Infection/Inflammation

Antimicrobial Susceptibility Profile
of Pseudomonas aeruginosa Isolates in Egypt
Gamal F. Gad, Ramadan A. El-Domany and Hossam M. Ashour*
From the Departments of Microbiology and Immunology, Faculties of Pharmacy, Minia University (GFG), Minia, Helwan University
(RAED), Helwan and Cairo University (HMA), Cairo, Egypt

Purpose: Pseudomonas aeruginosa is a leading cause of nosocomial respiratory tract, urinary tract and skin infections. Data
are sparse on the antimicrobial resistance of P. aeruginosa in Egypt. We sought to detect and compare the antimicrobial
susceptibility of P. aeruginosa isolates from respiratory tract, urinary tract and skin infections at 3 Egyptian hospitals.
Materials and Methods: Minimum inhibitory concentrations of antibiotics were determined by the agar dilution method.
Results: P. aeruginosa respiratory tract infections isolates were 100% resistant to ampicillin, ampicillin/sulbactam, amoxicillin, amoxicillin/clavulanate and chloramphenicol, highly resistant to cefuroxime (89%), tetracycline (89%) and azithromycin (84%), and susceptible to norfloxacin (89%), amikacin (84%) and meropenem (68%). P. aeruginosa urinary tract infection
isolates were 100% resistant to ampicillin, amoxicillin, chloramphenicol, cefuroxime and tetracycline, highly resistant
to amoxicillin/clavulanate (95%), azithromycin (95%), cefalexin (91%) and ampicillin/sulbactam (82%), and susceptible to
amikacin (82%), meropenem (73%) and norfloxacin (64%). P. aeruginosa skin infection isolates were 100% resistant to
ampicillin and amoxicillin, highly resistant to tetracycline (95%), amoxicillin/clavulanate (95%), cefalexin (87%) and azithromycin (84%), and susceptible to amikacin (87%), norfloxacin (71%) and meropenem (68%). The anti-pseudomonal effect of
antibiotics varied among different infection sites only for ampicillin/sulbactam, cefoperazone or chloramphenicol but not with
the other tested antibiotics.
Conclusions: Norfloxacin and amikacin could be used for initial therapy for P. aeruginosa mediated respiratory tract
infections. Amikacin, meropenem and norfloxacin could be used for P. aeruginosa mediated urinary tract and skin infections.
Such studies are essential to determine the current guidelines for empirical therapy regimens, which vary by location, and
help with the establishment of effective infection control measures.
Key Words: urinary tract infections; drug resistance, microbial; Pseudomonas aeruginosa; cross infection; infection control

antibiotics. Data on antimicrobial resistance in Egypt are
sparse, especially for P. aeruginosa strains. Thus, we sought
to detect the antimicrobial susceptibility of clinical P.
aeruginosa isolates from RTIs, UTIs and SIs at hospitals in
Egypt. Moreover, the antimicrobial susceptibility of P.
aeruginosa isolates from different infection sites to antibiotics was compared to determine whether the anti-pseudomonal effect of antibiotics varies among different infection
sites.

seudomonas aeruginosa is one of the main causes of
nosocomial infections. As an opportunistic human
pathogen, P. aeruginosa is a frequent cause of RTIs,
UTIs and SIs, especially in patients in intensive care units.1
Physicians must use empirical antibiotic treatment initially
for Pseudomonas infections. However, such treatment can
be targeted if clinicians establish the nature of a particular
Pseudomonas infection and know the susceptibility patterns
of Pseudomonas at the hospitals where they work. Susceptibility testing should be done when patients are seriously
ill, do not respond to therapy or require prolonged therapy.
It is also important when there are sparse data available on
a particular microorganism, or when the organism is frequently resistant, as in the case of P. aeruginosa.2 Thus, it is
essential to perform periodic surveys of the susceptibility
patterns of clinical isolates of P. aeruginosa to develop rational antimicrobial therapy recommendations.
The control of these nosocomial P. aeruginosa infections
necessitates the detection of susceptibility pattern of clinical
isolates from different infection sites to different classes of

P

MATERIALS AND METHODS
Sample Collection
A total of 100 urine samples from patients with UTI, 170
from patients with SI (wound, abscess and burn exudates)
and 130 from patients with RTI (sputum and purulent ear
discharge) were collected at Minia University Hospital,
Minia General Hospital and Minia Chest Hospital in Egypt.
All samples were examined for P. aeruginosa by standard
procedures and by polymerase chain reaction, as described
previously.3,4 Thus, nonduplicated isolates (1 isolate per
patient) positive for P. aeruginosa were included in susceptibility and MIC testing, including 22 positive isolates from
UTI, 19 from RTI and 38 from SI. Nosocomial infection by P.
aeruginosa was defined as infection with the typical signs
and symptoms of P. aeruginosa infection, provided that P.

Submitted for publication December 5, 2007.
Study received ethical approval from the hospital management
boards, and the Egyptian Ministry of Health and Population.
* Correspondence: Department of Microbiology and Immunology,
Faculty of Pharmacy, Cairo University, Cairo, Egypt (telephone:
⫹20106522867; e-mail: hossamking@mailcity.com).

0022-5347/08/1801-0176/0
THE JOURNAL OF UROLOGY®
Copyright © 2008 by AMERICAN UROLOGICAL ASSOCIATION

176

Vol. 180, 176-181, July 2008
Printed in U.S.A.
DOI:10.1016/j.juro.2008.03.081

cephalexin. amoxicillin/clavulanic acid. Spots with the lowest concentrations of antibiotic that showed no growth were defined as the MIC. Determination of MIC The MIC for each antibiotic was determined on MuellerHinton agar by the agar dilution method according to 1997 NCCLS guidelines. and the Egyptian Ministry of Health and Population.024 Ampicillin Ampicillin/sulbactam Amoxicillin Amoxicillin/clavulanate Cefalexin Cefuroxime Cefoperazone Cefotaxime Ceftriaxone Cefepime Meropenem Chloramphenicol Tetracycline Gentamicin Amikacin Ciprofloxacin Levofloxacin Norfloxacin Ofloxacin Azithromycin 8 8 8 8 16 16 16 8 8 8 4 8 4 4 16 1 2 4 2 4 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 8 1 4 9 0 0 0 0 0 0 0 0 0 0 0 3 0 0 1 2 7 12 10 7 2 0 0 0 0 0 0 0 0 0 4 2 0 0 2 6 3 5 3 2 1 0 0 0 0 0 0 2 1 3 6 3 0 2 6 5 1 0 0 1 1 0 0 0 0 2 1 6 7 5 4 2 0 2 6 3 0 0 2 0 2 0 0 0 0 2 2 8 4 4 3 0 0 3 2 1 0 0 0 0 3 0 3 0 3 0 0 1 3 2 1 1 2 5 2 2 0 1 0 0 5 0 6 0 1 6 2 2 2 3 1 0 0 6 0 0 0 0 0 0 2 2 8 3 8 0 3 0 2 2 0 0 2 0 0 0 0 0 0 0 3 7 1 2 6 1 2 0 0 0 0 0 5 1 0 0 0 0 0 0 0 8 1 8 1 8 8 0 0 0 0 0 8 0 0 0 0 0 0 0 0 2 0 6 0 0 1 0 0 0 0 0 2 0 0 0 0 0 0 0 0 * According to 1997 NCCLS guidelines.6 Ethical approval to perform the study was obtained from the management boards of the hospitals. Plates were incubated at 37C for 20 to 24 hours and the MIC was calculated. levofloxacin. aeruginosa RTI isolates.024 mg/l) of the respective antibiotics. .5 A nosocomial infection was defined according to Centers for Disease Control and Prevention definitions. gentamicin. The susceptibility percent of each antimicrobial agent used was calculated by dividing the number of susceptible isolates by the total number of tested isolates. cefuroxime. MICs of different antibiotics against P. aeruginosa RTI isolates Antibiotic No. ceftriaxone.024 128 256 256 64 16 Greater than 1. All p values were TABLE 2. Intermediate (%) No. Antibiotic susceptibility of 19 P. meropenem. aeruginosa on Mueller-Hinton broth were diluted to an initial cell density of 107 cfu/ml with fresh Mueller-Hinton broth. ampicillin/ sulbactam. Overnight cultures of P. amoxicillin.ANTIMICROBIAL SUSCEPTIBILITY PROFILE OF PSEUDOMONAS AERUGINOSA 177 TABLE 1.024 512 1.024 512 Greater than 1. aeruginosa was isolated from the clinical sample as a unique pathogen. Resistant (%) MIC90 Ampicillin Ampicillin/sulbactam Amoxicillin Amoxicillin/clavulanate Cefalexin Cefuroxime Cefoperazone Cefotaxime Ceftriaxone Cefepime Meropenem Chloramphenicol Tetracycline Gentamicin Amikacin Ciprofloxacin Levofloxacin Norfloxacin Ofloxacin Azithromycin 0 (0) 0 (0) 0 (0) 0 (0) 2 (11) 0 (0) 8 (42) 1 (5) 3 (16) 10 (53) 13 (68) 0 (0) 0 (0) 3 (16) 16 (84) 8 (42) 1 (5) 17 (89) 9 (47) 2 (11) 0 (0) 0 (0) 0 (0) 0 (0) 2 (11) 2 (11) 8 (42) 7 (37) 5 (26) 4 (21) 3 (16) 0 (0) 2 (11) 6 (32) 1 (5) 7 (37) 12 (63) 0 (0) 7 (37) 1 (5) 19 (100) 19 (100) 19 (100) 19 (100) 15 (78) 17 (89) 3 (16) 11 (58) 11 (58) 5 (26) 3 (16) 19 (100) 17 (89) 10 (52) 2 (11) 4 (21) 6 (32) 2 (11) 3 (16) 16 (84) Greater than 1. tetracycline. aeruginosa RTI isolates No. aeruginosa isolates from different infection sites was determined using the chi-square test. Statistics The significance of differences between resistance patterns of P. amikacin.024 1. Isolates With MIC (mg/l) Antibiotic Breakpoint* (mg/l) 1 2 4 8 16 32 64 128 256 512 1. cefepime.024 128 64 64 4 4 16 4 256 Percents in proportion to the total of 19 P. ciprofloxacin. Antibiotics The antibiotics used in this study were ampicillin. chloramphenicol. cefotaxime.024 Greater Than 1. norfloxacin and azithromycin. ofloxacin. cefoperazone. Inoculums of 105 cfu per spot were applied to the surface of dry MuellerHinton agar plates containing graded concentrations (1 to 1. Susceptible (%) No.

Susceptible (%) No. aeruginosa RTI isolates and the antibiotic susceptibility of P. tetracycline (89%) and azithromycin (84%). cefuroxime (100%). tetracycline (100%). RESULTS Tables 1 and 2 list the MICs of different antibiotics against P. amoxicillin/clavulanate (95%). Tables 3 and 4 list the MICs of different antibiotics against P. . chloramphenicol (100%). P. and to a lesser extent to norfloxacin (71%) and meropenem (68%). aeruginosa isolates of UTIs. UTIs and SIs). P.024 512 1. amoxicillin (100%). tetracycline (95%). and to a lesser extent to meropenem (68%). P. cefuroxime (89%). Isolates were susceptible to norfloxacin (89% susceptibility) and amikacin (84%). amoxicillin (100%). Tables 5 and 6 list the MICs of different antibiotics against P.024 Greater Than 1. Intermediate (%) No. aeruginosa UTI isolates Antibiotic No.024 Ampicillin Ampicillin/sulbactam Amoxicillin Amoxicillin/clavulanate Cefalexin Cefuroxime Cefoperazone Cefotaxime Ceftriaxone Cefepime Meropenem Chloramphenicol Tetracycline Gentamicin Amikacin Ciprofloxacin Levofloxacin Norfloxacin Ofloxacin Azithromycin 8 8 8 8 16 16 16 8 8 8 4 8 4 4 16 1 2 4 2 4 0 0 0 0 0 0 0 0 0 0 8 0 0 0 0 9 6 2 9 0 0 0 0 0 0 0 0 0 0 0 4 0 0 0 0 8 4 8 4 0 0 0 0 0 0 0 0 0 1 2 4 0 0 7 7 1 4 4 3 1 0 2 0 1 0 0 2 1 7 8 2 0 0 4 8 0 3 0 1 2 0 2 0 2 2 0 6 6 6 4 0 0 4 3 3 2 1 2 2 6 2 0 0 1 0 0 7 5 4 5 2 0 3 4 1 0 2 3 1 3 0 3 3 2 1 0 1 3 1 0 1 1 8 0 2 1 1 0 1 3 3 4 1 4 3 1 3 4 1 2 1 3 3 2 1 1 0 1 0 2 2 8 2 6 1 1 2 1 0 1 0 1 1 1 0 0 1 0 0 5 3 1 3 5 3 11 1 2 2 0 0 2 3 1 0 0 0 2 1 0 7 2 6 1 11 9 0 0 0 0 0 12 0 0 0 0 0 0 0 0 5 0 7 0 1 0 0 0 0 0 0 3 0 0 0 0 0 0 0 0 * According to 1997 NCCLS guidelines.178 ANTIMICROBIAL SUSCEPTIBILITY PROFILE OF PSEUDOMONAS AERUGINOSA TABLE 3.024 256 256 128 128 32 1. and to a lesser extent to meropenem (73%) and norfloxacin (64%). MICs of different antibiotics against P. chloramphenicol (100%). TABLE 4. azithromycin (95%). amoxicillin/clavulanate (100%). amoxicillin (100%). Isolates were susceptible to amikacin (82%). aeruginosa UTI isolates and the antibiotic susceptibility of P. Isolates were susceptible to amikacin (87% susceptibility). aeruginosa UTI isolates. ampicillin/sulbactam (100%). Isolates With MIC (mg/l) Antibiotic Breakpoint* (mg/l) 1 2 4 8 16 32 64 128 256 512 1.024 512 128 64 16 32 128 32 256 Percents in proportion to the total of 22 P. aeruginosa SI isolates were highly resistant to ampicillin (100% resistance). aeruginosa UTI isolates No. amoxicillin/clavulanate (95%). Antibiotic susceptibility of 22 P.024 1. Resistant (%) MIC90 Ampicillin Ampicillin/sulbactam Amoxicillin Amoxicillin/clavulanate Cefalexin Cefuroxime Cefoperazone Cefotaxime Ceftriaxone Cefepime Meropenem Chloramphenicol Tetracycline Gentamicin Amikacin Ciprofloxacin Levofloxacin Norfloxacin Ofloxacin Azithromycin 0 (0) 2 (9) 0 (0) 0 (0) 2 (9) 0 (0) 8 (36) 1 (5) 8 (36) 10 (45) 16 (73) 0 (0) 0 (0) 7 (32) 18 (82) 9 (41) 6 (27) 14 (64) 9 (41) 0 (0) 0 (0) 2 (9) 0 (0) 1 (5) 0 (0) 0 (0) 7 (32) 6 (27) 6 (27) 4 (18) 2 (9) 0 (0) 0 (0) 4 (18) 1 (5) 8 (36) 4 (18) 0 (0) 4 (18) 1 (5) 22 (100) 18 (82) 22 (100) 21 (95) 20 (91) 22 (100) 7 (32) 15 (68) 8 (37) 8 (37) 4 (18) 22 (100) 22 (100) 11 (50) 3 (13) 5 (23) 12 (55) 8 (36) 9 (41) 21 (95) Greater than 1. Table 7 shows resistance patterns of P. cefalexin (91%) and ampicillin/ sulbactam (82%). azithromycin (84%) and cefalexin (87%). aeruginosa SI isolates and the antibiotic susceptibility of P.024 512 Greater than 1. aeruginosa RTI isolates were highly resistant to ampicillin (100%). aeruginosa isolates of UTIs. aeruginosa isolates of RTIs.05 considered statistically significant. based on 2-tailed tests of significance with p ⱕ0. aeruginosa UTI isolates were highly resistant to ampicillin (100% resis- tance). aeruginosa isolates from different infections sites (RTIs.

7 In a multicenter study at hospitals in Thailand the susceptibility of P. The only significant differences among different infection sites were noted when using ampicillin/sulbactam.ANTIMICROBIAL SUSCEPTIBILITY PROFILE OF PSEUDOMONAS AERUGINOSA 179 TABLE 5. 50. However. Many investigators have reported that amikacin is the most effective drug with the least resistance against P. aeruginosa SI isolates Antibiotic No. respectively. . aeruginosa isolates from RTIs and SIs in the current study and the study from Thailand are in agreement. Antibiotic susceptibility of 38 P.024 512 Greater than 1.9% and 90. Thus. DISCUSSION Except for 3 antibiotics the susceptibility of isolates to the antibiotics tested were not significantly different among infection sites. aeruginosa SI isolates. SI isolates were significantly less resistant than RTI and UTI isolates to chloramphenicol and significantly less resistant than RTI isolates to ampicillin/sulbactam but significantly more resistant than RTI isolates to cefoperazone. For the remaining antibiotics examined there were no significant differences in resistance patterns of isolates at different infection sites.3%.024 1. MICs of different antibiotics against P.024 Greater Than 1. None of the antibiotics tested attained 90% susceptibility. aeruginosa to amikacin in RTIs.024 Ampicillin Ampicillin/sulbactam Amoxicillin Amoxicillin/clavulanate Cefalexin Cefuroxime Cefoperazone Cefotaxime Ceftriaxone Cefepime Meropenem Chloramphenicol Tetracycline Gentamicin Amikacin Ciprofloxacin Levofloxacin Norfloxacin Ofloxacin Azithromycin 8 8 8 8 16 16 16 8 8 8 4 8 4 4 16 1 2 4 2 4 0 0 0 0 0 0 0 0 0 0 12 0 0 0 0 14 8 2 14 0 0 0 0 0 0 0 0 0 0 0 8 0 0 1 1 9 12 7 8 2 0 0 0 0 0 0 0 0 1 9 6 0 0 8 4 3 2 18 3 4 0 9 0 2 2 5 11 6 8 13 1 3 2 2 13 4 3 0 5 3 0 3 0 2 1 4 3 4 9 6 4 7 7 6 15 3 2 3 2 10 3 4 2 1 2 1 5 9 6 3 6 6 4 4 4 0 6 2 1 9 2 7 4 3 1 2 6 6 3 4 1 4 10 5 0 1 3 1 2 6 5 5 2 2 3 1 4 2 6 1 0 3 9 8 0 3 2 1 3 4 1 6 3 8 2 4 5 6 2 0 0 7 2 2 1 1 0 2 0 0 10 2 6 16 8 10 4 4 1 2 0 5 4 2 0 0 0 2 0 0 14 2 16 4 19 11 0 1 2 0 0 3 0 0 0 0 0 0 0 0 3 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 * According to 1997 NCCLS guidelines. it is difficult to provide recommenda- tions for empirical treatment. the susceptibility rates of P. However. Intermediate (%) No. norfloxacin and amikacin seem to be good choices for initial therapy for RTI caused by P.024 1.5.2%. Amikacin and to a lesser extent meropenem and norfloxacin seem to be good choices for initial therapy for UTIs and SIs caused by P. Isolates With MICs (mg/l) Antibiotic Breakpoint* (mg/l) 1 2 4 8 16 32 64 128 256 512 1.8 Thus. aeruginosa isolates from UTIs in the current study showed higher susceptibility to amikacin than isolates from UTIs in the Thai study (82% TABLE 6. aeruginosa SI isolates No.024 1. aeruginosa. UTIs and SIs was reported to be 85. aeruginosa infection at different infection sites. Resistant (%) MIC90 Ampicillin Ampicillin/sulbactam Amoxicillin Amoxicillin/clavulanate Cefalexin Cefuroxime Cefoperazone Cefotaxime Ceftriaxone Cefepime Meropenem Chloramphenicol Tetracycline Gentamicin Amikacin Ciprofloxacin Levofloxacin Norfloxacin Ofloxacin Azithromycin 0 (0) 9 (24) 0 (0) 0 (0) 3 (8) 5 (13) 14 (37) 6 (16) 9 (24) 22 (58) 26 (68) 3 (8) 0 (0) 9 (24) 33 (87) 14 (37) 8 (21) 27 (71) 14 (37) 2 (5) 0 (0) 3 (8) 0 (0) 2 (5) 2 (5) 4 (11) 5 (13) 4 (11) 9 (24) 6 (16) 1 (3) 7 (18) 2 (5) 2 (5) 4 (11) 9 (24) 12 (32) 0 (0) 8 (21) 4 (11) 38 (100) 26 (68) 38 (100) 36 (95) 33 (87) 29 (76) 19 (50) 28 (73) 20 (52) 10 (26) 11 (29) 28 (74) 36 (95) 27 (71) 1 (2) 15 (39) 18 (47) 11 (29) 16 (42) 32 (84) 1. Susceptible (%) No. cefoperazone or chloramphenicol. P. aeruginosa.024 256 512 256 64 32 512 512 256 32 128 64 256 64 128 Percents in proportion to the total of 38 P.

12 as we have previously reported.10 The generally high resistance of P. J Antimicrob Chemother 2007. . Isolates (%) Antibiotic RTI UTI SI Chi-Square p Value Ampicillin Ampicillin/sulbactam Amoxicillin Amoxicillin/clavulanate Cefalexin Cefuroxime Cefoperazone Cefotaxime Ceftriaxone Cefepime Meropenem Chloramphenicol Tetracycline Gentamicin Amikacin Ciprofloxacin Levofloxacin Norfloxacin Ofloxacin Azithromycin 19 (100) 19 (100) 19 (100) 19 (100) 15 (78) 17 (89) 3 (16) 11 (58) 11 (58) 5 (26) 3 (16) 19 (100) 17 (89) 10 (52) 2 (11) 4 (21) 6 (32) 2 (11) 3 (16) 16 (84) 22 (100) 18 (82) 22 (100) 21 (95) 20 (91) 22 (100) 7 (32) 15 (68) 8 (37) 8 (37) 4 (18) 22 (100) 22 (100) 11 (50) 3 (13) 5 (23) 12 (55) 8 (36) 9 (41) 21 (95) 38 (100) 26 (68) 38 (100) 36 (95) 33 (87) 29 (76) 19 (50) 28 (74) 20 (52) 10 (26) 11 (29) 27 (74) 36 (95) 27 (71) 1 (2) 15 (39) 18 (47) 11 (29) 16 (42) 32 (84) — 7.05 p ⬎0. several groups have reported increasing trends of resistance of P. 34: 188.61 13.79 2. Resistance patterns of P. 88: S14.05 p ⬎0.05 p ⬎0. J Med Assoc Thai. Antimicrob Agents Chemother 2004. Factors influencing these guidelines and measures include regional information as well as changing local resistance profiles. aeruginosa is antibiotic pressure.18 The results presented in this study could also help the establishment and enforcement of infection control measures.05 p ⬎0. particularly in nosocomial isolates.05 vs 50.05 p ⬍0. it should be noted that monotherapy carries the risk of the possible emergence of resistant strains of the organism. J Environ Monit 2003. Horan TC and Hughes JM: CDC definitions for nosocomial infections 1988. Garner JS. Kheiralla ZH.05 p ⬎0.26 3.26 3.14 Consistent with our study.13 Accurate diagnosis could help discontinue unnecessary antibiotic administration and. 5.05 p ⬎0.05 p ⬎0.88 2. decrease the overall selective pressure. antibiogram and resistance mechanisms. especially in cases of severe infection. Danchaivijitr S.3 The main factor that drives the emergence of resistance in P. 60: 1010. aeruginosa.05 p ⬎0. Gad GF.05 p ⬍0. Weaver MK.9. aeruginosa isolates from UTIs to meropenem in this study (73%) is consistent with that reported in other studies. Kaur J. Am J Infect Control 2006.28 2.05 p ⬎0. Rongrungruang Y. Hasan AS. Kuzucu C and Durmaz R: Clinical.05 p ⬎0.5. 41: 848. Clin Infect Dis 2005. Thus. The high susceptibility of P.19 The results of such study would be beneficial for determining guidelines for empirical therapy regimens. Dhiraputra C. Yetkin G. Turkey. 2005. Gaynes R and Edwards JR: Overview of nosocomial infections caused by gram-negative bacilli. suppl. Rushdy AA and AbdEl-Rahiem W: Multiplex-PCR and PCR-RFLP assays to monitor water quality against pathogenic bacteria. 2.05 p ⬎0.12 This increasing resistance emphasizes the need for better use of currently available antibiotics and calls for the future discovery of novel therapeutic drugs. El-Domany RA. and epidemiologic characteristics of Pseudomonas aeruginosa infections in a University Hospital.05 p ⬎0. Jones ME.23 1. Flamm RK.180 ANTIMICROBIAL SUSCEPTIBILITY PROFILE OF PSEUDOMONAS AERUGINOSA TABLE 7.05 p ⬎0. It was reported that restricting fluoroquinolone use at an intensive care unit during a 6-month period allowed the reestablishment of fluoroquinolone sensitive strains. J Ayub Med Coll Abbottabad 2007. fluoroquinolones and carbapenems. 5: 865. Abd-El-Haleem D. Zaki S and Ashour HM: Characterization of Pseudomonas aeruginosa isolated from clinical and environmental samples in Minia. Zaki S. Emori TG. Karlowsky JA and Sahm DF: Factors associated with relative rates of antibiotic resistance in Pseudomonas aeruginosa isolates tested in clinical laboratories in the United States from 1999 to 2002. aeruginosa at the Thai hospitals.11 This could be attributable to the production of ␤-lactamases. Z Arztl Fortbild (Jena) 1991.07 6. Egypt: prevalence.9 — 1 1.36 3.. Cicek A.7 4. Worajitr M and Jintanothaitavorn D: Antimicrobial susceptibility of community and hospital acquired bacteria.7 1. combination therapy might be a good option. 6. Nair D.46 2. Otlu B. given the fact that an inappropriate choice of empirical antibiotics has been associated with poor outcomes and higher mortality rates in patients infected with P.78 1. 85: 818.18. Thornsberry C. However. 19: 39.9%). 48: 2431. This might be related to the excessive use of amikacin for UTIs caused by P. aeruginosa isolates to ampicillin and cefalexin reported in this study confirms similar observations in neighboring countries.05 p ⬎0.15–17 probably due to multiple drug resistance efflux pumps.71 2. 8. Baweja G. This is an important consideration. UTIs and SIs No. aeruginosa isolates from RTIs. thus. aeruginosa to cephalosporins.20 Abbreviations and Acronyms MIC ⫽ minimum inhibitory concentration NCCLS ⫽ National Committee for Clinical Laboratory Standards RTI ⫽ respiratory tract infection SI ⫽ skin infection UTI ⫽ urinary tract infection REFERENCES 1.2 0. 4. 7.05 — p ⬎0. Jarvis WR. 3. microbiologic. Malatya. Deb M and Aggarwal P: Resistance patterns of urinary isolates in a tertiary Indian hospital.82 — p ⬍0.

17. Vautrin AC. Alekhina VM. Sader HS and Fritsche TR: Assessment of pathogen occurrences and resistance profiles among infected patients in the intensive care unit: report from the SENTRY Antimicrobial Surveillance Program (North America.ANTIMICROBIAL SUSCEPTIBILITY PROFILE OF PSEUDOMONAS AERUGINOSA 9. J Chemother 2004. Drug Resist Updat 2000. 15. 11. Diagn Microbiol Infect Dis 2002. 19: 370. Verhoef J and Schmitz FJ: Antimicrobial resistance in European isolates of Pseudomonas aeruginosa. Ray GT. Chashchina IL and Abramov KS: Resistance of urinary tract infection pathogens and choice of antibacterial therapy in pediatric urologic practice. Jones RN. 32: 470. . Fluit AC. and healthcare-associated pneumonia. Page D et al: Impact of restricting fluoroquinolone prescription on bacterial resistance in an intensive care unit. New York: molecular epidemiology and in vitro activity of polymyxin B. Quale J. Katosova LK. European SENTRY Participants. 16: 264. 14. Clin Infect Dis 2005. Eur J Clin Microbiol Infect Dis 2005. Antibiot Khimioter 2004. Baxter R and DeLorenze GN: Hospital-level rates of fluoroquinolone use and the risk of hospital-acquired infection with ciprofloxacin-nonsusceptible Pseudomonas aeruginosa. Streit JM. Molina N. 10. 41: 441. 44: 289. Bratu S. Nino CR. ventilator-associated. Rodriguez AJ and Meijomil P: Comparative study of antimicrobial resistance of Pseudomonas aeruginosa strains isolated from urinary tract infection in patients from Caracas and Lima. Eur J Clin Microbiol Infect Dis 2000. Fonsale N. 181 2004. Sader HS and Jones RN: Urinary tract infection trends in Latin American hospitals: report from the SENTRY antimicrobial surveillance program (1997–2000). 20: 476. Guyomarc’h S. Guidelines for the management of adults with hospitalacquired. 20. Cebular S. 2001). 24: 196. Zorkin SN. Int J Antimicrob Agents 2004. issued October 2004. 49: 34. Gales AC. 18. National Nosocomial Infections Surveillance (NNIS) System Report: data summary from January 1992 through June 16. 171: 388. J Hosp Infect 2005. Astal Z: Susceptibility patterns in Pseudomonas aeruginosa causing nosocomial infections. Carricajo A. Aubert G. 24: 111. Garcia A. 59: 83. Am J Infect Control 2004. 12. Heddurshetti R and Landman D: Multidrug-resistant Pseudomonas aeruginosa in Brooklyn. 3: 247. Hancock RE and Speert DP: Antibiotic resistance in Pseudomonas aeruginosa: mechanisms and impact on treatment. 19. 13. Rodriguez CN. Am J Respir Crit Care Med 2005. Int J Antimicrob Agents 2002.