Antibiotic Resistance Rates Research Articles

The Prevalence of Fluoroquinolone-Resistant E. coli in Animals and Animal Products: A Systematic Review and Meta-Analysis

Background: Biological contamination of foods is a serious problem for human health. Animal and animal products may be contaminated by these biological and chemical contaminants. One of the most important causes of foodborne illness in humans is Escherichia coli. Fluoroquinolones can be used as a suitable treatment for enteric infections in food-producing livestock. We aimed to evaluate the current status of resistance of E. coli strains isolated from animals and animal products to fluoroquinolone in Iran. Methods: A systematic search was conducted using the Web of Science, PubMed, Embase, Google Scholar, and Scopus databases from 2000 to Oct 2020. Nineteen studies were selected based on the inclusion criteria and analysis by Comprehensive Meta-Analysis. Results: Based on the data analysis, The rates of antibiotic resistance in animal strains were as follows: Flumequine (75.1%), Enrofloxacin (55.2%), Danofloxacin (48.1%), Ciprofloxacin (48.4%), and Norfloxacin (52.9%). Next, the rates of quinolone resistance among E. coli strains isolated from animal products were Norfloxacin (45.5%), Ciprofloxacin (44.5%), and Enrofloxacin (60.9%). Based on the funnel plots and Egger's test, there was no significant publication bias. Conclusion: We finally concluded that antibiotic resistance in commensal E. coli is related to the overuse of antibiotics in livestock, especially fluoroquinolones.

Antibiotic resistance genes, colistin-resistant Escherichia coli, and physicochemicals in health care wastewater in Vinh Long General Hospital, Vietnam.

This study collected ten treated wastewater samples from Vinh Long General Hospital to determine their physicochemical characteristics and antibiotic properties. All treated wastewater samples collected during the monitoring periods complied with national regulations. In addition, these samples did not contain bacteria such as Salmonella, Shigella, and Vibrio cholerae. The investigation yielded a total of 25 Escherichia coli isolates. The E. coli isolates exhibied highest antibiotic resistance rate to ampicillin (100%), followed by ciprofloxacin, amoxicillin/clavulanic acid, and cefazolin (96%, 92%, and 92%, respectively). The resistance rate to fosfomycin was 88%, whereas 80% of the isolates were resistant to sulfamethoxazole-trimethoprim. The resistance rate to gentamicin was 72%, whereas that to imipenem and tetracycline was 52%. In addition, 44% isolates were resistant to chloramphenicol, and 32% of isolates were colistin-resistant. Among analyzed isolates, three were resistant to 10 of 11 tested antibiotics but only displayed intermediate resistance to imipenems (carbapenems). Surprisingly, 23 out of 25 isolates showed a positive ESBL phenotype. Eleven of them had both the blaTEM and blaCTX-M-1 group structural genes, while twelve only had the blaCTX-M-1 group gene. Furthermore, none of the isolated E. coli isolates exhibited the blaSHV gene. The minimum inhibitory concentration (MIC) of colistin exceeded 4μg/mL in 8 out of 25 (32%) isolates. Seven of eight isolates (87.5%) carried the mcr-1 gene, while one (12.5%) carried the mcr-8 gene. None of the other mcr (mcr-2 to mcr-9) genes were found.

Comprehensive Study of Antibiotic Resistance in Enterococcus spp.: Comparison of Influents and Effluents of Wastewater Treatment Plants

Background/Objectives: The spread of antibiotic resistance, particularly through Enterococcus spp., in wastewater treatment plants (WWTPs) poses significant public health risks. Given that research on antibiotic-resistant enterococci and their antibiotic-resistance genes in aquatic environments is limited, we evaluated the role of Enterococcus spp. in WWTPs by comparing the antibiotic resistance rates, gene prevalence, biofilm formation, and residual antibiotics in the influent and effluent using culture-based methods. Methods: In 2022, influent and effluent samples were collected from 11 WWTPs in South Korea. Overall, 804 Enterococcus strains were isolated, and their resistance to 16 antibiotics was assessed using the microdilution method. Results: High resistance to tetracycline, ciprofloxacin, kanamycin, and erythromycin was observed. However, no significant differences in the overall resistance rates and biofilm formation were observed between the influent and effluent. Rates of resistance to ampicillin, ciprofloxacin, and gentamicin, as well as the prevalence of the tetM and qnrS genes, increased in the effluent, whereas resistance rates to chloramphenicol, florfenicol, erythromycin, and tylosin tartrate, along with the prevalence of the optrA gene, decreased. E. faecium, E. hirae, and E. faecalis were the dominant species, with E. faecalis exhibiting the highest resistance. Conclusions: Our results suggest that WWTPs do not effectively reduce the rates of resistant Enterococcus spp., indicating the need for continuous monitoring and improvement of the treatment process to mitigate the environmental release of antibiotic-resistant bacteria.

"Molecular Characterization of Extended Spectrum Beta-Lactamase Resistance in Pediatric Shigella Isolates in Egypt".

Shigellosis is a major cause of morbidity and mortality among children, especially in developing countries. The increased extended-spectrum beta-lactamase (ESBL) resistance in Shigella poses a challenge for effective treatment. To examine the antibiotic resistance and ESBL profile of Shigella isolates from children with acute diarrhea. Shigella was isolated from stool cultures from pediatric patients suffering from acute diarrhea. The isolates were identified by bacteriological tests, serotyping, and multiplex polymerase chain reaction (PCR). The antimicrobial resistance was examined by disc diffusion. Phenotypic tests and PCR examined the ESBLs and CTX-M, SHV, and TEM genes. A total of 100 Shigella (10% prevalence rate) were isolated. The S. sonnei and S. dysenteries were the most prevalent species (33% and 31%, respectively), followed by S. flexneri (27%), and only 9% were S. boydii. The isolates had complete resistance (100%) to ampicillin. There was lower resistance to ciprofloxacin (24%), and no resistance to imipenem. By phenotypic tests, 54% of isolates had ESBL. By PCR, bla-CTX-M gene was the most prevalent (50%), followed by bla-TEM (48.1%). Only one isolate (1.9%) had the bla-SHV gene. The alarmingly high rates of antibiotic resistance and ESBL resistance among Shigella spp highlight the urgent need to restrict the unguided use of these drugs. Continuous monitoring of local and global antibiotic resistance patterns is required to prevent the spread of resistance.

Metagenomics and selective culture reveal the major transfer and prevalence of antibiotic resistance genes in Tibetan Plateau animals

The Tibetan Plateau, despite being the highest and least populated plateau on the Earth, harbors antibiotic-resistant bacteria (ARBs) as well as antibiotic resistance genes (ARGs) in its pristine environment and animals. There is, however, limited knowledge regarding antibiotic resistance in Tibetan Plateau animals. Here, fecal samples of grazing yaks and intestinal content samples of wild rats were collected at altitudes of 2920m and 4360m and subjected to selective culture, PCR, and metagenomic sequencing. The results revealed a higher antibiotic resistance rate in low-altitude regions than in high-altitude regions. The simultaneous presence of bacteria exhibiting different antibiotic resistance phenotypes across multiple samples suggests the potential emergence of multidrug-resistant strains within the animal gut microbiota. Pseudomonas spp. and Escherichia coli were the predominant ARBs. In contrast to low-altitude regions with frequent human activities, ARG dissemination in the Tibetan Plateau did not show a significant correlation with mobile genetic elements. ARGs in high-altitude regions relied more on vertical gene transmission. This study expands our knowledge of antibiotic resistance in grazing and wild animals inhabiting the Tibetan Plateau, thereby highlighting the potential threat posed by antibiotic resistance in this region.

Seven-year overview of antimicrobial resistance in diarrheagenic Escherichia coli from sporadic human diarrhea cases in 20 Chinese provinces

Diarrheagenic Escherichia coli is one of the most prevalent foodborne pathogens and poses significant clinical challenges due to increasing rates of antibiotic resistance. In this study, 9,068 diarrheagenic E. coli isolates from sporadic diarrhea cases across 20 provinces of China from 2016 to 2022 were systematically analyzed to determine the prevalence and distribution of resistance. A total of 14 antibiotics were included in the antimicrobial resistance surveillance. Antimicrobial susceptibility testing indicated that the majority of the isolates (89.3%) were resistant to at least one antimicrobial agent, with a significant proportion (60.3%) demonstrating multidrug resistance. Isolates showed high levels of resistance to ampicillin (68.2%) and high sensitivity to imipenem (97.0%). Over the 7 years, an increasing trend in resistance to cefoxitin and chloramphenicol among the isolates was found. Enteroaggregative E. coli was identified as the predominant pathotype. Furthermore, antimicrobial resistance rates were higher among the isolates from infants under 1 year of age compared to other populations and resistance levels differed among pathotypes. In summary, our findings revealed the detailed resistance characteristics of diarrheagenic E. coli strains isolated from human sporadic diarrhea cases in China, offering valuable insights that can inform clinical antibiotic treatment strategies and priorities.

Whole-genome sequencing analyses and antibiotic resistance situation of 48 Helicobacter pylori strains isolated in Zhejiang, China

PurposeIn the Zhejiang region, research on Helicobacter pylori is lacking. The purpose of this study was to assess the extent of antibiotic resistance in H. pylori in this region, explore alternative methods for predicting the resistance patterns of H. pylori, and investigate the colonization of native gastric mucosa by other clades of H. pylori in the structure population of this bacterium.MethodsStrains were cultured under microaerobic conditions, and antimicrobial susceptibility testing (AST) was performed via agar dilution. Whole-genome sequencing (WGS) was performed via next-generation sequencing (NGS) technology. Epidemiological data including data from this study and reported articles from Zhejiang, China, were included. Further analyses based on AST, WGS, and epidemiological date include virulence genes, antibiotic resistance-related mutations, and phylogenetic trees based on 7 housekeeping genes and core-genome single nucleotide polymorphisms (SNPs).ResultsThe bacterial isolates in this study presented higher antibiotic resistance rates than previously reported, especially against levofloxacin and clarithromycin. The point mutation A2147G in 23 S rRNA is specific to clarithromycin resistance. Mutations at position/s 87 and/or 91 of the gyrA gene amino acid sequence are highly consistent with levofloxacin resistance highly. The point mutations C1707T in 23 S rRNA and E463K in the gyrB gene have not been previously documented in China. All the bacterial isolates belong to Asian branches in the structure population. The resistance rate to clarithromycin of isolates from hosts born after January 1, 1977 is statistically higher than that of hosts born before 1977.ConclusionEradication therapy based on AST results is urgently needed in Zhejiang. The point mutation A2147G in 23 S rRNA and point mutations in the gyrA gene at amino acid/s 87 and/or 91 are sufficient for predicting resistance to clarithromycin and levofloxacin, respectively. The isolate with the mutation E463K in the gyrB gene represents a significant contribution to the field. Mutations in 23 S rRNA may offer valuable insights into the dynamics of H. pylori transmission among hosts.

Enterobacter cloacae Complex: An emerging pathogen with increasing rates of antibiotic resistance in a Tunisian Hospital

Enterobacter cloacae Complex: An emerging pathogen with increasing rates of antibiotic resistance in a Tunisian Hospital

Antibiotic susceptibility of uropathogens: a 3-year retrospective study at Ho Teaching Hospital of Ghana

BackgroundUrinary tract infection (UTI) remains one of the most treated infections in primary healthcare over the last two decades. The infection is treated with antibiotics. However, there have been reported cases of increasing antibiotic resistance globally, limiting the available antibiotics for the treatment of the infection. The study aimed to determine the frequency of bacterial urinary tract infections and their antibiotic resistance pattern in Ho Teaching Hospital of Ghana from 2019–2021.MethodologyData on urine culture and susceptibility testing and patient demographics from 2019–2021 were collected from the microbiology unit archives with a designed Microsoft Excel 2019 form and later exported to IBM SPSS (v26) for statistical analysis on the uropathogens and their antibiotic resistance pattern. P-value < 0.05 was considered statistically significant.ResultsOut of 4806 records, 1005 bacterial isolates were found, with a total prevalence of 20.91%. The most prevalent group of organisms was the Enterobacteriaceae, with E. coli 409 (40.70%) being the most frequent isolate. Of the 772 isolates subjected to amikacin, 48(6.22%) and 6(0.78%) of the Gram-negative and Gram-positive bacterial organisms showed resistance to the antibiotic respectively. 58.96% (148/251) and 3.59% (9/251) of Gram-negatives and Gram-positives were resistant to cotrimoxazole. Out of the 1005 bacterial isolates, 165(16.42%), 161(16.02%) and 2(0.20%) showed multidrug resistance (MDR), extensively-drug resistance (XDR), and pandrug resistance (PDR) respectively.ConclusionThere was a high antibiotic-resistant pattern among the uropathogens reported in this current study, hence, the Standard Treatment Guidelines may need to be updated to reflect the high rates of antibiotic resistance exhibited by most prevalent isolates.

Computational Exploration of Limonin as a Potential Inhibitor of DapB in Klebsiella pneumoniae.

Klebsiella pneumoniae has emerged as a significant multidrug-resistant pathogen, classified as a critical priority by the World Health Organization. The rising rates of antibiotic resistance have led to increased therapeutic failures, diminishing the effectiveness of existing antibiotics. Consequently, there is an urgent need for alternative treatments to effectively inhibit the growth of K. pneumoniae and mitigate associated diseases. Phytochemicals have demonstrated potential advantages over traditional antibiotics, prompting their exploration as innovative therapeutic agents. This study aimed to identify phytochemicals that can inhibit dapB, a vital enzyme in the lysine biosynthesis pathway of K. pneumoniae, which is essential for protein synthesis and the cross-linking of the bacterial peptidoglycan cell wall. We screened 17,934 phytochemicals based on Lipinski's Rule of Five, along with their Absorption, Distribution, Metabolism, Excretion properties and toxicological parameters. Next, we conducted triplicate docking studies against dapB to evaluate the library further. The most promising molecules then underwent 100 ns Molecular Dynamics simulations in triplicate, followed by binding free energy calculations to identify potential dapB inhibitors. This in silico analysis highlighted limonin as a promising inhibitor of dapB in K. pneumoniae. Further experimental validation is crucial to enhance limonin's potential as a novel therapeutic agent against K. pneumoniae-associated diseases.

Pattern Of Antibiotic Resistance In Urinary Tract Infections: Insights From A Tertiary Care Hospital In Bangladesh

Background: Urinary tract infections (UTIs) are one of the most common bacterial infections, with increasing rates of antibiotic resistance complicating treatment. This study aimed to assess the prevalence and antibiotic resistance patterns of uropathogens in patients with UTIs at a tertiary care hospital in Bangladesh. Methods: A cross-sectional, retrospective study was conducted from June, 2023 to July, 2024 involving 60 UTI patients. Clinical and microbiological data, including urine cultures and antibiotic susceptibility tests, were collected. Antibiotic susceptibility testing was performed using the Kirby-Bauer disk diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Data were analyzed using SPSS version 26.0. Results: Escherichia coli was the most frequently isolated pathogen (50.0%), followed by Klebsiella spp. (20.0%). Both pathogens exhibited high resistance to ciprofloxacin (66.7%) and amoxicillin (83.3%) (p &lt; 0.05). Pseudomonas spp. showed 66.7% resistance to ceftriaxone, and Proteus spp. exhibited 75.0% resistance to nitrofurantoin. However, E. coli and Klebsiella spp. demonstrated higher susceptibility to nitrofurantoin and gentamicin, with 50.0% and 66.7% susceptibility, respectively. Conclusion: The findings indicate a high prevalence of antibiotic-resistant uropathogens, particularly E. coli and Klebsiella spp., in the study population. Nitrofurantoin and gentamicin remain effective treatment options. These results highlight the urgent need for updated empirical treatment protocols and regular monitoring of resistance patterns to guide UTI management in Bangladesh.

Microbial profiling, antimicrobial resistance surveillance, and molecular detection of MecA gene in Staphylococcal strains from donor human milk: Insights from a milk bank investigation

PurposeDonor human milk (DHM) from milk banks provides vital nutrition to vulnerable infants. Understanding its microbial profile and antimicrobial resistance patterns is crucial for ensuring its safety and efficacy. This study aimed to profile the microbial composition, detect antibiotic resistance, and identify the presence of mecA gene in Staphylococcal strains from DHM samples. Materials and methodA total of 151 DHM samples were collected from a regional human milk bank in North India. Microbial identification was performed using MALDI TOF MS, and antimicrobial susceptibility testing was conducted using the disc diffusion method. Molecular methods, including PCR, were employed for mecA gene detection. ResultsThe study revealed a diverse microbial profile, with Staphylococcus species being predominant. Acinetobacter and Pseudomonas species were also prevalent, raising concerns due to their association with healthcare-associated outbreaks. High rates of antibiotic resistance were observed across both Gram-positive and Gram-negative bacteria, with resistance to commonly used antibiotics such as penicillin, clindamycin, erythromycin, and ceftriaxone. The mecA gene, associated with methicillin resistance, was detected in a significant proportion of Staphylococcal isolates. ConclusionThe study underscores the importance of rigorous microbial analysis and antimicrobial susceptibility testing in assessing the safety of DHM. The presence of diverse microbial species, including antibiotic-resistant strains and the mecA gene in Staphylococcal strains, emphasizes the need for stringent hygiene practices and continuous surveillance in milk banks. Implementing comprehensive screening protocols and adhering to best practices in milk handling and pasteurization are crucial for safeguarding the health of vulnerable infants reliant on donor milk.

KAJIAN RASIONALITAS PENGGUNAAN ANTIBIOTIK PADA ANAK DENGAN INFEKSI SALURAN KEMIH DI RSUD Dr. MOEWARDI SURAKARTA

Urinary tract infection (UTI) is the second highest infectious disease among children in Indonesia. Management of UTI requires antibiotic therapy, but the irrational use of antibiotics makes this disease one of the contributors to the high rate of antibiotic resistance. Therefore, there is a need for a study to measure the rationality of antibiotic use in children with UTI. This study is a descriptive observational study with a cross sectional design. Data were collected retrospectively using a purposive sampling technique based on medical record data of pediatric patients at Dr. Moewardi Surakarta Hospital in 2021-2023. The results showed that out of 100 medical records of pediatric patients with UTI, 68.00% were women and 32.00% were men. Based on age, the highest incidence of UTI occurred in the age range of 10-18 years as much as 52.00%. The most common antibiotic use was ampicillin 68.00%. The results of the rationality study showed 69.00% in category 0 (rational use of antibiotics). Irrationality occurred in category IIA (antibiotic use is not the right dose) 17.00%, IIIA (antibiotic use with too long duration) 1.00%, IIIB (antibiotic use with too short duration) 4.00%, IIA &amp; IIIB (antibiotic use is not the right dose &amp; duration is too short) 2.00%, IVA (there are other more effective antibiotic options) 4.00%, IIIB &amp; IVA (antibiotic use is too short duration &amp; there are other more effective antibiotic options) 3.00%. It can be concluded that the rational use of antibiotics needs to be improved.

Antibiotic susceptibility pattern of carbapenem resistant Escherichia coli and Klebsiella pneumoniae, 2019

The rise in the prevalence of carbapenem resistant bacteria worldwide has made the treatment of nosocomial infections challenging. This is because carbapenem resistant bacteria harbor multiple resistance genes aside the carbapenemase genes. This study was conducted to determine the susceptibility pattern of carbapenem resistant isolates of Escherichia coli and Klebsiella pneumoniae. Previously isolated and characterized carbapenem resistant E. coli and K. pneumoniae were screened for their susceptibility to ceftriaxone, trimethoprim-sulphamethoxazole, doxycycline, amikacin, gentamicin, nalidixic acid, chloramphenicol, colistin, tigecycline and fosfomycin by the Kirby Bauer technique. EUCAST and CLSI breakpoints were used to interpret the zones of inhibition. High level of resistance was observed among the isolates to ceftriaxone (100.00 %), trimethoprim-sulphamethoxazole (100.00 %) and doxycycline (83.33 %). Two-third of the isolates (66.67 %) were observed to be susceptible to amikacin, while 33.33 % of the isolates were gentamicin and nalidixic acid susceptible. Susceptibility to chloramphenicol and colistin was recorded in 16.67 % of the isolates while all the screened isolates (100.0 %) were susceptible to fosfomycin and tigecycline. A higher antibiotic resistance rate was observed among isolates habouring carbapenemase genes (blaNDM, blaOXA or both). The MAR indices of the carbapenem resistant isolates ranged between 0.46 and 0.82. So also, all the isolates screened were observed to be resistant to multiple antibiotics, hence MDR isolates. In conclusion, the carbapenem resistant isolates were resistant to multiple antibiotics but were however susceptible to tigecycline, fosfomycin and amikacin.

Bacterial Culture Results and Antibiograms in Chronic Rhinosinusitis Patients in Mekong Delta, Vietnam

Background The inappropriate use of antibiotics for chronic rhinosinusitis, exceeding established guidelines, is a growing concern in Vietnam. This practice is contributing to the emergence and spread of antibiotic-resistant bacteria. Objective This study aimed to evaluate the results of culture and antibiogram of bacteria on patients in the Mekong Delta, Vietnam, who were treated for chronic rhinosinusitis in 2022-2023. Methods It is a cross-sectional study, including 113 patients who came for treatment with a diagnosis of chronic rhinosinusitis at Can Tho University of Medicine and Pharmacy Hospital, Mekong Delta, Vietnam, from 2022-2023. The bacterial cultures were identified, and their antibiograms were performed in the Microbiology laboratory of Can Tho University of Medicine and Pharmacy. Statistical analysis was performed with SPSS version 20.0. Results The rate of bacterial growth was 97.35%. The cultured bacterial composition had 8 genera, 22 species, and 116 samples, of which 2 bacterial species were cultured, accounting for 5.45%. Antibiogram showed that Streptococcus pneumonia was resistant to cefaclor (83.33%), cefuroxime (100%), trimethoprim+ sulfamethoxazole (100%), and susceptible to chloramphenicol (100%) and vancomycin (100%). Streptococcus haemolyticus was resistant to amoxicillin+clavulanic acid (85.71%) and ampicillin (100%) and susceptible to linezolid (100%) and rifampin (100%). Streptococcus epidermidis was resistant to amoxicillin+clavulanic acid (82.35%), ampicillin (100%), penicillin (100%) and susceptible to linezolid (91.18%) and rifampin (88.24%). Streptococcus aureus was resistant to amoxicillin+clavulanic acid (95%) and ampicillin+sulbactam (90%), and susceptible to linezolid (90%) and synercid (95%). Pseudomonas aeruginosa was resistant to amikacin (100%), meropenem (100%) and tobramycin (90%). Conclusion This study offers some useful information to doctors in the Mekong Delta and across Vietnam. It can be used as a good orientation in choosing the most appropriate antibiotics for treating patients with chronic rhinosinusitis. It is important to be conscious of the current trend of the bacteriological profiles and to regulate the antibiotic treatment regime to improve the effectiveness and reduce antibiotic resistance rate.

Antibiotic susceptibility of orofacial infections in Bratislava: a 10-year retrospective study

ObjectivesAim of this study was to analyse causal microbiological agents and their bacterial resistance in orofacial infections requiring hospital admission.Materials and methodsPresented is a 10-year retrospective study of patients hospitalised at a single department in 2014–2023. 744 patients were involved. In the statistical analysis, following data was evaluated: causal microbes and their resistance to Penicillin, Amoxicillin-Clavulanate, Clindamycin and Metronidazole.ResultsMost frequent aetiology was odontogenic with causal tooth in socket (n = 468; 62,9%), followed by odontogenic – post extraction (n = 152; 20.4%), jaw fracture (n = 41; 5.5%), sialadenitis n = 31 (4.2%), osteonecrosis n = 22 (3.0%), oncological diagnosis in head and neck (n = 17; 2.3%), unknown (n = 10; 1.3%) and multiple factors (n = 3; 0.4%). 408 patients (54.8%) underwent extraoral abscess revision, 336 patients (45.2%) patients were treated locally without extraoral revision. In odontogenic group with tooth still present, superior CRP (m = 145.8 mg/l; SD = 117.7) and leukocyte values (m = 13.6*109l; SD = 6.6) were observed in comparison to other groups. There were 698 cultivated bacteria in 362 patients. Most frequent bacteria were Streptococci (n = 162; 23.2%), Prevotella (n = 83; 11.2%) and Parvimonas (n = 65; 9.3%). Clindamycin resistance was highest (n = 180 resistant bacteria; 25.8%), followed by Metronidazole (n = 178; 25.5%), Penicillin (n = 107; 15.3%) and Amoxicillin-Clavulanate (n = 34; 4.9%).ConclusionsOrofacial infections in head and neck region are mostly of odontogenic origin with causal tooth still in socket. Causal bacteria show a high antibiotic resistance rate, especially to Clindamycin and Metronidazole.Clinical RelevanceAcquired data will be used to determine guidelines for empirical antibiotic prescription in cases of orofacial infections.

Epidemiology, antimicrobial resistance profile and management of carbapenem-resistant Klebsiella pneumoniae among mothers with suspected sepsis in Ethiopia

BackgroundEarly detection and proper management of maternal sepsis caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) can significantly reduce severe complications and maternal mortality. This study aimed to describe the epidemiology, antimicrobial resistance profile, and management of carbapenem-resistant K. pneumoniae among sepsis-suspected maternal cases in Ethiopia.MethodsA prospective cross-sectional study was conducted in five tertiary hospitals from June 2021 to December 2023. Isolation, identification, and antimicrobial susceptibility testing of the isolates were carried out following standard microbiological procedures as stated in the CLSI guidelines. Data on socio-demographics, risk factors, and management strategies were collected with structured questionnaires. Associations between variables were determined using logistic regression analysis in STATA-21. A p-value of less than 0.05 was statistically significant.ResultsOf the 5613 total women suspected of having maternal sepsis, 609 (10.8%) of them were infected with K. pneumoniae. The prevalence rates of MDR, XDR, and PDR K. pneumoniae strains were 93.9%, 24.3%, and 10.9%, respectively. The resistance rates for the last-resort antibiotics; amikacin, tigecycline, carbapenem, and third-generation cephalosporin were 16.4%, 29.1%, 31.9%, and 93.0%, respectively. The combination of carbapenem with tigecycline or amikacin therapy was used to manage maternal sepsis caused by cephalosporin-and carbapenem-resistant strains. Sepsis associated risk factors, including septic abortion [AOR = 5.3; 95%CI:2.2–14.4]; extended hospitalization [AOR = 3.7; 95%CI: 1.6–19.4]; dilatation and curettage [AOR = 2.2; 95%CI:1.3–13.4]; cesarean wound infection [AOR = 4.1; 95%CI:2.0–9.2]; indwelling catheterization [AOR = 2.1;95%CI: 1.4–6.2]; ICU admission [AOR = 4.3; 95%CI:2.4–11.2]; post abortion [AOR = 9.8; 95%CI:5.7–16.3], and recurrent UTI [AOR = 3.3; 95%CI: 1.6–13.2] were significantly associated with maternal sepsis caused by K. pneumoniae.ConclusionsThe prevalence of maternal sepsis caused by carbapenem- resistant K. pneumoniae is high and serious attention needs to be given to combat transmission. Therefore, improving awareness, early diagnosis, IPC, integrated maternal surveillance, improved sanitation and efficient antimicrobial stewardship are crucial to combating bacterial maternal sepsis.

One decade of point-prevalence surveys for carriage of extended-spectrum beta-lactamase-producing enterobacterales: whole genome sequencing based prevalence and genetic characterization in a large Dutch teaching hospital from 2013 to 2022

ObjectivesTo determine the prevalence, trends, and potential nosocomial transmission events of the hidden reservoir of rectal carriage of extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E).MethodsFrom 2013 to 2022, yearly point prevalence surveys were conducted in a large Dutch teaching hospital. On the day of the survey, all admitted patients were screened for ESBL-E rectal carriage using peri-anal swabs and a consistent and sensitive selective culturing method. All Enterobacterales phenotypically suspected of ESBL production were analysed using whole genome sequencing for ESBL gene detection and clonal relatedness analysis.ResultsOn average, the ESBL-E prevalence was 4.6% (188/4,119 patients), ranging from 2.1 to 6.6% per year. The ESBL-prevalence decreased on average 5.5% per year. After time trend correction, the prevalence in 2016 and 2020 was lower compared to the other year. Among the ESBL-E, Escherichia coli (80%) and CTX-M genes (85%) predominated. Potential nosocomial transmission events could be found in 5.9% (11/188) of the ESBL-E carriers.ConclusionsThe ESBL-E rectal carriage prevalence among hospitalized patients was 4.6% with a downward trend from 2013 to 2022. The decrease in ESBL-E prevalence in 2020 could have been due to the COVID-19 pandemic and subsequent countrywide measures as no nosocomial transmission events were detected in 2020. However, the persistently low ESBL-E prevalences in 2021 and 2022 suggest that the decline in ESBL-E prevalence goes beyond the COVID-19 pandemic, indicating that overall ESBL-E carriage rates are declining over time. Continuous monitoring of ESBL-E prevalence and transmission rates can aid infection control policy to keep antibiotic resistance rates in hospitals low.

Antimicrobial resistance profile and associated factors of hospital-acquired gram-negative bacterial pathogens among hospitalized patients in northeast Ethiopia

BackgroundAntimicrobial resistance is a major global public health issue. Infections caused by resistant species are associated with higher mortality rates, longer hospital stays, medication failure, and rising medical costs. The World Health Organisation has declared multidrug resistance-associated infections as an epidemic of public health concern.ObjectiveThis study aimed to evaluate the antimicrobial resistance profile and associated factors of hospital-acquired Gram-negative bacterial pathogens among hospitalized patients in Northeast Ethiopia.Materials and methodsA health facility-based cross-sectional study was conducted among hospitalized patients from March 2021 to February 2022. About 810 clinical specimens were collected, transported, and processed from admitted patients following the standard bacteriological procedures. The clinical samples were inoculated onto blood agar, MacConkey agar, and chocolate agar. Furthermore, the species identification was done using gram reactions, colony morphology, and color and biochemical tests. Antimicrobial susceptibility tests, extended-spectrum beta-lactamase, and carbapenemase production were performed as per the clinical laboratory standard institute guidelines. For analysis, the information was entered into Epi-data and exported to SPSS. A P value of < 0.05 with a 95% confidence interval was considered as a statistically significant association.ResultsOut of 810 clinical specimens, 285/810 (35.2%) developed bacterial infections. From the isolated bacteria, E. coli was the predominant bacteria accounting for 78/285 (27.4%) followed by K. pneumoniae, 69/285(24.42%), whereas P. vulgaris accounted for the least, 7/285 (2.5%). Overall, 132/285 (46.3%) and 99/285 (34.7%) of culture-positive patients were infected by extended-spectrum beta-lactamase and carbapenemase-producing bacteria. The overall multidrug resistance rate of the isolated bacteria was 89.4%. The highest antibiotic resistance rates were detected for doxycycline (92.9%), amoxicillin-clavulanic acid (83.9%), and ampicillin (93%). The least antibiotic resistance rate was observed for meropenem at 41.1% and amikacin at 1.7%, respectively.Conclusions and recommendationsIn the study area, significant health concerns include a range of hospital-acquired bacterial infections associated with elevated rates of multidrug resistance, Extended-spectrum beta-lactamase (ESBL), and carbapenemase-producing bacterial pathogens. Consequently, it is recommended to conduct drug-susceptibility testing of isolates and molecular detection at a national level to optimize antibiotic usage for treating prevalent bacterial infections in this area.

Efficacy and safety of Vonoprazan-based treatment of Helicobacter pylori infection: a systematic review and network meta-analysis

ObjectiveThe aim of this study was to evaluate the effectiveness and safety of the nine most widely studied Vonoprazan (VPZ)-based treatment regimens along with traditional Proton pump inhibitor (PPI)-based treatment regimens in eradicating Helicobacter pylori (H. pylori) infection.DesignThrough searching PubMed, Embase, Cochrane Library, Web of Science, we exclusively included randomized controlled trials (RCTs) to investigate the efficacy of VPZ-based and PPI-based therapies for H. pylori infection. The included studies were evaluated for methodological quality using the Cochrane bias risk assessment tool, and the data analysis software was used to analyze the data accordingly.ResultsThe RCTs were collected from the earliest available date up to August 2023. Twenty-one RCTs were included, with a total sample size of 5481. The results of the network meta-analysis showed that the eradication rate of the VPZ-based quadruple 14-day (VPZ-Q14) treatment regimen in Intention-to-treat (ITT) analysis was the highest (SUCRA: 0.874); The eradication rate of the VPZ-based quadruple 10-day (VPZ-Q10) treatment plan in Per-protocol (PP) analysis was the highest (SUCRA: 0.849). All regimens were well tolerated without significant differences. According to the probability ranking of safety, high-dose VPZ-based dual 14-day therapy (H-VPZ-D14) ranked first in SUCRA, reaching 0.952. This indicates that H-VPZ-D14 treatment is the safest with a relatively low incidence of adverse effect. Therefore, VPZ-based therapies not only have a higher eradication rate, but also possess satisfactory safety.ConclusionCompared with traditional PPI-based therapies, VPZ-based therapies have shown superior eradication effects. Based on the Ranking Plot of the Network, the VPZ-Q14 or VPZ-Q10 treatment regimen for H. pylori has a higher eradication rate and acceptable differences compared to other treatment regimens. In addition, for regions with high antibiotic resistance rates, we recommend a 14-day quadruple therapy with bismuth based on VPZ.