Skip to main content

Prevalence of multi-drug resistant (MDR) and extensively drug-resistant (XDR) phenotypes of Pseudomonas aeruginosa and Acinetobacter baumannii isolated in clinical samples from Northeast of Iran



Multi and extensively drug-resistant (MDR and XDR), Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter baumannii (A. baumannii) are two main causative agents of nosocomial infections leading to increased morbidity and mortality. We aim to study the prevalence of MDR and XDR-A. baumannii and P. aeruginosa phenotypes in clinical specimens. We conducted this for 1 year (2017–2018) and isolated bacteria from the clinical samples. Then, XDR and MDR strains were determined by susceptibility testing (disc diffusion).


Out of 3248 clinical samples, A. baumannii and P. aeruginosa strains were detected in 309(9.51%) of them. Susceptibility testing indicated that (16.50%) and (15.53%) of the P. aeruginosa and (74.75%) and (73.13%) of the A. baumannii isolates were screened as the MDR and XDR strains. The frequency of MDR isolates was higher in wound samples 222 (71.8%). This rate in behavioral intensive care unit (BICU) and restoration ward, were 187 (60.5%) and 63 (20.4%). The frequency of XDR isolates in BICU 187 (59.54%), restoration 58(18.77%), and burns 30 (9.70%) were assessed as well. Considering high isolation rates of MDR and XDR of mentioned strains, it is necessary to apply prevention criteria for eradication of the mentioned bacteria from hospital wards.


In recent years, hospital-acquired infections have become one of the most common causes of mortality and morbidity [1,2,3]. Due to the increasing rates of antibiotic resistant Gram-negative infections, selection of therapeutic options against mentioned infections is restricted [4]. In Europe, published studies estimates that resistant bacterial healthcare-acquired infections account for an estimated nearly 400,000 patients each year. [5,6,7]. Mortality rates of P. aeruginosa as a frequent causative agent of 10–15% of nosocomial infections have been estimated to range from 18 to 61% [8, 9]. Recently, increasing of the MDR—A. baumannii as another non-fermentative Gram-negative bacilli in nosocomial infections has been demonestrared [8]. XDR bacterium associated infections treatment, because of limitations to effective antimicrobial agents administration, is still challenging and lead to significant infection control problems [10, 11]. Rates of MDR—P. aeruginosa are increasing in United States of America (4% in 1993 to 14% in 2002 and Italy (2.1% in 2007 to 4.1% in 2010) [4]. Moreover, MDR Paeruginosa account for 13–19% of hospital acquired infections (HAIs) each year in the US. Mortality rates between 2007 and 2009 was estimated 46.1%) [12, 13]. MDR—P. aeruginosa isolates in South America and Malaysia were estimated as 8.2% and 6.9%, as well [4]. Throughout last decades, MDR—A. baumannii phenotypes due to antibiotic resistant characteristics, environmental durability, and dissemination capability within health care facilities are assigned as morbidity and mortality related infection causative agent [14]. As example, mortality rate of MDR—A. baumannii in bacteremia was estimated to be 21.2% [15]. Mortality ranging from 5% in general wards to 54% in intensive care units (ICUs) is associated with A. baumannii infections [11, 16]. Cleaning and observing disinfection procedures are the main approaches to prevent nosocomial infections, otherwise, the rate of antibiotic—resistant bacteria would be constantly increased making the treatment process problematic, which may lead to longer duration of hospitalization, increased treatment costs, and also higher rates of mortality [17,18,19]. Accordingly, regarding the undeniable role of MDR and XDR—P. aeruginosa and A. baumannii isolates in the development of hospital acquired infections and their high resistance to several antibiotics, the present study was conducted to evaluate the prevalence of mentioned phenotypes and their antibiotic susceptibility patterns.

Main text

Materials and methods

Samples collection and culture

In the current cross-sectional study, a total of 3248 clinical samples including wound, urine, sputum, blood, feces, and trachea were collected from January 2017 to December 2018 from a burn center hospital, northeast of Iran. Samples were cultured on selective media including MacConkey agar, and Thioglycollate broth, by Liofilchem, Italy (24 h on 37 °C) based on bacteriology standards.

Identification of Bacterial Isolates

Isolates were identified based on the Bergeys̓ microbiology book guidelines [20]. In brief, conventional biochemical tests including oxidase, catalase, motility, metabolic procedure such as citrate, Indol production, Methyl red, Voges–Proskauer, and presence of lysine decarboxylase, and arginine dehydrogenase enzymes were performed.

Re-confirmation of P. aeruginosa and A. baumannii isolates by PCR

Molecular identification of P. aeruginosa and A. baumannii was performed by targeting the gene for P. aeruginosa and A. baumannii isolates using specifically designed primers (P. aeruginosa 16sDNA and blaOXA-51 to A. baumannii) which produced a 956 and 353 bp PCR product [21, 22]. Amplification was done based on the mentioned references [21, 22] with slight modification on the Gene Amp PCR system (Applied Biosystem, USA) in the total volume of 25 μl containing 14 μl master amplicon (Biolab, New England, UK), 1 pmol of each forward and reverse primers, a minor amount of colony as a template and 9 μl distilled water. The first cycle of denaturation was at 95 °C for 5 min, followed by 25 cycles at 94 °C for 1 min, then at 58 °C, (55 for blaoxa51) for 1 min, at 72 °C for 60 s, and finally a terminal extension for 5 min. PCR products were visualized by 1% agarose gel (KBC, Max Pure agarose, Spain) containing 0.5 µg/mL DNA Safe Stain dye in gel image analysis system (UVitec, Cambridge, UK). A. baumannii ATCC 19606 and P. aeruginosa ATCC 27853 were used as the positive and negative control strains, respectively.

Antibiotic susceptibility tests

Isolates confirmed as P. aeruginosa and A. baumannii by biochemical and molecular tests underwent the disc diffusion susceptibility test based on the clinical and laboratory standards institute (CLSI, M100S 26th edition breakpoints) guidelines [23]. In short, a 0.5 McFarland suspension of each isolate was inoculated on a whole plate surface Mueller–Hinton agar plate by streaking the swab in back and forth motions. Antimicrobial impregnated discs including amikacin (30 μg), ceftazidime (30 μg), cephalexin (30 μg), ciprofloxacin (5 μg), imipenem (10 μg), meropenem (10 μg), gentamycin (10 μg), tobramycin (10 μg), and cotrimoxazole (25 μg) were put on the surface of the agar, and the plates were incubated for 24 h at 37 °C. Following incubation, inhibition zone sizes to the nearest millimeter were measured using a ruler. Using published CLSI guidelines, susceptibility, or resistance of the organism to each tested drug was determined. Interpretation of Antibiotic susceptibility to evaluated MDR and XDR isolates was performed based on the european centre for disease prevention and control (ECDC) instructor as well [24].

Statistical analysis

In this study, we are using a Chi squared test, (χ2 test). Statistical analysis of results was accomplished by using SPSS version 19 and a P value < 0.05 was considered significant.


309 (9.51%) P. aeruginosa and A. baumannii isolates from clinical-samples were collected in a main center (Zareh Burn Hospital). 234 (75.7%) and 75 (24.3%) were identified respectively as A. baumannii and P. aeruginosa, using biochemical tests. All the isolates were then reconfirmed by PCR.

Isolates were collected from patients with mean age of 49.8 years old. Out of 309 obtained isolates, 246 (79.6%) of them were from wound, 29 (9.4%) of them were from urine, and 24 (7.8%) and 10 (3.2%) of them were from blood and sputum, respectively. Susceptibility testing indicated that, 48 (15.53%) and 23 (7.44%) of the P. aeruginosa isolates were screened as imipenem resistant and susceptible strains. The mentioned rates of the isolated A. baumannii against imipenem were 228 (97.4%) and 5 (2.1%). 228(97.4%) of A. baumannii isolates and 47 (62.7%) of P. aeruginosa isolates were resistant against ciprofloxacin, the data showed. Detailed data are listed in Table 1.

Table 1 Antibiotic susceptibility patterns of isolated P. aeruginosa and A. baumannii strains

According to the susceptibility testing results, 231 (74.75%) of A. baumannii and 51(16.50%) P. aeruginosa isolated strains were categorized as MDR strains. The prevalence of XDR—A. baumannii and P. aeruginosa strains were 226 (73.13%) and 48 (15.53%), respectively (Table 2).

Table 2 Prevalence of MDR and XDR isolated strain according to the gender

The frequency of MDR isolates in this main center was higher in wound samples 222 (71.8%).MDR strains in behavioral intensive care unit (BICU) 187 (60.5%) and restoration ward 63 (20.4%) more isolated than other hospital wards. The frequency of XDR isolates in BICU 184 (59.54%), restoration 58 (18.77%), and burns 30 (9.70%) were assessed as well. Detailed data according to the age/ward and clinical specimens of MDR and XDR isolates are listed in Additional files 1 and 2.

Considering the relationship between age and sex with resistance to different antibiotics, only aminoglycoside and meropenem resistant strains were statistically significant (P < 0.05).


Given the overuse of antibiotics in hospitals and constant rise in antibiotic resistance, to prevent new resistant strains appearance, evaluation of resistant isolates by susceptibility testing seems to be critical. Due to genetic alteration caused by unnecessarily prescribed antibiotics, resistance patterns could be different in each countries region [25]. Over the recent years, various articles have confirmed an increasing MDR features among P. aeruginosa isolates from burn hospitals [26]. Based on a previously published study [27] on P. aeruginosa in a burn center, high resistance patterns against ciprofloxacin (93.7%), and amikacin (82%) were observed. In the 79.2% of P. aeruginosa isolates, imipenem resistant pattern was observed. In a study conducted in 2013 at a burn hospital center of Gilan province in the northwest of Iran, the percentage of resistance to tested antibiotics was as follows; ceftazidime 57.5%, ciprofloxacin 65%, gentamycin 67.5%, piperacillin 87.5%, amikacin 90%, and imipenem 97.5%. In the current study, the frequency of the ciprofloxacin and amikacin resistant P. aeruginosa isolates were (62.7%) and (52%), respectively. Sixty-four percent of P. aeruginosa isolates was imipenem resistant, as well [27]. Corehtash reported that 93.1% of isolated strains were MDR-P. aeruginosa [27].

Based on the Nasimmoghadas et al., findings, P. aeruginosa isolates were almost resistant to all tested antibiotics, except polymixin B (2%) and ceftazidime (32%). Ninety-four percent and 85% of isolates of the mentioned study were assigned as MDR and XDR strains [24]. At the current research, MDR and XDR-P. aeruginosa isolates were estimated as 16.50% and 15.53% (n = 309). Other researchers found that totally, 45.3%, 30.1% and 5.46% of the isolates were MDR as well [28].

Preze et al., in 2019 by collecting fifty-nine P. aeruginosa from twelve different hospitals in Spain, Italy and Greece indicated that the prevalence of the XDR and MDR isolates in Greece samples was 88.9%. Totally, 19 (35.8%) P. aeruginosa isolates were XDR phenotype and 16 (30.2%) isolates were screened as MDR strains [29]. Another published study conducted by Saleem et al., in Pakistan which reported that, out of 88 P. aeruginosa isolates, 30.2%, 17.4% and 37.2% of them were resistant to imipenem, ciprofloxacin, and amikacin. Also, prevalence of MDR (36.3%) and XDR (18.1%) isolated strains were assessed [30]. The range of imipenem and ciprofloxacin resistant patterns in the current research were almost twice as the Saleem findings. The frequency of MDR and XDR isolates in our results were higher than the mentioned study too. There is a difference between our results and mentioned study findings. Improper antibiotic prescriptions in our hospital could be a possible reason for this variation.

Resistance to antibiotics in A. baumannii has reached alarming levels worldwide, particularly for carbapenems [10]. At the current study, tobramycin, ceftazidime, ciprofloxacin, and imipenem resistant A. baumannii were screened as follow; (97%), (96.6%), (97.4%) and (97%). MDR-A. baumannii and XDR-A. baumannii frequencies, in a published study in 2018, was 84% and 48% [31]. According to Hatami’s findings, up to 70% of A. baumannii isolates were resistant to tobramycin and ceftazidime. In addition, up to 50% and 80% of isolates were resistant to amikacin and imipenem [32]. Our findings to MDR and XDR-A. baumannii isolates revealed that, up to 89% of isolates were MDR (89.32%) and XDR (91.90%). MDR and XDR-A. baumannii frequencies in another published study were 83.9% and 16.1% [32]. Probably due to conducting improper infection control strategies in hospitals, the rate of resistance of A. baumannii against imipenem and meropenem has increased and become a major concern worldwide. Based on a previously published [32] study, all A. baumannii isolates were resistant to imipenem. This amount to meropenem was reported as 99.2% as well. According to the conducted study in Brazil in 2014, resistance rates of carbapenem resistant A. baumannii has been evaluated to be high (80.7%) [33]. Rossi and her colleagues by performing a cross-sectional study in Brazil in 2017 reported that between 2010 and 2014 a variation of 30% to 70% in carbapenem resistant A. baumannii was observed [34]. Romanin in 2019, by performing a study on 103 MDR-A. baumannii showed that carbapenem resistant A. baumannii isolates were the main part of MDR isolated strains (92.2%). The prevalence of XDR-A. baumannii strains in the mentioned study was estimated at 78.6% as well [35]. Our A. baumannii isolates demonstrated a high resistant pattern against carbapenems antibiotics as well (97%). The results presented similarity with the latest screenings of Brazilian researchers. Our finding confirms the observed data of the mentioned studies. In conclusion, high prevalence of MDR and XDR—P. aeruginosa and A. baumannii strains in the northeast of Iran regions is a serious concern in hospital wards. These findings highlight the need for hasty identification implement strict antimicrobial stewardship policies and strong microbiological surveillance procedures in the hospitals.


Responsible genes to antibiotic resistance and genetic relationship between the resistant strains are not determined and these are the limitation of this study.

Availability of data and materials

All the results of this study have been classified and maintained by the dissertation in the Mazandaran University of medical science. We have indeed provided all raw data on which our study is based. Competing Interests: The authors declare that they have no competing interests. All data generated or analysed during this study are included in this published article [and its supplementary information files.


MDR and XDR:

Multi and extensively drug-resistant

P. aeruginosa :

Pseudomonas aeruginosa

A. baumannii :

Acinetobacter baumannii


Behavioral intensive care unit


Hospital acquired infections


Intensive care units


Clinical and laboratory standards institute


European Centre for Disease Prevention and Control


  1. 1.

    Issler-Fisher AC, McKew G, Fisher OM, Harish V, Gottlieb T, Maitz PK. Risk factors for, and the effect of MRSA colonization on the clinical outcomes of severely burnt patients. Burns. 2015;41(6):1212–20.

    PubMed  Article  Google Scholar 

  2. 2.

    Hidalgo F, Mas D, Rubio M, Garcia-Hierro P. Infections in critically ill burn patients. Medicina Intensiva. 2016;40(3):179–85.

    CAS  PubMed  Article  Google Scholar 

  3. 3.

    Afkhamzadeh A, Majidi F, Ahmadi C: Risk factors for nosocomial infections among burn patients hospitalized in Tohid hospital, Sanandaj, Kurdistan Iran. ٠ج ٠٠د Ø § Ù Ø´ Ú© د Ù Ù¾Ø2Ø´ Ú© Û Ø¯ Ø § Ù Ø´ Ú¯ Ø § Ù Ø1Ù Ù Ù Ù¾Ø2Ø´ Ú© Û Ù Ø´ ٠د 2016, 59(4):225-232.

  4. 4.

    Nathwani D, Raman G, Sulham K, Gavaghan M, Menon V. Clinical and economic consequences of hospital-acquired resistant and multidrug-resistant Pseudomonas aeruginosa infections: a systematic review and meta-analysis. Antimicrob Resist Infect Contr. 2014;3(1):32.

    Article  Google Scholar 

  5. 5.

    Peleg AY, Hooper DC. Hospital-acquired infections due to gram-negative bacteria. N Engl J Med. 2010;362(19):1804–13.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  6. 6.

    Livermore DM. Has the era of untreatable infections arrived? J Antimicrob Chemother. 2009;64(1):29–36.

    Article  Google Scholar 

  7. 7.

    Zhanel GG, DeCorby M, Adam H, Mulvey MR, McCracken M, Lagacé-Wiens P, Nichol KA, Wierzbowski A, Baudry PJ, Tailor F. Prevalence of antimicrobial-resistant pathogens in Canadian hospitals: results of the Canadian Ward Surveillance Study (CANWARD 2008). Antimicrob Agents Chemother. 2010;54(11):4684–93.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  8. 8.

    Armin S, Karimi A, Fallah F, Tabatabaii SR, Alfatemi SMH, Khiabanirad P, Shiva F, Fahimzad A, Rahbar M, Mansoorghanaii R. Antimicrobial resistance patterns of Acinetobacter baumannii, Pseudomonas aeruginosa and Staphylococcus aureus isolated from patients with nosocomial infections admitted to tehran hospitals. Arch Pediatr Infect Dis. 2015;3:4.

    Article  Google Scholar 

  9. 9.

    Strateva T, Yordanov D. Pseudomonas aeruginosa—a phenomenon of bacterial resistance. J Med Microbiol. 2009;58(9):1133–48.

    CAS  PubMed  Article  Google Scholar 

  10. 10.

    Royer S, de Campos PA, Araújo BF, Ferreira ML, Gonçalves IR, da Fonseca Batistao DW, Cerdeira LT, Machado LG, de Brito CS, Gontijo-Filho PP. Molecular characterization and clonal dynamics of nosocomial blaOXA-23 producing XDR Acinetobacter baumannii. PLoS ONE. 2018;13(6):e0198643.

    PubMed  PubMed Central  Article  Google Scholar 

  11. 11.

    Doi Y, Husain S, Potoski BA, McCurry KR, Paterson DL. Extensively drug-resistant Acinetobacter baumannii. Emerg Infect Dis. 2009;15(6):980.

    PubMed  PubMed Central  Article  Google Scholar 

  12. 12.

    Raman G, Avendano EE, Chan J, Merchant S, Puzniak L. Risk factors for hospitalized patients with resistant or multidrug-resistant Pseudomonas aeruginosa infections: a systematic review and meta-analysis. Antimicrobial Resistance & Infection Control. 2018;7(1):79.

    Article  Google Scholar 

  13. 13.

    Matos EC, Andriolo RB, Rodrigues YC, Lima PD, Carneiro IC, Lima KV. Mortality in patients with multidrug-resistant Pseudomonas aeruginosa infections: a meta-analysis. Rev Soc Bras Med Trop. 2018;51(4):415–20.

    PubMed  Article  Google Scholar 

  14. 14.

    da Silva KE, Maciel WG, Croda J, Cayô R, Ramos AC, de Sales RO, Kurihara MNL, Vasconcelos NG, Gales AC, Simionatto S. A high mortality rate associated with multidrug-resistant Acinetobacter baumannii ST79 and ST25 carrying OXA-23 in a Brazilian intensive care unit. PLoS ONE. 2018;13(12):e0209367.

    PubMed  PubMed Central  Article  Google Scholar 

  15. 15.

    Yang S, Sun J, Wu X, Zhang L: Determinants of mortality in patients with nosocomial Acinetobacter baumannii bacteremia in Southwest China: a five-year case-control study. Can J Infect Dis Med Microbiol. 2018, 2018.

  16. 16.

    Bassetti M, Righi E, Esposito S, Petrosillo N, Nicolini L: Drug treatment for multidrug-resistant Acinetobacter baumannii infections. 2008.

  17. 17.

    Gastmeier P, Schwab F, Bärwolff S, Rüden H, Grundmann H. Correlation between the genetic diversity of nosocomial pathogens and their survival time in intensive care units. J Hosp Infect. 2006;62(2):181–6.

    CAS  PubMed  Article  Google Scholar 

  18. 18.

    Anusha S, Vijaya L, Pallavi K, Manna P, Mohanta G, Manavalan R. An Epidemiological study of surgical wound infections in a surgical unit of tertiary care teaching hospital. Indian J Pharm Pract. 2010;3:4.

    Google Scholar 

  19. 19.

    Akya A, Jafari S, Ahmadi K, Elahi A. Frequency of blaCTX-M, blaTEM and blaSHV genes in Citrobacters isolated from Imam Reza Hospital in Kermanshah. J Mazandaran Univ Med Sci. 2015;25(127):65–73.

    Google Scholar 

  20. 20.

    Parte A. Bergey’s manual of systematic bacteriology: actinobacteria. New York: Springer; 2012.

    Google Scholar 

  21. 21.

    Spilker T, Coenye T, Vandamme P, LiPuma JJ. PCR-based assay for differentiation of Pseudomonas aeruginosa from other Pseudomonas species recovered from cystic fibrosis patients. J Clin Microbiol. 2004;42(5):2074–9.

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  22. 22.

    AmirMoezi H, Javadpour S, Golestani F. Identification of different species of Acinetobacter Strains, and determination of their antibiotic resistance pattern and MIC of Carbapenems by E-Test. Hormozgan Med J. 2016;20(1):45–51.

    Google Scholar 

  23. 23.

    Patel J, Weinstein M, Eliopoulos G, Jenkins S, Lewis J, Limbago B. M100 Performance standards for antimicrobial susceptibility testing. United State: Clinical and Laboratory Standards Institute; 2017. p. 240.

    Google Scholar 

  24. 24.

    ECDC: Antimicrobial Resistance Surveillance in Europe 2014. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). In.: ECDC Stockholm, Sweden; 2017.

  25. 25.

    Ramazanzadeh R, Moradi G, Zandi S, Mohammadi S, Rouhi S, Pourzare M, Mohammadi B. A survey of contamination rate and antibiotic resistant of Gram-negative bacteria isolated from patients in various wards of Toohid and Besat Hospitals of Sanandaj city during 2013-2014 years. Pajouhan Sci J. 2016;14(3):11–9.

    Article  Google Scholar 

  26. 26.

    Nasirmoghadas P, Yadegari S, Moghim S, Esfahani BN, Fazeli H, Poursina F, Hosseininassab SA, Safaei HG. Evaluation of biofilm formation and frequency of multidrug-resistant and extended drug-resistant strain in Pseudomonas aeruginosa isolated from burn patients in Isfahan. Adv Biomed Res. 2018;7:61.

    PubMed  PubMed Central  Article  Google Scholar 

  27. 27.

    Corehtash ZG, Ahmad Khorshidi FF, Akbari H, Aznaveh AM. Biofilm formation and virulence factors among Pseudomonas aeruginosa isolated from burn patients. Jundishapur J Microbiol. 2015;8:10.

    Google Scholar 

  28. 28.

    Nikokar I, Tishayar A, Flakiyan Z, Alijani K, Rehana-Banisaeed S, Hossinpour M, Amir-Alvaei S, Araghian A. Antibiotic resistance and frequency of class 1 integrons among Pseudomonas aeruginosa, isolated from burn patients in Guilan, Iran. Iran J Microbiol. 2013;5(1):36.

    PubMed  PubMed Central  Google Scholar 

  29. 29.

    Pérez A, Gato E, Pérez-Llarena J, Fernández-Cuenca F, Gude MJ, Oviaño M, Pachón ME, Garnacho J, González V, Pascual Á, et al. High incidence of MDR and XDR Pseudomonas aeruginosa isolates obtained from patients with ventilator-associated pneumonia in Greece, Italy and Spain as part of the MagicBullet clinical trial. J Antimicrob Chemother. 2019;74(5):1244–52.

    PubMed  Article  Google Scholar 

  30. 30.

    Saleem S, Bokhari H. Resistance profile of genetically distinct clinical Pseudomonas aeruginosa isolates from public hospitals in central Pakistan. J Infect Public Health. 2019;13(4):598–605.

    PubMed  Article  Google Scholar 

  31. 31.

    Hatami R. The frequency of multidrug-resistance and extensively drug-resistant Acinetobacter baumannii in west of Iran. J Clin Microbiol Infect Dis. 2018;2:1.

    Google Scholar 

  32. 32.

    Monfared AM, Rezaei A, Poursina F, Faghri J: Detection of Genes Involved in Biofilm Formation in MDR and XDR Acinetobacter baumannii Isolated from Human Clinical Specimens in Isfahan, Iran. Arch Clin Infect Dis (In Press).

  33. 33.

    Vasconcelos ATR, Barth AL, Zavascki AP, Gales AC, Levin AS, Lucarevschi BR, Cabral BG, Brasiliense DM, Rossi F, Furtado GH. The changing epidemiology of Acinetobacter spp. producing OXA carbapenemases causing bloodstream infections in Brazil: a BrasNet report. Diagn Microbiol Infect Dis. 2015;83(4):382–5.

    CAS  PubMed  Article  Google Scholar 

  34. 34.

    Rossi F, Girardello R, Cury AP, Di Gioia TSR, de Almeida Jr JN, da Silva Duarte AJ. Emergence of colistin resistance in the largest university hospital complex of São Paulo, Brazil, over five years. Brazil J Infect Dis. 2017;21(1):98–101.

    Article  Google Scholar 

  35. 35.

    Romanin P, Palermo RL, Cavalini JF, et al. Multidrug-and Extensively Drug-Resistant Acinetobacter baumannii in a Tertiary Hospital from Brazil: the importance of carbapenemase encoding genes and epidemic clonal complexes in a 10-year study. Microbial Drug Resist. 2019;25(9):1365–73.

    CAS  Article  Google Scholar 

Download references


The authors wish to student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari Iran acknowledge and Zareh hospital staffs. The authors are grateful for the support of colleagues in Bacteriology and virology Departments at Zanjan University of Medical Sciences.


Not applicable.

Author information




Contributions of the authors in this study were as follow: BM: Supervision, Data curation, Writing—Original draft preparation Conceptualization, Methodology. ZNB: Sample collection, laboratory test performing. HRG: Performing laboratory tests. FI: laboratory tests performing, Software, Validation. FM: Performing laboratory tests. RB: Performing laboratory tests. All authors read and approved the manuscript.

Corresponding author

Correspondence to Bahman Mirzaei.

Ethics declarations

Ethics approval and consent to participate

This study was approved by Mazandaran University of Medical Sciences ethics committee All performed on the enlarged ethical statement IR.MAZUMS.REC.1398.015 meeting number at Mazandaran University of Medical Sciences. In this study, all ethics including Ethics and Consent to participate from the parents was written.

Consent to publication

Not applicable.

Competing interests

The authors announce that they have no difference in interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Additional file 1.

Frequency of MDR—P. aeruginosa and A. baumannii isolates regarding to the age, wards and clinical samples.

Additional file 2.

Frequency of XDR—P. aeruginosa and A. baumannii isolates regarding to the age, wards and clinical samples.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mirzaei, B., Bazgir, Z.N., Goli, H.R. et al. Prevalence of multi-drug resistant (MDR) and extensively drug-resistant (XDR) phenotypes of Pseudomonas aeruginosa and Acinetobacter baumannii isolated in clinical samples from Northeast of Iran. BMC Res Notes 13, 380 (2020).

Download citation


  • Multi-drug resistant (MDR)
  • Extensively-drug resistant (XDR)
  • Pseudomonas aeruginosa
  • Acinetobacter baumannii
  • Carbapenem resistant A. baumannii
  • Nosocomial infections