Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Dr. Saumya Navit

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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
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Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : DC14 - DC18 Full Version

Molecular Analysis of Oxacillinase Genes and Identification of Drug Resistance Pattern in MDR Strains of Acinetobacter baumannii Isolated from Burn Wound Samples in Kermanshah, Iran


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/53232.16337
Zainab Mohseni Afshar, Somayeh Asadi, Ronak Miladi, Camellia Danesh, Shohreh Farshid, Ebadullah Asadi, Faizullah Mansouri, Kamal Ahmadi

1. Assistant Professor, Department of Infectious Disease, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2. Department of Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran. 3. Assistant Professor, Department of Chemistry, Amirkabir University of Technology, Kermanshah, Iran. 4. Professor, Department of Infectious Disease, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran. 5. Research Assistant, Department of Microbiology, School of Medicine, Kermanshah University of Medical, Kermanshah, Iran. 6. Department of Chemistry, Amirkabir University of Technology, Tehran, Iran, Tehran, Kermanshah, Iran. 7. Department of Infectious Disease, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran. 8. Research Assistant, Department of Microbiology, School of Medicine, Kermanshah University of Medical, Kermanshah, Iran.

Correspondence Address :
Kamal Ahmadi,
Research Assistant, Department of Microbiology, Kermanshah University of Medical Sciences and Ph.D. Student of Medical Bacteriology, Pasteur Institute of Iran, Kermanshah, Iran.
E-mail: k_ahmadi@pasteur.ac.ir; kamal.ahmadi55@yahoo.com

Abstract

Introduction: Carbapenem Resistant Acinetobacter Baumannii (CRAB) is a dangerous nosocomial pathogen that can cause high mortality in patients. This bacterium has a remarkable ability to acquire various resistance mechanisms due to this it is considered as one of the health priorities.

Aim: To investigate the prevalence of the OXA-23, OXA-24, and OXA-58 genes in Acinetobacter baumannii isolates collected from burn wound samples in Kermanshah, Iran.

Materials and Methods: A cross-sectional study was done during 11 months period from December 2018 to October 2019, 74 A. baumannii isolates were collected from those admitted to the Burns Unit of Imam Khomeini Hospital in Kermanshah, Iran. The 74 A. baumannii isolates were detected using particular bacteriological methods. Following determination of the antibiotic sensitivity of the specimens using the disk diffusion technique, polymerase chain reaction was performed to determine the frequency of the OXA-23, OXA-24, and OXA-58 genes using their specific primers. Data were analysed using Fisher’s-exact test and Chi-squared test in Statistical Package for the Social Sciences (SPSS) version 20.0. A p-value <0.05 was considered statistically significant.

Results: All the 74 A. baumannii isolates were Multidrug-Resistant (MDR) (41 from males and 33 from females). The highest drug resistance was against cefotaxime (100%) and piperacillin (98.6%), while all the isolates were sensitive to polymyxin B and colistin. Oxacillinase genes with the highest and lowest frequencies were OXA-23 (64.7%) and OXA-58 (3.5%), respectively. The highest frequency of isolates with two genes were related to OXA-23 and OXA-24. A significant relationship was observed among the existence of oxacillinase genes and resistance to some antibiotics.

Conclusion: The results of this study indicated the significance of OXA carbapenemase genes in burn patients. Due to the high drug resistance of A. baumannii isolates collected from wound samples, the identification of carbapenemase-producing A. baumannii isolates is paramount in developing prevention and control programs for these drug-resistant isolates.

Keywords

Antibiotic sensitivity, Carbapenemase genes, Multidrug resistance

Acinetobacter is a gram negative, aerobic, forced aerobic coccobacillus capable of growing in a variety of environments (1). A. baumannii, as the most common species of this bacterium, can cause urinary tract infections, pneumonia, sepsis, skin and wound infections, meningitis, endocarditis, and peritonitis (2). Infections caused by this bacterium pose a serious challenge to the treatment process followed in burn patients due to the increased resistance to various antimicrobial agents (3),(4). In recent years, A. baumannii has been reported to be a major cause of nosocomial infections in burn patients. Burn cases are sensitive to infections because of damage to the skin and, subsequently, immune system disorders (5),(6). A.baumannii has been introduced as the second MDR bacterium causing nosocomial infections in burn patients (7).

Long-term hospitalisation, Intensive Care Unit (ICU) admission, surgery, burns, serious illness, immunosuppression, exposure to antimicrobial agents, use of central venous catheter, and other factors can lead to colonization or infection caused by this bacterium (8). Acinetobacter baumannii has a high resistance to a variety of antibiotics; this resistance is either inherent or acquired through resistance genetic factors, including resistance genes present on mobile genetic elements such as transposons and integrons (9). Carbapenems are among the beta-lactam antibiotics with extensive activity in the treatment of bacterial infections, especially severe and life-threatening infections (10). In recent years, the presence of Carbapenem-Resistant Acinetobacter Baumannii (CRAB) isolates, including imipenem, has increased significantly, and most of these isolates are Multidrug-Resistant (MDR). The frequency of CRAB isolates is a serious problem in burn patients (11),(12). Lack of proper management in the antibiotic treatment of infections caused by these isolates can cause strains with Extensively Drug Resistant (XDR) and Pandrug Resistant (PDR). The ability of these drug-resistant isolates to hydrolyse carbapenems through carbapenemase enzymes is one of the most common and significant underlying mechanisms of their resistance to carbapenems, with Ambler class D enzymes called oxacillinases (OXA-type) being the most common among all A. baumannii isolates (5),(7),(13).

OXA-type carbapenemases can be divided into eight subgroups or branches: OXA-23, OXA-24, OXA-40, OXA-58, OXA-143, OXA-235, and OXA-51, which are the most commonly identified subclasses of OXA in A. baumannii isolates (14),(15). Only OXA-51 is naturally present in A. baumannii, and other OXA genes are acquired by the bacterium (16). Thus, the identification of A. baumannii isolates producing carbapenemase genes is paramount in developing prevention and control programs for these drug-resistant isolates. Considering the importance of determining carbapenem-resistant A. baumannii isolates and the fact that in recent years no study has been performed in this field in Kermanshah, Iran to determine the frequency of OXA genes of this bacterium, the present study aimed at determining the frequency of the OXA-58, OXA-24, and OXA-23 genes and antibiotic-resistance pattern in MDR A. baumannii isolates separated from clinical samples of Imam Khomeini Hospital.

Material and Methods

This cross-sectional descriptive study was conducted in a period of 11 months (December 2018 to October 2019), all burn wound samples (374 burn wound samples) were collected from patients admitted to the burn ward of Imam Khomeini Hospital in Kermanshah, Iran. Then, after microbiological studies and culture of the samples, 74 isolates of A. baumannii were isolated. Informed consent was obtained from patients in this study. The Ethics Committee of Kermanshah University of Medical Sciences, Kermanshah, Iran (approval code no.: 1395.621) confirmed this study.

Inclusion criteria: All MDR isolates of A.baumannii separated from patients who had not consumed any antibiotic a week before being hospitalised based on their report and file in given time period were included in the study.

Exclusion criteria: Other bacterial isolates separated from patient's burn samples and other strains Acinetobacter separated from the samples were excluded from the study (17).

Procedure

All the samples in this study were the specimens of the burn wound. After collection, these samples were cultured on MacConkey agar and blood agar media (Indian media) and incubated for 1-2 days at 37°C under laboratory conditions. Then, to identify A. baumannii isolates, biochemical tests, including the growth of slant/alkaline butt pattern on Triple Sugar Iron (TSI) medium (Merck, Germany), oxidase and catalase negative test, immobility on Sulfide Indole Motility (SIM) medium (Merck, Germany), and no pigment production, were performed. Polymerase Chain Reaction (PCR) of the OXA-51 gene was used for the final confirmation of possible isolates of A. baumannii using its specific primer. A total of 74 A. baumannii isolates were identified. According to the Clinical and Laboratory Standards Institute (CLSI) instructions, antibiotic-sensitivity evaluation was performed by the disk diffusion method (Kirby-Bauer), by bacterial suspension equivalent to half McFarland turbidity (1.5×108 CFU/mL) and Müller-Hinton agar culture medium (media India) for antibiotic discs (MAST.UK), including amikacin (30 μg), gentamycin (10 μg), ceftazidime (30 μg), tobramycin (10 μg), ciprofloxacin (5 μg), meropenem (10 μg), levofloxacin (10 μg), imipenem (10 μg), cefepime (5 μg), polymyxin B (300 units), piperacillin (100 μg), colistin (25 μg), ampicillin-sulbactam (10 μg), and cefotaxime (30 μg). The suspension of isolated bacteria was first cultured on Müller-Hinton agar medium after comparison with the McFarland 0.5 standard. After placing the antibiotic disks and incubating at 37°C for one day, the diameter of their growth inhibition zone was evaluated and compared to that mentioned in the CLSI tables (18).

For quality control, standard strains of A. baumannii ATCC 19606 and Escherichia coli ATCC 25922 were used. Acinetobacter isolates with resistance to three or more groups of antibiotics were determined to be MDR strains. The PCR was performed to identify the presence of the OXA-58, OXA-24, and OXA-23 genes using specific primers (Takapou Zist Co., Iran) and according to (Table/Fig 1) (19). After that, the standard strains A. baumannii NCTC 13304, NCTC 13302 and NCTC 13305 were utilised as positive controls to detect the OXA-23, OXA-24 and OXA-58 genes, respectively. The boiling method was used to extract chromosomal Deoxyribonucleic Acid (DNA) of the isolates. In doing so, after culturing A. baumannii, we dissolved several pure bacterial colonies in 0.5 mL of sterile distilled water, and after 5 min of boiling and cooling in the next step, they were centrifuged at 7000 gm for 1 min. Afterward, we transferred the solution to new Eppendorf tubes as bacterial DNA to perform PCR. Then, using NanoDrop Synergy HTX (Bio Tek Instrument, Inc. Highland Park, USA), concentrations of DNA were measured at the Optical Density (OD) of 260 nm to be 33 pmol/μL, and DNA purity at the OD of 260/280 nm was calculated to be 1.85. PCR was performed with a final volume of 25 μL, including 12.5 μL of master mix, 1 μL of each primer, 3 μL of bacterial DNA, and sterile distilled water up to a volume of 25 μL. PCR reaction was performed separately for each of the oxacillinase genes. The PCR reaction temperature included primary denaturation at 94°C for 5 minutes, and followed by 35 main cycles, according to (Table/Fig 1) and the eventual extension at 72°C for 6 minutes (19). Finally, using 1.5% agarose gel and ethidium bromide staining under UV radiation in a gel doc device with a voltage of 80 V for 50 minutes, the PCR products were evaluated.

Statistical Analysis

Data were analysed using Chi-square test in Statistical Package for the Social Sciences (SPSS) version 20.0. A p-value ≤0.05 was considered statistically significant.

Results

In this study, 74 isolates of A. baumannii were investigated {41 (55.4%) from males and 33 (44.6%) from females} in the age group of 8-71 years, with a mean age of 44.22±14.55 years. All isolates of this bacterium were collected from burn wound samples. According to (Table/Fig 2), the highest drug resistance of A. baumannii isolates was against cefotaxime (100%) and piperacillin (98.6%), and all samples were susceptible to polymyxin B and colistin (0). All the 74 A. baumannii isolates (100%) were found to be MDR. In addition, total 85 OXA genes were found from 74 isolates of A. baumannii. The highest and lowest frequencies of OXA genes were related to OXA-23 55 (64.7%) and OXA-58 3(3.5%), respectively.

The frequency of the OXA-24 gene was 21.2% (18 isolates). The total number of isolates with two genes simultaneously was (9, 10.6%), among which the highest frequency was related to isolates with two genes OXA-23 and OXA-24 with a frequency of eight cases. None of the isolates had all the three genes present simultaneously (Table/Fig 3). The presence of OXA genes and resistance to some antibiotics, including the presence of the OXA-23 gene and resistance to carbapenems, amikacin, and ampicillin/sulbactam, as well as the presence of the OXA-58 gene and resistance to levofloxacin and amikacin, showed a significant relationship (Table/Fig 4). The PCR results for OXA genes are shown in (Table/Fig 5).

Discussion

A.baumannii is a major hospital pathogens, found especially in burn patients, which causes a high mortality in these patients (16). The reason for this is the ability of this microorganism to survive in hospital environments and to acquire a mechanism of resistance against antimicrobial agents (20). The prevalence of MDR A. baumannii isolates has been regarded as a serious concern worldwide (9). In the present study, all 74 (100%) A. baumannii isolates were found to be MDR. In studies conducted in Iran, the prevalence of MDR in burn patients was reported to be between 97.9% and 100%, which was consistent with the current study findings (21),(22),(23),(24),(25),(26). Similar results related to these MDR A. baumannii isolates have been reported in other studies abroad. In 2020, a study was performed on burn samples by Mabrouk A et al., where in all 21 A. baumannii isolates were identified to be MDR, which was consistent with present study (27). However, in few other studies, the prevalence of MDR was found to be lower than the present study (28),(29),(30).

Among all MDR isolates examined in the current study, cefotaxime (100%) presented the maximum antibiotic resistance, followed by piperacillin (98.6%), while all samples were susceptible sensitive to colistin and polymyxin B. Other national and international research reported enhanced resistance in MDR samples to various antibiotics such as cefotaxime, piperacillin, imipenem, and meropenem (28),(29),(31). In the study by Sarhaddi N et al., all MDR isolates were found to be sensitive to colistin and polymyxin B (32). According to these results, it can be concluded that these antibiotics are still effective in the treatment of infections caused by this bacterium, so their use should be controlled.

Recently, the prevalence of carbapenem-resistant isolates, including imipenem, has increased significantly, and most of these isolates are MDR. A frequent and principal cause of resistance to carbapenem antibiotics is their ability to hydrolyse carbapenems through carbapenemase enzymes, with Ambler class D enzymes called oxacillin (OXA-type) being the most common among A. baumannii isolates (13).

The most common A. baumannii carbapenemase genes involved in carbapenem resistance are OXA-23, OXA-24, and OXA-58. The frequencies of the OXA-23, OXA-24, and OXA-58 genes among the 74 isolates of A. baumannii collected from burn samples were determined to be 64.7%, 21.2%, and 3.5%, respectively. In two studies, conducted in Iran, including the present study, the prevalence of OXA-23 was higher than OXA-24 and OXA-58 (6),(11),(21).

Tafreshi N et al., reported the prevalence of these three genes at 53.57%, 41.66%, and 30.95% in A. baumannii isolates collected from burn samples, respectively (22). Mohajeri P et al., reported the frequencies of 77.9%, 19.2%, and 0% for OXA-23, OXA-24, and OXA-58, respectively, indicating that the prevalence of OXA-23 was much higher than the other genes, which was consistent with the present study findings (33). The results of the current study were compared with other previous studies in Iran and other countries (Table/Fig 6) (11),(22),(23),(24),(28),(29),(31),(32),(34),(35),(36),(37). In the present study, the number of isolates carrying the two genes OXA-23 and OXA-24, which had the highest frequencies, was equal to 8 (9.4%) out of 85, and the combination of these two genes always showed resistance or reduced sensitivity to antibiotics (30).

Among the reasons for the differences in the reports on the frequency of these genes include the diversity in the pattern of antibiotic use and appropriate control strategies in different wards of hospitals. The OXA-58 gene produces a broad-spectrum class D beta-lactamase that can hydrolyse penicillin, oxacillin, and imipenem. The results of this study showed a significant relationship between the presence of the OXA-58 gene and resistance to levofloxacin and amikacin. Of the 55 strains resistant to imipenem and meropenem, all carried the OXA-23 gene. The OXA-23 gene produces a carbapenem-hydrolysing beta-lactamase that promotes resistance to imipenem and meropenem (14). Therefore, the reason for carbapenem resistance can be the high prevalence of these carbapenem genes. There is a significant link between the presence of the OXA-23 gene and resistance to carbapenems, amikacin, and ampicillin/sulbactam.

Limitation(s)

The limitations of this study was the sample small size examined and and lack of access to patient files.

Conclusion

In this study, A. baumannii showed resistance to most of the available antibiotics and it also appears that colistin and polymyxin B are currently the only antibiotics effective in treating infections caused by this bacterium. Therefore, it is necessary to pay more attention to controlling the use of these antibiotics in nosocomial infections. The results of this study show the importance of OXA-type carbapenemases in treating burn patients. Therefore, the identification of A. baumannii isolates producing carbapenemase genes is paramount in the development of prevention and control programs for these drug-resistant isolates.

Acknowledgement

Authors appreciate the support extended by the Deputy of Research and Technology and the Clinical Research Development Unit of Imam Reza Hospital affiliated to Kermanshah University of Medical Sciences, Kermanshah, Iran (No. 96082).

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DOI and Others

DOI: 10.7860/JCDR/2022/53232.16337

Date of Submission: Nov 09, 2021
Date of Peer Review: Dec 30, 2021
Date of Acceptance: Feb 04, 2022
Date of Publishing: May 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
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