Bacterial superinfection in cutaneous Leishmaniasis

Background and Aim : Pathogenic bacteria are risk factor for chronic lesion of cutaneousleishmaniasis. Rapid detection of drug resistant bacteria can also contribute to the success ofleishmaniasis treatment. The purpose of this study was determination of multiple drug resistancebacteria in leishmaniasis wounds.Methods : Totally ۱۴۹ wound specimens were cultured on Blood and MacConkey Agar.Identification tests such as gram staining, catalase, oxidase, triple sugar iron agar, citrate, SIM,urea agar and Methyl Red / Voges-Proskauer were used. The antimicrobial susceptibility testingto routine antibiotics by disk diffusion method and MIC( minimal inhibitory concentration),Extended spectrum beta-lactamases( ESBLs) and D-Zone test according to CLSI protocols andPCR (for mecA gene) were performed.Results : In a cross-sectional study( Nov ۲۰۲۱- July ۲۰۲۲), ۱۰۷ males and ۴۲ females were referredto Dezful Leishmaniasis Laboratory from different urban and rural areas. All patients had ulcersfor more than one month. Prevalence of bacterial secondry infection was ۶۱.۵% ( S.aureus ۷۳%,K.pneumonia ۱۴.۶%, E.cloacae ۱۰%, and P.mirabilis ۲.۴%). In S.aureus isolates resistance ratesto penicillin, Erythromycin, Ciprofloxacin, Clindamycin, Linezolid, Gentamicin, and Amikacinwere ۹۳.۳%, ۶۶.۷%, ۴۶.۷%, ۳۰%, ۱۳.۳%, ۱۲.۵%, ۱۲.۵%, respectively. In ۴ (۱۳.۳%) S.aureus wereresistance to clindamycin and positive D test. Teicoplanin MIC values were found between ۰.۱۹ -۱.۵ μg/ml in susceptibility ranges. Among the ۳۰ isolates of S. aureus, mecA gene (۳۵۳ bp) wasamplified in ۸ ( ۲۷%) strains as Methicillin-resistant Staphylococcus aureus (MRSA). In gramnegative bacteria, the cephalosporin or carbapenem resistance strains not detected but the ESBLsproduction were detected in ۲ K.pneumonia strains isolated from lesions similar to cutaneousleishmaniasis.Conclusion : Isolation of MRSA and inducible resistance to clindamycin from the samples ofpatients who had no history of hospitalization in the last ۶ months is an alarm for the health systemto use an effective treatment process to control and prevent the spread of these infections in thecommunity.

کلیدواژه ها:

Antibiotic resistance ، wound ، leishmaniasis ، MRSA ، ESBL ، PCR