{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T07:34:48Z","timestamp":1777880088641,"version":"3.51.4"},"reference-count":48,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Therapeutic Advances in Infection"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>\n                      <jats:italic toggle=\"yes\">Pseudomonas aeruginosa<\/jats:italic>\n                      is known to cause hospital-acquired infections. This bacterium produces \u03b2-lactamase enzymes that enzymatically degrade \u03b2-lactam drugs, reducing their efficacy.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>\n                      The objective of this investigation was to examine the occurrence, susceptibility, and production of various \u03b2-lactamases by multidrug-resistant\n                      <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                      (MDR-PA) and to determine the risk factors associated with extensively drug-resistant\n                      <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                      (XDR-PA) and their \u03b2-lactamases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>A descriptive cross-sectional study was conducted to investigate the occurrence, susceptibility, and \u03b2-lactamase production of MDR-PA and the risk factors associated with XDR-PA. The study involved collecting and analyzing 390 specimens from different 390 participants over a period from August 2021 to April 2023.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      The study utilized standard methodologies to screen and characterize\n                      <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                      . The antimicrobial-resistant patterns and presence of MDR-PA and XDR-PA were determined following standard guidelines supported by the Clinical Laboratory Standards Institute (CLSI) using various methods such as the disk diffusion method and colistin disk elution tests. Combined disk and inhibitor-based tests were used to determine extended-spectrum \u03b2-lactamases (ESBL), Metallo-\u03b2-lactamases (MBL), and AmpC-\u03b2-lactamases (AmpC) using two different methods. Clinical data were extracted from the medical records and patient requisition forms provided by clinicians. Clinical data were extracted for XDR-PA and \u03b2-lactamases applying binary logistic regression by adjusting for the confounding factors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      In our study, the antimicrobial-resistant pattern showed significant differences (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.05) in the antibiotic-resistant pattern among \u03b2-lactamase and non-\u03b2-lactamase. The prevalence of MBL-\n                      <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                      was determined to be 13.5%, while ESBL accounted for 23.8%, and\n                      <jats:italic toggle=\"yes\">AmpC<\/jats:italic>\n                      accounted for 20.5%. Coexistence of MBL\u2009+\u2009ESBL, ESBL\u2009+\u2009AmpC, MBL\u2009+\u2009\n                      <jats:italic toggle=\"yes\">AmpC<\/jats:italic>\n                      , and MBL\u2009+\u2009ESBL\u2009+\u2009\n                      <jats:italic toggle=\"yes\">AmpC<\/jats:italic>\n                      was determined to be 5.3%, 2.8%, 2.3%, and 4.1%, respectively. Among the nine assessed risk factors in a multivariate regression model, prolonged hospital stays (odd ratio\u2009=\u200911.2, 95% CI 3.7\u201333.8) provided substantial risk compared to other risk factors for the colonization of XDR-PA. Similarly, in a multivariate model, previous therapy with immunosuppressant drugs (OR\u2009=\u20096.7, 95% CI 1.5\u201329.3) was found to be the leading risk factor for the colonization of \u03b2-lactamase producers\n                      <jats:italic toggle=\"yes\">P. aeruginosa<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Identification of XDR-PA and \u03b2-lactamases among MDR-PA isolates is crucial to prevent the use of unnecessary antibiotics. Early and prompt diagnosis of drug-resistant pathogens prevents treatment failure and encourages proper antibiotic therapy. Therefore, it is necessary to implement strict policies on the use of antibiotics without proper diagnosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20499361251345920","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T06:17:04Z","timestamp":1750227424000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Multidrug-resistant\n                    <i>Pseudomonas aeruginosa<\/i>\n                    and its coexistence with \u03b2-lactamases at a tertiary care hospital in a low-resource setting: a cross-sectional study with an association of risk factors"],"prefix":"10.1177","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1778-4345","authenticated-orcid":false,"given":"Pragyan","family":"Dahal","sequence":"first","affiliation":[{"name":"Department of Microbiology, Grande International Hospital, Dhapasi, Kathmandu 44600, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahendra","family":"Shrestha","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Grande International Hospital, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manisha","family":"Maharjan","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Grande International Hospital, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ranjana","family":"Parajuli","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Grande International Hospital, Kathmandu, Nepal"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s40265-021-01635-6"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2024.1374466"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2017.00039"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.mib.2021.09.010"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.201906-459OC"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/tropicalmed8040205"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1186\/cc10425"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00031-19"},{"key":"e_1_3_4_10_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13756-018-0404-3","article-title":"Incidence and outcomes of multidrug-resistant gram-negative bacteria infections in intensive care unit from Nepal-a prospective cohort study","volume":"7","author":"Siwakoti S","year":"2018","unstructured":"Siwakoti S, Subedi A, Sharma A, et al. Incidence and outcomes of multidrug-resistant gram-negative bacteria infections in intensive care unit from Nepal-a prospective cohort study. Antimicrobial Resist Infect Control 2018; 7: 1\u20138.","journal-title":"Antimicrobial Resist Infect Control"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511543470"},{"key":"e_1_3_4_12_2","unstructured":"Meningitis Lab Manual: Primary culture and presumptive ID https:\/\/www.cdc.gov\/meningitis\/lab-manual\/chpt06-culture-id.html (2020 accessed 20 June 2021)."},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1099\/00221287-38-3-329"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-0-387-68233-4"},{"key":"e_1_3_4_15_2","unstructured":"Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing 35th ed CLSI supplement M100 Clinical and Laboratory Standards Institute 2024."},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2011.03570.x"},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0180121"},{"key":"e_1_3_4_18_2","unstructured":"EUCAST Guidelines: resistant mechanism [Internet] https:\/\/www.eucast.org\/resistance_mechanisms (2017 accessed March 2025)."},{"key":"e_1_3_4_19_2","article-title":"Genotypic and phenotypic detection of AmpC \u03b2-lactamases in Enterobacter spp. isolated from a teaching hospital in Malaysia","volume":"11","author":"Fatin Izzati MK","year":"2016","unstructured":"Fatin Izzati MK, Karunakaran R, Roshalina Rosli RR, et al. Genotypic and phenotypic detection of AmpC \u03b2-lactamases in Enterobacter spp. isolated from a teaching hospital in Malaysia. PLoS One 2016; 11: e0150643.","journal-title":"PLoS One"},{"issue":"2","key":"e_1_3_4_20_2","first-page":"81","article-title":"Comparison of four phenotypic methods for detection of metallo-\u03b2-lactamase-producing Gram-negative bacteria in rural teaching hospital","volume":"9","author":"Panchal CA","year":"2017","unstructured":"Panchal CA, Oza SS, Mehta SJ. Comparison of four phenotypic methods for detection of metallo-\u03b2-lactamase-producing Gram-negative bacteria in rural teaching hospital. J Lab Phys 2017; 9(2): 81\u201383.","journal-title":"J Lab Phys"},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.3855\/jidc.497"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.1592\/phco.28.2.235"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.3109\/1040841X.2010.481763"},{"key":"e_1_3_4_24_2","first-page":"20","article-title":"Phenotypic detection of metallo-beta-lactamase producing Pseudomonas aeruginosa strains isolated from burned patients","volume":"3","author":"Saderi H.","year":"2008","unstructured":"Saderi H., Karimi Z, Owlia P, et al. Phenotypic detection of metallo-beta-lactamase producing Pseudomonas aeruginosa strains isolated from burned patients. Iran J Pathol 2008; 3: 20\u201324.","journal-title":"Iran J Pathol"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00453-09"},{"key":"e_1_3_4_26_2","first-page":"707","article-title":"Simple screening tests for detection of carbapenemases in clinical isolates of nonfermentative Gram-negative bacteria","volume":"129","author":"Noyal MJ","year":"2009","unstructured":"Noyal MJ, Menezes GA, Harish BN, et al. Simple screening tests for detection of carbapenemases in clinical isolates of nonfermentative Gram-negative bacteria. Indian J Med Res 2009; 129: 707\u2013712.","journal-title":"Indian J Med Res"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-020-05224-w"},{"key":"e_1_3_4_28_2","doi-asserted-by":"crossref","unstructured":"Golemi-Kotra D. \u2018Pseudomonas infections\u2019 xPharm: The Comprehensive Pharmacology Reference 2008; pp. 1\u20138. doi:10.1016\/b978-008055232-3.63828-0.","DOI":"10.1016\/B978-008055232-3.63828-0"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-003-2096-1"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.31729\/jnma.6408"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.20546\/ijcmas.2016.510.081"},{"key":"e_1_3_4_32_2","article-title":"Antimicrobial susceptibility and prevalence of extended spectrum betalactamase (ESBL) and metallobetalactamase (MBL) and its co-existence among Pseudomonas aeruginosa recovered from ocular infections","volume":"7","author":"Murugan N","year":"2015","unstructured":"Murugan N, Malathi J, Therese KL, et al. Antimicrobial susceptibility and prevalence of extended spectrum betalactamase (ESBL) and metallobetalactamase (MBL) and its co-existence among Pseudomonas aeruginosa recovered from ocular infections. Int J Pharm Pharm Sci 2015; 7: 147e51.","journal-title":"Int J Pharm Pharm Sci"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.18203\/2320-6012.ijrms20150817"},{"issue":"1","key":"e_1_3_4_34_2","first-page":"85","article-title":"Occurrence of ESBL &Amp-C \u03b2-lactamases & susceptibility to newer antimicrobial agents in complicated UTI","volume":"127","author":"Taneja N","year":"2008","unstructured":"Taneja N, Rao P, Arora J, et al. Occurrence of ESBL &Amp-C \u03b2-lactamases & susceptibility to newer antimicrobial agents in complicated UTI. Indian J Med Res 2008; 127(1): 85\u201388.","journal-title":"Indian J Med Res"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.7860\/JCDR\/2012\/5016.2673"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1590\/S1517-83822010000300009"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.5812\/jjm.16436"},{"issue":"4","key":"e_1_3_4_38_2","article-title":"ESBL and MBL in cefepime resistant Pseudomonas aeruginosa: an update from a rural area in Northern India","volume":"10","author":"Kotwal A","year":"2016","unstructured":"Kotwal A, Biswas D, Kakati B, et al. ESBL and MBL in cefepime resistant Pseudomonas aeruginosa: an update from a rural area in Northern India. J Clin Diagn Res 2016; 10(4): DC09\u2013DC011.","journal-title":"J Clin Diagn Res"},{"issue":"1","key":"e_1_3_4_39_2","first-page":"005","article-title":"Rising antimicrobial resistance of Pseudomonas aeruginosa isolated from clinical specimens in India","volume":"6","author":"Chaudhary M","year":"2013","unstructured":"Chaudhary M, Payasi A. Rising antimicrobial resistance of Pseudomonas aeruginosa isolated from clinical specimens in India. J Proteom Bioinform 2013; 6(1): 005\u2013009.","journal-title":"J Proteom Bioinform"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.5812\/jjm.7178"},{"key":"e_1_3_4_41_2","first-page":"21","article-title":"Detection of different \u03b2-lactamases and their co-existence by using various discs combination methods in clinical isolates of Enterobacteriaceae and Pseudomonas spp","volume":"5","author":"Rawat V","year":"2013","unstructured":"Rawat V, Singhai M, Verma PK. Detection of different \u03b2-lactamases and their co-existence by using various discs combination methods in clinical isolates of Enterobacteriaceae and Pseudomonas spp. J Lab Phys 2013; 5: 21\u201325.","journal-title":"J Lab Phys"},{"key":"e_1_3_4_42_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0193431"},{"key":"e_1_3_4_43_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-018-0370-9"},{"key":"e_1_3_4_44_2","article-title":"Phenotypical detection of \u03b2-lactamases in a multidrug-resistant and extensively drug-resistant Chryseobacteriumindologens: a rare human pathogen with special references to risk factor","volume":"16","author":"Parajuli R","year":"2023","unstructured":"Parajuli R, Limbu T, Chaudhary R, et al. Phenotypical detection of \u03b2-lactamases in a multidrug-resistant and extensively drug-resistant Chryseobacteriumindologens: a rare human pathogen with special references to risk factor. MicrobiolInsights 2023; 16: 11786361221150755.","journal-title":"MicrobiolInsights"},{"key":"e_1_3_4_45_2","doi-asserted-by":"publisher","DOI":"10.2174\/157488512803988049"},{"issue":"1","key":"e_1_3_4_46_2","first-page":"39","article-title":"Prevalence and risk factors of Metallo \u03b2-lactamase producing Pseudomonas aeruginosa and Acinetobacter species in burns and surgical wards in a tertiary care hospital","volume":"4","author":"Kumar SH","year":"2012","unstructured":"Kumar SH, De AS, Baveja SM, et al. Prevalence and risk factors of Metallo \u03b2-lactamase producing Pseudomonas aeruginosa and Acinetobacter species in burns and surgical wards in a tertiary care hospital. J Lab Phys 2012; 4(1): 39\u201342.","journal-title":"J Lab Phys"},{"key":"e_1_3_4_47_2","first-page":"1","article-title":"Bacteriophage therapy against Pseudomonas aeruginosa biofilms: a review","volume":"19","author":"Chegini Z","year":"2020","unstructured":"Chegini Z, Khoshbayan A, Taati Moghadam M, et al. Bacteriophage therapy against Pseudomonas aeruginosa biofilms: a review. Annal Clin Microbiol Antimicrob 2020; 19: 1\u20137.","journal-title":"Annal Clin Microbiol Antimicrob"},{"key":"e_1_3_4_48_2","unstructured":"How to treat Pseudomonas aeruginosa naturally https:\/\/adelaidenaturopathic.com.au\/pseudomonas-aeruginosa\/ (2025 accessed January 2025)."},{"key":"e_1_3_4_49_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12866-024-03397-z"}],"container-title":["Therapeutic Advances in Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20499361251345920","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/20499361251345920","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/20499361251345920","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:01:27Z","timestamp":1777593687000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/20499361251345920"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,18]]},"references-count":48,"alternative-id":["10.1177\/20499361251345920"],"URL":"https:\/\/doi.org\/10.1177\/20499361251345920","relation":{},"ISSN":["2049-9361","2049-937X"],"issn-type":[{"value":"2049-9361","type":"print"},{"value":"2049-937X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,18]]},"article-number":"20499361251345920"}}