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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
0022-5347/08/1801-0176/0
THE JOURNAL OF UROLOGY
Copyright 2008 by AMERICAN UROLOGICAL ASSOCIATION
176
177
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
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
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)
178
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
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).
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)
179
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
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
180
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
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