Antimicrobial Resistance Research Articles

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

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

Database resources of the National Center for Biotechnology Information in 2025.

The National Center for Biotechnology Information (NCBI) provides online information resources for biology, including the GenBank® nucleic acid sequence repository and the PubMed® repository of citations and abstracts published in life science journals. NCBI provides search and retrieval operations for most of these data from 31 distinct repositories and knowledgebases. The E-utilities serve as the programming interface for most of these. Resources receiving significant updates in the past year include PubMed, PubMed Central, Bookshelf, the NIH Comparative Genomics Resource, BLAST, SequenceReadArchive, Taxonomy, iCn3D, Conserved Domain Database, Pathogen Detection, antimicrobial resistance resourcesand PubChem. These resources can be accessed through the NCBI home page at https://www.ncbi.nlm.nih.gov.

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.

Wide possibilities of topical therapy in the treatment of patients with infectious and inflammatory diseases of the pharynx

Despite medical advances, infectious and inflammatory upper respiratory diseases are the most common groups of diseases among outpatients. Viruses induce acute respiratory diseases in most patients; however, bacterial and “atypical” pathogens can cause exacerbations of chronic diseases such as adenoiditis, tonsillitis, pharyngitis and others. Prescribing etiotropic drugs to patients with infectious and inflammatory diseases of the pharynx can reduce the effectiveness of the therapy due to the growth of antimicrobial resistance. Increasing etiotropic drug resistance of some pathogens requires the selection of alternative agents for patients with infectious and inflammatory diseases of the pharynx. The non-specific prophylaxis of the latter is aimed to activate inner defense mechanisms using bacterial lysates (BL). Based on a review of the literature, the article discusses the features of the use and clinical effectiveness of topical BL in infectious and inflammatory diseases of the pharynx. BL are an important supplementation to the standard therapy regimen for inflammatory upper respiratory diseases, which contributes to the restoration of the immune response autoregulation, a reliable decrease in the frequency and duration of acute forms and exacerbations of chronic upper respiratory diseases, and reduced use of antibiotics and antipyretics. Evidence of possible mechanisms to correct immunity in infectious and inflammatory diseases of the pharynx, as well as a review of the clinical effectiveness of the medicine was demonstrated by example of Imudon. Its beneficial use to treat disease in the acute period is associated with its focal action on the infectious and inflammatory lesions. The drug is effective at any stage of the disease and can be used for prophylactic purposes due to activation of mucosal immunity in the respiratory tract. The high efficiency of Imudon is determined by its ability to activate phagocytosis and production of specific immunoglobulins by plasma cells, which reduces the risk of relapses and chronicity of the disease.

ACTINOBACTERIAL DIVERSITY DETERMINATION IN MALAYSIAN BRIS (BEACH RIDGES INTERSPERSED WITH SWALES) SOIL BY CULTURE-DEPENDENT APPROACH

Globally, the rapid emergence of antibiotic-resistant bacteria poses a major threat to public health, threatening the effectiveness of antibiotics. Addressing the crisis of antimicrobial resistance requires urgency in new drug discovery and the effort in finding novel compounds is dramatically evolving. However, one of the main obstacles is the rediscovery of known compounds from natural resources. To overcome this challenge, exploring underexploited location for new resource of actinomycetes, such as Beach Ridges Interspersed with Swales (BRIS) soil in Malaysia, was selected. Soil samples from Jambu Series and Rudua Series in Setiu, Terengganu were collected and analysed. A total of 87 actinomycetes strains were isolated on yeast malt agar (ISP2), Actinomyces agar and Zobell marine agar, with the highest number from the Jambu series using serial dilution and spread plate method. Antimicrobial screening revealed that 31 isolates exhibited activity against ESKAPE pathogens, with 28 and 12 isolates showing activity against Gram-positive and Gram-negative bacteria, respectively. These isolates showed strong inhibiting response towards one or more ESKAPE pathogens. This study highlights the potential of BRIS soil as an underexploited habitat for discovering actinobacterial communities which could lead to the discovery of a new potential antimicrobial producer to serve as novel drug leads.

Correction for Pérez-Viso et al., "A long-term survey of Serratia spp. bloodstream infections revealed an increase of antimicrobial resistance involving adult population".

Correction for Pérez-Viso et al., "A long-term survey of Serratia spp. bloodstream infections revealed an increase of antimicrobial resistance involving adult population".

In-Vitro Antimicrobial Activities of Grape Seed, Green Tea, and Rosemary Phenolic Extracts Against Liver Abscess Causing Bacterial Pathogens in Cattle

Liver abscesses, which occur in finishing cattle, are of significant economic concern to the feedlot industry. The causative agents include both Fusobacterium necrophorum subspecies (F. necrophorum and F. funduliforme), Trueperella pyogenes (T. pyogenes), and Salmonella enterica serotype Lubbock (S. Lubbock). Tylosin, a macrolide antibiotic, is supplemented in the feed to reduce liver abscesses. However, due to the concern with emergence of antimicrobial resistance, the antimicrobial activities of the plant-based phenolic compounds could be an antibiotic alternative to control liver abscesses. We investigated the inhibitory activities of phenolic compounds extracted from grape seed, green tea, and rosemary on liver-abscess-causing bacterial pathogens. Total phenolic content was determined spectrophotometrically. Anaerobic Brain–Heart Infusion broth (for Fusobacterium) and Muller–Hinton broth (for S. enterica and T. pyogenes) with phenolic extracts at 0, 0.1, 1, and 2 mg/mL were prepared. Growth was measured at 0, 12, 24 and 48 h by determining bacterial concentrations. A micro-broth dilution method was used to quantify the inhibition. Grape seed and green tea phenolics inhibited growth of both Fusobacterium subspecies, T. pyogenes and S. enterica. Green tea at 1 mg/mL concentration was more effective in inhibiting the growth of Fusobacterium when compared to grape seed and rosemary. Green tea at 2 mg/mL was more effective than at 1 mg/mL against Salmonella. The inhibitory effect was dose-dependent, which was consistent across all strains within the same bacterial species. The phenolic extracts were inhibitory against T. pyogenes with minimum inhibitory concentration ranging from 6.25 to 12.5 µg/mL. Among the phenolic extracts tested, green tea showed the most potent activity, suggesting its strong potential as a natural alternative to conventional antibiotics. Plant-based phenolic compounds supplemented in the feed may have the potential to control liver abscesses.

Genomic and Transcriptomic Comparison Between Invasive Non-Typhoidal Salmonella and Non-Invasive Isolates

Invasive non-typhoidal Salmonella (iNTS) poses a significant threat to global public health. Salmonella enterica Enteritidis and Typhimurium are the primary serovars responsible for both invasive diseases and gastroenteritis. This study aims to investigate the genomic and transcriptomic differences between isolates associated with these contrasting clinical presentations. We retrieved genomes of Salmonella Enteritidis and Salmonella Typhimurium from Enterobase, utilizing blood and stool isolates as representatives for iNTS and non-iNTS, respectively. An indistinguishable phylogenetic relationship was revealed between the blood and stool isolates for both serovars. Few genes were specifically identified in iNTS. Random forest and principal coordinates analysis permitted moderate discrimination between the two sources of isolates based on overall genome content. Notably, the blood isolates of Salmonella Typhimurium displayed an elevated level of antimicrobial resistance and genome degradation compared to stool isolates. Meanwhile, transcriptome sequencing identified few genes that were differentially expressed between blood and stool isolates. Hierarchical clustering and principal component analysis did not effectively differentiate the expression profile of iNTS from non-iNTS. In summary, few genes could serve as reliable biomarkers to distinguish iNTS and non-iNTS at either the genomic or transcriptomic level. Nevertheless, iNTS has indeed accumulated subtle genomic differences from non-iNTS, which might contribute to invasiveness.

Miniature Robots for Battling Bacterial Infection.

Micro/nanorobots have shown great promise for minimally invasive bacterial infection therapy. However, bacterial infections usually form biofilms inside the body by aggregation and adhesion, preventing antibiotic penetration and increasing the likelihood of recurrence. Moreover, a substantial portion of the infection happens in those hard-to-access regions, making delivery of antibiotics to infected sites or tissues difficult and exacerbating the challenge of addressing bacterial infections. Micro/nanorobots feature exceptional mobility and controllability, are able to deliver drugs to specific sites (targeted delivery), and enhance drug penetration. In particular, the emergence of bioinspired microrobot surface design strategies have provided effective alternatives for treating infections, thereby preventing the possible development of bacterial resistance. In this paper, we review the recent advances in design, mechanism, and actuation modalities of micro/nanorobots with exceptional antimicrobial features, highlighting active therapy strategies for bacterial infections and derived complications at various organs, from the laboratory bench to in vivo applications. The current challenges and future research directions in this field are summarized. Those breakthroughs in micro/nanorobots offer a huge potential for clinical translation for bacterial infection therapy.

High‐strength silicone polyurea/DOCIT coating with anti‐biofouling and self‐healing characteristics

AbstractA new organosilicon‐based polyurea/DOCIT composite coating with excellent mechanical, self‐healing characteristics has been successfully prepared in this paper. The optimal ratio of the two isocyanates has been explored to acquire the highest mechanical strength with 8.56 MPa and best tensile properties with 763%. The breaking strength and elongation remain 3.50 MPa and 915% with 1% antimicrobial agent DOCIT. The self‐healing characteristic comes from dense hydrogen and dynamic disulfide bonds between molecule chains. The composite coating exhibited ideal bacterial resistances for 98.02% and 96.75% against Escherichia coli (E. coli) and Staphylococcus aureus (S. aureus), respectively. The adhesion of chlorella was significantly reduced by approximately 86.48%. This work provides a promising avenue for the development of high‐performance silicone polyurea coatings for marine anti‐biofouling.

Impact of salmon farming in the antibiotic resistance and structure of marine bacterial communities from surface seawater of a northern Patagonian area of Chile

BackgroundAquaculture and salmon farming can cause environmental problems due to the pollution of the surrounding waters with nutrients, solid wastes and chemicals, such as antibiotics, which are used for disease control in the aquaculture facilities. Increasing antibiotic resistance in human-impacted environments, such as coastal waters with aquaculture activity, is linked to the widespread use of antibiotics, even at sub-lethal concentrations. In Chile, the world's second largest producer of salmon, aquaculture is considered the primary source of antibiotics residues in the coastal waters of northern Patagonia. Here, we evaluated whether the structure and diversity of marine bacterial community, the richness of antibiotic resistance bacteria and the frequency of antibiotic resistance genes increase in communities from the surface seawater of an area with salmon farming activities, in comparison with communities from an area without major anthropogenic disturbance.ResultsThe taxonomic structure of bacterial community was significantly different between areas with and without aquaculture production. Growth of the culturable fraction under controlled laboratory conditions showed that, in comparison with the undisturbed area, the bacterial community from salmon farms displayed a higher frequency of colonies resistant to the antibiotics used by the salmon industry. A higher adaptation to antibiotics was revealed by a greater proportion of multi-resistant bacteria isolated from the surface seawater of the salmon farming area. Furthermore, metagenomics data revealed a significant higher abundance of antibiotic resistant genes conferring resistance to 11 antibiotic families in the community from salmon farms, indicating that the proportion of bacteria carrying the resistance determinants was overall higher in salmon farms than in the undisturbed site.ConclusionsOur results revealed an association between bacterial communities and antibiotic resistance from surface seawater of a coastal area of Chile. Although the total bacterial community may appear comparable between sites, the cultivation technique allowed to expose a higher prevalence of antibiotic resistant bacteria in the salmon farming area. Moreover, we demonstrated that metagenomics (culture-independent) and phenotypic (culture-dependent) methods are complementary to evaluate the bacterial communities’ risk for antibiotic resistance, and that a human—influenced environment (such as salmon farms) can potentiate bacteria to adapt to environmental stresses, such as antibiotics.

Antimicrobial Resistance Profile of Enterococcal Isolates From Clinical Specimens at a Tertiary Care Hospital in Western Maharashtra, India

Antimicrobial Resistance Profile of Enterococcal Isolates From Clinical Specimens at a Tertiary Care Hospital in Western Maharashtra, India

Commercial Day-Old Chicks in Nigeria Are Potential Reservoirs of Colistin- and Tigecycline-Resistant Potentially Pathogenic Escherichia coli

Background: Frequent use of colistin (COL) and tetracyclines in the Nigerian poultry sector potentially triggers bacterial resistance against COL and tigecycline (TIG), which are last-line antibiotics used to treat multidrug-resistant infections. Aim/Objectives: This study aimed to isolate COL- and TIG-resistant E. coli from commercial day-old chicks distributed to poultry farmers in Nsukka Southeastern Nigeria, assess the production of extended-spectrum β-lactamase (ESBL) and carbapenemase by the isolates, and establish their pathogenic potentials. Materials and Methods: Non-duplicate cloacal swabs were systematically collected from 250 randomly selected day-old chicks. MacConkey agar with 1 µg/mL of COL and 16 µg/mL of tetracycline was used for the isolation of putative COL- and tetracycline-resistant E. coli, respectively. E. coli isolates were confirmed biochemically using the API20E Gram-negative identification kit and molecularly by polymerase chain reaction targeting the uidA gene. Phenotypic COL resistance was established using COL agar and COL disc elution tests, while TIG insusceptibility was determined with disc diffusion. ESBL and carbapenemase production was assessed by double-disc synergy and modified carbapenem inactivation methods, respectively. Pathogenic potentials were determined using phenotypic methods. Results: COL- and TIG-resistant E. coli was recovered from 95 (38.0%) and 62 (24.8%) swabs from the 250 chicks, respectively. None of the isolates were potential ESBL or carbapenemase producers. The COL-resistant isolates displayed pathogenic potentials such as biofilm formation, haemagglutination, cell surface hydrophobicity, surface layer, and gelatinase activities at rates of 30.7%, 8.4%, 33.7%, 23.5%, and 17.6%, respectively. Meanwhile, the TIG-resistant isolates exhibited their respective potentials at rates of 47.0%, 21.0%, 35.5%, 58.1%, and 43.6%. Red, dry, and rough (RDAR) was the predominant curli fimbriae, and the cellulose morphotype portrayed by both the COL- and TIG-unsusceptible potential biofilm-producing isolates. Conclusions: This study demonstrates that a significant percentage of commercial day-old chicks distributed to farmers in Nsukka, southeastern Nigeria, are colonized by potentially pathogenic COL- and TIG-resistant E. coli, which could spread to humans and the environment.

A possible alternative to antibacterial therapy in the treatment of acute rhinosinusitis

High incidence of acute rhinosinusitis in a population remains one of the topical issues in practical otolaryngology. Statistical data show an increasing trend towards transition of acute rhinosinusitis in patients into chronic rhinosinusitis. According to literary sources, the emergence of bacterial resistance to antibiotics is as a rule the major reason of protracted course of the disease. Unreasonable antibiotics prescription, irrational use and uncontrolled intake result in the rapid development of antibiotic resistance. In this context, the use of herbal medicines having not only antibacterial, but also mucolytic, fungicidal, antioxidant effects in the complex therapy is a modern solution for disease management. Respero Myrtol, a standardized myrtol-based medicine, has taken its rightful place in the therapy. This article is aimed to investigate the possibilities of the effective use of medicine containing standardized myrtol as its main ingredient in the treatment of acute rhinosinusitis (based on the review of literature). Research materials included scientific articles on aspects of acute rhinosinusitis in otorhinolaryngology practice that were published in domestic specialized periodicals of eLIBRARY and scientific databases Scopus, Web of Science, Medline from 2014 to 2024. The published literature was analysed using the cause-and-effect technique. A clinical example was dis-cussed. With regard to the analysis of scientific literature, a brief overview of the epidemiology, etiology, predisposing factors for the development, diagnosis and treatment of acute rhinosinusitis was provided. The article addresses relevant socio-economic issues related to acute rhinosinusitis, the problem of antibiotic resistance. The issues of improving acute rhinosinusitis treatments using a standardized myrtol medicine in complex therapy as an alternative to antibiotic therapy were brought to attention. As a result, the authors concluded that the use of Respero Myrtol contributes to the rapid relief of clinical symptoms of acute rhinosinusitis, improves the patient’s quality of life, and can be advised as an alternative to antibiotic therapy in uncomplicated course of the disease.

Machine Learning Approaches for Microorganism Identification, Virulence Assessment, and Antimicrobial Susceptibility Evaluation Using DNA Sequencing Methods: A Systematic Review.

Microbial infections pose a substantial global health challenge, particularly impacting immunocompromised individuals and exacerbating the issue of antimicrobial resistance (AMR). High virulence of pathogens can lead to severe infections and prolonged antimicrobial treatment, increasing the risk of developing resistant strains. Integrating machine-learning (ML) with DNA sequencing technologies offers potential solutions by enhancing microbial identification, virulence assessment, and antimicrobial susceptibility evaluation. This review explores recent advancements in these integrated approaches, addressing current limitations and identifying gaps in the literature. A comprehensive literature search was conducted across databases including PubMed, Scopus, Web of Science, and IEEE Xplore, covering publications from January 2014 to June 2024. Using a detailed Boolean search string, relevant studies focusing on ML applications in microorganism identification, antimicrobial susceptibility testing, and microbial virulence were included. The screening process involved a two-stage review of titles, abstracts, and full texts, with data extraction and critical appraisal performed using the QIAO tool. Data were analyzed through narrative synthesis to identify common themes and innovations. Out of 1,650 initially identified records, 19 studies met the inclusion criteria. These studies primarily focused on AMR, with additional research on microbial virulence and identification. Machine learning algorithms such as Random Forest, Support Vector Machines, and Convolutional Neural Networks, combined with DNA sequencing techniques like Whole Genome Sequencing and Metagenomic Sequencing, demonstrated significant advancements in predictive accuracy and efficiency. High-quality studies achieved impressive performance metrics, including F1-scores up to 0.88 and AUC scores up to 0.96. The integration of ML and DNA sequencing technologies has significantly enhanced microbial analysis, improving the identification of pathogens, assessment of virulence, and evaluation of antimicrobial susceptibility. Despite advancements, challenges such as data quality, high costs, and model interpretability persist. This review highlights the need for continued innovation and provides recommendations for future research to address these limitations and improve disease management and public health strategies. The systematic review is registered with PROSPERO (CRD42024571347).

The diabetic foot ulcer: Biofilm, antimicrobial resistance, and amputation

The diabetic foot ulcer: Biofilm, antimicrobial resistance, and amputation

Dual role of ramR mutation in enhancing immune activation and elevating eravacycline resistance in Klebsiella pneumoniae

AbstractThe rise of Klebsiella pneumoniae resistant to last‐resort antimicrobials poses an urgent threat to global health. The ramR‐ramA regulatory system critically influences drug resistance by regulating the AcrAB‐TolC efflux pump, which also plays a crucial role in the pathogenicity of K. pneumoniae. However, the mechanism of the ramR‐ramA system on bacteria‐host interaction remains unclear. To determine how specific mutations in ramR influence eravacycline (ERV) resistance and their impact on the immune activation capabilities of K. pneumoniae, thereby highlighting potential targets for therapeutic intervention, we performed genetic sequencing to identify mutations in ramR. Then, the CRISPR‐Cas9 technology was employed to construct specific ramR mutations into K. pneumoniae, which were then subjected to phenotypic and functional assays in both in vitro and in vivo (mouse models, macrophage, and blood‐killing experiment) settings. ramR L58P and F165L genetic alterations disrupt the binding affinity of RamR to the ramA promoter, thereby upregulating the efflux pump expression and increasing ERV minimum inhibitory concentration values up to 64‐fold compared to the wild‐type. Concurrently, these mutations modulate lipid A structure by increasing 2‐hydroxy fatty acid chain abundance. In mouse models, ramR L58P and F165L mutants showed lower bacterial burden in organs (spleen, lung, and kidney) 6 h post‐infection, and are fast cleared in 48 h. Furthermore, despite lower intracellular bacterial loads, ramR L58P and F165L mutants induce heightened pro‐inflammatory cytokine responses in macrophages and elevate systemic cytokine levels (interleukin [IL]2, IL4, IL6, IL12, interferon‐α, and interferon‐γ) in human blood co‐culture experiments. This study illuminates the critical role of ramR mutations in conferring ERV resistance and enhancing immune responses in K. pneumoniae. The dual impact of these mutations on both antimicrobial resistance and immune activation not only underscores the challenges in treating infections but also advocates for heightened surveillance and innovative strategies to counteract the emerging threat of antimicrobial‐resistant K. pneumoniae.

Exploring the Role of Artificial Intelligence in Revolutionizing Microbial Diagnostics

Identifying the microorganisms responsible for illnesses and infections is crucial for accurate diagnosis, which is an essential aspect of providing medical care. Artificial intelligence (AI) systems can enhance drug discovery, epidemiological monitoring, prediction of antibiotic resistance, and disease management in the field of microbiological diagnosis. Artificial intelligence (AI) is a branch of science and technology that uses computers to simulate human intelligence. AI has recently shown tremendous promise as a powerful computational tool for the detection and management of bacterial infections. These machines can imitate human thought processes and cognitive capacities. Today, pathogen identification and Antimicrobial Susceptibility Testing (AST) in clinical laboratories often rely on culturing and isolating pathogens. With the rapid advancement of technology, Artificial Intelligence (AI) has become a vital tool for bacterial AST, providing numerous fast and efficient methods for testing drug susceptibility. AI systems offer enhanced diagnostic methods and early detection of antibiotic resistance. Moreover, they can rapidly and accurately identify diseases, including those that are novel or drug-resistant. In addition, AI can be applied to identify cells infected with malaria, detect drug resistance in pathogens like tuberculosis (TB) and HIV, understand and tackle antimicrobial resistance (AMR), and predict outbreaks. The primary goals of applying AI to bacterial diagnosis are the rapid and precise identification of pathogens and the prediction of drug resistance.

Molecular epidemiology of carbapenemase-producing Klebsiella pneumoniae in Gauteng South Africa

Klebsiella pneumoniae multidrug-resistant (MDR) high-risk clones drive the spread of antimicrobial resistance (AMR) associated infections, resulting in limited therapeutic options. This study described the genomic characteristics of K. pneumoniae MDR high-risk clones in Gauteng, South Africa. Representative carbapenem-resistant [K. pneumoniae carbapenemase (KPC)-2, New-Delhi metallo-beta (β)-lactamase (NDM)-1, oxacillinase (OXA)-181, OXA-232, OXA-48, Verona integron-encoded metallo-β-lactamase (VIM)-1] K. pneumoniae isolates (n = 22) obtained from inpatient and outpatient’s urine (n = 9) and inpatients rectal carriage (n = 13) were selected for short-read whole genome sequencing. Klebsiella pneumoniae population include sequence type (ST)-307 (n = 3), ST2497 (n = 5) and ST17 (n = 4). The ST17 strains were exclusively obtained from rectal screening. Ten isolates co-harboured carbapenemase genes including β-lactamase gene encoding KPC-2 + OXA-181, NDM-1 + OXA-48 and NDM-1 + OXA-181. One ST307 isolate (UP-KT-73CKP) co-harboured three carbapenemase genes (blaNDM-1 + blaOXA-48 + blaOXA-181), while all the ST2497 strains co-harboured (blaNDM-1 + blaOXA-232). Phenotypically, hypermucoviscosity was observed in a single ST307 isolate. The ST307 isolate UP-KT-151UKP harboured colibactin genotoxins. The following mobile genetic elements were detected: plasmids [incompatibility group (Inc)-FIB(K), IncX3], and bacteriophages [e.g. Klebsi_ST16_OXA48phi5.4_NC_049450, Klebsi_3LV2017_NC_047817(36)]. The study highlights the importance of local genomic surveillance systems to characterise K. pneumoniae MDR high-risk clones. This data will aid in designing infection and prevention measures for limiting the spread of carbapenemase-producing K. pneumoniae in Gauteng, South Africa.

Effects of Prospective Audit and Feedback in Patients with Extended-Spectrum β-Lactamase-Producing Escherichia coli Bacteremia

Antimicrobial stewardship (AS) Guidelines by the Infectious Diseases Society of America recommend employing prospective audit and feedback (PAF) as an effective intervention in AS programs. Since July 2022, our hospital has implemented PAF for all patients with positive blood cultures, including those with extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (EC) bacteremia. Our study examined the effect of PAF on clinical outcomes in patients with ESBL-EC bacteremia. We enrolled 62 patients diagnosed with ESBL-EC via blood culture who were undergoing antibiotic treatment. The patients were divided into the pre-PAF and post-PAF implementation groups. The rate of antibiotic de-escalation from broad-spectrum antibiotics to narrow-spectrum cefmetazole was significantly higher in the post-PAF group than in the pre-PAF group (80.7% vs. 32.4%, p = 0.0003). The treatment failure rate in the pre-PAF group was higher than that in the post-PAF group (38.7% vs. 12.9%, p = 0.04). The results of this study indicate that the implementation of PAF is advantageous not only in terms of process indicators but also in improved clinical outcomes, including reduced treatment failure rates. We hope that this study will encourage the implementation of PAF in more facilities to instigate a collective effort to reduce the incidence of antimicrobial resistance.