Study the Epidemiology of Antibiotics Resistance in Ramadi Hospitals of Iraq

 

Laith Muslih Najeeb1, Safaa Abed Latef Al Meani2, Ali Hazim Abdulkareem3,

Zyad Hameed Fyadh4, Mohammed Mukhles Ahmed5

1Department of Biology, College of Science, University of Anbar, Anbar, Iraq.

2,3,5Department of Biotechnology, College of Science, University of Anbar, Anbar, Iraq.

4Iraqi Ministry of Health - Anbar Health Department

*Corresponding Author E-mail: moh.mukhles@uoanbar.edu.iq

 

ABSTRACT:

In many hospitals around the world, antibiotic resistance has reached a crisis. Mainly, Staphylococcus aureus (MRSA), which is immune to methicillin, is swamped and many with Gram-negative multidrug-resistant (MDR). The occurrence of carbapenmases for the first time was considered a major problem because of several factors, such as: many plasmids carrying gene resistance elements take on other resistance elements, including QnrA (QnrA and QnrB) and aminoglycoside (rmtB) Resistance elements. For severe MRSA infections, good treatment options are available, death rates continue to be high. The condition is more complicated and disturbing for MDR Gram-negatives. In developing countries, there are few new agents who can profit from the situation in the coming decade . Although the meanings are muddled, some patients in intensive care are thought to die because of the lack of antibiotics effective against Pseudomonas aeruginosa and A. baumanni. If molecular resistance is to be overcome, additional understanding is needed urgently. We additionally need to install early warning systems to keep pace with new resistances.

 

KEYWORDS: Antibiotics Resistance, Epidemiology, MRSA, β-lactamses, blaVIM.

 

 

INTRODUCTION:

Gram-negative bacilli have become increasingly resistant to antimicrobials world-wide in this last decade, along with a lack of functionality and a lack of new antimicrobial agents. Such resistance is associated with major clinical and economic effects, including longer hospitalization, higher hospital and antimicrobial costs and increased death rates1,2.

 

The value of monitoring increasingly antibiotic-resistant pathogens that can lead to serious sepsis is obvious if one thinks that antibiotic policies need to be informed in order to provide optimal treatment choices. In Europe we are lucky enough to have the European Union sponsored EARSS, but much of the world is less prepared than normal3,4. The United States has valuable data from programs administered by organizations such as (NIH) and (CDC). It, like Europe, benefits from pharmaceutical company-sponsored surveys5,6,7.

 

About 30% of patients also have antibiotic resistance in South America, the Middle East, and small parts of Asia, Figure (1) warns researchers of the public health implications of antibiotic resistance danger8,7. This study designed to Know the epidemiology of antibiotic-resistant bacteria in Ramadi hospitals.

Figure 1. Antibiotic target and bacterial resistance mechanisms.

 

METHODOLOGY:

In order to classify studies and papers on antibiotic resistance in bacteria, gram negative bacteria in Al-Ramadi hospitals, Iraq, a systematic literature review has been conducted with PubMed, Scopus and Google Scholar databases. In addition, selecting papers published in peer-reviewed journals between January 2010 and May 2021 was based upon the requirements for selection of literature.

 

Dissemination of antibiotics – resistant genes producing bacteria in Al-Ramadi Hospitals:

In 2018, 22.0% K. pneumoniae isolated from ramadi hospitals were resistance for carbapenem . Genotypic testing on six CRE isolates revealed that the blaOXA-48 and blaVIM genes were equally detected in these isolates, followed by blaKPC9,10. Moreover, Mohammed and Safaa reported blaFOX11 (42.3%), blaACC8 (30.7%), blaDHA 8 (30.7%), blaCIT 9(34.6%) and blaMOX 7 (26.92%)11. Many researchers reported spread A. baumannii resistant to different antibiotics in Irag hospitals . A. baumannii possess high capacity to acquire new resistance genes.12,13

 

For the first time, this work identifies NDM-1 producing Escherichia coli isolates from Baghdad governance14. The increasing prevalence rate of bla IMP in carbapenem –resistant A. bauamani and Pseudomonas aeroginosa isolates from wounds/Iraq14,15

 

In this study, disseminating new genes in the province of Anbar as a result of terrorist foreign organizations of different nationalities which destroyed our town in 2014, as carbapenemases were not registered previously. Moving people to local and global cities, medical tourism and cross-border transfer of patients who are particularly involved in the development and distribution of different variants of carbapenemase encoding genes can play an important role in the development16,17. Figure 2 .

 

Awaad and laith, 2020 reported OXA-51, and OXA-23 in A. bauammanii in Ramadi hospitals18,19. Another study by Yoser and Ali, 2021 reported blaFOX gene was detected in 13 isolate (56.5%), blaACC gene was detected in 12 isolate (52.1%), bla DAH gen was detected in 12 isolate (52.1%),8 isolate (34.7% ) had bla CIT gene, bla EBC Where was identified in 6 isolate (26.08), while the lowest percentage for bla MOX gene was identified in 5 isolate (21.7%)20,21. In 2021, Shiamaa and Mayada reported bla CTX-M2 and bla OXA1 genes 22,23

 

 

Figure 2: Distribution of resistance genes among bacteria in Al-Ramadi hospitals from 2010 to 2021

Unfortunately, nearly all antibiotics produced have eventually been resisted (Figure 3). Vancomycin was introduced to clinical practice in 1972 in both S. aureus and coagulase-negative staphylococci for the treatment of methicillin resistance. Vancomycin resistance was so hard to cause that it was thought that in a therapeutic environment it was impossible. In the 1979 and 1983 coagulase-negative staphylococci, however, cases of vancomycin resistance were identified24,25. From late 1960s to the early 1980s, many new antibiotics were developed by the pharmaceutical industry to resolve the issue of resistance, but then the antibiotic pipeline was destroyed and fewer new drugs were introduced. As a consequence bacterial infections again became a concern in 2015, several decades after antibiotics were treated to the first patients26,27.

 

Figure 3: Developing Antibiotic Resistance24

 

Over time, bacteria can collect multiple resistor traits and become immune to multiple antibiotic groups. Resistance to chromosome mutations, inefficient transport into the bacterium of aminoglycosides, as well as alteration to enzymes have been found for example in Staphylococci28,19. A single antibiotic could not selectively select for resistance to a single drug. Resistance to other substances with a structural connection is possible in the same class. For example, resistance to tetracycline can result in oxytetracycline, chlortetracycline, doxycycline and minocycline resistance. Resistance genes that protect their antimicrobial products contain antimicrobial products and these genes have developed antibiotic resistance long before the antibiotic had been used for treatment. The different mechanisms of the common drug resistance are shown in Table 1.29,30,31

 

Table: 1Antibiotics resistance Action of common antibiotics

Antibiotic class

Example(s)

Mode (s) of resestance

Β-Lactams

Penicillins, Cephalosporins Penems, Monobactams

Hydrolysis, effux, altered target

Aminoglycosides

Gentamicin, Streptomycin, Spectinomycin

Phosphorylation, acetylation, nucleotidylation, effux, altered target

Glycopeptides

Vancomycin, Teicoplanin

Reprogramming peptidoglycan biosynthesis

Tetracyclines

Minocycline, Tigecycline

Monooxygenation, effux altered target

Macrolides

Erythromycin. Azithromycin

Hydrolysis, glycosylation, phosphotylation, effux, altered tatget

Lincosamides

Clindamycin

Nucleotidylation, effux, altered target

Streptogramins

Synercid

Carbon-Oxygen lyase, acetylation, effux, altered target

Oxazolidinones

Linezolid

Effux, altered target

Phenicols

Chloramphenicol

Acetylation, effuc, altered target

Quinolones

Ciprofloxacin

Acetylation, effux, altered target

Sulfonamides

Sulfamethoxazole

Effux, altered target

Rifamycins

Rifampin

ADP-ribosylation, effux, altered target

Lipopeptides

Daptomycin

Altered target

Cationic peptides

Colistin

Altered target, effux

 

CONCLUSION:

The dynamic nature of this severe situation is covered by this short resistance survey around the world. The pace of MDROs seems to be really rising, without a doubt fuelled by extensive use of antibiotics of wide spectrum, weak infection control, very immune-stop patients, and fast and regular air travel. What the MDR Gram negative is meant by the literature is not at all obvious. It means most typically resistance to at least three of the five major classes of agents usually employed in care, i.e. penicillins of wide-spectrum, cephalosporins of broad spectrum, carbapenems, aminoglycosides and fluoroquinolones. In these contexts too, the terms PDRand Extreme(or Large) Drug Resistant (XDR) have been used, but the exact meaning of both of these terms over and above MDR is confusing. The author considers that PDR implies resistance to all approved agents, which would include the five groups of tigecycline and Polymyxin, in Gram-negative bacteria, while XDR implies somewhat from MDR to PDR..

 

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Received on 31.12.2021            Modified on 29.01.2022

Accepted on 05.03.2022           © RJPT All right reserved

Research J. Pharm. and Tech 2022; 15(9):4204-4207.

DOI: 10.52711/0974-360X.2022.00706