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The Role of MexCD-OprJ and MexEF-OprN Efflux Systems in the Multiple Antibiotic Resistance of Pseudomonas aeruginosa Isolated from Clinical Samples

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Abstract

Increasing antimicrobial resistance and the development of multi-drug resistant (MDR) Pseudomonas aeruginosa is dependent on the expression of efflux pumps. This study aimed to investigate the role of overexpression of MexCD-OprJ and MexEF-OprN efflux pumps in reduced susceptibility to antimicrobial agents among P. aeruginosa strains. Totally, 100 clinical isolates of P. aeruginosa were collected from patients and the strains were identified by standard diagnostic tests. The MDR isolates were detected using the disk agar diffusion method. The expression levels of MexCD-OprJ and MexEF-OprN efflux pumps were evaluated by the real-time PCR. Forty-one isolates showed MDR phenotype, while piperacillin-tazobactam and levofloxacin were the most- and least-effective antibiotics, respectively. Also, all 41 MDR isolates showed a more than tenfold increase in the expression of mexD and mexF genes. In this study, a significant relationship was observed between the rate of antibiotic resistance, the emergence of MDR strains, and increasing the expression levels of MexEF-OprN and MexCD-OprJ efflux pumps (P < 0.05). Efflux systems mediated resistance was a noteworthy mechanism causative to multidrug resistance in P. aeruginosa clinical isolates. The study results demonstrated mexE and mexF overexpression as the primary mechanism conferring in the emergence of MDR phenotypes among P. aeruginosa strains. In addition, we also show that piperacillin/tazobactam exhibited a stronger ability in the management of infections caused by MDR P. aeruginosa in this area.

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Acknowledgements

We thank the laboratory staffs of studied hospitals for assist in the collection of the clinical isolates.

Funding

This work was financially supported by Mazandaran University of Medical Sciences, Sari, Iran, with Grant No. 7064.

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Authors and Affiliations

  1. Molecular and Cell Biology Research Centre, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran

    Zeynab Jamal, Mehrdad Gholami & Hamid Reza Goli

  2. Department of Medical Microbiology and Virology, Faculty of Medicine, Mazandaran University of Medical Sciences, Farah Abad Blv, Khazar Square, Sari, Mazandaran, Iran

    Zeynab Jamal, Mehrdad Gholami & Hamid Reza Goli

  3. Pharmaceutical Sciences Research Center, School of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran

    Mohammad Ali Ebrahimzadeh

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  1. Zeynab Jamal
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Contributions

All authors (ZJ, MG. ME, HG) were equally contributed in preparing this article (the conception and design of the study, Data analysis and Manuscript drafting, editing). All authors read and approved the final manuscript.

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Correspondence to Hamid Reza Goli.

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The authors declare that they have no conflict of interest.

Ethics Approval

This research was approved by ethics committee of Mazandaran University of Medical Sciences, Sari, Iran under the ethics application IR.MAZUMS.REC.1399.181.

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This study was conducted in accordance with the Declaration of Helsinki, however written informed consent form was provided by the patients or a close relative before hospitalization, and categorizing information of each sample was reserved secret.

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Informed consent was obtained from all individual participants included in the study for publication of this research.

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Jamal, Z., Gholami, M., Ebrahimzadeh, M.A. et al. The Role of MexCD-OprJ and MexEF-OprN Efflux Systems in the Multiple Antibiotic Resistance of Pseudomonas aeruginosa Isolated from Clinical Samples. Curr Microbiol 80, 221 (2023). https://doi.org/10.1007/s00284-023-03330-z

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