Antimicrobial Resistance Rates Research Articles

A longitudinal point prevalence survey of antimicrobial use and resistance in tertiary care hospitals in Kerman: results from the national Iranian multicenter point prevalence survey of antimicrobials in 2021.

The Global Point Prevalence Survey (PPS) of antimicrobial consumption and resistance has been widely undertaken to combat the global threat of antimicrobial resistance (AMR). This study was conducted in alignment with the Global-PPS in three tertiary care hospitals in Kerman, Iran, to evaluate antimicrobial consumption patterns. The study was conducted from January 2020 to January 2021 in Afzalipour, Shafa, and Shahid Bahonar Hospitals. Data were collected using the standardized Global-PPS method at three different points throughout the year to minimize bias. Information on antimicrobial prescriptions, primary diagnosis, prophylaxis, therapy indications, and treatment type were documented. Antimicrobial prevalence was calculated using the total number of admitted patients as the denominator and those on antimicrobial regimens as the numerator. The point prevalence of antimicrobial consumption in adult wards was 65.6% in Afzalipour Hospital, 42.3% in Shafa Hospital, and 78.7% in Bahonar Hospital. Non-penicillin beta-lactams, macrolides, lincosamides, and streptogramins were the most frequently prescribed antibiotic classes. Approximately 80% of prescriptions had explicit reasons documented, and targeted antibiotic therapy rates varied between 7.7% and 44.8% across hospitals. Antimicrobial consumption in Kerman's tertiary care hospitals exceeded national and global levels, indicating an urgent need for interventions to promote rational antibiotic use. Infection control committees must implement rigorous monitoring measures to reduce antimicrobial resistance. Ongoing surveillance and targeted interventions are essential to curb the rising rates of antimicrobial resistance in the region.

The Influence of COVID-19 on Antimicrobial-Resistance in Gram-Positive Bacteria at a Private Saudi Hospital: A Five-Year Evaluation

Due to the emergence of antimicrobial-resistance (AR) as a public health threat, the Saudi National Action Plan (SNAP) was implemented in 2017, incorporating various strategies to combat AR. To evaluate the effectiveness of SNAP and the impact of COVID-19, the study analyzed pre- and post-pandemic rates of AR, methicillin-resistant Staphylococcus aureus (MRSA), and multidrug resistance (MDR) among Gram-positive bacteria at a private medical center in Saudi Arabia. This study reviewed the cases of all patients who had been diagnosed with Gram-positive bacterial infection between January 2017 and December 2021. Bacterial strain identification was conducted using VITEK-2 ID-GP cards, while AR, MRSA, and MDR were defined using AST-GP 67 and AST-ST02 cards, all adhering to the manufacturer’s recommended protocols. The five-year study from 2017 to 2021 yielded 6,271 Gram-positive bacteria isolates from patients in a Saudi private hospital. Though the rate of AR initially declined between 2017 and 2019, it spiked significantly from 2020 to 2021. Similarly, the MRSA rate exhibited a substantial decrease (p < 0.05) from 2017 to 2019, followed by a significant rise (p < 0.05) between 2020 and 2021. Out of the isolated pathogens, 1,031 (16.44%) exhibited MDR, with all isolates showing a marked increase (p < 0.05) in MDR from 2020 to 2021. The study highlights the aggravating impact of the COVID-19 pandemic on AR, underscoring the need for the SNAP to intensify its efforts in combating AR.

Prevalence of blaOXA-48 and other carbapenemase encoding genes among carbapenem-resistant Pseudomonas aeruginosa clinical isolates in Egypt.

Resistance to carbapenem, the last line of treatment for gram-negative bacterial infections has been increasing globally and becoming a public health threat. Since integrons may aid in the transmission of resistance genes, the purpose of this study was to detect the frequency of class 1, 2, and 3 integrons as well as carbapenem-resistant genes in clinical isolates of P. aeruginosa that are resistant to carbapenem. This study was carried out on 97 clinical isolates of P. aeruginosa isolated from wound and urine samples. The antimicrobial susceptibility for all isolates was tested by the disc diffusion method. The presence of integrons and carbapenem-resistant genes among carbapenem-resistant P. aeruginosa isolates was evaluated by conventional PCR. The antimicrobial resistance rate among P. aeruginosa clinical isolates was high, with imipenem resistance in 58.8% of the studied isolates. In this study, 86% of the carbapenem-resistant P. aeruginosa isolates carry carbapenemase genes, with blaVIM being the most common gene followed by the blaOXA-48 gene. Class 1 and class 2 integrons were reported in 37 (64.9%) and 10 (17.5%) of the tested carbapenem-resistant P. aeruginosa isolates, respectively. Our data reported a high prevalence of class 1 integrons in carbapenem-resistant P. aeruginosa clinical isolates, suggesting the important role of integrons in carbapenem-resistant gene transfer among such isolates.

Sales of Veterinary Antibiotics in Serbia: Identification of Problem Areas Using Standardized Metrics

One Health, as a multi-disciplinary approach, considers animal, human, and environmental health. Serbia continuously records high rates of antimicrobial resistance, with a knowledge gap on practices regarding veterinary antibiotic use, as no standardized data regarding veterinary consumption of antibiotics that would allow for temporal or spatial comparison are available in Serbia. This study aimed to describe the sales of veterinary antibiotics in Serbia. Aggregated wholesale data on veterinary drug sales were retrieved from the annual reports available from the Medicines and Medical Devices Agency of the Republic of Serbia for a period between 2017 and 2020. Veterinary use was analyzed using standard European Medicines Agency proposed methodology and expressed in milligrams of active substance per population correction unit (mg/PCU). Overall, there has been a 13% increase in aggregated sales, in mg/PCU, of antibiotic veterinary medicinal products (VMPs) for food-producing animals in Serbia between 2017 and 2020. With sales of around 110 mg/PCU in 2020, Serbia would have ranked ninth in Europe. In 2020, the overall highest-selling antibiotic classes were penicillins (27.62 mg/PCU), tetracyclines (27.54 mg/PCU), and aminoglycosides (12.8 mg/PCU), accounting for 61.9% of the total sales of antibiotic VMPs for food-producing animals, in mg/PCU. An increase in the use of macrolides and lincosamides and a decrease in the use of penicillins and the group classified as “other antibacterials” was noted. The current study identified an increase in the sales of veterinary antibiotics in Serbia and pointed out several potential problem areas.

Performance of Risk Models for Antimicrobial Resistance in Adult Patients With Sepsis

The results of prediction models that stratify patients with sepsis and risk of resistant gram-negative bacilli (GNB) infections inform treatment guidelines. However, these models do not extrapolate well across hospitals. To assess whether patient case mix and local prevalence rates of resistance contributed to the variable performance of a general risk stratification GNB sepsis model for community-onset and hospital-onset sepsis across hospitals. This was a retrospective cohort study conducted from January 2016 and October 2021. Adult patients with sepsis at 10 acute-care hospitals in rural and urban areas across Missouri and Illinois were included. Inclusion criteria were blood cultures indicating sepsis, having received 4 days of antibiotic treatment, and having organ dysfunction (vasopressor use, mechanical ventilation, increased creatinine or bilirubin levels, and thrombocytopenia). Analyses were completed in April 2024. The model included demographic characteristics, comorbidities, vital signs, laboratory values, procedures, and medications administered. Culture results were stratified for ceftriaxone-susceptible GNB (SS), ceftriaxone-resistant but cefepime-susceptible GNB (RS), and ceftriaxone- and cefepime-resistant GNB (RR). Negative cultures and other pathogens were labeled SS. Deep learning models were developed separately for community-onset (patient presented with sepsis) and hospital-onset (sepsis developed ≥48 hours after admission) sepsis. The models were tested across hospitals and patient subgroups. Models were assessed using area under the receiver operating characteristic curve (AUROC) and area under precision recall curve (AUPRC). A total of 39 893 patients with 85 238 sepsis episodes (43 207 [50.7%] community onset; 42 031 [48.3%] hospital onset) were included. Median (IQR) age was 65 (54-74) years, 21 241 patients (53.2%) were male, and 18 830 (47.2%) had a previous episode of sepsis. RS contributed to 3.9% (1667 episodes) and 5.7% (2389 episodes) of community-onset and hospital-onset sepsis episodes, respectively, and RR contributed to 1.8% (796 episodes) and 3.9% (1626 episodes), respectively. Previous infections and exposure to antibiotics were associated with the risk of resistant GNB. For example, in community-onset sepsis, 375 RR episodes (47.1%), 420 RS episodes (25.2%) and 3483 of 40 744 (8.5%) SS episodes were among patients with resistance to antimicrobial drugs (P < .001). The AUROC and AUPRC results varied across hospitals and patient subgroups for both community-onset and hospital-onset sepsis. AUPRC values correlated with the prevalence rates of resistant GNB (R = 0.79; P = .001). In this cohort study of 39 893 patients with sepsis, variable model performance was associated with prevalence rates of antimicrobial resistance rather than patient case mix. This variability suggests caution is needed when using generalized models for predicting resistant GNB etiologies in sepsis.

FOSFOMYCIN SUSCEPTIBILITY IN MULTIDRUG-RESISTANT UROPATHOGENS: A RETROSPECTIVE STUDY IN THE ERA OF ANTIMICROBIAL RESISTANCE

Objective: Urinary tract infection (UTI) is one of the most prevalent clinical entities affecting people worldwide. The accelerating rate of Antimicrobial resistance due to the unimpeded and rampant use of antimicrobials with over-the-counter availability of drugs has limited the therapeutic options for the treatment of UTIs. Fosfomycin, an old broad-spectrum antimicrobial with good pharmacokinetics has regained importance for the treatment of multidrug-resistant (MDR) isolates. The purpose of this study was to determine the in vitro Fosfomycin susceptibility of common uropathogens and to study the resistance pattern of these organisms against commonly prescribed antimicrobial agents. Methods: A retrospective cross-sectional study was conducted in the Bacteriology section of the Microbiology laboratory at Adesh Institute of Medical Sciences and Research, Bathinda, Punjab for duration of 6 months from December 2022 to May 2023 from urine samples received from all clinically suspected cases of UTI. Samples were processed immediately as per standard microbiological techniques, followed by culture by a semi-quantitative method. Kass criteria was followed for interpretation of significant bacteriuria according to which significant growth was considered if the colony count was more than 105 colony forming units (CFU)/mL. Culture positives were analyzed by Gram staining and on the basis of colony characteristics, Gram staining, final identification, and Antimicrobial Susceptibility were done through Vitek 2 compact system. Results: A total of 2292 urine samples received in the Microbiology laboratory were processed and cultured during the study period, which yielded 509 significant bacterial isolates i.e.509/2292 (22.2%) culture positivity. Among 509 culture-positive samples, Escherichia coli 235/509 (46.1%) was the most common uropathogens isolated followed by Klebsiella pneumoniae 107/509 (21.1%), Enterococcus species 40/509 (7.8%). Fosfomycin depicted good in vitro susceptibility of a minimum of 94% in both Gram-negative and Gram-positive uropathogens as compared to Nitrofurantoin, which showed sensitivity of 74% and 85%, respectively. Maximum resistance was observed toward Cephalosporins i.e., Ceftriaxone in E. coli (60%) and K. pneumoniae (64%), respectively, followed by 50% in Acinetobacter baumannii. Maximum resistance to Ciprofloxacin (62%) was seen in case of A. baumannii. 172/405(42.4%) isolates of Enterobacteriaceae family were extended-spectrum β-lactamase (ESBL) producers with an average Fosfomycin susceptibility of 95.9%. Among the total isolated uropathogens, 135/509 (26.5%) were MDR, out of which 116/135 (85.9%) depicted Fosfomycin susceptibility. Metallo-beta-lactamase (MBL) production was seen in 14.3% of the isolated Gram-negative uropathogens. 63/73(86.3%) of the MBL producers were found susceptible to Fosfomycin. Conclusion: Fosfomycin has emerged as an effective alternative for the treatment of common uropathogens including the MDRs, ESBL producers, and the MBLs in the era of increasing antimicrobial resistance. It has the potential to act as a promising oral agent for the treatment of UTI in both community and healthcare setups.

Impact of COVID-19 on the Prevalence and Drug Resistance of Bacteria Isolated From Bacterial Meningitis Cerebrospinal Fluid in Shandong Province: A Multicenter Retrospective Study.

Our objective was to evaluate the ramifications of the 2019 coronavirus disease (COVID-19) pandemic on the microbial profile and antimicrobial resistance patterns of bacteria isolated from cerebrospinal fluid (CSF) specimens of patients with bacterial meningitis. We conducted a retrospective analysis of laboratory results and clinical records about positive CSF cultures reported by the SPARSS network from 2017 to 2023. The study covered three distinct periods: January 2017 to December 2019 (before the COVID-19 pandemic), January 2020 to December 2022 (during the COVID-19 pandemic), and January 2023 to December 2023 (after the COVID-19 pandemic), with a total of 5793 CSF isolates collected. Notably, the proportion of male patients (61.3%) was higher than that of females. After COVID-19, we observed a notable shift in the seasonal peak of CSF pathogens, with a delay of approximately 3 months. Remarkable alterations were evident in both pediatric and adult CSF isolate profiles. In children, the predominant pathogens included coagulase-negative Staphylococcus (CoNS), Streptococcus pneumonia, and Escherichia coli. Notably. After COVID-19, there was a significant decrease in the proportion of CoNS (p = 0.0039) and a notable increase in E. coli (p = 0.0067). In adults, the top three pathogens were CoNS, Acinetobacter baumannii, and Klebsiella pneumoniae. After the pandemic, we observed a significant reduction in the prevalence of A. baumannii (p = 0.0059), while the proportions of K. pneumoniae, Pseudomonas aeruginosa, Enterobacter cloacae, and Enterococcus faecalis increased significantly (p < 0.05). Additionally, among multidrug-resistant bacteria, the detection rate of carbapenem-resistant E. coli escalated (p = 0.0375). Antimicrobial susceptibility analysis indicated a declining trend in resistance rates for CoNS and A. baumannii to certain antibiotics following the pandemic. Conversely, resistance to imipenem in A. baumannii increased. In conclusion, the COVID-19 pandemic has significantly influenced the composition, antimicrobial resistance patterns, and epidemiological dynamics of CSF-isolated bacteria in Shandong province. To effectively address these changes, ongoing and dynamic surveillance of pathogen trends and antimicrobial resistance rate is essential.

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.

Healthcare waste management and antimicrobial resistance: a critical review

ABSTRACT The rapid growth of populations and urbanization has led to a significant increase in healthcare waste, posing serious health risks. A search on Google Scholar identified seven relevant articles from Ethiopia that examine the relationship between improper waste management in healthcare facilities (HCFs) and the rise of antimicrobial resistance (AMR) genes. This review aims to highlight key concepts, evidence sources, and knowledge gaps specific to the Ethiopian context. The unsafe disposal of antibiotics through leaks and solid waste has contributed to what some are calling a ‘silent pandemic,’ raising concerns about emerging infectious diseases. Studies have revealed alarming rates of infectious agents and AMR in healthcare wastewater. Isolates of C. jejuni, Escherichia coli, Enterococcus faecalis, and Enterococcus faecium from various healthcare waste sites in Ethiopia demonstrate high levels of AMR genes. Additionally, research indicates that HCFs produce significant amounts of waste, with high per-person daily waste production rates. Leachate from landfills containing this waste can negatively affect soil health, biological activity, water quality, agriculture, animal health, and human well-being. To mitigate these risks, effective waste management practices and the promotion of alternative antimicrobial use are essential strategies for reducing the emergence of pandemic diseases in developing countries.

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.

Synthesis, Biological Evaluation and Molecular Modeling Studies of Novel Tribromo-substituted Imidazole Analogs

IntroductionWith the increasing rate of antimicrobial resistance, there is an urgent demand of developing newer antimicrobial agents. In the present study we report a novel series of eighteen 1-(aryl)-2-(2,4,5-tribromo-1H-imidazol-1-yl)ethan-1-ones, which were synthesized and their spectral characterization was performed. The in-vitro studies of the compounds were carried out. Molecular modeling studies were performed on the most promising compound. The results obtained would help develop new compounds that may have broad-spectrum therapeutic effects. MethodsThe compounds were synthesized by reacting the corresponding bromo-imidazoles with substituted phenacyl bromides. The predictive ADME studies, MM-GBSA studies, and In-vitro studies were carried out for all the compounds. Binding mode analysis of the most active compounds was carried out. DFT investigations were also performed. Results and discussionsAll the synthesized compounds were found to be active against the different strains of microorganisms used in the in-vitro analysis. Binding mode analysis of the most active compounds were carried out in the active site of glucosamine-6-phosphate synthase (2VF5) and crystal structure of Mycobacterium tuberculosis InhA inhibited by PT70 (2X22). With the increasing global challenge of multi-drug resistance and the urgent need for new antimicrobial agents, these compounds show promising potential to meet emerging therapeutic demands in treating infectious diseases.

Prevalence of bacteremia and antimicrobial resistance pattern among patients in South Lebanon

Bacteremia is a leading cause of morbidity and mortality worldwide. Rising prevalence and antimicrobial resistance (AMR) are critical public health issues. This study aims to determine the prevalence of bacteremia and the AMR pattern among patients in South Lebanon. A cross-sectional study analyzed 76 positive blood cultures from Hammoud and Labib Hospitals in South Lebanon between September 2023 and March 2024. The phenotype and antimicrobial susceptibility of gram-positive and gram-negative were determined by using disk diffusion. Genotypically, polymerase chain reaction was used to detect the carbapenemase-resistant Enterobacterales (CRE), extended-spectrum β-lactamases (ESBL), and methicillin-resistant Staphylococcus aureus genes. Out of 76 isolates, 38 (50%) were gram-positive and 38 (50%) were gram-negative. Escherichia coli was the most common among gram-negative (18. 42%), with 10.52% ESBL and 3.94% CRE. Staphylococcus coagulase negative was the most common among gram-positive (40.78%), followed by Staphylococcus aureus (6.57%), with 3.94% methicillin-resistant S. aureus. The prevalent ESBL gene was CTX-M (100%), and for the CRE, NDM (66.66%) was the most common gene. Regarding S. aureus, 66.66% were mecA. The diverse bacteremia isolates and resistance genes in South Lebanon reflect global variability in incidence and resistance profiles. High rates of bacteremia and AMR in South Lebanon underscore the need for effective antibiotic stewardship programs.

Investigating an outbreak of extensively drug-resistant Acinetobacter baumannii in a tertiary healthcare centre in lebanon using next-generation sequencing

The frequent occurrence of Acinetobacter baumannii in hospital settings and the elevated rate of antimicrobial resistance in this pathogen represent a serious clinical and public health threat worldwide, and particularly in Lebanon where outbreak surveillance and control are still insufficient. Whole-genome sequencing (WGS) is a fast and reliable tool to study outbreaks at the molecular level and obtain actionable knowledge, leading to better control measures. A total of 59 A. baumannii isolates were collected from intensive care unit (ICU) patients (57 isolates) and from the hospital environment (2 isolates) between August 2022 and May 2023, antimicrobial susceptibility testing (AST) was performed and gDNA was subjected to WGS. Analysis was performed to reveal the sequence types (ST), the relatedness to strains that caused other outbreaks and the arsenal of resistance genes harboured by these bacteria. Of 59 isolates, 85% were categorised as extensively drug-resistant (XDR), 13.6% as multidrug-resistant (MDR) and 1.7% as pan-drug-resistant. All isolates belonged to international clone (IC)2, of which the majority were of ST2 (91.5%). The isolates clustered well with those of a previous outbreak in the same hospital. In addition, isolates from hospitals in Lebanon clustered well together and some clustered with those originating from other countries. The observed genetic relatedness between the current isolates and those from the previous outbreaks underscores the importance of strict surveillance to limit the threat of outbreaks. Moreover, the clustering of isolates from Lebanon with others from distant countries proves the necessity to further investigate the international spread of drug-resistant pathogens and the implementation of control strategies.

Investigations of Antibiotic Susceptibilities of S. aureus Strains Isolated from Various Clinical Samples

Objective: Staphylococcus aureus (S. aureus) is a critical microorganism that causes a range of infections with high morbidity and mortality rates, including skin and soft tissue infections, urinary tract infections, endocarditis, pneumonia, septic arthritis, osteomyelitis, and sepsis in both community and healthcare settings. The objective of this study was to ascertain the antimicrobial resistance rates of methicillin-resistant S. aureus (MRSA) and Methicillin-susceptible S. aureus (MSSA) isolates derived from a range of clinical samples submitted to the Medical Microbiology Laboratory of our hospital and to examine the resistance profile specific to our hospital. Methodology: The study included 229 S. aureus isolates collected between 2022 and 2023. The isolates were identified through the application of conventional methods and the MALDI-TOF-MS system (VITEK MS, bioMerieux France). The antimicrobial susceptibility of the isolates was determined by the BD Phoenix automated system (Becton Dickinson, USA) in accordance with the criteria set forth by the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Results: The MRSA rate in the one-year period was 25.77%. When the distribution of S. aureus isolates was analyzed, it was determined that blood cultures were the most common clinical specimens from which S. aureus was isolated. Resistance to glycopeptides and linezolid was determined in MRSA isolates, albeit at a low rate. No resistance to glycopeptide and linezolid was detected in MSSA isolates. MSSA isolates were found to have a more sensitive profile to other antibiotics than MRSA isolates. The highest resistance rate was detected against penicillin with 100% and 87.06% in MRSA and MSSA isolates, respectively. In addition, the most sensitive antibiotics were determined to be glycopeptide, linezolid, daptomycin, and aminoglycoside. Conclusion: In conclusion, knowing the resistance profiles of S. aureus isolates in our hospital, will guide empirical treatment. Furthermore, the implementation of effective infection control measures and a cautious approach to antibiotic use will contribute to the management of MRSA infections.

Prevalence and antimicrobial resistance of Pseudomonas aeruginosa in food in Ho Chi Minh City

Pseudomonas aeruginosa is a bacterium that commonly found in various environments, including food, soil, and water. The significant concern is it&amp;rsquo;s resistance to many antimicrobial agents and it&amp;rsquo;s role in the spread of antibiotic resistance genes. This study investigated P. aeruginosa contamination in food products in Ho Chi Minh City and found the following contamination rates: pork (44.8%; 13/29), beef (38.5%; 10/26), fish (30.0%; 9/30), chicken (25.9%; 7/27), street drinks (25.9%; 7/27), shrimp (17.9%; 5/28), raw milk (10.7%; 3/28). The highest average quantity of P. aeruginosa contamination was observed in beef samples, with over 104 CFU/g, while shrimp samples had the lowest, nearly 103 CFU/g. Among the 94 isolates examined, 63 were sensitive or showed intermediate resistance to ten antimicrobial agents. Resistance was observed in 32 isolates, with the hightest resistance rates to aztreonam (28.9%), followed by ciprofloxacin (11.7%), and gentamicin (2.1%). The antimicrobial resistance rates of P. aeruginosa isolates varied by food type: pork (27.6%), fish (16.7%), shrimp (10.7%), chicken (7.4%), street drinks (7.4%), and beef (3.9%). All P. aeruginosa isolates from raw milk were sensitive to the tested antimicrobials. The findings suggest a need for stricter regulations to control P. aeruginosa contamination in food products. Further research is also recommended to explore the potential for transmission of drug resistance genes from P. aeruginosa in contaminated food.

Antibiotic resistance in community-acquired urinary tract infections. Did the COVID-19 pandemic cause a change?

This study aimed to evaluate the antimicrobial resistance rates before and during the coronavirus disease 2019 (COVID-19) pandemic. 897 positive urine cultures collected from outpatients of all ages between January 1, 2017, and December 31, 2022, were analyzed. The antibiotic susceptibility tests (AST) were analyzed by using an automated VITEK 2 (Biomerieux, Marcy-l`Étoile, France) compact system. AST results were interpreted according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. The significance of resistance rates was tested with the Pearson's Chi-squared test and risk factors of extended-spectrum beta-lactamases (ESBL) positiveness were identified with binary logistic regression. E. coli (n = 774) and K. pneumoniae (n = 123) were isolated in 86.3% and 13.7% of the patients, respectively. During this period of six years before and during pandemic, the highest resistance rate was found for cefuroxime axetil (49.8%) and the lowest for nitrofuratoin (6.0%). Statistically significant increases in resistance compared to the pre-pandemic period were only determined for cefixime (37.2 vs 46.0%) and ceftriaxone (37.6 vs 46.1%) (p = 0.010). ESBL positivity was the most important factor that statistically increased resistance for all antibiotics (p < 0.001 for all). Being male [OR (95% CI) 1.56 (1.13-2.15)] and presenting to the clinic after the pandemic period [1.4 (1.1-1.8)] were found to increase ESBL positiveness significantly. Ceftriaxone and Cefixime resistance rates and ESBL positivity among the uropathogens E. coli and K. pneumoniae increased during the pandemic compared with the pre-pandemic period. ESBL positivity was higher in males.

Association of Race or Ethnicity With Extended-Spectrum Beta-Lactamase Production in Escherichia Coli: A Case Control Study.

There are limited and conflicting data regarding the impact of race or ethnicity on the rate of gram-negative antimicrobial resistance. This study was performed to determine whether there is a difference in extended-spectrum beta-lactamase (ESBL) Escherichia coli infection or colonization in minoritized patients when compared to White patients from a diverse US Midwestern city. A case control study was performed, with controls with non-ESBL E. coli matched 1:1 to patients with ESBL-producing E coli based on age, sex, and ZIP code. A variety of other evidence-based factors for ESBL Enterobacterales infection and colonization were collected via chart review. Multivariate conditional logistic regression assessed the odds of minoritized patients as compared to White patients, while controlling for other common risk factors for ESBL Enterobacterales. A total of 364 matched pairs were included in the analysis. Females were the majority of the sample (91%), with median age of 65 years. The majority of the sample identified as White (73%), followed by Hispanic (14%) and Black (10%). Urine cultures made up the majority of the cultures in the sample (97%), and this was similar between ESBL and non-ESBL groups. While controlling for these risk factors for ESBL E coli, minoritized patients had a statistically significant greater odds of ESBL-producing E coli (odds ratio, 2.53; 95% confidence interval, 1.68-3.82). In our sample, which is demographically similar to the United States, minoritized patients had higher odds of ESBL-producing E coli. Further research on the drivers for this disparity is needed.

Comprehensive insights into UTIs: from pathophysiology to precision diagnosis and management.

Urinary tract infections (UTIs) are the second most common infectious disease, predominantly impacting women with 150 million individuals affected globally. It increases the socio-economic burden of society and is mainly caused by Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Enterobacter spp., and Staphylococcus spp. The severity of the infection correlates with the host factors varying from acute to chronic infections. Even with a high incidence rate, the diagnosis is mainly based on the symptoms, dipstick analysis, and culture analysis, which are time-consuming, labour-intensive, and lacking sensitivity and specificity. During this period, medical professionals prescribe empirical antibiotics, which may increase the antimicrobial resistance rate. Timely and precise UTI diagnosis is essential for addressing antibiotic resistance and improving overall quality of life. In response to these challenges, new techniques are emerging. The review provides a comprehensive overview of the global burden of UTIs, associated risk factors, implicated organisms, traditional and innovative diagnostic methods, and approaches to UTI treatment and prevention.

DeepPBI-KG: a deep learning method for the prediction of phage-bacteria interactions based on key genes.

Phages, the natural predators of bacteria, were discovered more than 100years ago. However, increasing antimicrobial resistance rates have revitalized phage research. Methods that are more time-consuming and efficient than wet-laboratory experiments are needed to help screen phages quickly for therapeutic use. Traditional computational methods usually ignore the fact that phage-bacteria interactions are achieved by key genes and proteins. Methods for intraspecific prediction are rare since almost all existing methods consider only interactions at the species and genus levels. Moreover, most strains in existing databases contain only partial genome information because whole-genome information for species is difficult to obtain. Here, we propose a new approach for interaction prediction by constructing new features from key genes and proteins via the application of K-means sampling to select high-quality negative samples for prediction. Finally, we develop DeepPBI-KG, a corresponding prediction tool based on feature selection and a deep neural network. The results show that the average area under the curve for prediction reached 0.93 for each strain, and the overall AUC and area under the precision-recall curve reached 0.89 and 0.92, respectively, on the independent test set; these values are greater than those of other existing prediction tools. The forward and reverse validation results indicate that key genes and key proteins regulate and influence the interaction, which supports the reliability of the model. In addition, intraspecific prediction experiments based on Klebsiella pneumoniae data demonstrate the potential applicability of DeepPBI-KG for intraspecific prediction. In summary, the feature engineering and interaction prediction approaches proposed in this study can effectively improve the robustness and stability of interaction prediction, can achieve high generalizability, and may provide new directions and insights for rapid phage screening for therapy.

Preventing and Controlling Healthcare-Associated Infections: The First Principle of Every Antimicrobial Stewardship Program in Hospital Settings.

Antimicrobial resistance (AMR) is one of the main public health global burdens of the 21st century, responsible for over a million deaths every year. Hospital programs aimed at improving antibiotic use, referred to as antimicrobial stewardship programs (ASPs), can both optimize the treatment of infections and minimize adverse antibiotics events including the development and spread of AMR. The challenge of AMR is closely linked to the development and spread of healthcare-associated infection (HAIs). In fact, the management of patients with HAIs frequently requires the administration of broader-spectrum antibiotic regimens due to the higher risk of acquiring multidrug-resistant organisms, which, in turn, promotes resistance. For this reason, even before using antibiotics correctly, it is necessary to prevent and control the spread of HAIs in our hospitals. In this narrative review, we present seven measures that healthcare workers, even if not directly involved in the tasks of infection prevention and control, must know, support, and embrace. We hope that this review may raise awareness among all healthcare professionals about the issues with the increasing rate of AMR and the ongoing efforts towards minimizing its rise.