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Rezaeiet al (2016) conductedthis study inorder to select a better antibiotic choice for treatment of infections causedbyPseudomonas aeruginosa as well as to investigate theoccurrence ofresistance of P.

aeruginosa strains to some antipseudomonal ?-lactamsdrugs in Iran. This also explain the relation among the presence of ?-lactams (ampC,mexC1,2, and mexC3,4genes) resistance genes and phenotype betweenP. aeroginosaisolates which is resistant were investigated.They collect 100isolatesof P. aeruginosa, among them 89% mexC3,4genes, 86%mexC1,2 and 82% had ampC, while the combinations of these geneswere found absent in most of isolateswhile only in 3% of isolates non of thesegenes were seen. Among the isolates 41% were found to be resistant tomezlocillin, 36% were resistant to cefepime and 29% ofisolates were resistanttopiperacillin/ tazobactam and ceftazidime antibiotic.

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In the current study Significantrelation (P value ?0.05 by Fisher Exacttest or Chi-square) was seenamong the existence of ampCgene and resistance to all thestudied?-lactams drugs. Phenotypically observed resistant isolates containsthese genes however no relation was found for mexCgenes. The currentstudy shows for the first time that the presence of mexCand ampCgenes in appropriatepercent of P. aeruginosa  among clinical isolatesinIran as wellas relation among resistance to ?-lactams and the presence of ampCgene.Delgado et al. (2016)reported that 113 bacterial isolates, 98(86.

72%) remained unaffected by(resistant) to nor?oxacin, 57 (50.44%), 92 (81.41%) and 35(30.93%) indicatedless vulnerability to o?oxacin, cipro?oxacin and levo?oxacin separately. Morethan a few variations were noticed in E.coli,Staphylococcus epidermidis, Pseudomonas on genetic level.Khan (2014) organized the currentcross sectional study from January 2012 to January 2013 at the department ofMicrobiology, university of Karachi.

The clinical isolates were collected fromdifferent hospitals in order to investigate the frequency and pattern ofsensitivity of multi-drug resistant (MDR) strains of Pseudomonas aeruginosa. Screening of the diagnostic strains weredone by standard microbiological techniques. For the evaluation ofantimicrobial sensitivity they used the Kirby Bauer Disc diffusion technique.The result was determined according to the Clinical and Laboratory StandardsInstitute (CLSI) guidlines. Among the clinically isolated samples the Prevalenceof MDR P.

aeruginosa were observed30%. Amikacin followed by Quinolones followed by Co-trimaxazole antibioticswere found to most effective. kireçci (2014) defined that themortality and morbitity rate of the Pseudomonasaeruginosa causes infection is very high. Urgent and competent antibiotictherapy can successfully reduce these infections. The study was done in Iraq inorder to investigate the antibiotic susceptibility pattern of clinicallyisolated P.

  aeruginosa  strains obtained from different SulaimaniTeaching Hospitals. This study was done in one year from June 2012 to June2013. During this period of time total of 420 P.

  aeruginosasamples weretested Out of which they isolate 75 diagnostic isolates. Among the clinicallyisolated samples(54.7%) were sensitive to gentamicin followed by 96% toimipenem (96%), toward meropenem was 98.7%, towards imikacin was 62.7%,piperacillin (70.7%), ceftazidime (82.7%), ciprofloxacin(73.

3%), 69.3% totobramycin, 8% to ceftraxon and totaly resistant to cefotaxime antibiotic.There results shows that the P.Aeruginosa isolates collected from there hospitals were sensitive towardsimipenem, meropenem and ceftazidime by comparing with other antibiotics.

  Liu (2014) stated that theextended-spectrum ?-lactamase (ESBL) OXA-142 genes (Blaaxa-142) in bacterial species Pseudomonas aeruginosa were found less in Asia as compared toBulgaria and other Countries of Europe. They isolate 90 samples of P aeruginosafond resistanant toceftazidem (MIC ?8 mg/L) from January 2009 to December 2012 and then with thehelp of polymerase chain reaction they were tested for identification ofbroad-spectrum ?-lactamase and ESBL genes. With the help of Pulsed-field gelelectrophoresis the clonal relation of these isolates were determined. Amongthe ceftazidime resistant isolates three various positive ESBL producingisolates carry the gene blaOXA-142. In class 1 integron the blaOXA-142gene was joined. With the help of southern blot technique analysis on theplasmid of all three isolates the integron containing blaOXA-142gene was detected with the ?-lactamase and blaOXA-142 gene.Ghamgosha (2014) suggested that one ofthe major clinical problems is the formation of metallo-beta lactamases (MBL)enzymes in the pseudomonas aeruginosa.This enzymes group is a member of beta-lactamases responsible for theproduction of Ambler class B, which have the ability to hydrolase theantibiotic carbapenems.

The main goal of the current was to analyse theincidence rate of metallo-beta lactamases (MBL) by phenotypic and genotypictechnique and to investigate the pattern of antibiotic resistance P. Aeruginosa isolated in Iran fromZahedan Hospital. 191 species were isolated after the minimum inhibitoryconcentration (MIC) determination by biochemical methods and antibioticresistance pattern (ARP) against the p.aeruginosa. Those isolates having MIC> 4 microgram / ml were examined byphenotypic and genotype way.

  The currentstudy shows that the rate of resistance to imipenem was 5.7% and after thephenotypic experiments completion 9 isolates have the ability of productionMetallo-beta Lactamase (MBL) were determined. Total 7 out of 9 isolates wereconfirmed by PCR analysis. The VIM-1 gene was found dominant among theisolates. The results of the current research study showed the existance ofmetallo-beta-lactam (MBL) genes in some isolated samples from ZahedanHospitals.Aghamiri(2014) Suggested that different strains ofPseudomonas aeruginosa can produce Beta-lactamase which are responsiblemainly for casing hospital infections. The drug Carbapenem was considered themost efficient antibiotic among all of the antibiotics agaist P. Aeruginosa but these are noneffective against the metallo-beta lactamase producing group of P.

Aeruginosa. For the identification ofMBLs genes (bla-VIM and bla-IMP) and theantibiotic sensitivity, various samples of P. aeruginosa were collected from9 different hospital in Iran. During this study total 212 isolates of P. Aeruginosawereidentified with the help of biochemical and PCR analysis.

For theidentification of antibiotic sensitivity the Kirby-Burr disk diffusiontechnique were used while with the help of DDST technique the resistant speciesagainst imipenem were determined followed by PCR testing inorder to determinethe genes of MBL which are bla-VIM  andbla-IMP.  Among all of the species which were confirmedas imepenim resistant by DDST phenotypic technique, 75 were confirmed as theycontain MBL gene. PCR technique reveals that 33% strains (70 isolates)containing bla-VIM gene while 9% of the isolates (20 strains) carryingthe bla-IMP gene. There results shows that due to the production ofMBL enzymes in P.aeroginosa the limitof antibiotic resistance increases. Therefore, the determination of antibioticsensitivity and presence of MBL gene is necessary inorder to control theinfection of P.aeroginosa.

Zaferet al. (2014) examined the presence of metallo-?-lactamase andextended-spectrum ? lactamase (ESBL) in 122 P.Aeruginosa isolates from january2011to March 2012 obtained from two different hospitals in Cairo, Egypt. Therephenotypic screening for ESBLs and MBL as well as antibiotic sensitivity were determined. There ESBLs and MBLs genewere detected by PCR and also determines MICs which shows that the resistancerate of P. Aeruginosa was  39.34% to imipenem,80.

3% to cefoperazone, 45.1% to aztreonam, 87.7% tocefuroxime and 25.4% to tazobactam. Out of all 122 isolates 27% were MBLpositive and 7.4% were ESBL positive. The spread of blaNDMwas4.

2%,2.1% wasblaIMP-1 positive, 41.7% wasblaOXA-10 positive,10.

4% was blaVEB-1 and 58.3% containing blaVIM-2gene. In the current research study the genes such as OXA-2, SPM-, GIM-and SIM-, were not identified. The gene such as OXA-10 was linked to VEB and/orVIM-2. In 12 strains the VIM-2 and OXA-10 genes were present, two isolates wascontaing both theVEB and OXA-10 genes while only a single isolates have VEB,VIM-2 and OXA-10 genes. It is cleared from the results that the genes blaOXA-10and blaVIM-2 were widely present among P. Aeruginosa in Egypt while the genes blaOXA-10, blaIMP-1, BlaVIM-2and  blaNDM,  were reported for the first time in P.

aeruginosa in Egypt.Anna Diana in 2014 conducted a studyto investigate the prevalence of genes encoding resistance toaminoglycosidesand fluoroquinolones among twenty-five among twenty-five Pseudomonasaeruginosa isolated between2002 and 2009. In PCR, following genes weredetected: ant(2″)-Ia in 9 (36.0%), aac(6′)-Ib in 7 (28.

0%), qnrBin5 (20.0%), aph(3″)-Ibin 2 (8.0%) of isolates.Poirel,2012 studied plasmid-associatedresistance to fluroquinolones can be mediated by theproductionof Qnr proteins, which preserve DNA gyrase andtopoisomerase IV frominhibition by quinolones.

Borra (2013) suggested that theMetallo-?-lactamases (MBLs) are widely spread among those Gram-negativebacteria which are clinically significant because it show resistance to betalactam antibiotics especially to carbapenems. In 2002 the gene blaGIM-1 werediscovered in Pseudomonas aeruginosa strain for the first timewhile now discovered in Enterobacteriaceae. In the current researchstudy they present the crystaline structure of GIM-1 in the mono-zinc,dizinc(where Cys221 was found to be oxidized) and apo-zinc which is metal-free,and arranged nine autonomously complicated views of enzymes. The gene GIM-1 isunlike from the other correlated MBLs in maintenance of a narrow active sitechannel definite by aromatic side chains (Tire 233 and Trip 228) on usuallypresent in hydrophilic residues in other MBLs. By screening there structuresshows important elasticity in there two loops (Residues 60 to 66 represent theloop1 while residues 223 to 242 show the loop2) moreover to active site withclosed and open arrangement cleared by pattern of alternative hydrogen bindingwhich involves Trp228. They recommend that the rearrangement ability of thegene GIM-1 allows to hydrolyse a wide variety of ?-lactams regardless of havinga more restricted active site.

There results focus the structural variabilityamong the family of MBL enzyme.                Young(2012) studied three clinically metallo-?-lactamase (MBL) producing isolates ofPseudomonas aeruginosa which wereWCH2813, WCH2677 and WCH2837 from the Women’s and Children’s Hospital,Adelaide, Australia. All the clinically isolates for known MBL genes werenegative by PCR. A gene bank was prepared in which the bla (AIM-1) gene belongfrom MBL family, was cloned and characterized completely. AIM-1 Encoded enzymewhich belong to group B3MBL has highest level of identity to Thin-B and L1. Itis chromosomal and flanked by two copies (one intact and one truncated) of anISCR element, ISCR15. Southern hybridization screening identifies the movementof both bla(AIM-1) and ISCR15 among the three different clinical strains. AIM-1possesses efficiently high k(cat) values for carbapenems and cefepime than mostother MBLs and AIM-1 can hydrolyze most of the ?-lactams drugs except aztreonamand up to some extent to ceftazidime.

The first identified mobile group B3enzyme was AIM-1 declaires more problems for already present antibiotics usedto treat the severe infection caused byP. aeruginosa and other Gram-negative bacteria.Abdelrazig (2012)studed the existence of antimicrobial resistance genes involved in theproduction of infection by Pseudomonasaeruginosa. A total of 74 P.aeruginosa isolates were obtained from the admitted patients in KhartoumTeaching Hospital of Sudan. These obtaining isolates and serotype were studiedat the Research Laboratory in University of Science and Theology Sudan fromFebruary to June 2011.

The different strains were collected from differenttypes of infection, mainly from postoperative wound infection, respiratorytract and urinary tract infections. By the help of PCR the genes involved in antimicrobialdrug resistance were investigated. The first step was denaturation of cell wallin order to jump out the extraction of DNA. In the isolates of P. Aeruginosa the IMP-6 and IMP-7 geneswere investigated which belong to the IMP Gene family. Among the P.

aeruginosa isolates the IMP-10 andIMP-7 were reported for the first time in Khartoum State, Sudan.

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