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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

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

ANTIMICROBIAL SUSCEPTIBILITY PROFILE OF PSEUDOMONAS AERUGINOSA

177

TABLE 1. MICs of different antibiotics against P. aeruginosa RTI isolates


No. Isolates With MIC (mg/l)
Antibiotic

Breakpoint*
(mg/l)

16

32

64

128

256

512

1,024

Greater Than
1,024

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.

aeruginosa was isolated from the clinical sample as a unique


pathogen.5 A nosocomial infection was defined according to
Centers for Disease Control and Prevention definitions.6
Ethical approval to perform the study was obtained from the
management boards of the hospitals, and the Egyptian Ministry of Health and Population.
Antibiotics
The antibiotics used in this study were ampicillin, ampicillin/
sulbactam, amoxicillin, amoxicillin/clavulanic acid, cephalexin,
cefuroxime, cefotaxime, cefoperazone, ceftriaxone, cefepime,
meropenem, gentamicin, amikacin, chloramphenicol, tetracycline, ciprofloxacin, levofloxacin, ofloxacin, norfloxacin and
azithromycin.
Determination of MIC
The MIC for each antibiotic was determined on MuellerHinton agar by the agar dilution method according to 1997

NCCLS guidelines. Overnight cultures of P. aeruginosa on


Mueller-Hinton broth were diluted to an initial cell density
of 107 cfu/ml with fresh Mueller-Hinton broth. Inoculums of
105 cfu per spot were applied to the surface of dry MuellerHinton agar plates containing graded concentrations (1 to
1,024 mg/l) of the respective antibiotics. Plates were incubated at 37C for 20 to 24 hours and the MIC was calculated.
Spots with the lowest concentrations of antibiotic that
showed no growth were defined as the MIC. The susceptibility percent of each antimicrobial agent used was calculated by dividing the number of susceptible isolates by the
total number of tested isolates.

Statistics
The significance of differences between resistance patterns
of P. aeruginosa isolates from different infection sites was
determined using the chi-square test. All p values were

TABLE 2. Antibiotic susceptibility of 19 P. aeruginosa RTI isolates


Antibiotic

No.
Susceptible (%)

No.
Intermediate (%)

No.
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 1,024


512
Greater than 1,024
512
1,024
1,024
128
256
256
64
16
Greater than 1,024
128
64
64
4
4
16
4
256

Percents in proportion to the total of 19 P. aeruginosa RTI isolates.

178

ANTIMICROBIAL SUSCEPTIBILITY PROFILE OF PSEUDOMONAS AERUGINOSA


TABLE 3. MICs of different antibiotics against P. aeruginosa UTI isolates
No. Isolates With MIC (mg/l)
Antibiotic

Breakpoint*
(mg/l)

16

32

64

128

256

512

1,024

Greater Than
1,024

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.

based on 2-tailed tests of significance with p 0.05 considered statistically significant.


RESULTS
Tables 1 and 2 list the MICs of different antibiotics against
P. aeruginosa RTI isolates and the antibiotic susceptibility
of P. aeruginosa isolates of RTIs. P. aeruginosa RTI isolates
were highly resistant to ampicillin (100%), ampicillin/sulbactam (100%), amoxicillin (100%), amoxicillin/clavulanate
(100%), chloramphenicol (100%), cefuroxime (89%), tetracycline (89%) and azithromycin (84%). Isolates were susceptible to norfloxacin (89% susceptibility) and amikacin (84%),
and to a lesser extent to meropenem (68%).
Tables 3 and 4 list the MICs of different antibiotics
against P. aeruginosa UTI isolates and the antibiotic susceptibility of P. aeruginosa isolates of UTIs. P. aeruginosa
UTI isolates were highly resistant to ampicillin (100% resis-

tance), amoxicillin (100%), chloramphenicol (100%), cefuroxime (100%), tetracycline (100%), amoxicillin/clavulanate
(95%), azithromycin (95%), cefalexin (91%) and ampicillin/
sulbactam (82%). Isolates were susceptible to amikacin
(82%), and to a lesser extent to meropenem (73%) and norfloxacin (64%).
Tables 5 and 6 list the MICs of different antibiotics
against P. aeruginosa SI isolates and the antibiotic susceptibility of P. aeruginosa isolates of UTIs. P. aeruginosa
SI isolates were highly resistant to ampicillin (100% resistance), amoxicillin (100%), tetracycline (95%), amoxicillin/clavulanate (95%), azithromycin (84%) and cefalexin
(87%). Isolates were susceptible to amikacin (87% susceptibility), and to a lesser extent to norfloxacin (71%) and
meropenem (68%).
Table 7 shows resistance patterns of P. aeruginosa isolates from different infections sites (RTIs, UTIs and SIs).

TABLE 4. Antibiotic susceptibility of 22 P. aeruginosa UTI isolates


Antibiotic

No.
Susceptible (%)

No.
Intermediate (%)

No.
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 1,024


512
Greater than 1,024
512
1,024
1,024
256
256
128
128
32
1,024
512
128
64
16
32
128
32
256

Percents in proportion to the total of 22 P. aeruginosa UTI isolates.

ANTIMICROBIAL SUSCEPTIBILITY PROFILE OF PSEUDOMONAS AERUGINOSA

179

TABLE 5. MICs of different antibiotics against P. aeruginosa SI isolates


No. Isolates With MICs (mg/l)
Antibiotic

Breakpoint*
(mg/l)

16

32

64

128

256

512

1,024

Greater Than
1,024

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.

The only significant differences among different infection


sites were noted when using ampicillin/sulbactam, cefoperazone or chloramphenicol. 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.
DISCUSSION
Except for 3 antibiotics the susceptibility of isolates to the
antibiotics tested were not significantly different among
infection sites. None of the antibiotics tested attained 90%
susceptibility. Thus, it is difficult to provide recommenda-

tions for empirical treatment. However, norfloxacin and


amikacin seem to be good choices for initial therapy for
RTI caused by P. aeruginosa. Amikacin and to a lesser
extent meropenem and norfloxacin seem to be good choices
for initial therapy for UTIs and SIs caused by P. aeruginosa.
Many investigators have reported that amikacin is the
most effective drug with the least resistance against P.
aeruginosa infection at different infection sites.5,7 In a
multicenter study at hospitals in Thailand the susceptibility of P. aeruginosa to amikacin in RTIs, UTIs and SIs
was reported to be 85.3%, 50.9% and 90.2%, respectively.8
Thus, the susceptibility rates of P. aeruginosa isolates
from RTIs and SIs in the current study and the study from
Thailand are in agreement. However, P. aeruginosa isolates
from UTIs in the current study showed higher susceptibility
to amikacin than isolates from UTIs in the Thai study (82%

TABLE 6. Antibiotic susceptibility of 38 P. aeruginosa SI isolates


Antibiotic

No.
Susceptible (%)

No.
Intermediate (%)

No.
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)

1,024
512
Greater than 1,024
1,024
1,024
1,024
256
512
256
64
32
512
512
256
32
128
64
256
64
128

Percents in proportion to the total of 38 P. aeruginosa SI isolates.

180

ANTIMICROBIAL SUSCEPTIBILITY PROFILE OF PSEUDOMONAS AERUGINOSA


TABLE 7. Resistance patterns of P. aeruginosa isolates from RTIs, UTIs and SIs
No. 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)

7.9

1
1.26
3.07
6.7
1.46
2.2
0.78
1.61
13.79
2.36
3.28
2.71
2.88
2.26
3.7
4.23
1.82

p 0.05

p 0.05
p 0.05
p 0.05
p 0.05
p 0.05
p 0.05
p 0.05
p 0.05
p 0.05
p 0.05
p 0.05
p 0.05
p 0.05
p 0.05
p 0.05
p 0.05
p 0.05

vs 50.9%). This might be related to the excessive use of


amikacin for UTIs caused by P. aeruginosa at the Thai hospitals.
The high susceptibility of P. aeruginosa isolates from
UTIs to meropenem in this study (73%) is consistent with
that reported in other studies.9,10 The generally high
resistance of P. aeruginosa isolates to ampicillin and
cefalexin reported in this study confirms similar observations in neighboring countries.11 This could be attributable to the production of -lactamases,12 as we have previously reported.3 The main factor that drives the
emergence of resistance in P. aeruginosa is antibiotic
pressure.13 Accurate diagnosis could help discontinue unnecessary antibiotic administration and, thus, decrease the
overall selective pressure. It was reported that restricting
fluoroquinolone use at an intensive care unit during a
6-month period allowed the reestablishment of fluoroquinolone sensitive strains.14
Consistent with our study, several groups have reported increasing trends of resistance of P. aeruginosa to
cephalosporins, fluoroquinolones and carbapenems, particularly in nosocomial isolates,5,1517 probably due to
multiple drug resistance efflux pumps.12 This increasing
resistance emphasizes the need for better use of currently
available antibiotics and calls for the future discovery of
novel therapeutic drugs. However, it should be noted that
monotherapy carries the risk of the possible emergence of
resistant strains of the organism. Thus, combination therapy might be a good option, especially in cases of severe
infection.18,19
The results of such study would be beneficial for determining guidelines for empirical therapy regimens. This is an
important consideration, 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. aeruginosa.18 The results presented in this
study could also help the establishment and enforcement of
infection control measures. Factors influencing these guidelines and measures include regional information as well as
changing local resistance profiles.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

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