Antibiotic Susceptibility Rates Research Articles

Causative Microorganisms in Community-Acquired Urinary Tract Infections and Risk Factors for the Development of Infection with Extended-Spectrum β-Lactamase-Producing Species.

This study aimed to determine the microorganisms grown in the urine cultures of patients followed up with the diagnosis of community-acquired urinary tract infection (CA-UTI), their antibiotic susceptibility, and the risk factors that cause extended-spectrum β-lactamase (ESBL) production in microorganisms. Patients diagnosed with CA-UTI in the Yıldırım Beyazıt University City Hospital Infectious Diseases and Clinical Microbiology Clinic between February 2019 and February 2020 were prospectively analyzed. The microorganisms grown in the urine cultures and antibiotic susceptibility rates were examined. The clinical and demographic characteristics of the patients were compared in terms of the isolated agent producing ESBL. Escherichia coli (63.8%) and Klebsiella pneumoniae (22.0%) were the most common microorganisms detected in the urine cultures; the rate of those producing ESBL was 46.6%. Antibiotics with high resistance rates were ampicillin (74.2%), cefuroxime (49.6%), and ceftriaxone (49%). Male gender, complicating factors, immunosuppression, kidney transplantation and history of antibiotic use were determined as significant risk factors for ESBL production. Male gender, immunosuppression, and history of antibiotic use were also independent risk factors. ROC analysis of risk factors showed ESBL-producing bacteria were isolated at a high rate in patients having ≥3 risk factors. The resistance rates in our study are quite high. Male gender, history of antibiotic use and immunosuppression status were found to be independent risk factors for ESBL positivity in patients with CA-UTI, and the more risk factors a patient has, the higher the risk of ESBL positivity.

The Impact of SARS-CoV-2 Pandemic on Antibiotic Prescriptions and Resistance in a University Hospital from Romania.

This paper aimed to evaluate the effects of the COVID-19 pandemic on prescription rates and antibiotic resistance in a university hospital. A retrospective study was conducted on the medical records of patients admitted to the Bihor Emergency Clinical County Hospital in Romania in 2019 (pre-pandemic) and 2021 (during the pandemic period). We evaluated the antibiotic consumption index (ACI) and susceptibility rates. The overall percentage of antibiotic prescribing increased in 2021, while the total number of patients decreased. Genito-urinary, digestive, respiratory infections, heart diseases and wounds were the most common conditions for antibiotic prescriptions, but the number of them decreased in 2021. There was a decrease in the proportion of antibiotics from the Watch and Reserve class and an increase in the proportion of antibiotics from the Access class. Antibiotic use has been reduced despite an increase in the number of patients, with a high consumption in the Watch group in the ICU wards. By contrast, surgical wards had the highest rate of antibiotic prescriptions, but a decrease in the number of patients. The patients who were administered antibiotics were hospitalized for diagnoses other than COVID-19. Almost all prescribed antibiotics displayed decreasing sensitivity rates. The number of isolated ESKAPE pathogens, except for Staphylococcus aureus methicillin-resistant strains, were increased. Strategies to control antibiotic prescriptions and the spread of resistant pathogens should be improved.

Antibiotic point prevalence survey and antimicrobial resistance in hospitalized patients across Peruvian reference hospitals

BackgroundPeru reports higher levels than other countries in Latin America of resistance to antimicrobials among Gram-positive and Gram-negative bacteria, however data on antibiotic use in Peru are scarce. This study aims to estimate the prevalence and quality of antibiotic prescription in hospitalized patients and to determine the antibiotic susceptibility rates of bacteria causing key bacterial infections. MethodsWe carried out a point prevalence survey of antibiotic prescription at ten public hospitals in nine regions of Peru. Data was collected from patients hospitalized during a 3-week period, with details about antibiotic use, patient information, and antimicrobial susceptibility. Results1620 patient charts were reviewed; in 924 cases antibiotics were prescribed (57.0 %, range 45.9–78.9 %). Most of the antibiotics (74.2 %) were prescribed as empirical treatment, only 4.4 % as targeted treatment. For 9.5 % of cases the reason for antibiotic use was unknown. Cephalosporins were the most prescribed (30.0 %), followed by carbapenems (11.3 %). Ninety-four blood cultures were positive for bacterial growth, 48.8 % of the Staphylococcus aureus were methicillin-resistant, among Escherichia coli and Klebsiella pneumoniae, 51.7 % and 72.7 % were resistant to third-generation cephalosporins (3GC), 3.4 % and 18.2 % were resistant to carbapenems, respectively. Among bacteria isolated from urine cultures (n = 639), 43.9 % of E. coli and 49.2 % of K. pneumoniae were resistant to 3GC, and 0.9 % of E. coli and 3.2 % of K. pneumoniae were resistant to meropenem. ConclusionsThe overall proportion of hospitalized patients receiving antibiotics in hospitals from different regions in Peru was high, with only a small proportion receiving targeted treatment. Cephalosporins and carbapenems were the most frequently prescribed antibiotics, reflecting high resistance rates against 3GC and carbapenems in Enterobacterales isolated from blood and urine.

Evaluation of antibiotic susceptibility in enterococci isolated from blood culture samples

Aims: Increased vancomycin resistance in enterococci is an important cause of life-threatening bloodstream infections in hospitalized patients. The aim of this study is to determine the antibiotic susceptibility rates of Enterococcus strains isolated from blood cultures in hospitalized patients in Antalya Training and Research Hospital. 
 Methods: The antibiotic resistance rates of Enterococcus strains isolated from blood cultures of patients hospitalized in the service and intensive care units (ICU) between 1 January 2018 and 30 December 2022 were examined retrospectively. Blood samples were studied with the BacT/ALERT 3D culture system (Biomerieux, France). Bacterial identification was performed using conventional methods, Matrix Assisted Laser Desorption-Ionization Time-of-Flight Mass Spectrometer (MALDI-TOF MS) and VITEK 2 (Biomerieux, France) systems. Antimicrobial susceptibility tests were performed with VITEK 2 (Biomerieux, France) systems. Ampicillin, vancomycin, teicoplanin, high-level gentamicin resistance (HLGR) and linezolid susceptibility of isolated strains were evaluated according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Vancomycin minimal inhibitory concentration (MIC) values of vancomycin resistant strains were studied by microdilution gradient strip test (Bioanalyse).
 Results: A total of 623 strains of enterococci were isolated from blood culture samples. Of the enterococci, 305 (48.9%) were identified as Enterococcus faecalis, 281 (45.6%) Enterococcus faecium, 12 (1.9%) Enterococcus avium, 11 (1.8%) Enterococcus gallinarum, 7 (1.2%) Enterococcus casseliflavus, 2 (0.4%) Enterococcus durans and 1 Enterococcus hirae (0.2%). Ampicillin and HLGR resistance rates of isolated E. faecalis strains were 11 (3.6%) and 72 (23.6%), respectively, and all strains were found to be susceptible to vancomycin, teicoplanin and linezolid. The ampicillin, vancomycin, teicoplanin and HLGR resistance rates of E. faecium strains were determined as 229 (81.5%), 36 (12.8%), 30 (10.7%) and 142 (50.5%), respectively, and all strains were found to be susceptible to linezolid. 
 Conclusion: In infections caused by enterococci, identification and determination of antibiotic susceptibility rates according to culture antibiogram results would be the right approach. Knowing the current susceptibility rates of enterococci isolated from blood culture samples in our hospital will contribute for clinicians' planning of empirical treatment.

The Change in Antimicrobial Resistance During the COVID-19 Pandemic in Türkiye

Antimicrobial resistance (AMR) is one of the most important problems threatening human health worldwide. The impact of the Coronavirus disease-2019 (COVID-19) pandemic on AMR continues to be discussed. Some researchers argue that the pandemic will increase AMR rates, while others suggest the opposite. The aim of this study was to investigate the change in AMR of Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus strains in three cross-sectional periods in Türkiye, the first one before the COVID-19 pandemic, the second and the third one during the pandemic. The change in antibiotic susceptibility in Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus strains isolated from urine, blood, and lower respiratory tract samples of patients hospitalized in intensive care units and wards of hospitals before (November 2019) and during the COVID-19 pandemic (November 2020 and July 2021) was investigated in this study. A total of 17 voluntary hospitals, members of the Antibiotic Susceptibility Surveillance Study Group (ADSI) of the Society for Clinical Microbiology Specialists (KLIMUD), participated in the study. Identification of bacteria was performed with automated bacterial identification systems (VITEK2, bioMérieux, France or Phoenix, BD, USA). Antibiotic susceptibility tests were performed in one center with the Kirby-Bauer disc diffusion method and in other centers with automated antibiotic susceptibility test systems (VITEK2, bioMérieux, France or Phoenix, BD, USA), and the results were evaluated according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Antibiotic susceptibility ratios were statistically analyzed using either the chi-square or Fisher's exact test. A p-value of < 0.05 was considered statistically significant. Antibiotic susceptibility test results of a total of 4030 strains; 1152, 1139, and 1739 belonging to November 2019, November 2020, and July 2021, respectively; were examined. While cefotaxime and ceftazidime susceptibility rates in E.coli strains increased during the pandemic period compared to previous period (p= 0.04, p= 0.001, respectively); nitrofurantoin sensitivity (p= 0.02) and extended-spectrum beta-lactamase (ESBL) ratios (p< 0.001) were found to be decreased. It was determined that the susceptibility rates of all other examined antimicrobials did not change statistically. It was observed that the susceptibility rates of all antibiotics in K.pneumoniae isolates decreased during the pandemic period, but the ESBL rates increased between 2019-2020 (p= 0.01) and decreased between 2020-2021 (p= 0.02). It was found that ESBL rates increased before and after the pandemic. It was observed that the susceptibility to ciprofloxacin (p= 0.0001), levofloxacin (p= 0.003), and gentamicin (p= 0.005) in S.aureus strains increased during the pandemic period. No significant changes were observed in other antibiotic susceptibility rates. Methicillin resistance of S.aureus (MRSA) strains decreased between 2019-2020 (p= 0.03) and increased again in 2021 (p= 0.04) and returned to the pre-pandemic rate. Our study results suggest that the measures taken to reduce the spread of COVID-19 with the pandemic (such as quarantine practices, increased hand hygiene, mask use, and national/international travel restriction) may reduce the spread of bacteria such as ESBL-producing E.coli and the rate of MRSA, which is considered as a hand hygiene indicator. The increase in the later stages of the pandemic recalls the relaxation in compliance with hand hygiene rules. The decrease in the susceptibility rate of K.pneumoniae isolates to antibiotics and the increase in the ESBL rate may be due to inappropriate and excessive use of antibiotics during the pandemic period. However, we believe that these data should be supported by studies to be conducted nowadays when all the rules and measures are back as if the pandemic has ended.

Antibiotic resistance of bacterial pathogens isolated from the conjunctiva in the Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) surveillance study (2009–2021)

Antibiotic resistance in bacterial ocular infections is of significant clinical concern and may affect treatment outcomes. We report on in vitro antibiotic susceptibility rates and trends among conjunctival-sourced isolates collected in the Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) surveillance study. A total of 2214 conjunctival isolates (918 Staphylococcus aureus, 589 coagulase-negative staphylococci [CoNS], 194 Streptococcus pneumoniae, 171 Pseudomonas aeruginosa, and 342 Haemophilus influenzae) obtained between 2009–2021 were analyzed. Staphylococci were commonly resistant to azithromycin (≥54.8%) and oxacillin (≥29.3%). Resistance among S. pneumoniae isolates was notable for azithromycin (34.0%) and penicillin (28.9%), while P. aeruginosa and H. influenzae isolates were highly susceptible to most tested antibiotics. Methicillin-resistant staphylococci demonstrated greater concurrent resistance to other antibiotics than methicillin-susceptible isolates and exhibited high rates of multidrug resistance (≥74.0%). Among staphylococci, antibiotic resistance increased with patient age, and there were small decreases in resistance to several drugs over the 13-year period. These findings indicate that resistance to antibiotics routinely used in ophthalmic practice remains high among conjunctival isolates.

A geospatial approach to identify patterns of antibiotic susceptibility at a neighborhood level in Wisconsin, United States

The global threat of antimicrobial resistance (AMR) varies regionally. This study explores whether geospatial analysis and data visualization methods detect both clinically and statistically significant variations in antibiotic susceptibility rates at a neighborhood level. This observational multicenter geospatial study collected 10 years of patient-level antibiotic susceptibility data and patient addresses from three regionally distinct Wisconsin health systems (UW Health, Fort HealthCare, Marshfield Clinic Health System [MCHS]). We included the initial Escherichia coli isolate per patient per year per sample source with a patient address in Wisconsin (N = 100,176). Isolates from U.S. Census Block Groups with less than 30 isolates were excluded (n = 13,709), resulting in 86,467 E. coli isolates. The primary study outcomes were the results of Moran’s I spatial autocorrelation analyses to quantify antibiotic susceptibility as spatially dispersed, randomly distributed, or clustered by a range of − 1 to + 1, and the detection of statistically significant local hot (high susceptibility) and cold spots (low susceptibility) for variations in antibiotic susceptibility by U.S. Census Block Group. UW Health isolates collected represented greater isolate geographic density (n = 36,279 E. coli, 389 = blocks, 2009–2018), compared to Fort HealthCare (n = 5110 isolates, 48 = blocks, 2012–2018) and MCHS (45,078 isolates, 480 blocks, 2009–2018). Choropleth maps enabled a spatial AMR data visualization. A positive spatially-clustered pattern was identified from the UW Health data for ciprofloxacin (Moran’s I = 0.096, p = 0.005) and trimethoprim/sulfamethoxazole susceptibility (Moran’s I = 0.180, p < 0.001). Fort HealthCare and MCHS distributions were likely random. At the local level, we identified hot and cold spots at all three health systems (90%, 95%, and 99% CIs). AMR spatial clustering was observed in urban areas but not rural areas. Unique identification of AMR hot spots at the Block Group level provides a foundation for future analyses and hypotheses. Clinically meaningful differences in AMR could inform clinical decision support tools and warrants further investigation for informing therapy options.

Comparison of Antibiotic Susceptibility of Carbapanem-Resistant Enterobactericeae Species with Two Different Panels (Phoenix BD)

Amaç: Bu çalışmanın amacı; hastanemiz mikrobiyoloji laboratuvarında izole edilen karbapenem dirençli Enterobactericeae türlerinin antibiyotik duyarlılıklarının iki farklı panelle karşılaştırılması ve CPO testinin perfomansının değerlendirilmesidir. Gereç ve Yöntemler: 01.01.2020-31.12.2020 tarihleri arasında hastanemiz mikrobiyoloji laboratuvarına gönderilen örnekler değerlendirilmiştir. Üremesi olan örnekler BD Phoenix 100 otomatize sistem BD Phoenix NMIC 433 paneline yüklenmiş olup, karbapenem dirençli olarak sonuçlanan 50 Enterobacteriaceae izolatı BD Phoenix NMIC 505 CPO paneliyle çalışılmıştır. Karbapenem dirençli 50 Enterobacteriaceae izolatı CPO paneliyle Ambler sınıfına göre A, B ve D’ye göre sınıflandırılmıştır. Bulgular: İzolatların 28’i (%56) erkek hastalardan, 22’si (%44) kadın hastalardan izole edilmiştir. Karbapenem dirençli Enterobacteriaceae izolatlarının 43’ü (%86) Klebsiella pneumoniae, 4’ü (%8) Escherichia coli olarak saptanmıştır. Karbapenem dirençli Enterobacteriaceae izolatlarının CPO paneli ve NMIC 433 panelinin antibiyotik duyarlılık oranlarının değerlendirmesi incelendiğinde; iki panelde de çalışılan 50 Enterobacteriaceae izolatının antibiyotik duyarlılık sonuçlarının aynı olduğu saptanmıştır. CPO panelinde çalışılabilen antibiyotikler incelendiğinde en etkili antibiyotiğin seftazidim-avibaktam olduğu gözlenmiştir. Sonuçlar incelendiğinde seftazidim-avibaktama 46 (%92) izolatın duyarlı olduğu gözlemlenmiştir. Sınıf B karbapenemaz üreten bakteri sayısı 4 (%8), sınıf D karbapenemaz üreten bakteri sayısı 42 (%84) olarak belirlenmiştir. Sonuçlar: Seftazidim-avibaktamın karbapenem dirençli türlerde tedavi seçeneği olarak kullanılabileceği unutulmamalıdır. CPO paneli ile ilgili daha fazla çalışma yapılması, CPO panelinin rutin iş akışına katkısının belirlenmesine fayda sağlayacaktır.

Determination of factors isolated from catheter culture and antibiotic susceptibility of patients in intensive care unit

Aims: Catheter-related bloodstream infections are important causes of mortality and morbidity. In this study, it was aimed to retrospectively determine the distribution of bacterial factors isolated from intra-catheter blood culture and antibiotic susceptibility rates of patients diagnosed with catheter infection in the intensive care unit of XXXXXXX Training and Research Hospital, Cardiovascular Surgery and Neurosurgery. Methods: In the intensive care unit of XXXXXXX Training and Research Hospital, Cardiovascular Surgery, and Neurosurgery, 79 bacteria isolated from intra-catheter blood cultures of patients diagnosed with catheter infection between January 1, 2021, and December 31, 2022, were included in the study.Antibiotic susceptibility of the factors reproducing in catheter blood culture was obtained from the hospital information system. Antibiotic susceptibilities of bacteria isolated from intra-catheter culture were determined by the disc diffusion method or VITEK-2 automated system. Results: The frequency of factors reproducing from intra-catheter blood culture of patients hospitalized in the intensive care unit of cardiovascular surgery and neurosurgery were Enterococcus spp., Klebsiella pneumoniae, Staphylococcus epidermidis, and Escherichia. coli retrospectively. Klebsiella pneumoniae isolates from intra-catheter blood cultures were resistant to ceftriaxone 75%, piperacillin-tazobactam 25%, amikacin 6.25%, but not to imipenem and meropenem. Antibiotic resistance rates of Staphylococcus aureus isolates isolated from intra-catheter blood cultures were as follows: 100% with penicillin, no resistance to vancomycin. In Escherichia coliisolate isolated from intra-catheter blood cultures, resistance to ceftriaxone was 6.3%, to piperacillin-tazobactam, 12.5%, to imipenem and meropenem, 16.6%, but not to amikacin. Acinetobacter baumanniiisolates isolated from intra-catheter blood culture showed 100% resistance to ceftriaxone, 100% to piperacillin-tazobactam, 85.7% to imipenem, 83.3% to meropenem, and no resistance to amikacin. In the Stenotrophomonas maltophilia isolatesisolated from intra-catheter blood culture, resistance to ceftriaxone, piperacillin-tazobactam, imipenem and meropenem was 100% and levofloxacin was 25%, while no resistance to trimethoprim/sulfamethoxazole was detected. Conclusion: Determining the antibiotic susceptibility of bacteria isolated from catheter culture will contribute to the determination of the appropriate treatment option in the empirical treatment of catheter infections in our hospital and contribute to decreasing in mortality and morbidity rates due to catheter infections.

Evaluation of antibiotic susceptibility rates of non-fermentative Gram negative bacteria

Evaluation of antibiotic susceptibility rates of non-fermentative Gram negative bacteria

927. Successful Implementation of an Inpatient Fluoroquinolone (FQ) Pre-Authorization (PA) Program at a Tertiary Care Academic Center and Associated Changes in Antibiotic Use, Antibiogram Susceptibility, and Provider Behavioral Changes

Abstract Background In 2017, our adult tertiary care academic hospital in the Midwest implemented an inpatient fluoroquinolone (FQ) prior authorization (PA) policy using the electronic health record (EHR) as a stewardship tool. We examined the changes in antibiotic use, the antibiogram, and antibiotic use at an affiliated hospital without PA but staffed by physicians from the PA site. Methods This quasi-experimental study used a pre-post implementation design to evaluate a PA policy at our University Hospital requiring approval of all inpatient FQ use from the antimicrobial stewardship physician or infectious disease consult teams. Time periods consisted of 2.5 year pre-implementation, 9-month wash-in (pilot on 2 wards), and 5-year post-implementation periods. Monthly antibiotic use in days of therapy per 1000 patient days (DOT/KPD) and antibiogram data, limited to first inpatient culture per patient per week from any anatomic site, were collected. Monthly FQ use from an affiliated hospital without the restriction policy staffed by physicians from the University Hospital was also collected. Changes in antibiotic use were examined using t-test, or Mann-Whitney Rank Sum, and antibiotic susceptibility rates were compared using z-test. Results Following implementation of PA, FQ use decreased by 76% (-53.2 DOT/KPD, p&amp;lt; 0.001) (Fig. 1). FQ use also declined from 26.4 DOT/KPD to 7.7 DOT/KPD (p&amp;lt; 0.001) at the affiliated hospital without PA but staffed by physicians from University Hospital. Changes in gram-negative agents use are shown in Table 1, with greatest increase noted for ceftriaxone (∼50%). The ciprofloxacin inpatient antibiogram improved significantly (Table 2); whereas, a slight decline in susceptibility was noted for ceftriaxone and cefepime. Figure 1.Fluoroquinolone use across study periods. Wash-in period included a pilot fluoroquinolone prior authorization in 2 wards. Abbreviations: Days of Therapy (DOT); patient days (PD) Table 1.Mean antibiotic days of therapy during each study period. Successive shortages for cefepime and piperacillin-tazobactam during the wash-in period, as indicated by NA. Table 2.Proportion of susceptible isolates pre- and post-implementation of Fluoroquinolone prior-authorization.Pip-tazo, piperacillin-tazobactam; %S, the percent susceptible for Pre- or Post-implementation periods; * indicates significant improvement and ¥ significant decline (p&amp;lt;0.05) pre vs post; R indicates intrinsic resistance. Conclusion FQ PA leads to significant and sustained decline in FQ use, indicating that suitable alternative choices exist for most hospitalized patients. Decreased FQ use was associated with increased use of cephalosporins, mainly ceftriaxone. As might be expected, changes in use were associated with subsequent changes in the antibiogram. This intervention was associated with a significant decline in FQ use at a site without the restriction policy and the EHR modifications, suggesting successful diffusion of educational and behavioral changes. Disclosures Lindsay Taylor, MD, Merck: Grant/Research Support Jessica S. Tischendorf, MD, MS, Merck: Grant/Research Support.

Antibiotic resistance surveillance of Klebsiella pneumoniae complex is affected by refined MALDI-TOF identification, Swiss data, 2017 to 2022.

BackgroundModern laboratory methods such as next generation sequencing and MALDI-TOF allow identification of novel bacterial species. This can affect surveillance of infections and antimicrobial resistance. From 2017, increasing numbers of medical microbiology laboratories in Switzerland differentiated Klebsiella variicola from Klebsiella pneumoniae complex using updated MALDI-TOF databases, whereas many laboratories still report them as K. pneumoniae or K. pneumoniae complex.AimOur study explored whether separate reporting of K. variicola and the Klebsiella pneumoniae complex affected the ANRESIS surveillance database.MethodsWe analysed antibiotic susceptibility rates and specimen types of K. variicola and non-K. variicola-K. pneumoniae complex isolates reported by Swiss medical laboratories to the ANRESIS database (Swiss Centre for Antibiotic Resistance) from January 2017 to June 2022.ResultsAnalysis of Swiss antimicrobial resistance data revealed increased susceptibility rates of K. variicola compared with species of the K. pneumoniae complex other than K. variicola in all six antibiotic classes tested. This can lead to underestimated resistance rates of K. pneumoniae complex in laboratories that do not specifically identify K. variicola. Furthermore, K. variicola strains were significantly more often reported from blood and primarily sterile specimens than isolates of the K. pneumoniae complex other than K. variicola, indicating increased invasiveness of K. variicola.ConclusionOur data suggest that refined differentiation of the K. pneumoniae complex can improve our understanding of its taxonomy, susceptibility, epidemiology and clinical significance, thus providing more precise information to clinicians and epidemiologists.

Antibiotic Susceptibility Profile of Bacterial Uropathogens in Al-Shomali General Hospital, Babylon, Iraq

BACKGROUND: Urinary tract infection (UTI) is a group of common diseases that are among the most common bacterial infections in humans. Antibiotics are often effective therapy, although antibiotic resistance is increasing. The study aimed to isolated pathogenic bacteria from UTI patients attended to Al-Shomali General Hospital and to detect the antibiotic susceptibility rate to isolated bacteria. MATERIALS AND METHODS: The bacterial identification and antibacterial susceptibility of this work were done in the Clinical Microbiology Laboratory of Al-Shomali General Hospital for the period between March 1, 2022, and June 1, 2022. Bacteria have been diagnosed by morphology and biochemical tests as well as using some selective and differential media. The results were analyzed using Microsoft Excel and SPSS version 26 (SPSS Inc., Chicago, IL, USA). RESULTS: A total of 124 positive urine cultures were studied that showed 101 (81.4%) females and 23 (18.5%) males. The data revealed the most predominant of uropathogen isolates were Escherichia coli (34%), Staphylococcus aureus (31%), Staphylococcus saprophyticus (13%), Enterococcus spp. (11%), Pseudomonas aeruginosa (4%), Klebsiella spp. (3%), Micrococcus spp. (2%), and Proteus mirabilis (2%). Antibiotic resistance in this study shows the most bacteria resistance for an antibiotic is P. mirabilis (81%), P. aeruginosa (76%), Enterococcus spp. (66%), S. aureus (65%), E. coli (54%), S. saprophyticus (52%), Micrococcus spp. (48%), and Klebsiella spp. (44%). CONCLUSIONS: In UTI infections, resistant bacteria are becoming increasingly prevalent, with a high proportion of multidrug-resistant isolates. Furthermore, the meropenem, imipenem, and amikacin seemed to be more effective against bacterial UTI infection in this setting.

Epidemiological evolution of early-onset neonatal sepsis over 12 years: A single center, population-based study in central Taiwan.

We aimed to explore the epidemiology and evolution of pathogens, antibiotic susceptibility, and mortality rate in cases of neonatal early-onset sepsis (EOS) reported over a period of 12 years in a level III neonatal center in Central Taiwan. Patients' medical records in a neonatal center from 2007 to 2018 were reviewed to obtain information on infants with culture-proven EOS, which included pathogens found in the blood or cerebrospinal fluid cultures. The incidence of neonatal EOS during this period was 2.11 cases/1,000 admissions. Group B streptococcal (GBS) and Escherichia coli were the most common pathogens. The overall rates of GBS and E. coli infections were 0.68/1,000 and 0.77/1,000 live births, respectively. The incidence of EOS in infants with a birth weight ≥1,500 g decreased significantly with decreasing incidence of GBS-related sepsis. The incidence of EOS remained high in very-low-birth-weight (VLBW) infants and increased over time. There was an increasing trend in of E. coli infection and emergence of drug-resistant strains. In addition, E. coli sepsis had high mortality in VLBW infants. Novel screening and prevention strategies against E. coli and reserving broad-spectrum antibiotics for the most critically ill or VLBW patients with maternal chorioamnionitis might help in early diagnosis and further improve the outcomes of EOS.

Effects of Radiofrequency Electromagnetic Fields Emitted from Mobile Phones and Wi-Fi Router on the Growth Rate and Susceptibility of Enterococcus faecalis to Antibiotics.

Background: During the last decade, people have been dramatically exposed to radiation emitted from widely-used radiofrequency electromagnetic fields (RF-EMF) generating devices.Objective: This study aimed to evaluate the effects of exposure to RF-EMF emitted from smart phones and Wi-Fi routers on the growth rate and antibiotic sensitivity of Enterococcus faecalis (E. faecalis) as a pathogen in the root canals of teeth.Material and Methods: In this experimental study, E. faecalis ATCC 19115 was used, characterized and confirmed by morphological and biochemical tests. Antibiotic susceptibility test was measured for several common antibiotics. To perform antibiotic susceptibility tests, disk diffusion (Kirby-Bauer) method on Mueller-Hinton agar plates was used before and after exposure to RF-EMFs emitted from a commercial Wi-Fi router or a mobile phone simulator. Moreover, we measured the optical density at 625 nm after different exposure times using a calibrated UV-visible spectrophotometer to evaluate the effect of RF-EMF exposure on the bacterial growth rate.Results: Exposure to RF-EMF significantly altered the antimicrobial sensitivity of the E. faecalis. While, the susceptibility of the bacteria decreased significantly after 6 h of exposure, longer exposure time (e.g. exposure for 24 h) increased the susceptibility of the bacteria to all antibiotics. Furthermore, it was found that the bacteria tended to regress to their early state. Moreover, the non-exposed E. faecalis showed a slower growth rate than the bacteria exposed to RF-EMFs.Conclusion: Exposure to RF-EMF emitted by Wi-Fi routers or mobile phone simulator can significantly change the antibiotic susceptibility and growth rate of E. faecalis.

Infection Sources and Klebsiella pneumoniae Antibiotic Susceptibilities in Endogenous Klebsiella Endophthalmitis.

Endogenous endophthalmitis is an uncommon intraocular infection with potentially devastating consequences on vision. Klebsiella pneumoniae is highly prevalent in East Asian countries, with an increasing incidence recently worldwide. This retrospective study investigates infection sources and antibiotic susceptibilities of K. pneumoniae in patients with endogenous K. pneumoniae endophthalmitis (EKE) in Northern Taiwan. One hundred and fifty-seven patients with EKE were reviewed between January 1996 and April 2019. Pyogenic liver abscess (120/157, 76.4%) was the most common infection source, followed by pneumonia (13, 8.3%), urinary tract infection (7, 4.5%), and intravenous drug use (4, 2.5%). Bilateral involvement was identified in 12.1% (19/157) of patients, especially in patients with pyogenic liver abscess (16/120, 13.3%), pneumonia (2/13, 15.4%), and urinary tract infection (1/7, 14.3%). The antibiotic susceptibility rates were 98.1%, 92.5%, 97.5%, 96.8%, 100%, 99.3%, and 100% for amikacin, cefuroxime, ceftazidime, ceftriaxone, carbapenems, ciprofloxacin, and levofloxacin, respectively. Four extended-spectrum β-lactamase-producing multidrug-resistant (MDR) K. pneumoniae isolates were identified. In conclusion, pyogenic liver abscess was the major infection source in EKE. In addition, K. pneumoniae was still highly susceptible to ceftazidime and amikacin, and the MDR K. pneumoniae isolates were not common in EKE.

A Systematic Review of Multi-decade Antibiotic Resistance Data for Ocular Bacterial Pathogens in the United States.

IntroductionSince 2009, the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) surveillance study has been assessing in vitro antibiotic resistance for bacterial isolates sourced from ocular infections in the US. The main goal of this systematic review was to compare in vitro resistance data for ocular pathogens from published US studies with the most recently published data from the ARMOR study (2009–2018) and, where possible, to evaluate trends in bacterial resistance over time over all studies.MethodsA literature search was conducted using MEDLINE®, BIOSIS Previews®, and EMBASE® databases (1/1/1995–6/30/2021). Data were extracted from relevant studies and antibiotic susceptibility rates for common ocular pathogens (Staphylococcus aureus, coagulase-negative staphylococci [CoNS], Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae), longitudinal changes in susceptibility, and multidrug resistance (MDR) were compared descriptively.ResultsThirty-two relevant studies were identified. High in vitro resistance was found among S. aureus and CoNS to fluoroquinolones, macrolides, and methicillin/oxacillin across studies, with high rates of MDR noted, specifically among methicillin-resistant staphylococci. Data from studies pre-dating or overlapping the early years of ARMOR reflected increasing rates of S. aureus resistance to fluoroquinolones, macrolides, methicillin/oxacillin, and aminoglycosides, while the ARMOR data suggested slight decreases in resistance to these classes between 2009 and 2018. Overall, methicillin-resistant S. aureus (MRSA) prevalence peaked from 2005 to 2015 with a possible decreasing trend in more recent years.Discussion and ConclusionsData from local and regional US datasets were generally consistent with data from the national ARMOR surveillance study. Continued surveillance of ocular bacterial pathogens is needed to track trends such as methicillin resistance and MDR prevalence and any new emerging antibiotic resistance phenotypes. Susceptibility data from ARMOR can inform initial choice of therapy, especially in practice areas where local antibiograms are unavailable.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-021-00449-9.

The evaluation of five commercial bacteriophage cocktails against methicillin-resistant Staphylococcus aureus isolated from nasal swab samples.

Infections due to methicillin-resistant Staphylococcus aureus (MRSA) are a growing concern for public health resulting in increase in morbidity, length of hospital stay, and cost of treatment. MRSA nasal swab screening may give clinicians additional information for decision of empiric antimicrobial agents. While increasing antibiotic resistance leads to new treatment approaches, bacteriophages are one of the most promising methods for these alternatives. It was aimed to determine the effectiveness of bacteriophages against MRSA isolates. Nasal swab samples were collected from outpatients without any evidence of infection who applied to Hatay, Mersin and Gaziantep family and immigration health centers. A series (35) were isolated from Turkish patients, and G series (64) were isolated from Syrian immigrants. Methicillin resistance was determined phenotypically and genotypically. Also, antibiotic susceptibilities of all isolates were determined against erythromycin, clindamycin, gentamicin, linezolid, rifampicin, and mupirocin. The total antimicrobial resistance rates of isolates were found to be 11%, 28%, 8%, 5%, 16%, 19%, and 29% respectively. The high susceptibility rate against ciprofloxacin (88.8%) was remarkable. The overall susceptibility of MRSA strains to ENKO, INTESTI, PYO, SES, and staphylococcal bacteriophages was 67.7%, 55.5%, 53.5%, 61.6% and 44.4%, respectively.The antibiotic susceptibility rates (except erythromycin) and efficacy of bacteriophages were higher in group A. Considering that high efficacy rates were not achieved in the study and the sensitivity rates of Turkish isolates to all phages were found to be higher than those of Syrian isolates, searching for phages in the geographic regions where the pathogen is common may be helpful to obtain suitable phages for treatment.

A multicentre analysis of Clostridium difficile in persons with Cystic Fibrosis demonstrates that carriage may be transient and highly variable with respect to strain and level

PurposeClostridium difficile has been reported to occur in the gastrointestinal tract of 50% of Cystic Fibrosis (CF) subjects, however, clinical C. difficile infection (CDI) is a rare occurrence in this cohort despite the presence of toxigenic and hypervirulent ribotypes. Here, we present the first longitudinal, multicentre analysis of C. difficile prevalence among adult CF subjects. MethodologyFaecal samples were collected from adults with CF (selected based on confirmed Pseudomonas aeruginosa pulmonary colonisation) from Ireland, UK and Belgium as part of the CFMATTERS clinical research trial (grant No. 603038) and from non-CF controls. Faecal samples were collected on enrolment, at three monthly intervals, during pulmonary exacerbation and three months post exacerbation. C. difficile was isolated from faecal samples by ethanol shocking followed by culturing on cycloserine cefoxitin egg yolk agar. Isolates were characterised in terms of ribotype, toxin type and antibiotic susceptibility to antibiotics routinely used in the treatment of CDI (metronidazole and vancomycin) and those implicated in induction of CDI (ciprofloxacin and moxifloxacin). ResultsPrevalence of C. difficile among CF subjects in the three sites was similar ranging from 47% to 50% at baseline, while the healthy control cohort had a carriage rate of 7.1%. Including subjects who were positive for C. difficile at any time point there was a higher carriage rate of 71.4%, 66.7% and 63.2% in Ireland, UK, and Belgium, respectively. Ribotyping of 80 isolates from 45 CF persons, over multiple time points revealed 23 distinct ribotypes with two ribotypes (046 and 078) shared by all centres. The proportion of toxigenic isolates varied across the sites, ranging from 66.7% in Ireland to 52.9% in Belgium and 100% in the UK. Antibiotic susceptibility rates to vancomycin, metronidazole, ciprofloxacin and moxifloxacin was 100%, 97.5%, 1.3% and 63.8%, respectively. ConclusionsThis study demonstrates the highest carriage rate of C. difficile to date in a CF cohort. Longitudinal data show that C. difficile can be a transient inhabitant of the CF gut, changing both in terms of strain and excretion rates.

Nasal Carriage of Staphylococcus aureus in Different Age Groups among Healthy School Children and its Antimicrobial Susceptibility Pattern

Introduction: Staphylococcus aureus (S.aureus) is associated with increased risk for acquiring invasive disease. There exists an increasing prevalence of resistant community acquired S.aureus infections due to the nasal colonisation of S.aureus and Methicillin-Resistant S.aureus (MRSA) worldwide. Aim: To evaluate the prevalence rate of S.aureus and MRSA nasal colonisation among healthy school children and to determine its antibiotic susceptibility rate of the S.aureus isolates. Materials and Methods: The community based cross-sectional study was conducted among 344 school going children of 5-16 years of age. Samples were obtained from the anterior nares from each child and cultured on Blood Agar (BA) and Mannitol Salt Agar (MSA). Antibiotic susceptibility pattern of S.aureus was done by Kirby-Bauer disc diffusion method. MRSA detection was done through Cefoxitin 30 μg discs along with MIC for Oxacillin and Vancomycin simultaneously according to Clinical Laboratory Standard Institute (CLSI). Results: Of the 344 children, 26 (7.55%) were found to be with nasal carriage for S.aureus of which MRSA was found to be in 12 (3.48%) isolates. S.aureus isolates exhibited resistance to multiple classes of antibiotics including Penicillin (100%), Co- trimoxazole (50%), Ciprofloxacin (15.4%), Vancomycin (7.7%), Clindamycin (7.7%), Gentamycin (7.7%). No resistance to Linezolid was observed. Conclusion: A relatively high rate of nasal carriage of S.aureus in children of age group 5-10 years was observed when compared to children of age group 11-15 years. With the risk involved transmission of infection and resistance to many classes of antibiotics among S.aureus strains exists and hence, emphasis needs to be laid to design control measures, continued surveillance and its eradication.