Trends In Antibiotic Resistance Research Articles

P-176. Detecting Evidence for Bystander Selection by Comparing Trends in Antibiotic Resistance among Infection Causing Bacteria in a Large Global AMR Database

Abstract Background Unintentional exposure to antibiotics meant for the treatment of infections caused by other bacteria promote the selection of antibiotic resistant strains in off-target organisms in a phenomenon called bystander selection (BS). Some of these organisms could subsequently cause drug resistant infections or spread to others, promoting antibiotic resistant bacteria in the population. The importance of BS as a driver for antimicrobial resistance (AMR) at the global level is not well understood. We conducted an ecological time trends study to identify and compare trends over time of different clinically relevant bacteria-antibiotic pairs to detect evidence for BS globally and in the United States. Schematic Representation of the Development of Bystander Selection Methods We identified global and US trends in resistance using the Cochran-Armitage and Mann-Kendall tests. We compared trends in resistance using Pearson’s correlation coefficient. Among bacteria pairs with highly correlated trends in resistance, we eliminated pairs that belong to the same genus or commonly colonize the same niche, where horizontal genome transfer may explain the high degree of correlation, to arrive at bacteria pairs that were most likely experiencing BS. Figure showing how we arrived at the 16 and 9 highly correlated antibiotic-bacteria pairs that have the most likely experienced bystander selection globally and in the United States. Results We found 16 and 9 bacteria pairs respectively from our global and United States analysis that most likely experienced BS. Trends in resistance of Acinetobacter baumannii to carbapenems and cefepime were highly correlated with members of the family Enterobacteriace and Psuedomonas. In the United States, rates of levofloxacin resistance among Staphylococcus aureus were significantly correlated with Strepococcus pneumoniae. Figure showing the final 16 bacterial pairs from the global analysis in whom bystander selection was the most likely cause for significantly correlated trends in antimicrobial resistance. Each bubble represents one bacterial species. Intersection between 2 bubbles represents highly correlated trends in resistance between those 2 bacterial species to the antibiotics mentioned in the overlapping area. The size of the bubble represents the total number of correlations for that bacterium. Bubbles of bacterial species with 4 or more correlations are depicted in green. Conclusion To the best of our knowledge this is the first study to find evidence for BS driving the development of AMR in a global AMR surveillance database. Our findings suggest that judicious use of carbapenems for the treatment of Pseudomonas, E. coli, K. pneumoniae and Enterobacter infections could help address carbapenem resistance in A. baumannii. This work highlights the need to study antimicrobial resistance using a systems approach as opposed to studying the development of resistance in single bacteria-antibiotic pairs. Figure showing the final 9 bacterial pairs from the US specific analysis in whom bystander selection was the most likely cause for significantly correlated trends in antimicrobial resistance. Each bubble represents one bacterial species. Intersection between 2 bubbles represents highly correlated trends in resistance between those 2 bacterial species to the antibiotics mentioned in the overlapping area. The size of the bubble represents the total number of correlations for that bacterium. Bubbles of bacterial species with 4 or more correlations are depicted in green. Disclosures All Authors: No reported disclosures

P-1575. Trends in antibiotic resistance in community-acquired urinary tract infections among children - a retrospective descriptive nation-wide study

Abstract Background Urinary tract infection (UTI) is one of the most common bacterial infections in children. Early antibiotic treatment may prevent complications. Empirical treatment requires up-to-date knowledge of the local epidemiology. This study aims to describe trends in resistance rates in community-acquired UTI`s between 2017-2022, assess whether current recommendations for empirical treatment are valid and identify risk factors for resistance. Methods Data was collected retrospectively from the computerized system of Maccabi Health Services for all children under 18 years-old diagnosed with a UTI in 2017 and 2022 and analyzed using chi-square test and regression models. Results A total of 240,122 urinary samples were included in the study. The most common isolated pathogen was Escherichia coli (78%); there was a slight but significant increase in extended-spectrum beta-lactamases (ESBL) incidence for all Gram-negative Enterobacteriaceae from 6% in 2017 to 8% in 2022, (P-value 0.001). Higher incidence (12%) was detected among Klebsiella isolates compared to E. coli (8%). Aminoglycosides resistance rates increased from 5% to 6% (P-value 0.001). The most impressive increase was in resistance to Fluoroquinolones from 7% to 23% (P-value 0.001). Female gender, younger age, previous antibiotic treatment and urinary tract abnormalities were associated with an increased resistance rate. Conclusion The increased resistance rate observed for most pathogens and antibiotics was statistically significant, nevertheless, due to small absolute changes, the recommendations for empirical antibiotic treatment in Israel are still valid. Fluoroquinolones, which are not recommended as empirical treatment, should be avoided due to high levels of resistance. Disclosures Shirley Shapiro Ben David, MD, GSK: Lecturer|Pfizer: Grant/Research Support|Pfizer: Lecturer

Antibiotic Resistance Trends of Uropathogens in Community-acquired Urinary Tract Infection in Children: A Single-center Retrospective Study

Antibiotic Resistance Trends of Uropathogens in Community-acquired Urinary Tract Infection in Children: A Single-center Retrospective Study

Empiric antibiotic therapy resistance and mortality in emergency department patients with bloodstream infection: a retrospective cohort study

BackgroundTimely management of sepsis in the emergency department, including the use of appropriate antimicrobials, is crucial for improving patient outcomes. Inadequate empiric antimicrobial treatment is associated with potential changes in patient outcomes. We aimed to pinpoint risk factors, characterize antibiotic resistance trends, and investigate the association between antibiotic resistance and mortality among patients with bacteremia admitted to the emergency department.MethodsWe conducted a retrospective analysis of emergency department patients admitted between 15/06/2016 and 30/09/2022. Patients with a positive blood culture receiving emergency department-initiated antibiotic therapy were included. Antibiotic administration, resistance, and survival data were collected. Descriptive statistics, survival analysis, and Cox proportional hazards models were performed.ResultsOf 157,884 emergency department visits, 1,136 patients had a positive blood culture and received antibiotic therapy initiated in the emergency department. Resistance against empiric antibiotics was 14.5%. The overall 30-day and one-year mortality was 38.6% and 61.8%, respectively. In adjusted Cox models, patients with Escherichia coli or Staphylococcus aureus infection had 36% lower and 44% higher risk of death, respectively. Although resistance to emergency department-administered antibiotic therapy was not associated with overall mortality, one-year mortality of patients with Escherichia coli bacteremia was higher in those with antibiotic resistance (69.0% vs. 49.4%, p = 0.011); these patients had a 1.5-fold increased risk of death in an adjusted Cox model.ConclusionThe mortality of patients with bloodstream infection is high. The association of mortality with empiric emergency department-initiated antibiotic adequacy is pathogen-dependent.

Retrospective Analysis of Antibiotic Resistance Patterns of Uropathogenic Escherichia coli With Focus on Extended-Spectrum β-Lactamase at a Tertiary Central Hospital in Saudi Arabia.

Urinary tract infections (UTIs) are a prevalent bacterial infection that has substantial implications for healthcare on a global scale. Escherichia coli (E. coli) is a gram-negative rod responsible for most UTI cases. ESBL-producing E. coli is widely recognized as a significant contributor to antibiotic resistance. This study aims to evaluate the prevalence and antibiotic resistance trends of ESBL-producing E. coli in patients with UTIs at a tertiary hospital in Jazan, Saudi Arabia. A retrospective cross-sectional analysis was conducted on 347 urine specimens collected between January 2022 and March 2023. The study found that 31% of E. coli specimens were positive for ESBL. Among patients with ESBL-producing E. coli, 78.9% were females, and the majority of ESBL-producing E. coli cases were observed in the outpatient clinic departments. Among all E. coli isolates, ampicillin exhibited the highest resistance rate at 69.3%, aztreonam at 66.7%, and colistin at the lowest resistance. ESBL-producing E. coli strains exhibited higher resistance rates than non-ESBL-producing E. coli strains. The study agrees with others in the region and shows a higher prevalence of ESBL-producing E. coli in the region, emphasizing the importance of antibiotic stewardship programs and infection control measures to mitigate the prevalence and spread of ESBL-producing E. coli in our region.

Carbapenem-Resistant Gram-Negative Bacterial Infections at a Tertiary Health Care Center in Nepal: An Observational Study

Introduction: Carbapenems are last-resort antibiotics and are considered the drugs of choice for infections caused by multi-drug-resistant bacteria. During the last several years, there has been an alarming global increase in the detection and spread of Carbapenem-resistant organisms among gram-negative bacteria. Therefore, the main objective of this study is to determine Carbapenem-resistant gram-negative bacterial infections.Methodology: A descriptive cross-sectional study was performed. Ethical approval was granted by the Institutional Review Committee (Reference number: CMC-IRC/080/081-071). A total of 3149 non-repeated, different clinical specimens were collected, from November 2023 to February 2024, processed aseptically under the standard protocol of the American Society for Microbiology (ASM), and screened according to the Antibiotic sensitivity pattern. The analysis of the results was performed using Microsoft Excel and manual calculations.Results: Out of 3149 samples, 361 had culture-positive. Among 361 isolates, 316 were Gram-negative bacteria, among the specimens, 83 (26.26%) were identified as Carbapenem-resistant gram negative bacteria. Within this group, Acinetobacter baumannii was present in 37 (44.57%) cases, followed by Escherichia coli with 20 (24.09%), Klebsiella pneumoniae with 19 (22.89%), Stenotrophomonas maltophilia with 3 (4.81%), and Pseudomonas aeruginosa and Klebsiella aerogenes, each with 2 (2.40%) cases. The most effective antibiotics against Carbapenem-resistant Enterobacteriaceae included Colistin and Fosfomycin, whereas Carbapenem-resistant non-fermenter included Colistin and Tigecycline.Conclusions: Among Carbapenem-resistant Organisms, Acinetobacter baumannii was most prevalent. The results revealed a significant proportion of infections resistant to commonly used antibiotics, highlighting an alarming trend in antibiotic resistance.

Antibiotic Resistance Trends in ESKAPE Pathogens Isolated at a Health Practice and Research Hospital: A Five-Year Retrospective Study.

Antimicrobial resistance remains a global threat with increasing morbidity and mortality rates. The aim of this study was to identify the antimicrobial resistance trends among ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) isolated from clinical samples at a Health Practice and Research Hospital over five years. Microbiological diagnosis utilized classical culture methods and automated systems. Antimicrobial susceptibility analysis was conducted using BD Phoenix, adhering to European Committee on Antimicrobial Susceptibility Testing (EUCAST) standards. A total of 15,272 clinical strains of ESKAPE pathogens were identified in this study. The most frequently isolated pathogens among ESKAPE were K. pneumoniae (3.938, 27.79%), Acinetobacter baumannii (3,013, 19.73%) and Enterococcus faecium (2,966, 19.24%). Bacterial strains were isolated predominantly from urine (3,263, 21.37%), followed by blood cultures (3,099, 20.29%). ESKAPE pathogens were most commonly found in internal intensive care units (4,758, 31.16%), followed by surgical intensive care units (4,000, 26.19%). Reduced resistance rates were observed for most antibiotics against Enterococcus faecium and Staphylococcus aureus. The vancomycin resistance rate for Enterococcus faecium was 18.48%, and the methicillin resistance rate for Staphylococcus aureus was 44.87%. A concerning trend of increasing antimicrobial resistance was noted in Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. The alarming rise in antimicrobial resistance among Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumoniae is a significant concern. The high rates of antimicrobial resistance observed in ESKAPE pathogens underscore the urgent need for improvement in antimicrobial stewardship and infection prevention and control programs.

Antibiotic Resistance Trends in Carbapenem-Resistant Gram-Negative Pathogens and Eight-Year Surveillance of XDR Bloodstream Infections in a Western Greece Tertiary Hospital.

Background: The increased prevalence of antibiotic resistance among Gram-negative bacteria presents a severe public health challenge, leading to increased mortality rates, prolonged hospital stays, and higher medical costs. In Greece, the issue of multidrug-resistant Gram-negative bacteria is particularly alarming, exacerbated by overuse of antibiotics and inadequate infection control measures. This study aimed to detect the prevalence of extensively drug-resistant (XDR) Gram-negative bacteria in a tertiary hospital in Western Greece over the last eight years from 2016 to 2023. Materials and Methods: In the present study, all Carbapenem-resistant (CR) Acinetobacter baumannii, K. pneumoniae and Pseudomonas aeruginosa. bloodstream isolates from patients hospitalized in the University General Hospital of Patras in Western Greece, from January 2016 to December 2023, were recorded. XDR strains were defined as non-susceptible to at least one agent in all but two or fewer antimicrobial categories (i.e., bacterial isolates remain susceptible to only one or two categories). The prevalence and distribution of these pathogens across different hospital wards and their susceptibility patterns to key antibiotics (aminoglycosides, trimethoprim-sulfamethoxazole, tigecycline, colistin, ampicillin-sulbactam, ceftolozane-tazobactam and ceftazidime-avibactam) were recorded. Results: A total of 1142 blood cultures growing carbapenem-resistant Klebsiella pneumoniae (CRKp), Acinetobacter baumannii (CRAB) and Pseudomonas aeruginosa (CRPsA) were studied. In the present study, we found an increased resistance of both A. baumannii and K. pneumoniae in colistin. Acinetobacter baumannii had colistin resistance rates between 8.4% and 49.3%, showing a stable increase during the study period. K. pneumoniae showed an increased colistin-resistance rate in 2022 and 2023 (46.8% and 31.2%, respectively) Regarding P. aeruginosa, amikacin was almost inactive with a rate 68.4% and 87.5% in 2020 and 2023, respectively. Of all CR isolates, 69.3% were extensively drug-resistant (XDR). Acinetobacter baumannii had the highest percentage of XDR isolates (34.3%), followed by K. pneumoniae (26.8%) and P. aeruginosa (8.1%). Most XDR pathogens were isolated from the ICU (73.4%), followed by the internal medicine units (64%) and surgical units (22%). Conclusions: The rate of antimicrobial resistance and extensive drug resistance is alarmingly high, which calls for strict surveillance, control measures, and antibiotic stewardship to prevent the development of further resistance.

Characterization of Aminoglycoside-Modifying Enzymes in Uropathogenic Enterobacterales of Community Origin in Casablanca, Morocco

Community-acquired urinary tract infections (UTIs) represent a significant public health issue, primarily due to the increasing antibiotic resistance among uropathogens. This study assesses the resistance status of uropathogenic community Enterobacterales to various antibiotics, particularly aminoglycosides, and determines the prevalence of aminoglycoside-modifying enzyme (AME) genes, while investigating the coexistence of 16S rRNA methylating enzymes. We analyzed 628 clinical isolates of Enterobacterales obtained from 4282 cytobacteriological urine examinations at the Pasteur Institute Casablanca, Morocco, collected from October 2018 to December 2021. Identification and antibiotic susceptibility testing were conducted using the VITEK 2® COMPACT system, following CA-SFM guidelines. DNA extraction utilized the heat shock method, and subsequent PCR was performed. Gram-negative bacteria accounted for 85% of isolates, with Enterobacterales representing 91% of this group. E. coli (73%) and Klebsiella pneumoniae (20%) were the most common species among Enterobacterales. Resistance was particularly high for ampicillin (76.7%) and amoxicillin-clavulanate (58%). Among aminoglycosides, gentamicin and tobramycin resistance rates were 33.5% and 35%, respectively, while amikacin resistance was observed in 21.3% of isolates. High frequencies of AME genes were detected, with AAC(3′)-IIa (27.7%) and AAC(6′)-Ib (25.9%) being the most prevalent. Notably, no 16S rRNA methylation genes (rmtA, rmtB, rmtC, rmtD) were found. All tested strains exhibited biofilm-forming capacity, with K. pneumoniae demonstrating intense biofilm production. The study highlights a concerning trend of antibiotic resistance among uropathogenic Enterobacterales in the community setting, correlating genotype with resistance phenotype and emphasizing the need for enhanced surveillance and targeted treatment strategies.

The increasing burden of group B Streptococcus from 2013 to 2023: a retrospective cohort study in Beijing, China.

Group B Streptococcus (GBS) is a leading pathogen responsible for fatal infections in newborns primarily due to vertical transmission from colonized mothers. Cases of invasive GBS infections in adults have also increased and attracted attention recently. To comprehensively understand the evolving burden of vaginal GBS carriage in pregnant and non-pregnant women, as well as the trends in invasive GBS diseases and antibiotic resistance in China, we conducted a retrospective study using data from a large tertiary hospital in Beijing from 2013 to 2023. Over the past decade, improvements in GBS screening methods for pregnant women have significantly increased the GBS recovery rate. The detection rate of GBS and its proportion among vaginal pathogens have shown a gradual increase in GBS colonization in both pregnant and non-pregnant women. An analysis of vaginal pathogen composition revealed variations in GBS prevalence across different age groups, as well as a potential competitive relationship between GBS and Enterococcus faecalis in the vaginal environment. Additionally, we analyzed 165 invasive GBS cases, including three in newborns. The incidence of invasive GBS cases has risen since 2016, particularly among individuals over the age of 40. The 5,858 GBS isolates exhibited notably high resistance rates to erythromycin (72.2%), clindamycin (60%), and levofloxacin (50.1%), with 30.8% classified as multidrug-resistant. Importantly, invasive GBS strains exhibited a higher resistance rate to levofloxacin (61.2%) compared to colonizing strains (49.8%). This study highlights the importance of continuous screening and monitoring for GBS, especially given the concerning antibiotic resistance rates of GBS.IMPORTANCEGroup B Streptococcus (GBS) is an important pathogen that commonly causes infections in newborns and the elderly. This retrospective study provides a comprehensive analysis of GBS strains isolated from a large tertiary hospital in Beijing between 2013 and 2023, revealing an increasing colonization rate of GBS in both pregnant and non-pregnant women. Analysis of vaginal pathogens indicates a growing proportion of GBS among vaginal pathogens. Additionally, the high resistance rates of GBS to erythromycin, clindamycin, and levofloxacin, as well as the prevalence of multidrug resistance, are issues that merit attention. We also examined the differences in resistance rates of GBS strains from various sample types, finding that the levofloxacin resistance rate in GBS strains causing invasive infections was significantly higher than in colonizing strains. This study provides new data and insights for clinical research on GBS.

Monitoring of Antibiotic Resistance Patterns Within Al-Karak Governmental Hospital, Jordan, in 2022.

Background/Objectives: Antimicrobial resistance is considered one of the foremost global public health challenges, and its prevalence is increasing. In Jordan, particularly in Al-Karak Governorate, there is a lack of sufficient data on antimicrobial resistance to make accurate assessments. The main aim of the current study was to evaluate antibiotic resistance trends in clinical specimens from 2022 and assess antibiotic resistance patterns. The emphasis on the WHO antibiotic classification as Access, Watch, and Reserved (AWaRe) was adopted in the current study. Results: Among Gram-positive bacteria, Enterococcus faecalis exhibited 100% susceptibility to nitrofurantoin and 96% to vancomycin, Streptococcus viridans exhibited 100% susceptibility to teicoplanin, while CoNS (coagulase-negative Staphylococci) showed moderate resistance to Trimethoprim + Sulfamethoxazole (63%) and clindamycin (47%). Among Gram-negative bacteria, Escherichia coli and Klebsiella pneumoniae displayed high susceptibility to fosfomycin (E. coli: 95%, K. pneumoniae: 80%) and amikacin (E. coli: 93%, K. pneumoniae: 81%). Resistance was notable for trimethoprim + sulfamethoxazole (E. coli: 47%, K. pneumoniae: 53%) and nitrofurantoin (K. pneumoniae: 30%). Pseudomonas aeruginosa exhibited the highest proportion of XDR strains (15%), followed by K. pneumoniae (11%) and E. coli (4%), while PDR strains were found in P. aeruginosa (6%), K. pneumoniae (3%), and E. coli (0.6%). XDR was observed in 4% of CoNS and 3% of S. viridans (α), with Staphylococcus aureus exhibiting both XDR and PDR at 1%. Methods: A cross-sectional retrospective study of bacterial species and their antimicrobial susceptibility was carried out at a hospital in Al Karak, Jordan, from January to December of 2022, the study included 1187 isolates from all locations in Al-Karak Governmental Hospital. Conclusions: The significant prevalence of XDR and PDR strains in key pathogens, particularly P. aeruginosa and K. pneumoniae, underscores the need for a robust Antimicrobial Stewardship Program (ASP) and infection control measures at Al-Karak Governmental Hospital. High susceptibility in several Access group antibiotics (e.g., amikacin and nitrofurantoin) supports their prioritization in empirical therapy, while the emergence of resistance in Watch and Reserved antibiotics highlights the necessity for rational use. These findings are very important for adjusting the local strategies to lower the spread of resistant strains and improve clinical outcomes.

Is It Time to Start Worrying? A Comprehensive Report on the Three-Year Prevalence of ESBL-Producing Bacteria and Their Trends in Antibiotic Resistance from the Largest University Hospital in Slovakia.

Over the past few decades, extended-spectrum β-lactamase (ESBL)-producing bacteria have become a great concern in healthcare systems worldwide, imposing large burdens by increasing antimicrobial resistance and patient morbidity. Given the high mortality rates and emergence of multidrug-resistant (MDR) strains, monitoring ESBL prevalence and resistance patterns is crucial. This study aimed to evaluate ESBL-producing Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae over three years, focusing on phenotypic distribution and resistance profiles. A total of 1599 ESBL-producing bacterial samples were collected and analysed. A panel of 20 antibiotics was tested to determine resistance traits. Data were recorded on phenotypical distribution, isolation types, changes in antibiotic resistance, and the relation of such changes to antibiotic consumption (defined daily dose) from clinical isolates. Phenotypical analysis revealed the minimal presence of the Cefotaximase from Munich (CTX-M) phenotype in E. coli and K. pneumoniae, creating a distinct epidemiological profile compared to global patterns. Shifts in isolation trends, particularly in P. mirabilis, suggest an expected increase in associated-mortality-rate in the coming years. While resistance trends were not statistically significant, MDR and extensively drug-resistant (XDR) strains were identified across all three bacteria. Only meropenem showed consistent 100% efficacy against E. coli, with other antibiotics displaying only partial effectiveness. These findings highlight the need for ongoing surveillance of ESBL-producing bacteria and underscore challenges in managing antibiotic resistance due to limited efficacy of last-resort treatments. The unique phenotypical distribution observed could impact local resistance management strategies in hospital settings in the coming years.

Characterization of Antibacterial Compounds from Marine Sponge-associated Streptomyces spp. against Some Pathogenic Bacteria

The increasing trend of antibiotic resistance among pathogenic bacteria is a worldwide problem. Streptomyces produce a number of bioactive compounds such as antibacterial. This study aimed to investigate the effect of different media and incubation time in increasing the antibacterial activity of marine sponge-associated Streptomyces spp. and characterize antibacterial compounds of marine sponge-associated Streptomyces spp. against pathogenic bacteria. Among the three tested media and some days of incubation times, Streptomyces spp. produce more antibacterial activity when grown using modified molasses medium at 15 days incubation. The ethyl acetate extracts of Dbi28t exhibited a significant inhibitory zone against Extended Spectrum β-Lactamase (ESBL)-producing Escherichia coli, Providencia rettgeri then followed by Proteus mirabilis and Pseudomonas putida and the results were higher than some commercial antibiotics. This study has identified nine antibacterial compounds in Dbi28t using Liquid Chromatography-tandem Mass Spectrometric (LC-MS/MS) analysis, with the most abundance belonging to pumilacidin A, then followed by pumilacidin B, surfactin B, surfactin A, phenazostatin B, chalcomycin B, neopyrrolomycin C, saquayamycin A and saphenamycin. This work provides the first report from a Streptomyces sp. Dbi28t produced pumilacidin, surfactin and other bioactive compounds with the modified molasses medium for optimization of characterization of its antibacterial compounds.

Investigating trends in antibiotic resistance of Escherichia coli isolated from clinical urine specimens in the Orkney Islands.

Urinary tract infections (UTIs) are extremely common, affecting people of all ages and health statuses. Although UTIs do not usually cause severe illness, in some cases they can lead to more serious complications, especially if their initial treatment is ineffective due to antimicrobial resistance (AMR). AMR is an increasing issue, exacerbated by misdiagnosis and inappropriate prescribing of antibiotics, thus facilitating further resistance. The aim of this study was to investigate the rates of AMR in Escherichia coli isolated from clinical urine specimens tested at the Balfour Hospital, Orkney, and determine trends related to patient risk factors. Antibiotic susceptibilities were tested for 100 isolates of uropathogenic E. coli using the VITEK 2 Compact (bioMérieux), and data were analysed using percentage resistance rates. Resistance rates were compared by patient sex, age and source (hospital versus community). The findings showed higher AMR in males compared with females, particularly for trimethoprim (TMP), with 52% in males and only 12% in females. AMR tended to be higher in E. coli isolated from hospital inpatients than from community specimens, except for amoxicillin (AMX) and co-amoxiclav. Finally, the study found that AMR of E. coli isolates was greater in patients aged over 50 than 18-50 years old, particularly for AMX and TMP. The highest resistance rates across all patient demographics were for AMX, implying that the use of this antibiotic for the treatment of E. coli UTIs is not appropriate.

Ten-Year Antimicrobial Resistance Trend in Uropathogenic Escherichia coli (UPEC) Isolated from Dogs and Cats Admitted to a Veterinary Teaching Hospital in Italy.

Urinary tract infections (UTIs) are a common occurrence in cats and dogs. Surveillance of antibiotic resistance trends helps in the prudent selection of suitable antimicrobial agents. However, there are limited available data on this matter in Italy. This retrospective study aimed to investigate the trends of antimicrobial resistance in uropathogenic Escherichia coli (UPEC) isolated from cats and dogs over ten years (January 2014 to October 2023). Three hundred thirty-nine UPEC strains were isolated from urine samples submitted to the Veterinary Teaching Hospital of Torino (Italy). Antimicrobial susceptibility testing was conducted for up to 11 classes of antibacterials, categorized into four categories (A, B, C, and D) following the European Medicine Agency guidelines for prudent antimicrobial use in animals. The results reveal a higher resistance towards compounds in categories C and D, while fewer isolates were resistant to antibacterials in categories B and A. Resistance has steadily increased from 2014 to 2019. Starting from 2020, a decline in resistance is evident in all four categories. The reduction is more pronounced for the categories subject to the greatest restrictions under European and national legislation. The change in resistance trend is in line with findings from other European countries and food-production animals in Italy.

Effects of the COVID-19 Pandemic on Microbial Keratitis: A 5-Year Comparative Study.

To report the clinical and microbiological profiles of microbial keratitis and its antimicrobial resistance before, during, and after COVID-19. This was a retrospective case-note review of all corneal scrape specimens collected from patients with microbial keratitis from January 2018 to December 2023. Case records were analyzed for demographic characteristics, microbiological diagnosis, and antibiograms. All outcome variables were collected, stratified, and compared between 3 periods: the pre-COVID-19 group (January-December 2019), the COVID-19 group (January 2020-December 2022), and the post-COVID-19 group (January-December 2023). A total of 947 corneal cultures from 947 patients were reviewed. Gram-positive bacteria predominated in all periods, with no significant differences in their distribution. Staphylococcus epidermidis was the most frequently identified organism. Pseudomonas aeruginosa was the most common Gram-negative bacterium, with its incidence significantly lower in the post-COVID period. Fungal infections showed a significant increase in the post-COVID group, with Fusarium sp. being the most common fungus and showing a significant increase in incidence in the post-COVID group. Despite a stable incidence of microbial keratitis, this study highlights a concerning trend in antibiotic resistance. Although some pathogens became less common, those that persisted have become increasingly difficult to treat. Understanding the clinical and microbiological profiles of microbial keratitis and antimicrobial resistance patterns before and after the COVID-19 pandemic is crucial for informed treatment decisions.

Knowledge, attitude and practice (KAP) towards antibiotic use and its resistance among the general public in Klang Valley

Antibiotics have saved millions of lives and changed the history of infectious diseases. However, in recent years, antibiotic resistance has become a major global public health problem. Likewise, an increasing trend of antibiotic resistance (ABR) is observed in Malaysia. This study aims to determine the knowledge, attitude and practice (KAP) towards antibiotics use and its resistance among the general public in Klang Valley, Malaysia. Our hypothesis is the general public has a low level of KAP towards antibiotic use and its resistance. A cross-sectional study was distributed through a pre-validated questionnaire to all Klang Valley residents who are ≥18 years old through email and social media. Vulnerable residents and those from non-English speaking backgrounds were excluded. All data were analysed by SPSS software version 27.0. A total of 408 participants were recruited. Based on the scoring system of the study it was found that 47.0% had moderate knowledge, 41.7% had good attitude and 59.6% had good practice towards antibiotic use and its resistance. Overall, 53.4% recruited participants had moderate KAP towards antibiotic use and its resistance. Chi-Square test of independence was used to determine the association of socio-demographic variables and KAP towards antibiotic use and its resistance. The results indicated that only one categorical variable “area” was statistically significant with a p value of 0.041. The mean± SD values indicated that those individuals living in Selangor have a comparatively higher KAP towards antibiotic use and its resistance as compared to those living in Kuala Lumpur (KL) most probably due to higher educational levels. This study provided us with baseline evidence about the KAP regarding antibiotic use among the general public in Malaysia. Hence, it will be useful in guiding further interventions to improve awareness about antibiotics use and enhance antimicrobial stewardship in our community.

Increasing trends of antibiotic resistance in Uganda: analysis of the national antimicrobial resistance surveillance data, 2018–2021

BackgroundContinuous monitoring of antimicrobial resistance (AMR) in Uganda involves testing bacterial isolates from clinical samples at national and regional hospitals. Although the National Microbiology Reference Laboratory (NMRL) analyzes these isolates for official AMR surveillance data, there's limited integration into public health planning. To enhance the utilization of NMRL data to better inform drug selection and public health strategies in combating antibiotic resistance, we evaluated the trends and spatial distribution of AMR to common antibiotics used in Uganda.MethodsWe analyzed data from pathogenic bacterial isolates from blood, cerebrospinal, peritoneal, and pleural fluid from AMR surveillance data for 2018–2021. We calculated the proportions of isolates that were resistant to common antimicrobial classes. We used the chi-square test for trends to evaluate changes in AMR resistance over the study period.ResultsOut of 537 isolates with 15 pathogenic bacteria, 478 (89%) were from blood, 34 (6.3%) were from pleural fluid, 21 (4%) were from cerebrospinal fluid, and 4 (0.7%) were from peritoneal fluid. The most common pathogen was Staphylococcus aureus (20.1%), followed by Salmonella species (18.8%). The overall change in resistance over the four years was 63–84% for sulfonamides, fluoroquinolones macrolides (46–76%), phenicols (48–71%), penicillins (42–97%), β-lactamase inhibitors (20–92%), aminoglycosides (17–53%), cephalosporins (8.3–90%), carbapenems (5.3–26%), and glycopeptides (0–20%). There was a fluctuation in resistance of Staphylococcus aureus to methicillin (60%-45%) (using cefoxitin resistance as a surrogate for oxacillin resistance) Among gram-negative organisms, there were increases in resistance to tetracycline (29–78% p < 0.001), ciprofloxacin (17–43%, p = 0.004), ceftriaxone (8–72%, p = 0.003), imipenem (6–26%, p = 0.004), and meropenem (7–18%, p = 0.03).ConclusionThe study highlights a concerning increase in antibiotic resistance rates over four years, with significant increase in resistance observed across different classes of antibiotics for both gram-positive and gram-negative organisms. This increased antibiotic resistance, particularly to commonly used antibiotics like ceftriaxone and ciprofloxacin, makes adhering to the WHO's Access, Watch, and Reserve (AWaRe) category even more critical. It also emphasizes how important it is to guard against the growing threat of antibiotic resistance by appropriately using medicines, especially those that are marked for "Watch" or "Reserve."

Mapping spatial analysis of fish disease incidence and antibiotic resistance trends in selected provinces of Indonesia

Abstract Monitoring and visiting farmers affected by fish mortality is imperative. It offers insights into fish disease mapping and the trend of antibiotic resistance, serving as a fundamental for future strategies for preventing and treating fish diseases. The data collection was carried out by visiting farmers who suffered from fish mortality in 2022 in East Java, South Kalimantan, and Bali provinces. A total of 128 samples of infected fish were collected and analyzed using PCR and standard microbiological methods, and the findings were analyzed using spatial analysis and visual interpretation. Based on PCR results, the prevalence of fish diseases showed 65% iridovirus cases in gourami and tilapia, 31% in tilapia was TiLV, and 4% were Francisella sp. infection in tilapia. According to the results of microbiological tests, 86% of Edwardsiella tarda samples in pangasius were resistant to Oxytetracycline. Aeromonas sp. infection was the highest case in catfish, 58% were sensitive to Sulfamethoxazole. Streptococcosis was a typical tilapia disease that was 62% susceptible to Enrofloxacine and Sulfamethoxazole. Cases of Nocardia sp. and Staphylococcus sp. infection in gourami were found to be 71% intermediate to Enrofloxacine and Oxytetracycline, respectively.

Nephrostomy Cultures: 5 Year Trend in Antibiotic Resistance Across the South-Eastern Trust in Northern Ireland

Nephrostomy Cultures: 5 Year Trend in Antibiotic Resistance Across the South-Eastern Trust in Northern Ireland