible to ceftazidimeavibactam and KPC 15%, while ceftolozane-tazobactam susceptibility was zero, and 14% for CRE, and 0% for Ceftobiprole. A. baumannii was 13% susceptible to ceftazidime-avibactam, meropenem 9%, and 2% for ceftolozane-tazobactam, respectively. Conclusion: Ceftazidime-avibactam and ceftolozane-tazobactam may be useful alternatives for the treatment of ESBL-producers and P. aeruginosa, though the MDR-bacteria isolates demonstrated few percentage of resistance to the newly introduced agents before their wide spread use in the country.