Prevalence and Resistance Pattern of Pseudomonas aeruginosa Isolated from Surface Water
Affiliation(s)
1 Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science and Technology University, Santosh, Tangail, Bangladesh. 2 Department of Microbiology, University of Dhaka, Dhaka, Bangladesh. 3 International Centre for Diarrheal Diseases Research, Dhaka, Bangladesh.
1 Department of Biotechnology and Genetic Engineering, Mawlana Bhashani Science and Technology University, Santosh, Tangail, Bangladesh. 2 Department of Microbiology, University of Dhaka, Dhaka, Bangladesh. 3 International Centre for Diarrheal Diseases Research, Dhaka, Bangladesh.
ABSTRACT
Pseudomonas aeruginosa is one of the most common pathogenic bacteria, frequently found in different environmental samples. The prevalence of multidrug resistant isolates has become an alarming concern for both patients and their surroundings. The present study was carried out to record prevalence of P. aeruginosa in surface water of Dhaka city and to screen their antibiotic resistance pattern. The study was also extended to typing of resistant isolates according to extended spectrum beta lactamase production. Hereby, Kirby-Bauer method was applied to test antibiotic sensitivity according to Clinical and Laboratory Standards Institute. Then, the Ampicillin resistant isolates were screened for ESBL production by Double Disk Synergy Test (DDST). In these prospects, 52 water samples were tested, of which 32 were found positive for P. aeruginosa isolates. Hundred percent of the positive isolates were found to Ampicillin (AMP) resistant followed by 93.7% to both Tetracycline and Gentamycin and 71.8% to Co-triimoxazole. P. aeruginosa is completely susceptible to third generation antibiotics ciprofloxacin, Imipenem and Aztreonam followed by moderately susceptible to Polymyxin-B (78.2%) and Colistin (87.5%). According to DDST, all of the susceptible isolates were found positive for AMC type beta-lactamase production. It is evident from this study that the surface water is contaminated with antibiotic resistant P. aeruginosa and that through the water systems antibiotic resistance can be transferred to humans and animals. So, appropriate and rationale use of antibiotic should be applied to minimize the emergence of multidrug isolates to environment.
Pseudomonas aeruginosa is one of the most common pathogenic bacteria, frequently found in different environmental samples. The prevalence of multidrug resistant isolates has become an alarming concern for both patients and their surroundings. The present study was carried out to record prevalence of P. aeruginosa in surface water of Dhaka city and to screen their antibiotic resistance pattern. The study was also extended to typing of resistant isolates according to extended spectrum beta lactamase production. Hereby, Kirby-Bauer method was applied to test antibiotic sensitivity according to Clinical and Laboratory Standards Institute. Then, the Ampicillin resistant isolates were screened for ESBL production by Double Disk Synergy Test (DDST). In these prospects, 52 water samples were tested, of which 32 were found positive for P. aeruginosa isolates. Hundred percent of the positive isolates were found to Ampicillin (AMP) resistant followed by 93.7% to both Tetracycline and Gentamycin and 71.8% to Co-triimoxazole. P. aeruginosa is completely susceptible to third generation antibiotics ciprofloxacin, Imipenem and Aztreonam followed by moderately susceptible to Polymyxin-B (78.2%) and Colistin (87.5%). According to DDST, all of the susceptible isolates were found positive for AMC type beta-lactamase production. It is evident from this study that the surface water is contaminated with antibiotic resistant P. aeruginosa and that through the water systems antibiotic resistance can be transferred to humans and animals. So, appropriate and rationale use of antibiotic should be applied to minimize the emergence of multidrug isolates to environment.
Cite this paper
Nasreen, M. , Sarker, A. , Malek, M. , Ansaruzzaman, M. and Rahman, M. (2015) Prevalence and Resistance Pattern of Pseudomonas aeruginosa Isolated from Surface Water. Advances in Microbiology, 5, 74-81. doi: 10.4236/aim.2015.51008.
Nasreen, M. , Sarker, A. , Malek, M. , Ansaruzzaman, M. and Rahman, M. (2015) Prevalence and Resistance Pattern of Pseudomonas aeruginosa Isolated from Surface Water. Advances in Microbiology, 5, 74-81. doi: 10.4236/aim.2015.51008.
References
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http://dx.doi.org/10.1126/science.173.3999.836 [2] Remington, J.S and Schimpff, S.C. (1981) Please Don’t Eat Salads. The New England Journal of Medicine, 304, 433-435.
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http://dx.doi.org/10.1086/317501 [5] Anthony, M., Rose, B., Pegler, M.B., Elkins, M. Service, H., Thamotharampillai, K., Watson, J., Robinson, M., Bye, P., Merlino, J. and Harbour, C. (2002) Genetic Analysis of Pseudomonas aeruginosa Isolates from the Sputa of Australian Adult Cystic Fibrosis Patients. Journal of Clinical Microbiology, 40, 2772-2778.
http://dx.doi.org/10.1128/JCM.40.8.2772-2778.2002 [6] Kato, K., Iwai, S., Kumasaka, K., Horikoshi, A.,Inada, S., Inamatsu, T., Ono, Y., Nishiya, H., Hanatani, Y., Na rita, T., Sekino, H., and Hayashi, I. (2001) Survey of Antibiotic Resistance in Pseudomonas aeruginosa by the Tokyo Johoku Association of Pseudomonas Studies. Journal of Infection and Chemotherapy, 7, 258-262.
http://dx.doi.org/10.1007/s101560170024 [7] Aeschlimann, J. (2003) The Role of Multidrug Efflux Pumps in the Antibiotic Resistance of Pseudomonas aeruginosa and Other Gram-Negative Bacteria. Pharmacother, 23, 916-924.
http://dx.doi.org/10.1592/phco.23.7.916.32722 [8] Lister, P.D., Wolter, D.J. and Hanson, N.D. (2009) Antibacterial-Resistant Pseudomonas aeruginosa: Clinical Impact and Complex Regulation of Chromosomally Encoded Resistance Mechanisms. Clinical Microbiology Reviews, 22, 582-610.
http://dx.doi.org/10.1128/CMR.00040-09 [9] Gales, A.C., Jones, R.N., Turnidge, J., Rennie, R. and Ramphal, R. (2001) Characterization of Pseudomonas aeruginosa Isolates: Occurrence Rates, Antimicrobial Susceptibility Patterns, and Molecular Typing in the Global SENTRY Antimicrobial Surveillance Program, 1997-1999. Clinical Infectious Diseases, 32, S146-S155.
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http://dx.doi.org/10.1001/archinte.159.10.1127 [11] Goossens, H., Ferech, M., Vander Stichele, R. and Elseviers, M. (2005) Outpatient Antibiotic Use in Europe and Association with Resistance: A Cross-National Database Study. Lancet, 365, 579-587.
http://dx.doi.org/10.1016/S0140-6736(05)17907-0 [12] D’Agata, FEMC (2000) Antibiotic Resistance and Exposure to Different Generation Cephalosporins. The New England Journal of Medicine, 28, 2678-2681. [13] Fridkin, S., Steward, C., Edwards, J., Pryor, E., McGowan, J., Archibald, L., et al. (1999) Surveillance of Antimicrobial Use and Antimicrobial Resistance in United States Hospitals: Project ICARE Phase 2. Clinical Infectious Diseases, 29, 245-252.
http://dx.doi.org/10.1086/520193 [14] Paterson, D., Mulazimoglu, L., Casellas, J., Ko, W., Goossens, H., Von Gottberg, A., et al. (2005) Epidemiology of Ciprofloxacin Resistance and Its Relationship to Extended-Spectrum Beta-Lactamase Production in Klebsiella pneumoniae Isolates Causing Bacteremia. Clinical Infectious Diseases, 30, 473-478.
http://dx.doi.org/10.1086/313719 [15] Bradford, P. (2001) Extended-Spectrum Beta-Lactamases in the 21st Century: Characterization, Epidemiology, and Detection of This Important Resistance Threat. Clinical Microbiology Reviews, 14, 933-951.
http://dx.doi.org/10.1128/CMR.14.4.933-951.2001 [16] Giraud-Morin, C. and Fosse, T. (2003) A Seven-Year Survey of Klebsiella pneumoniae Producing TEM-24 Extended-Spectrum Beta-Lactamase in Nice University Hospital (1994-2000). Journal of Hospital Infection, 54, 25-31.
http://dx.doi.org/10.1016/S0195-6701(03)00038-0 [17] Pelczar, M., Reid, R. and Chan, E. (1957) Microbiology. T.M.H. Edition, Tata McGraw-Hill Publishing Company Ltd., Noida. [18] Cheesbrough, M. (2006) District Laboratory Practice in Tropical Countries. Part 2. Cambridge University Press, Cambridge, 434. [19] Bauer, A., Kirby, W., Sherris, J. and Turck, M. (1966) Antibiotic Susceptibility Testing by a Standardized Single Disk Method. American Journal of Clinical Pathology, 45, 493-496. [20] Clinical and Laboratory Standards Institute (2008) Performance Standards for Antimicrobial Susceptibility Testing; Eighteenth Informational Supplement (Document M100-S18). Vol. 4, The Clinical and Laboratory Standards Institute, Wayne, 354. [21] Ho, P., Chow, K., Yuen, K., Ng, W. and Chau, P. (1998) Comparison of a Novel, Inhibitor-Potentiated Disc-Diffusion Test with Other Methods for the Detection of Extended-Spectrum Beta-Lactamases in Escherichia coli and Klebsiella pneumoniae. Journal of Antimicrobial Chemotherapy, 42, 49-54.
http://dx.doi.org/10.1093/jac/42.1.49 [22] Ambler, R., Coulson, A., Frere, J., Ghuysen, J., Oris, J., Forsman, R., Levesques, R., Tirabi, G. and Waley, S. (1991) A Standard Numbering Scheme for the Class A Beta Lactamase. Biochemical Journal, 276, 269-272. [23] Bonnet, R. (2004) Growing Group of Extended Spectrum β-Lactamase: The CTX-M Enzymes. Antimicrobial Agents and Chemotherapy, 48, 1-14.
http://dx.doi.org/10.1128/AAC.48.1.1-14.2004 [24] Sivaraj, S., Murugesan, P., Muthuvelu, S., Purusothaman, S. and Silambarasan, A. (2011) Comparative Study of Pseudomonas aeruginosa Isolate Recovered from Clinical and Environmental Samples against Antibiotics. International Journal of Pharmacy & Pharmaceutical Science, 4, 103-110. [25] Anjum, F. and Mir, A. (2010) Susceptibility Pattern of Pseudomonas aeruginosa against Various Antibiotics. African Journal of Microbiology Research, 4, 1005-1012. [26] Krishnakumar, S., Rajan, R.A., Babu, M.M. and Bai, V.D.M. (2012) Antimicrobial Susceptibility Pattern of Extended Spectrum of Beta Lactamase (ESBL) Producing Uropathogens from Pregnant Women. Indian Journal of Medicine and Healthcare, 1, 188-192. [27] Mahmoud, A.B., Zahran, W.A., Hindawi, G.R., Labib, A. and Galal, R. (2013) Prevalence of Multidrug-Resistant Pseudomonas aeruginosa in Patients with Nosocomial Infections at a University Hospital in Egypt, with Special Reference to Typing Methods. Journal of Virology & Microbiology, 2013, 10-13. [28] Rakesh, M.R., Govind, N.L., Kalpesh, M., Rosy, P., Kanu, P. and Vegad, M.M. (2012) Antibioitc Resistance Pattern in Pseudomonas aeruginosa Species Isolated at a Tertiary Care Hospital, Ahmadabad. National Journal of Medical Research, 2, 156-159. [29] Angadi, K.M., Kadam, M., Modak, M.S., Bhatavdekar, S.M., Dalal, B.A., Jadhavvar, S.R., Tolpadi, A.G., Thakkar, V. and Shah, S.R. (2012) Detection of Antibiotic Resistance in Pseudomonas aeruginosa Isolates with Special Reference to Metallo β-Lactamases from A Tertiary Care Hospital in Western India. International Journal of Microbiology Research, 4, 295-298. [30] Raja, N.S. and Singh, N.N. (2007) Antimicrobial Susceptibility Pattern of Clinical Isolates of Pseudomonas aeruginosa in a Tertiary Care Hospital. Journal of Microbiology, Immunology and Infection, 40, 45-49. [31] Saderi, H., Lotfalipour, H., Owlia, P. and Salimi, H. (2010) Detection of Metallo-β-Lactamase Producing Pseudo monas aeruginosa Isolated from Burn Patients in Tehran, Iran. Laboratory Medicine, 41, 609-612.
http://dx.doi.org/10.1309/LMQJF9J3T2OAACDJ [32] Naqvi, Z.A., Hashmi, K., Rizwan, Q. and Kharal, S.A. (2005) Multi Drug Resistant Pseudomonas aeruginosa: A Nosocomial Infection Threat in Burn Patients. Pakistan Journal of Pharmacology, 22, 9-15. [33] Rashid, A., Chowdhury, A., Rahman, S.H.Z., Begum, S.A. and Muazzam, N. (2007) Infections by Pseudomonas aeruginosa and Antibiotic Resistance Pattern of the Isolates from Dhaka Medical College Hospital. Bangladesh Journal of Medical Microbiology, 1, 48-51. [34] Upadhyay, S., Sen, M.R. and Bhattacharjee, A. (2010) Presence of Different Beta-Lactamase Classes among Clinical Isolates of Pseudomonas aeruginosa Expressing AmpC Beta-Lactamase Enzyme. Journal of Infection in Developing Countries, 4, 239-242. [35] Moazami-Goudarzi, S. and Eftekhar, F. (2013) Assessment of Carbapenem Susceptibility and Multidrug-Resistance in Pseudomonas aeruginosa Burn Isolates in Tehran. Jundishapur Journal of Microbiology, 6, 162-165. [36] Anil, C. and Shahid, R.M. (2013) Antimicrobial Susceptibility Patterns of Pseudomonas aeruginona Clinical Isolates at a Tertiary Care Hospital in Kathmandu, Nepal. Asian Journal of Pharmaceutical and Clinical Research, 6, 235-238. [37] Pathmanathan, S.G., Samat, N.A. and Mohamed, R. (2009) Antimicrobial Susceptibility of Clinical Isolates of Pseudomonas aeruginosa from a Malaysian Hospital. Malaysian Journal of Medical Sciences, 16, 27-32.
[1] Favero, M.S., Carson, L.A., Bond, W.W. and Petersen, N.J. (1971) Pseudomonas aeruginosa: Growth in Distilled Water. Science, 173, 836-838.
http://dx.doi.org/10.1126/science.173.3999.836 [2] Remington, J.S and Schimpff, S.C. (1981) Please Don’t Eat Salads. The New England Journal of Medicine, 304, 433-435.
http://dx.doi.org/10.1056/NEJM198102123040730 [3] Joklik, K.W., Willet, P.H., Amos, B.D. and Catherine, M.W. (1992) Pseudomonas. Zinser Microbiology, 20, 576-583. [4] Berrouane, F.Y., McNutt, L., Buschellman, B.J., Rhomberg, P.R., Sanford, M.D., Hollis, R.J., Pfaller, M.A. and Herwaldt, L.A. (2000) Outbreak of Severe Pseudomonas aeruginosa Infection Caused by Contaminated Drains in a Whirlpool Bathtubs. Clinical Infectious Diseases, 31, 1331-1337.
http://dx.doi.org/10.1086/317501 [5] Anthony, M., Rose, B., Pegler, M.B., Elkins, M. Service, H., Thamotharampillai, K., Watson, J., Robinson, M., Bye, P., Merlino, J. and Harbour, C. (2002) Genetic Analysis of Pseudomonas aeruginosa Isolates from the Sputa of Australian Adult Cystic Fibrosis Patients. Journal of Clinical Microbiology, 40, 2772-2778.
http://dx.doi.org/10.1128/JCM.40.8.2772-2778.2002 [6] Kato, K., Iwai, S., Kumasaka, K., Horikoshi, A.,Inada, S., Inamatsu, T., Ono, Y., Nishiya, H., Hanatani, Y., Na rita, T., Sekino, H., and Hayashi, I. (2001) Survey of Antibiotic Resistance in Pseudomonas aeruginosa by the Tokyo Johoku Association of Pseudomonas Studies. Journal of Infection and Chemotherapy, 7, 258-262.
http://dx.doi.org/10.1007/s101560170024 [7] Aeschlimann, J. (2003) The Role of Multidrug Efflux Pumps in the Antibiotic Resistance of Pseudomonas aeruginosa and Other Gram-Negative Bacteria. Pharmacother, 23, 916-924.
http://dx.doi.org/10.1592/phco.23.7.916.32722 [8] Lister, P.D., Wolter, D.J. and Hanson, N.D. (2009) Antibacterial-Resistant Pseudomonas aeruginosa: Clinical Impact and Complex Regulation of Chromosomally Encoded Resistance Mechanisms. Clinical Microbiology Reviews, 22, 582-610.
http://dx.doi.org/10.1128/CMR.00040-09 [9] Gales, A.C., Jones, R.N., Turnidge, J., Rennie, R. and Ramphal, R. (2001) Characterization of Pseudomonas aeruginosa Isolates: Occurrence Rates, Antimicrobial Susceptibility Patterns, and Molecular Typing in the Global SENTRY Antimicrobial Surveillance Program, 1997-1999. Clinical Infectious Diseases, 32, S146-S155.
http://dx.doi.org/10.1086/320186 [10] Carmeli, Y., Troillet, N., Karchmer, A.W. and Samore, M.H. (1999) Health and Economic Outcomes of Antibiotic Resistance in Pseudomonas aeruginosa. JAMA Internal Medicine 159, 1127-1132.
http://dx.doi.org/10.1001/archinte.159.10.1127 [11] Goossens, H., Ferech, M., Vander Stichele, R. and Elseviers, M. (2005) Outpatient Antibiotic Use in Europe and Association with Resistance: A Cross-National Database Study. Lancet, 365, 579-587.
http://dx.doi.org/10.1016/S0140-6736(05)17907-0 [12] D’Agata, FEMC (2000) Antibiotic Resistance and Exposure to Different Generation Cephalosporins. The New England Journal of Medicine, 28, 2678-2681. [13] Fridkin, S., Steward, C., Edwards, J., Pryor, E., McGowan, J., Archibald, L., et al. (1999) Surveillance of Antimicrobial Use and Antimicrobial Resistance in United States Hospitals: Project ICARE Phase 2. Clinical Infectious Diseases, 29, 245-252.
http://dx.doi.org/10.1086/520193 [14] Paterson, D., Mulazimoglu, L., Casellas, J., Ko, W., Goossens, H., Von Gottberg, A., et al. (2005) Epidemiology of Ciprofloxacin Resistance and Its Relationship to Extended-Spectrum Beta-Lactamase Production in Klebsiella pneumoniae Isolates Causing Bacteremia. Clinical Infectious Diseases, 30, 473-478.
http://dx.doi.org/10.1086/313719 [15] Bradford, P. (2001) Extended-Spectrum Beta-Lactamases in the 21st Century: Characterization, Epidemiology, and Detection of This Important Resistance Threat. Clinical Microbiology Reviews, 14, 933-951.
http://dx.doi.org/10.1128/CMR.14.4.933-951.2001 [16] Giraud-Morin, C. and Fosse, T. (2003) A Seven-Year Survey of Klebsiella pneumoniae Producing TEM-24 Extended-Spectrum Beta-Lactamase in Nice University Hospital (1994-2000). Journal of Hospital Infection, 54, 25-31.
http://dx.doi.org/10.1016/S0195-6701(03)00038-0 [17] Pelczar, M., Reid, R. and Chan, E. (1957) Microbiology. T.M.H. Edition, Tata McGraw-Hill Publishing Company Ltd., Noida. [18] Cheesbrough, M. (2006) District Laboratory Practice in Tropical Countries. Part 2. Cambridge University Press, Cambridge, 434. [19] Bauer, A., Kirby, W., Sherris, J. and Turck, M. (1966) Antibiotic Susceptibility Testing by a Standardized Single Disk Method. American Journal of Clinical Pathology, 45, 493-496. [20] Clinical and Laboratory Standards Institute (2008) Performance Standards for Antimicrobial Susceptibility Testing; Eighteenth Informational Supplement (Document M100-S18). Vol. 4, The Clinical and Laboratory Standards Institute, Wayne, 354. [21] Ho, P., Chow, K., Yuen, K., Ng, W. and Chau, P. (1998) Comparison of a Novel, Inhibitor-Potentiated Disc-Diffusion Test with Other Methods for the Detection of Extended-Spectrum Beta-Lactamases in Escherichia coli and Klebsiella pneumoniae. Journal of Antimicrobial Chemotherapy, 42, 49-54.
http://dx.doi.org/10.1093/jac/42.1.49 [22] Ambler, R., Coulson, A., Frere, J., Ghuysen, J., Oris, J., Forsman, R., Levesques, R., Tirabi, G. and Waley, S. (1991) A Standard Numbering Scheme for the Class A Beta Lactamase. Biochemical Journal, 276, 269-272. [23] Bonnet, R. (2004) Growing Group of Extended Spectrum β-Lactamase: The CTX-M Enzymes. Antimicrobial Agents and Chemotherapy, 48, 1-14.
http://dx.doi.org/10.1128/AAC.48.1.1-14.2004 [24] Sivaraj, S., Murugesan, P., Muthuvelu, S., Purusothaman, S. and Silambarasan, A. (2011) Comparative Study of Pseudomonas aeruginosa Isolate Recovered from Clinical and Environmental Samples against Antibiotics. International Journal of Pharmacy & Pharmaceutical Science, 4, 103-110. [25] Anjum, F. and Mir, A. (2010) Susceptibility Pattern of Pseudomonas aeruginosa against Various Antibiotics. African Journal of Microbiology Research, 4, 1005-1012. [26] Krishnakumar, S., Rajan, R.A., Babu, M.M. and Bai, V.D.M. (2012) Antimicrobial Susceptibility Pattern of Extended Spectrum of Beta Lactamase (ESBL) Producing Uropathogens from Pregnant Women. Indian Journal of Medicine and Healthcare, 1, 188-192. [27] Mahmoud, A.B., Zahran, W.A., Hindawi, G.R., Labib, A. and Galal, R. (2013) Prevalence of Multidrug-Resistant Pseudomonas aeruginosa in Patients with Nosocomial Infections at a University Hospital in Egypt, with Special Reference to Typing Methods. Journal of Virology & Microbiology, 2013, 10-13. [28] Rakesh, M.R., Govind, N.L., Kalpesh, M., Rosy, P., Kanu, P. and Vegad, M.M. (2012) Antibioitc Resistance Pattern in Pseudomonas aeruginosa Species Isolated at a Tertiary Care Hospital, Ahmadabad. National Journal of Medical Research, 2, 156-159. [29] Angadi, K.M., Kadam, M., Modak, M.S., Bhatavdekar, S.M., Dalal, B.A., Jadhavvar, S.R., Tolpadi, A.G., Thakkar, V. and Shah, S.R. (2012) Detection of Antibiotic Resistance in Pseudomonas aeruginosa Isolates with Special Reference to Metallo β-Lactamases from A Tertiary Care Hospital in Western India. International Journal of Microbiology Research, 4, 295-298. [30] Raja, N.S. and Singh, N.N. (2007) Antimicrobial Susceptibility Pattern of Clinical Isolates of Pseudomonas aeruginosa in a Tertiary Care Hospital. Journal of Microbiology, Immunology and Infection, 40, 45-49. [31] Saderi, H., Lotfalipour, H., Owlia, P. and Salimi, H. (2010) Detection of Metallo-β-Lactamase Producing Pseudo monas aeruginosa Isolated from Burn Patients in Tehran, Iran. Laboratory Medicine, 41, 609-612.
http://dx.doi.org/10.1309/LMQJF9J3T2OAACDJ [32] Naqvi, Z.A., Hashmi, K., Rizwan, Q. and Kharal, S.A. (2005) Multi Drug Resistant Pseudomonas aeruginosa: A Nosocomial Infection Threat in Burn Patients. Pakistan Journal of Pharmacology, 22, 9-15. [33] Rashid, A., Chowdhury, A., Rahman, S.H.Z., Begum, S.A. and Muazzam, N. (2007) Infections by Pseudomonas aeruginosa and Antibiotic Resistance Pattern of the Isolates from Dhaka Medical College Hospital. Bangladesh Journal of Medical Microbiology, 1, 48-51. [34] Upadhyay, S., Sen, M.R. and Bhattacharjee, A. (2010) Presence of Different Beta-Lactamase Classes among Clinical Isolates of Pseudomonas aeruginosa Expressing AmpC Beta-Lactamase Enzyme. Journal of Infection in Developing Countries, 4, 239-242. [35] Moazami-Goudarzi, S. and Eftekhar, F. (2013) Assessment of Carbapenem Susceptibility and Multidrug-Resistance in Pseudomonas aeruginosa Burn Isolates in Tehran. Jundishapur Journal of Microbiology, 6, 162-165. [36] Anil, C. and Shahid, R.M. (2013) Antimicrobial Susceptibility Patterns of Pseudomonas aeruginona Clinical Isolates at a Tertiary Care Hospital in Kathmandu, Nepal. Asian Journal of Pharmaceutical and Clinical Research, 6, 235-238. [37] Pathmanathan, S.G., Samat, N.A. and Mohamed, R. (2009) Antimicrobial Susceptibility of Clinical Isolates of Pseudomonas aeruginosa from a Malaysian Hospital. Malaysian Journal of Medical Sciences, 16, 27-32.