Antimicrobial Resistance Rates Research Articles

Carbapenem-Resistant Enterobacterales in the Western Balkans: Addressing Gaps in European AMR Surveillance Map.

In the context of global efforts to combat antimicrobial resistance (AMR), the importance of comprehensive AMR data is more crucial than ever. AMR surveillance networks, such as the European Antimicrobial Resistance Surveillance Network (EARS-Net) and the Central Asian and European Surveillance of Antimicrobial Resistance (CAESAR), support member states in obtaining high-quality AMR data. Nevertheless, data gaps persist in some countries, including those in the Western Balkans (WBs), a region with high AMR rates. This review analyzed existing research on carbapenem-resistant Enterobacterales (CRE) to better understand the AMR landscape in the WB countries. The most prevalent CRE was Klebsiella pneumoniae, followed by Escherichia coli, Enterobacter cloacae, and Proteus mirabilis, with sporadic cases of Morganella morganii, Providencia spp., Klebsiella oxytoca, and Citrobacter sedlakii. Carbapenemase production was identified as the most common mechanism of carbapenem resistance, but other resistance mechanisms were not investigated. An increasing trend in carbapenem resistance has been observed over the last decade, alongside a shift in carbapenemase epidemiology from the NDM type in 2013-2014 to the OXA-48 type in recent years. Few studies have applied whole-genome sequencing for CRE analysis, which has demonstrated the spread of resistance determinants across different niches and over time, emphasizing the importance of molecular-based research. The overall low number of studies in the WB countries can be attributed to limited resources, highlighting the need for enhanced support in education, training, technology, and equipment to improve data collection and evaluation.

Antimicrobial resistance of Serratia marcescens causing blood stream infections in a large University Hospital in Bulgaria, an 8-year analysis (2016-2023).

The aim of this study is to evaluate the antimicrobial susceptibility of invasive isolates of Serratia marcescens, associated with blood stream infections (BSIs) in patients hospitalized in Varna University Hospital, Bulgaria, as well as to identify the genetic mechanisms responsible for 3rd generation cephalosporin and carbapenem-resistance among these isolates. A total of 45 consecutive S. marcescens isolates, obtained from blood cultures of 45 patients with BSIs, hospitalized during an 8-year period (2016-2023) were included. Species identification and antimicrobial susceptibility testing were done by Phoenix (BD, USA) and Vitek 2 (BioMerieux, France) systems and the results were interpreted according to EUCAST guidelines. The genetic mechanisms of beta-lactam resistance were studied by PCR. During the study period, a total of 45 patients were diagnosed with S. marcescens-associated BSIs. All infections were defined as nosocomial, predominantly intensive care unit-acquired (42.2%) and 28.8% were central venous catheter-associated. The following antimicrobial resistance rates were found: ceftriaxone,piperacillin/tazobactam, 57.8%; ceftazidime, 55.6%; cefepime, trimethoprime/sulfamethoxazole, 53.3%; gentamicin, 48.8%; ciprofloxacin, 44.5%; amikacin, 15.6%; carbapenems, 2.2%. TheblaCTX-M was identified in 88.9% of the tested 3rd generation cephalosporin resistant isolates. Among these, 50% were also blaTEM positive. The single carbapenem-resistant isolate harboured blaKPC, blaCTX-M1/9, blaCMY-2 and blaTEM. This study demonstrates S. marcescens as a problematic nosocomial pathogen and we report a KPC-producing S. marcescens clinical isolate from a BSI in Bulgaria.

Isolation, characterization and antimicrobial activity study of Thymus vulgaris

Herbal medicines are important for ensuring sustainable development goals (SDGs) in healthcare, particularly in developing countries with high rates of antimicrobial resistance (AMR) and little access to medical facilities. Thymus vulgaris is a widely used herbal medicinal plant known for its secondary metabolites and antimicrobial properties. The present study involved a comprehensive examination of the isolation, characterization, and antibacterial activity of Thymus vulgaris obtained from Ethiopia. The aerial part of the plant Thymus vulgaris was successively extracted with hexane, chloroform, and methanol based on differences in polarity. Phytochemical screening tests conducted against hexane, chloroform and MeOH crude extracts indicated the presence of some secondary metabolites. Based on the thin-layer chromatography tests, the chloroform extract was subjected to column chromatography, yielding Tv-2 compounds, namely 5-isopropyl-2-methylphenol. The structures of the compounds were elucidated via spectroscopic methods (UV–Vis, FT-IR and NMR). We investigated the antibacterial properties of hexane crude extract, chloroform crude extract, MeOH crude extract, and isolated fractions derived from T. vulgaris against various bacterial strains. This study contributes to a better understanding of the bioactive components present in Thymus vulgaris crude extracts and their potential role in tackling microbial infections.

The long-term impact of an antimicrobial stewardship program in febrile neutropenia: an 8 years follow up.

To describe the long-term effects of an ASP among febrile neutropenia (FN) patients. A quasi-experimental study was conducted between 2015 and 2023 at a tertiary care hospital in Istanbul, Türkiye. The ASP was implemented for FN patients, and the effects were assessed before and after the ASP interventions, which included FN clinical pathways and regular multi-disciplinary meetings with relevant healthcare workers. A total of 489 FN episodes of 290 patients were included, 42% were female, and the mean age was 56 years (SD: 15, range: 18-89 years). After the intervention, the rate of appropriate antimicrobial therapy at the levels of starting (p = 0.005), switching (p < 0.001), and de-escalation/discontinuation, (p < 0.001) significantly increased. Another positive impact of the ASP was a significant reduction in candidemia (from 4.88 to 0.74, p = 0.004), as well as a significant reduction in the 90-day mortality rate (from 19 to 5%, p < 0.001). In multivariate analysis, having a gram-negative bloodstream infection, prolonged days with fever, and a high risk for neutropenia were found to be significant predictors of 90-day mortality, while follow-up with ASP significantly reduced mortality. Implementation of ASP led to reduced candidemia and LOS without increasing mortality, even in a country with a high rate of antimicrobial resistance. Implementation of sustainable ASP for FN patients is critical in combating antimicrobial resistance.

Aetiology, susceptibility and outcomes of fever in patients receiving chemotherapy in Malawi: a prospective study.

To evaluate causes of fever, including resistance patterns, in patients undergoing cancer treatment in Malawi. In this prospective cohort study, enrolled patients undergoing chemotherapy at Kamuzu Central Hospital in Lilongwe, Malawi were given a thermometer. If a temperature of ≥38°C was recorded, they were instructed to return for hospitalization, standardized fever workup, and antibiotics. All patients were followed through 90 days post-fever event or completion of chemotherapy. One hundred and five patients were screened and 50 were enrolled. Of the enrollees, 26 (52%) were men and 26 (52%) were HIV positive, with a mean ART duration of 7 years and CD4 count of 293 cells/µL. The most common diagnoses were aggressive non-Hodgkin lymphoma (40%) and Hodgkin lymphoma (22%). Twenty-three febrile events were recorded from 15 patients. Of the 23 events, a causative agent was isolated in 13 cases: Escherichia coli (6), Plasmodium falciparum (3), Streptococcus pneumoniae (2), Pseudomonas aeruginosa (1) and Citrobacter freundii (1). Of the six E. coli isolates, all were found to be resistant to fluoroquinolones and 4/6 (66%) were resistant to cephalosporins. All patients but one survived; the death was attributed to Pseudomonas bacteraemia. This study describes laboratory-confirmed causes of neutropenic fever (NF) in cancer patients in Malawi. Gram-negative rods, followed by malaria, were the most common source of infection. Gram-negative rods were associated with high rates of antimicrobial resistance. Malaria and resistant bacterial infections should be considered for NF treatment and prevention in sub-Saharan Africa.

Nosocomial, Healthcare-Associated, and Community-Acquired Acinetobacter baumannii in China: Clinical Characteristics, Antimicrobial Resistance Patterns and Risk Factors Associated with Carbapenem Resistance.

Acinetobacter baumannii (A. baumannii) is an widespread pathogen and carbapenem-resistant strains are great threat to hospitalized patients. This study is aimed to investigate the clinical characteristics, antimicrobial resistance patterns, and risk factors associated with carbapenem resistance in nosocomial, healthcare-associated (HCA), and community-acquired (CA) A. baumannii infections. This study retrospectively reviewed cases in a tertiary hospital in southern China between January 1, 2019, and December 31, 2021. Univariate and multivariate logistic regression analyses were performed to identified the risk factors of carbapenem resistance in nosocomial, HCA and CA A. baumannii infections. A total of 391 patients with A. baumannii infection were included. Of these patients, 96 (24.6%) had nosocomial infections, 215 (55.0%) had HCA infections, and 80 (20.5%) had CA infections. The overall 30-day mortality rates of nosocomial and HCA infection patients was significantly higher than that of CA infection (P<0.05). The incidence of antimicrobial resistance was also higher in nosocomial and HCA bacteremia than that in CA bacteremia (P<0.05). Logistic regression analysis identified age ≥60 years, urethral catheterization, and exposure to two or more antibiotics as the independent risk factors for carbapenem-resistant A. baumannii (CRAB) infection in the nosocomial infection group and exposure to two or more antibiotics and endotracheal intubation in the HCA infection group. However, malignant tumors and hematological diseases were identified as protective factors against CRAB infection in the HCA group. These data suggest that HCA A. baumannii infection is quite different from CA infection, with antimicrobial resistance and 30-day mortality rates similar to those of nosocomial infections. Additionally, the risk factors for CRAB development in the CA, HCA, and nosocomial groups were not the same, which may provides the help for controlling practices and instruction empirical clinical medication.

Epidemiology and antimicrobial resistance rates for Shigella species in a resource-rich setting

Shigellosis is an acute, often dysenteric, diarrhoeal illness that is responsible for much morbidity and mortality worldwide. Increasing rates of multidrug-resistant (MDR) and extensively drug-resistant (XDR) ​Shigella spp. have been detected worldwide and a regular review of local epidemiological and resistance rates is necessary to help guide empirical antibiotic choice. This retrospective laboratory study of faecal isolates between 2013 and 2023 demonstrates increasing rates of resistance to third-generation cephalosporins, azithromycin and ciprofloxacin, alongside an overall increase in MDR and XDR isolates.

Methods for Measuring Sensitivity and Prevalence of Anti Microbial Resistance in Campylobacter Spp

Objective: The aim of this study is to examine the prevalence of antimicrobial resistance in thermophilic Campylobacter. Campylobacter has become the leading cause of infectious enteric zoonoses in developed and developing countries worldwide, with the aim of identifying key predictors to improve clinical outcomes and reduce food poisoning and infections, particularly in children, in line with the Sustainable Development Goals (SDGs)( good health and well-being). Theoretical framework: This theme presents the main concepts and theories underlying the research. The framework includes understanding the data on morphology, structure and percentages of each antibiotic, as well as means of phenotypic identification based on selective media for bacteria, the prevalence of resistance on a global scale and a clear message for public health that this is part of the Sustainable Development Goals (SDGs) for reducing the rate of antimicrobial resistance. The methodology adopted: for this search consisted of a systematic review of the literature. A comprehensive search was conducted in PubMed, SpringerLink, ScienceDirect, Neliti and Research Gate using the keywords "antimicrobial resistance Campylobacter ssp". The search yielded 203 articles, which were reviewed according to the inclusion criteria: published between 1980 and 2024, original articles, accessible full text, in English or Spanish, Brazilian, Chinese and relevant to mechanisms and percentages over time. A more in-depth review based on exclusion criteria, such as discrepancies in search titles, inaccessibility of articles and duplication, resulted in the selection of nine targeted articles that dealt solely with the bacterium Campylobacter ssp. Results and discussion: Antibiotic resistance has emerged in Campylobacter, mainly due to the use of antibiotics in animals entering the food chain. Resistance to the antibiotics mainly used in the treatment of infections, macrolides and fluoroquinolones, has become a clinical problem, and interventions aimed at reducing this resistance are recommended. Resistance to fluoroquinolones and macrolides is due to chromosomal mutations. Resistance to other usable antibiotics, which is due to the acquisition of resistance genes, has not yet spread. However, the fact that resistance genes come from both Gram-positive and Gram-negative bacterial species suggests the possibility of the emergence of acquired resistance in Campylobacter. Implications of the research: The practical and theoretical implications of this research are discussed, offering insight into how the results may be applied or influence practice in the field of public health and also for clinicians. These implications could include clinical practice guidelines, developing predictive tools and developing policies to reduce gastroenteritis infections, particularly in neonates and young children. Originality/value: this study provides information on a bacterium which has alerted public health through food poisoning, which increases resistance in silent mode and which affects a large age group between 0-14 years, which is more frequent and is linked to effective identification tools. Not forgetting the prevalence of the percentages of each antibiotic.

Multidrug Resistance of Escherichia coli in cats and the Level of Understanding of Cat Owners on Antimicrobial Resistance

Multidrug resistance poses a global health risk to humans, animals, and the environment.The impact of this issue is so great that it has gained international attention, ranging from the rising morbidity to the mortality rate of infectious diseases in humans and animals. Because of their peculiar eliminative behavior habit of burying their waste in the ground, cats may contribute to the spread of microorganisms resistant to antibiotics. The purpose of this study was to map the prevalence of antibiotic-resistant E. coli bacteria in cats and to determine the degree of cat owners' comprehension as a risk factor for the development of antimicrobial resistance. In this investigation, 353 cat anal swab samples were found to contain E. coli. The study was carried out in 2023 between March and May. The Mueller Hilton Agar medium was used to test for multidrug resistance to beta-lactam, aminoglycoside, and tetracycline class antibiotics using the diffusion method. Using a questionnaire, the degree of knowledge on antibiotic resistance among 373 cat owners was assessed. Respondent variables include identification, knowledge, demeanor, attitude, and cat care. After that, data were descriptively examined. E. coli was detected in 87.82% (310/353) of the cat anal swab samples (n = 353) in this investigation. Additionally, multidrug resistance was shown in 7.4% (23/310) of the isolates; this frequency was higher in stray cats (8.75%) than in domestic cats (6%). For ampicillin, tetracycline, and streptomycin, the rates of antimicrobial resistance were 28.39% (88/310), 15.81% (49/310), and 14.84% (46/310), in that order. According to an analysis of the questionnaires used to gauge cat owners' comprehension of antimicrobial-resistant events, 64.3% (240/373) of the owners did not know what antimicrobial resistance was. In addition, 72.7% (271/373) of the cat owners were aware of the medications their cats were given, and 66% (246/373) of them knew how to give antibiotics to their pets. These findings are consistent with the findings of another survey that showed 70% (261/373) of cat owners took their sick cats to the veterinarian. Compared to domestic cats, stray cats in this study had a higher rate of multidrug resistance.This is consistent with the relatively positive findings of a survey on cat owners' comprehension of cat maintenance and care; yet, the poor awareness of antimicrobial resistance among cat owners may contribute to its emergence. To raise awareness regarding antimicrobial resistance in cats, cat owners need to get education.

High rates of nosocomial infections and antimicrobial resistance in a Moroccan pediatric intensive care unit: A cause for alarm

ObjectivesThis study aimed to determine the epidemiology of nosocomial infections (NIs) in a pediatric intensive care unit and define the risk factors associated with NIs. MethodsWe performed a prospective descriptive and analytical monocentric study on the incidence of NIs in the pediatric intensive care unit between July 2021 and May 2022. Children with NIs (cases) were compared with matched controls without NIs. ResultsWe analyzed 396 patients; 102 had NIs. The global incidence of NIs is 44.7% (incidence density of 10.6 per 1000 days of hospitalization). The incidence densities of blood stream infection, pneumonia associated with mechanical ventilation, and urinary tract infection were 10 per 1000 days of central venous catheter use, 7.2 per 1000 of mechanical ventilation use, and 11.1 per 1000 days urinary catheter use. The overall microbiological profile of NIs is dominated by gram-negative bacilli in 78%, followed by gram-positive cocci in 13%. The most common agents in sepsis were Klebsiella pneumoniae. In pneumonias, Acinetobacter Baumanii was the most common cause, and, in urinary tract infection, the most frequent agents were gram-negative bacteria, especially Escherichia coli (33.3%). The presence of NIs was associated with a long period of hospitalization, use of invasive devices (central venous catheter, mechanical ventilation, and bladder catheters), and use of antibiotics. ConclusionsThe incidence of NIs acquired in this unit was high and was associated with extrinsic and intrinsic factors.

DESCRIPTIVE CHARACTERISTICS, ETIOLOGICAL AGENTS, AND RISK FACTORS FOR MORTALITY OF URINARY TRACT INFECTIONS IN OLDER ADULTS

OBJECTIVE: Urinary tract infections are common in older adults and associated with significant morbidity and mortality. This study aimed to characterize the clinical features, bacterial etiologies, antimicrobial resistance patterns, and risk factors for mortality in elderly patients hospitalized with urinary tract infection. MATERIAL AND METHODS: Data were retrospectively analyzed from 118 patients aged ≥65 years hospitalized with a diagnosis of urinary tract infection between January 2018 and December 2022. Urinary tract infections were defined according to Centers for Disease Control and Prevention criteria. Isolated microorganisms in urine cultures and antimicrobial resistance rates were determined. Risk factors associated with mortality were evaluated by logistic regression analysis. RESULTS: 50.8% of patients were female; the mean age was 72.5±7.0 years. The most common symptoms were dysuria (65.3%), anorexia (65.3%), and flank pain (57.6%). Forty-nine patients (41.5%) had nosocomial urinary tract infections. All cause in hospital mortality was observed in 48 patients (40.6%), and 22 patients (18.6%) had in-hospital mortality directly related to urinary tract infection. Urosepsis (OR: 13.518, 95% CI: 1.711-106.793, p=0.014), kidney stones (OR: 7.529, 95% CI: 1.596-35.525, p=0.011) and urinary tract infections caused by multidrug-resistant organisms (OR: 18. 612, 95% CI: 1.564-4.283, p&amp;lt;0.001) were independent risk factors for mortality, and appropriate treatment (OR: 0.090, 95% CI: -3.736--1.085, p&amp;lt;0.001) was an independent protective factor for mortality. CONCLUSIONS: Urinary tract infections in elderly adults present with a wide range of symptoms and are predominantly caused by drug-resistant Escherichia coli. Urosepsis and kidney stones are critical determinants of mortality, emphasizing the need for rapid and appropriate management strategies. Understanding the etiology, clinical features, and mortality risk factors of urinary tract infections in elderly adults is crucial for optimizing infection management in this vulnerable population.

Salmonella spp. in Domestic Ruminants, Evaluation of Antimicrobial Resistance Based on the One Health Approach-A Systematic Review and Meta-Analysis.

Salmonella spp. pose a global threat as a leading cause of foodborne illnesses, particularly prevalent in the European Union (EU), where it remains the second cause of foodborne outbreaks. The emergence of antimicrobial resistance (AMR) in Salmonella spp. has become a critical concern, complicating treatment strategies and escalating the risk of severe infections. The study focuses on large and small ruminants, identifying a prevalence of Salmonella spp. in slaughterhouses and revealing varied AMR rates across antimicrobial families throughout a meta-analysis. Also, comparison with AMR in human medicine was carried out by a systematic review. The results of the present meta-analysis displayed a prevalence of Salmonella spp. in large and small ruminants at slaughterhouses of 8.01% (8.31%, cattle; 7.04%, goats; 6.12%, sheep). According to the AMR of Salmonella spp., 20, 14, and 13 out of 62 antimicrobials studied were classified as low (<5%), high (>5% but <10%), and very high (>10%), respectively. Salmonella spp. did not display AMR against aztreonam, mezlocillin, ertapenem, meropenem, cefoxitin, ceftazidime, levofloxacin, tilmicosin, linezolid, fosfomycin, furazolidone, quinupristin, trimethoprim and spectinomycin. In contrast, a prevalence of 100% of AMR has been described against ofloxacin, lincomycin, and cloxacillin. In the context of the main antibiotics used in the treatment of human salmonellosis, azithromycin was shown to have the highest resistance among Salmonella spp. isolates from humans. Regarding cephalosporins, which are also used for the treatment of salmonellosis in humans, the prevalence of Salmonella spp. resistance to this class of antibiotics was similar in both human and animal samples. Concerning quinolones, despite a heightened resistance profile in Salmonella spp. isolates from ruminant samples, there appears to be no discernible compromise to the efficacy of salmonellosis treatment in humans since lower prevalences of AMR in Salmonella spp. isolated from human specimens were observed. Although the resistance of Salmonella spp. indicates some degree of concern, most antibiotics are not used in veterinary medicine. Thus, the contribution of cattle, sheep and goats to the rise of antibiotic resistance of Salmonella spp. and its potential impact on public health appears to be relatively insignificant, due to their low prevalence in carcasses and organs. Nevertheless, the observed low prevalence of Salmonella spp. in ruminants at slaughterhouse and the correspondingly low AMR rates of Salmonella spp. to key antibiotics employed in human medicine do not indicate that ruminant livestock poses a substantial public health risk concerning the transmission of AMR. Thus, the results observed in both the meta-analysis and systematic review suggests that AMR is not solely attributed to veterinary antibiotic use but is also influenced by factors such as animal health management (i.e., biosecurity measures, prophylactic schemes) and human medicine.

Presence and antimicrobial susceptibility profile of Salmonella spp. isolated from fish farms

Salmonella spp. are important foodborne pathogens often associated with infectious outbreaks caused by consuming contaminated food. Although these microorganisms are widely distributed in several animal production chains, there are few records of their occurrence in aquaculture. This study aimed to evaluate the presence and antimicrobial resistance of Salmonella spp. isolated from fish farms. Samples were collected from three fish farms, covering water, fish, and epilithic biofilm. Salmonella isolates were identified by PCR, and serotyping was performed using the slide agglutination method, according to the Kaufman-White system. Susceptibility to antimicrobial agents was assessed using the Kirby and Bauer disk diffusion method. The presence of class 1 and 2 integrons was determined by PCR. Ninety samples were examined, of which 13 (14.44%) were positive for S. enterica, of which 5 strains were isolated from lagoon water, 3 from fish, and 5 from epilithic biofilm. Among the samples, the serotypes S. Minnesota, S. Panamá, and S. Anatum were identified. Antimicrobial resistance rates were highest for sulfonamides (92.30%), trimethoprim (84.61%), tetracycline (46.15%), and streptomycin (46.15%). Multiple antibiotic resistance was confirmed in 84.61% of the isolates, with 100% presenting integron class 1 and 7.69% integron class 2. This study demonstrated a high prevalence of multiresistant bacteria in fish farms, which reinforces public health concerns due to the use of antibiotics and the risk associated with food from farmed freshwater fish. Given these results, the need for new external research into control and prevention strategies for Salmonella spp. is evident. in aquaculture, as well as greater regulation in fish production chains.

Incidence, antimicrobial resistance and mortality of Klebsiella pneumoniae bacteraemia in Shanghai, China, 2018–2022

Background Klebsiella pneumoniae (KP) accounts for high antimicrobial resistance and mortality rates of bloodstream infections (BSIs). Objectives To investigate incidence, antimicrobial resistance and risk factors for mortality of KP BSIs in East China. Methods A retrospective study of patients with KP BSIs was conducted in a tertiary care hospital from 2018 to 2022. Medical records of all hospitalised patients with KP BSIs were reviewed and analysed. The incidence, antimicrobial resistance and mortality of KP BSIs were evaluated. The Kaplan-Meier method was used to plot survival curves and logistic regression was used to analyse risk factors for crude 30-day mortality. Results A total of 379 inpatients with KP BSIs were enrolled. The incidence of patients with KP BSIs was fluctuating between 4.77 and 9.40 per 100,000 patient-days. The crude 30-day mortality rate of these patients was 26.39%. Of the 379 KPisolates, 197 (51.98%) were carbapenem-resistant (CR) and 252 (66.49%) were multidrug-resistant (MDR). All isolates showed the lowest resistance to tigecycline (13.77%) and polymyxin B (14.61%). Cases with MDR/CR isolates had significantly longer length of hospital stay, higher crude 30-day mortality and medical costs than non-MDR/non-CR isolates. Age, CR phenotype, paracentesis, indwelling central venous catheter (CVC), use of carbapenems, tetracyclines, polymyxins B, and irrational empiric treatment were independently associated with crude 30-day mortality. Conclusion MDR/CR KP BSIs are associated with increased mortality, healthcare costs and prolonged hospitalisation. Patients with advanced age, CR phenotype, paracentesis, CVC, exposure to some antibiotics, and irrational empirical antibiotic treatment are at higher mortality risk.

COVID-19 restrictions limited interactions of people and resulted in lowered E. coli antimicrobial resistance rates.

Antibiotic resistance is rising globally and is a major One Health problem. How much person-to-person transmission or 'contagion' contributes to the spread of resistant strains compared with antibiotic usage remains unclear. As part of its COVID-19 response, Australia introduced strict people movement restrictions in early 2020. Along with internal lockdown measures, movement of people into Australia from overseas was severely restricted. These circumstances provided a unique opportunity to examine the association of people movements with changes in resistance rates. Monthly resistance data on over 646 000 Escherichia coli urine isolates from 2016 till 2023 were modelled for statistical changes in resistance trends during pre-lockdown, lockdown and post-lockdown periods. Data were available for three clinical contexts (community, hospital and aged-care facilities). Data were also available for antibiotic usage volumes and movements of people into Australia. In 2020, arrivals into Australia decreased by >95%. Antibiotic community use fell by >20%. There were sharp falls in trend rates of resistance for all antibiotics examined after restrictions were instituted. This fall in trend rates of resistance persisted during restrictions. Notably, trend rates of resistance fell in all three clinical contexts. After removal of restrictions, an upsurge in trend rates of resistance was seen for nearly all antibiotics but with no matching upsurge in antibiotic use. Restricting the movement of people appeared to have a dramatic effect on resistance rates in E. coli. The resulting reduced person-to-person interactions seems more closely associated with changes in antibiotic resistance than antibiotic usage patterns.

Global trends of antimicrobial resistance rates in Neisseria gonorrhoeae: a systematic review and meta-analysis.

Antimicrobial resistance (AMR) of Neisseria gonorrhoeae (NG) is a significant public health concern. The objective of our study was to assess global AMR rates and test them both temporally and geographically. We conducted a systematic search of relevant reports from international databases up to 2021. The R statistical package was used for all statistical analyses. A total of 225 articles were analyzed, and 432,880 NG isolates were examined. The weighted pooled resistance (WPR) rate of different antibiotics was as follows: ciprofloxacin, 51.6%; tetracycline, 45.4%; trimethoprim/sulfamethoxazole, 42.4%; chloramphenicol, 4.1%; kanamycin, 2.1%; gentamicin, 0.6%; and spectinomycin, 0.3%. The resistance to spectinomycin, gentamicin, and kanamycin decreased over time. Significant differences in antibiotic resistance rates were found between the countries. Our findings reveal a continuous increase in resistance to some antibiotics (tetracycline and ciprofloxacin) historically used for gonorrhea, even after discontinuation. However, encouraging trends of decreasing resistance to spectinomycin, gentamicin, and kanamycin were observed. Continued global monitoring of AMR profiles in NG isolates is essential for informing appropriate treatment strategies and mitigating the threat of untreatable gonorrhea.

Plasmid Curing of Bacteria Isolated from Upper Respiratory Tract Infections among Patients Attending Specialist Hospital Sokoto

Study’s Novelty/Excerpt This study focuses on curing plasmid-mediated antibiotic resistance in bacteria associated with upper respiratory tract infections in patients at Specialist Hospital Sokoto, an area previously underexplored in this context. It uniquely demonstrates the successful reversal of antibiotic resistance in Staphylococcus aureus, Streptococcus pyogenes, and Pseudomonas aeruginosa through plasmid curing experiments, highlighting the significant role of plasmids in resistance mechanisms. Additionally, the study underscores the potential for plasmid-mediated resistance to be transferred among bacterial populations, presenting a critical concern for antimicrobial resistance management in the region. Full Abstract Presences of resistant plasmids (R-plasmids) in microorganisms make the cells avert the effect of antibiotics and complicates chemotherapy of infections. This study aimed to cure the plasmid of antibiotic-resistant bacteria associated with upper respiratory tract infections among patients attending Specialist Hospital Sokoto by reassessing their susceptibility to antibiotics that were previously resistant. One hundred (100) throat swab samples were collected and analysed. The isolates were isolated and identified using standard methods (Gram staining, biochemical and serological tests). The susceptibility of the isolates to various beta-lactam antibiotics was evaluated, and resistant bacteria were subjected to plasmid curing experiments followed by further susceptibility testing to reassess their susceptibility to the erstwhile resistance. Bacteria isolated were Staphylococcus aureus, Streptococcus pyogenes, and Pseudomonas aeruginosa, with the frequency of occurrence of 20 (57.2%), 9 (25.7%), and 6 (17.1%), respectively. The result of antibiotic susceptibility tests before plasmid curing showed that Staphylococcus aureus, Streptococcus pyogenes, and Pseudomonas aeruginosa resisted Cloxacilline, Cefuroxime, Cloxacillin and Augmentin. Susceptibility results after curing showed that almost all bacteria have reverted to sensitivity to all antibiotics except Cloxacillin and Augmentin. This research implies that the resistance possessed by the bacterial isolates is plasmid-mediated and may easily be transferred to other non-resistant bacteria, which may lead to an alarming rate of antimicrobial resistance in the study area.

A Study of Antimicrobial Resistance Rates in Clinical Burn Center Isolates of Pseudomonas aeruginosa in the South of Iran

Background: This research aimed to examine the frequency of resistance to antimicrobial agents and their variations in Pseudomonas aeruginosa clinical isolates, which are accountable for invasive infections in the southern part of Iran, from 2018 to 2022. Methods: A retrospective study was conducted, involving the gathering of microbiological data from Taleghani Burn Hospital from 2018 to 2022. The primary variables under scrutiny were department, sample origin, the antiprogram system (e.g., disc diffusion and strip methods, and clinical laboratory standards), and the rate or percentage of resistant isolates investigated by antimicrobial susceptibility testing. The interpretation criteria employed for the study were those of the Clinical Laboratory Standards Institute (CLSI). And the percentage of resistant isolates was also taken into consideration. Results: The disc diffusion and strip method is the most commonly used approach for antimicrobial susceptibility testing. According to the CLSI, resistance rates ranged from 3.64% (colistin) to 77.38% (amikacin). The rates of antimicrobial resistance remained relatively constant over time in 2018-2022. Approximately 67.62% of isolates were multidrug resistant, and the remaining 9.46% were extensively drug-resistant. Wound and urine isolates demonstrated higher resistance, except for amikacin and piperacillin, than those from blood culture and biopsy. Conclusion: Antimicrobial resistance is widely prevalent in P. aeruginosa, a common bacterium in southern Iran. The findings revealed the highest resistance rates for commonly used antibiotics such as amikacin, piperacillin, ceftazidime, and meropenem. However, colistin and nitrofurantoin are more effective against this bacterium. The wound and urine isolates represented the highest resistance rates, indicating the need for prompt and appropriate treatment. Interestingly, the resistance rates for most antibiotics remained relatively stable during the study period, emphasizing the need to develop alternative treatments for P. aeruginosa infections.

Antimicrobial susceptibility rates in gram-positive catalase-negative cocci from sheep and goat genital microbiota

Gram-positive catalase-negative cocci (GPCNCs) are significant components of the genital microbiota in sheep and goats. However, characterizing them can be difficult due to overlapping culture features and the limited information on their susceptibility to antibiotics. In this study, 97 foreskin and 13 vaginal swabs were investigated using a culturomic approach. Of 110 animals, 76 (69.09 %) hosted GPCNCs, including strains from Streptococcaceae (37, 33.64 %), Aerococcaceae (30, 27.27 %), Enterococcaceae (6, 5.45 %) and other minor species. With increasing antimicrobial resistance rates in livestock, surveillance programs are globally required, so we conducted a pilot study on GPCNCs isolated from the genital mucosa surfaces of sheep and goats using the minimal inhibitory concentration assay (MIC). Due to gaps in interpretative standard breakpoints, normalized resistance interpretation was used for setting epidemiological susceptibility cut-off values (COWTs). Of 57 suitable strains, the majority (80.71 %) showed high COWTs with decrease susceptibility to at least one antimicrobial class, with 22.81 % displaying multiresistant profiles. Of interest, combined resistances to beta-lactams, macrolides, lincosamides, and tetracyclines were detected in strains of Streptococcus plurianimalium. Further combinations, including resistance to beta-lactams, pleuromutilins, aminoglycosides, and lincosamides, were also recorded in both Streptococcus uberis and Enterococcus spp. strains. Being beta-lactams, macrolides, and tetracyclines the most used antibiotics in livestock worldwide, our results highlight the need for their prudent use. Collectively, our findings highlight that small ruminant genital microbiota can serve as reservoirs for opportunistic severe pathogens, often zoonotic, carrying multidrug resistances, thus standing for high risks for both animals and humans.

The Molecular Mechanisms and Therapeutic Potential of Cranberry, D-Mannose, and Flavonoids against Infectious Diseases: The Example of Urinary Tract Infections.

The treatment of infectious diseases typically includes the administration of anti-infectives; however, the increasing rates of antimicrobial resistance (AMR) have led to attempts to develop other modalities, such as antimicrobial peptides, nanotechnology, bacteriophages, and natural products. Natural products offer a viable alternative due to their potential affordability, ease of access, and diverse biological activities. Flavonoids, a class of natural polyphenols, demonstrate broad anti-infective properties against viruses, bacteria, fungi, and parasites. Their mechanisms of action include disruption of microbial membranes, inhibition of nucleic acid synthesis, and interference with bacterial enzymes. This review explores the potential of natural compounds, such as flavonoids, as an alternative therapeutic approach to combat infectious diseases. Moreover, it discusses some commonly used natural products, such as cranberry and D-mannose, to manage urinary tract infections (UTIs). Cranberry products and D-mannose both, yet differently, inhibit the adhesion of uropathogenic bacteria to the urothelium, thus reducing the likelihood of UTI occurrence. Some studies, with methodological limitations and small patient samples, provide some encouraging results suggesting the use of these substances in the prevention of recurrent UTIs. While further research is needed to determine optimal dosages, bioavailability, and potential side effects, natural compounds hold promise as a complementary or alternative therapeutic strategy in the fight against infectious diseases.