Bacterial Sensitivity Testing Research Articles

Overuse of antibiotics for urinary tract infections in pregnant refugees, Lebanon.

To determine whether adding urine culture to urinary tract infection diagnosis in pregnant women from refugee camps in Lebanon reduced unnecessary antibiotic use. We conducted a prospective, cross-sectional study between April and June 2022 involving pregnant women attending a Médecins Sans Frontières sexual reproductive health clinic in south Beirut. Women with two positive urine dipstick tests (i.e. a suspected urinary tract infection) provided urine samples for culture. Bacterial identification and antimicrobial sensitivity testing were conducted following European Committee on Antimicrobial Susceptibility Testing guidelines. We compared the characteristics of women with positive and negative urine culture findings and we calculated the proportion of antibiotics overprescribed or inappropriately used. We also estimated the cost of adding urine culture to the diagnostic algorithm. The study included 449 pregnant women with suspected urinary tract infections: 18.0% (81/449) had positive urine culture findings. If antibiotics were administered following urine dipstick results alone, 368 women would have received antibiotics unnecessarily: an overprescription rate of 82% (368/449). If administration was based on urine culture findings plus urinary tract infection symptoms, 144 of 368 women with negative urine culture findings would have received antibiotics unnecessarily: an overprescription rate of 39.1% (144/368). The additional cost of urine culture was 0.48euros per woman. A high proportion of pregnant women with suspected urinary tract infections from refugee camps unnecessarily received antibiotics. Including urine culture in diagnosis, which is affordable in Lebanon, would greatly reduce antibiotic overprescription. Similar approaches could be adopted in other regions where microbiology laboratories are accessible.

Inhibitory and preventive effects of Arnebia euchroma (Royle) Johnst. root extract on Streptococcus mutans and dental caries in rats

BackgroundDental caries is one of the prevalent conditions that threaten oral health. Arnebia euchroma (Royle) Johnst. root (AR) extracts exhibit anti-inflammatory, anti-cancer, and antibacterial properties. This study was designed to investigate the antibacterial impact of AR extract on Streptococcus mutans (S. mutans) UA159 and the anti-caries effect on rats.MethodsThe antibacterial activity of AR extract against S. mutans and its biofilm was determined using the bacterial sensitivity test, the biofilm sensitivity test, and the live-dead staining technique. By fluorescently tagging bacteria, the influence of bacterial adhesion rate was determined. Using a rat caries model, the anti-caries efficacy and safety of AR extract were exhaustively investigated in vivo.ResultsAR extract inhibit not only the growth of S. mutans, but also the generation of S. mutans biofilm, hence destroying and eliminating the biofilm. Moreover, AR extract were able to inhibit S. mutans’ adherence to saliva-encapsulated hydroxyapatite (HAP). Further, in a rat model of caries, the AR extract is able to greatly reduce the incidence and severity of caries lesions on the smooth surface and pit and fissure of rat molars, while exhibiting excellent biosafety.ConclusionsAR extract exhibit strong antibacterial activity against S. mutans and can lower the incidence and severity of dental cavities in rats. These findings suggest that Arnebia euchroma (Royle) Johnst. could be utilized for the prevention and treatment of dental caries.

Social and biological evaluation of antimicrobial resistance (SOBEAR) in rural India: a study protocol.

Antimicrobial resistance (AMR) has been one of the biggest global health threats in recent years, mostly in low- and middle-income countries, which requires urgent research using a multidisciplinary research approach. The use of large quantities of antimicrobial drugs inappropriately for humans, poultry and agriculture has been recognized as a leading cause of antibiotic resistance and the predominance of drug-resistance pathogens in the environment. This protocol aims to describe the use/misuse of antibiotics (ABs) in the community and evaluate clinical samples from healthcare settings to detect genes associated with antimicrobial resistance. We will conduct a community-level survey in different villages of the Tigiria block to assess knowledge and awareness on ABs and AMR. We will conduct in-depth interviews (IDIs) with doctors, pharmacists, nurses and drug sellers, as well as focus group discussions (FGDs) with ASHA and ANM workers who are involved in antibiotic supplies to the community. Quantitative data from the community survey and qualitative data of IDIs and FGDs will be linked and analyzed using statistical modeling and iterative thematic content analysis. Specimens (stool, urine, blood and wound/pus) will be collected from clinically diagnosed patients of different healthcare centers of Tigiria block. The samples will be cultured for bacterial isolation and antibiotic sensitivity testing. Genomic DNA will be isolated from positive bacterial cultures and sequenced using PCR to evaluate high-threat multi-drug resistance organisms (MDROs), screening of plasmid-mediated quinolone resistance (PMQR) genes, antimicrobial genes responsible for MDR and quinolone resistance-determining regions (QRDRs). This is the community-based protocol to evaluate the knowledge, attitudes, awareness and practices regarding ABs and AMR. The study protocol establishes a foundation for evaluating population-based prevalence and risk factors for AMR and MDROs in rural areas of the Odisha state, India.

Antimicrobial resistance of clinical bacterial isolates according to the WHO’s AWaRe and the ECDC-MDR classifications: the pattern in Ghana’s Bono East Region

IntroductionAntimicrobial resistance (AMR) remains a significant health challenge globally and nations have the responsibility to maintain a constant surveillance of AMR, particularly for the emergence of multidrug-resistant (MDR) isolates to existing antibiotics. Against this backdrop, we applied the WHO’s AWaRe (ACCESS, WATCH, and RESERVE) antibiotics classification and the European Centre for Disease Prevention and Control (ECDC)’s multidrug resistance definition for AMR isolates from clinical specimens.MethodThis study reviewed bacterial culture and antibiotic sensitivity test outcomes. These results were then grouped according to the AWaRe and ECDC-MDR classifications.ResultsIn all, the culture and sensitivity results of the 3,178 clinical specimens were investigated, of which 59.5% were from female patients. The pathogens were isolated from 1,187 specimens (37.4%). The WHO’s ACCESS antibiotics, tetracycline, showed a relatively high level of insusceptibility, particularly among Gram-positive (GP) isolates (ranging from 66.7% to 76.7%), along with augmentin (ranging from 44.7% to 81.3%) and cloxacillin (ranging from 50.0% to 78.1%). However, the Gram-negative (GN) isolates showed a relatively high level of susceptibility to amikacin, augmentin, and nitrofurantoin. The WHO’s WATCH antibiotics, cefuroxime, ceftriaxone, cefotaxime, and ciprofloxacin showed a relatively high level of non-responsiveness among the GN isolates, particularly Proteus (ranging from 31.4% to 78.4%), Pseudomonas (ranging from 21.4% to 96.4%), and Enterobacter (ranging from 62.5% to 100%) spp. Among the WHO’s RESERVE antibiotics, resistance to ceftazidime was commonly associated with the GN coliform isolates: Eschericha coli, Klebsiella, and Citrobacter spp. Insusceptibility to meropenem was frequently observed in Staphylococcus spp., E. coli, coliforms, and Proteus spp. Out of the 1,187 isolates, 15.5% (184) were GAT (gentamycin, ampicillin, and tetracycline) MDR, of which 61% (112/184) were from specimens of female patients. The most predominant GAT-MDR isolates were Staphylococcus spp., E. coli, coliforms, and Klebsiella spp.ConclusionIn conclusion, the study revealed a relatively high level and diverse range of AMR. However, MDR in accordance with the ECDC definition was relatively low. There is, therefore, a need to have further research on AMR to inform national criteria for MDR in Ghana.

Integrative proteomic and metabonomic profiling elucidates amino acid and lipid metabolism disorder in CA-MRSA-infected breast abscesses.

Bacterial culture and drug sensitivity testing have been the gold standard for confirming community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in breast abscess with a long history. However, these tests may delay treatment and increase the risk of nosocomial infections. To handle and improve this critical situation, this study aimed to explore biomarkers that could facilitate the rapid diagnosis of CA-MRSA infection. This study for the first time applied label-free quantitative proteomics and non-targeted metabonomics to identify potential differentially expressed proteins (DEPs) and differentially expressed metabolites (DEMs) in breast abscess infected with CA-MRSA compared to methicillin-susceptible S. aureus (MSSA). The two omics data were integrated and analyzed using bioinformatics, and the results were validated using Parallel Reaction Monitoring (PRM). Receiver operating characteristic (ROC) curves were generated to evaluate the predictive efficiency of the identified biomarkers for diagnosing CA-MRSA infection. After using the above-mentioned strategies, 109 DEPs were identified, out of which 86 were upregulated and 23 were downregulated. Additionally, a total of 61 and 26 DEMs were initially screened in the positive and negative ion modes, respectively. A conjoint analysis indicated that the amino acid metabolism, glycosphingolipid biosynthesis, and glycerophospholipid metabolism pathways were co-enriched by the upstream DEPs and downstream DEMs, which may be involved in structuring the related network of CA-MRSA infection. Furthermore, three significant DEMs, namely, indole-3-acetic acid, L-(-)-methionine, and D-sedoheptulose 7-phosphate, displayed good discriminative abilities in early identification of CA-MRSA infection in ROC analysis. As there is limited high-quality evidence and multiple omics research in this field, the explored candidate biomarkers and pathways may provide new insights into the early diagnosis and drug resistance mechanisms of CA-MRSA infection in Chinese women.

Profile of Carbapenem Resistant Gram Negative Bacilli in Grha Kedoya Hospital Jakarta

Carbapenems are beta-lactam antibiotics included in the 3rd line of antibiotics, which are the last choice in therapy to overcome various bacterial infections. The more use of antibiotics that are not in accordance with the clinical situation, the more cases of carbapenem resistance found in the hospital. This study aims to analyze gram-negative bacteria, which are resistant to carbapenem antibiotics, in Grha Kedoya Hospital from January to March 2022 using an observational analytical research design for bacterial identification and antibiotic sensitivity testing using colorimetric and turbidimetric methods with a cross-sectional research design. The examination material was all samples infected with Gram-negative bacteria, as many as 174 samples. The data analysis used in this study was descriptive crosstabs. The results stated that there were carbapenem-resistant bacteria in as many as 32 samples (18.4%); the most carbapenem-resistant bacteria were Acinetobacter baumannii bacteria in as many as 16 patients (50%); Pseudomonas aeruginosa and Klebsiella pneumoniae in as many as 8 patients (25%); and the resistance test showed 100% resistance to the antibiotics Doripenem, Imipenem, Meropenem, and Ertapenem.

A Study of Spontaneous Bacterial Peritonitis in Cirrhosis of Liver with Ascites at a Tertiary Care Hospital in North India: Prevalence, Clinical, and Microbiological Profile

Background and Objectives: In patients with chronic liver disease and ascites, spontaneous bacterial peritonitis (SBP) is a common complication. This can progress gradually and subtly or go undiagnosed until signs start to show. Early diagnosis is essential for effective treatment and the prevention of subsequent episodes because the mortality rate following a single episode varies from 20% to 40%. The goal was to study the incidence, clinical profile, and microbiological characteristics of SBP and its variants in people with liver cirrhosis and ascites. Materials and Methods: This observational study was done on 104 cirrhotic patients with ascites admitted at a tertiary care hospital. Basic demographics, symptoms, and clinical signs of patients were recorded. Diagnostic paracentesis was done aseptically and immediately sent for ascitic fluid cytology, biochemistry, and culture. Bacterial examination and antibiotic sensitivity tests were carried out by standard microbiological techniques. Results: Out of a total of 104 cirrhotic patients, 28 (26.9%) were diagnosed with SBP. Alcohol was the most common etiological factor, followed by hepatitis C infection. Among the SBP patients, the most common presentation was culture-negative neutrocytic ascites (71.4%), followed by classical SBP (17.8%), then mono bacterial non neutrocytic bacterascites MNB (10.7%). Among the symptoms, the most common was abdominal distension, followed by icterus, pedal edema, and abdominal pain. Majority of the patients belonged to Child–Pugh’s Grade C. Of 28 cases of SBP, 8 were culture positive. Gram-negative isolates were predominant (75%) and Escherichia coli were the most common isolate. Interpretation and Conclusion: The prevalence of SBP in cirrhotic patients was 26.9%, and Gram-negative isolates were predominant. Ascitic fluid culture and susceptibility testing can lead to accurate diagnosis of SBP and can guide for treatment as resistance to antibiotics is common.

The change of antibiotic resistance rates over the years in Enterococcus spp. isolated from clinical specimens

Aims: The aim of this study was to retrospectively evaluate the change in antibiotic resistance rates of Enterococcus species isolated from various clinical samples of outpatients and inpatients in our hospital over the years.
 Methods: Between January 2018 and December 2021, various clinical samples sent to Tekirdağ Namık Kemal University Hospital Microbiology Laboratory from outpatients, inpatients and intensive care patients were retrospectively examined. The samples were inoculated on 5% sheep blood agar, chocolate agar and EMB agar media according to their types and incubated at 37°C. The blood cultures were performed by BACTEC 1280 System (Becton Dickinson, MA, USA). Bacterial identification and antimicrobial sensitivity tests were made using conventional methods and automated systems.
 Results: A total of 417 Enterococcus strains were isolated in our laboratory at four years and included in the study. Of the 417 isolates, 204 (48.9%) were isolated from male patients and 213 (51.1%) from female patients. The mean age of the patients was 57.79±22.9 years (0-96 years). It was determined that 36.9% of the isolates belonged to outpatients, 33.4% to inpatients and 29.7% to intensive care unit patients. Of the 122 enterococci isolates identified as species, 49.2% were typed as Enterococcus faecalis (E. faecalis) and 40.2% as Enterococcus faecium (E. faecium). Of the 417 isolates, 60.4% were isolated from urine samples, 24.2% from blood samples, and 8.9% from wound samples. Considering the total antibiotic resistance rates; ampicillin was 34.9%, ciprofloxacin was 46.4%, vancomycin was 8.4%, tigecline was 3.2%, high-level gentamicin was 49.0%. Linezolid and nitrofurantoin resistance were not detected. Ampicillin and vancomycin resistance rates were determined to have a statistically significant increase within four years. Ampicillin, ciprofloxacin, vancomycin and high-level gentamicin resistance rates were found to be significantly higher in isolates obtained from inpatients and intensive care patients compared to enterococcal isolates obtained from outpatients.
 Conclusion: In our study, it was determined that antibiotic resistance in enterococcal isolates, which are the causative agents of infection in our hospital, increased over the years. In this way, determining the change in antibiotic resistance rates is beneficial in determining appropriate antibiotic use policies. It is thought that conducting surveillance studies on antibiotic resistance periodically and taking new measures according to changing antibiotic resistance rates will be beneficial in terms of treatment.

A Pilot Clinical Study on the Efficacy of Bilvamuladi Kwatha Aschyotana in the Management of Kaphaj Abhishyanda w.s.r. to Bacterial Conjunctivitis

Bacterial conjunctivitis is one of the most common ocular diseases that occurs worldwide and affects every age group and social strata. The disease Kaphaj Abhishyanda, which is due to vitiation of Kapha Pradhana Tridosha is comparable with this condition. In the management of bacterial conjunctivitis as per modern ophthalmology antibiotic and antihistaminic eye drops are prescribed. Because of recurrent use of antibiotics, chances of antibiotic resistance are increasing. The present study was planned to evaluate the management of same disease with Ayurvedic formulation. Ayurveda can provide better alternative treatment in such manifestation. Ayurvedic formulation mentioned in Ashtanga Sangraha on Kaphaj Abhishyanda was selected and the Bilwamuladi Kwatha was prepared for Aschyotana as mode of administration. 3 patients diagnosed with Kaphaj Abhishyanda were selected and given Bilwamuladi Kwatha Aschyotana 1 drop twice a day for 7 days. The assessment of symptoms was done before, during the treatment and after treatment. The Bilvamuladi Kwatha has Ushna Veerya and Kaphaghna properties, which helps in treating vitiated Kapha Dosha as well as Madhu and Shigru are known to be Chakshushya. Bilvamuladi Kwatha was found effective with significantly reducing symptoms of Kaphaj Abhishyanda and shows marked difference in bacterial culture and sensitivity testing of conjunctival smear, which is studied as objective parameter.

Analysis of biofilm-forming ability and drug resistance for Hypervirulent Klebsiella pneumoniae

Investigate the biofilm-forming ability and drug resistance of Hypervirulent Klebsiella pneumoniae (HvKP) to provide scientific basis for the treatment of HvKP-infection. A total of 96 Klebsiella pneumoniae strains isolated from clinical infection specimens in Changsha Central Hospital from January to December in 2021 were retrospectively collected, and the clinical data of patients were collected. The string test preliminarily distinguished between HvKP and classic Klebsiella pneumoniae (CKP). The biofilm-forming ability of clinical strains of Klebsiella pneumoniae (KP) was determined by microplate method. The Vitek 2 Compact automatic microbial identification/drug sensitivity analysis system was used for bacterial identification and drug sensitivity test. The clinical data of patients, biofilm forming ability and drug resistance in the HvKP group and those in the CKP group were compared and analyzed. The results showed that a total of 20 strains of HvKP were isolated from 96 non-repetitive KP, and the detection rate was 20.8%. HvKP mainly come from respiratory specimens, up to 75.0%.The prevalence of hepatobiliary diseases and the infection rate of multiple sites in patients with HvKP infection were higher than those in patients with CKP infection, and the difference was statistically significant(χ2=5.184,7.488;P=0.023,0.006).There was no significant difference between the two groups in terms of gender, age, ICU admission, hypertension, diabetes, coronary heart disease, lung disease, urinary system disease, central nervous system disease and laboratory test indexes (all P>0.05).17 (85.0%) strains of HvKP can form biofilm, including 2 strains with weak biofilm-forming ability (10.0%), 10 strains with moderate biofilm-forming ability (50.0%) and 5 strains with strong biofilm-forming ability (25.0%). Among the 76 CKP, 71 (93.4%) could form biofilm, including 13 (17.1%) with weak biofilm-forming ability, 30(39.5%) with moderate biofilm-forming ability and 28 (36.8%) with strong biofilm-forming ability. There was no significant difference in biofilm-forming ability between HvKP and CKP (χ2=1.470,P=0.225).The overall resistance rate of HvKP was not high, but a multi-resistant HvKP resistant to carbapenems was found. The detection rate of multi-resistant HvKP (5.0%) was lower than that of multi-resistant CKP (28.9%), and the difference was statistically significant (χ2=4.984, P=0.026).The resistance rate of HvKP to piperacillin/tazobactam, aztreonam, ciprofloxacin, levofloxacin, ceftazidime, cefepime, tobramycin, minocycline, doxycycline, and compound sulfamethoxazole was lower than that of CKP, and the difference was statistically significant (all P<0.05). In conclusion, most of hypervirulent Klebsiella pneumoniae can form biofilm in this study, but the difference of biofilm-forming ability is not obvious compared with classic Klebsiella pneumoniae. HvKP maintains high sensitivity to commonly used antibacterial drugs, but the drug resistance monitoring of the bacteria cannot be ignored.

Distribution and antimicrobial sensitivity pattern of multidrug-resistant Pseudomonas aeruginosa from the clinical specimen in Aceh, Indonesia

The development of P. aeruginosa resistance to antibiotics is increasing globally due to the inappropriate use of antibiotics. This retrospective descriptive study aimed to determine the distribution of multidrug resistant P. aeruginosa (MDRPA) and its antimicrobial sensitivity profiles. Data were taken from the bacterial identification and antibiotic sensitivity testing of clinical specimens in Aceh Provincial Referral Hospital from July 2017 to June 2019, where the VITEK® 2 Compact automatic device was used for the identification. In total, there were 307 P. aeruginosa isolates analyzed in this study. The results of this study revealed that 54.39% of P. aeruginosa isolates were multidrug resistant. The MDRPA were mostly found in sputum and pus cultures (41.91% and 23.95%, respectively). Based on the wardroom as the source, most samples came from the internal medicine unit, intensive care unit, and surgical unit with prevalence of 27.54%, 25.74%, and 20.35%, respectively. High proportion of infected patients were male (52.09%) and aged 56–65 years (23.95%). P. aeruginosa showed the highest sensitivity rate to amikacin (77.1%), followed by meropenem (74.4%), ceftazidime (70.1%), levofloxacin (65.1%), tobramycin (64.9%), piperacillin-tazobactam (64.3%), and gentamicin (61.4%). In conclusion, our data suggest that the MDRPA infection is prevalent in Aceh Province and Amikacin is recommended as the highest standard of therapy for MDRPA.

Procalcitonin as a Sepsis Marker in Patients of Critical Care Unit

Introduction: The aim of this study was to observe the diagnostic role of procalcitonin to evaluate sepsis and assess the level of inflammation for the patients of Critical Care Unit of different departments. Methods: This cross sectional, prospective and observational study was conducted at Armed Forces Institute of Pathology on the patients at Critical Care Unit of Paediatric, Surgery, Gynae and Medicine department in a tertiary care hospital (Combined Military Hospital, Dhaka) from June, 2020 to May, 2021. Total 106 patients were enrolled in this study. As the study was conducted during corona pandemic, RT-PCR test for Corona virus disease 2019 (COVID-19) along with serum procalcitonin and bacterial culture and sensitivity tests for different samples were prescribed for all 106 patients. Result: Out of 106 patients, 30.2% (32) patients were found positive and 69.69% (74) were found negative for COVID- 19 and 14.15% (15) patients had clinical documentation of bacterial co-infection, confirmed by blood, respiratory, or urine culture. After PCT test, 20.75 % (22) samples were found with severe sepsis or septic shock, 7.54% (08) samples were found with systemic infection, 18.06% (20) samples were with possible systemic infection, 31.13 % (33) samples were with local infections and 21.69% (23) were found within normal ranges of PCT. Conclusion: This study supports the importance of the diagnostic role of PCT to assess the level of sepsis as well as presence of co-infection which suggests that PCT level is a good biomarker for early diagnosis, assessment and treatment of patients in CCU. J Bangladesh Coll Phys Surg 2023; 41: 198-204

Retracted: Correlation between Sputum Bacterial Culture Positive Rate and Drug Sensitivity Test Results and Disease Severity in Inpatients and Its Clinical Significance: A Systematic Review and Meta-Analysis.

[This retracts the article DOI: 10.1155/2022/5102100.].

Microbial distributions in the conjunctiva and lacrimal sacs of patients with chronic dacryocystitis in a tertiary hospital.

The aim was to clarify the distributions of bacteria in the conjunctival sac and lacrimal sac in patients with chronic dacryocystitis. In total, 297 (322 eyes) chronic dacryocystitis patients who underwent nasal endoscopic dacryocystorhinostomy (EN-DCR) were included. Conjunctival sac secretions from the affected eye were collected preoperatively, and lacrimal sac retention fluid from the affected side in the same patient was collected intraoperatively. Bacterial culture and drug sensitivity testing were performed to determine bacterial distributions. In total, 127 bacterial isolates (49 species) were detected in 123 eyes in the conjunctival group, with a positivity rate of 38.2% (123/322); 85 bacterial isolates (30 species) were detected in 85 eyes in the lacrimal sac group, with a positivity rate of 26.4% (85/322). The positivity rates were significantly different (P = 0.001) between two groups. The gram-negative bacilli proportion in the lacrimal sac group (36/85, 42.4%) was significantly higher than that in the conjunctival sac group (37/127, 29.2%) ( P = 0.047). Positive conjunctival sac secretion culture (123/322) was significantly associated with increased ocular secretion (281/322, 87.3%) (P = 0.002). Among the culture-positive bacteria in the conjunctival sac group and the lacrimal sac group, 30/127, 23.6% and 43/127, 26.7% and 21/85, 24.7% and 20/85, 23.5% were resistant to levofloxacin and tobramycin, respectively. This study illustrated differences in bacterial distributions between conjunctival sac secretions and retained lacrimal sac fluid in chronic dacryocystitis patients, with a higher proportion of gram-negative bacilli in lacrimal sac secretions. The ocular surface flora in chronic dacryocystitis patients is partially resistant to levofloxacin and tobramycin, which need to be considered by ophthalmologists.

PENGARUH WAKTU INKUBASI TERHADAP DIAMETER ZONA HAMBAT ANTIBIOTIK PADA UJI SENSITIVITAS BAKTERI KLEBSIELLA PNEUMONIA

Background: Several analytical factors can affect the diameter of the inhibition zone; This factor must beinvestigated toguarantee thevalidityofthe sensitivitytestresults. Aims: This study was to determine the pattern of influence of variations in incubation time on thediameterofthe antibiotic inhibition zone in the sensitivity test of Klebsiella pneumoniae. Methode: this research is a pre experimental design with a Static Group Comparison design.The diameter of the antibiotic inhibition zone with variations in incubation time was measured and analyzeddescriptively.The results: The diameter of the inhibition zone on the variation of the incubation time showed a patternof the influence of the incubation time on the diameter of the antibiotic inhibition zone in the bacterialsensitivity test, namely at 6-18 hours, an increase in the diameter of the inhibition zone and 18-48 hours a decrease in the diameter of the zone. Inhibite ach antibiotic. Conclucion:This study concludes that the reisasignificant effect with the pattern of theinitial incubation time(6-18hours) affecting the broader or larger diameter of the inhibition zone and the subsequent incubation time of 18-48 hours decreasing the diameter of the inhibition.Keywords: Inhibition zone diameter, incubation time, sensitivity test

Pneumatosis in cervical fascial space and necrotizing fasciitis of neck

Backgroud Pneumatosis in the cervical fascial space is a common imaging manifestation of cervical necrotizing fasciitis. At present, although there are some literature reports on pneumatosis in the cervical necrotizing fasciitis, there are few comparative reports. Objective To compare the imaging findings of necrotizing fasciitis of the neck and other cervical space infections, and explore the relationship between pneumatosis in cervical fascial space and necrotizing fasciitis of the neck. Methods A retrospective study was conducted on 56 cases of cervical fascia space infection in our department from May 2015 to March 2021, including 22 cases of necrotizing fasciitis and 34 cases of non-necrotizing fasciitis. 22 cases underwent incision, debridement and catheter drainage in the necrotizing fasciitis group. 26 cases underwent incision, debridement and catheter drainage, and 8 cases underwent ultrasound-guided puncture biopsy and catheter drainage in the non-necrotizing fasciitis group. All cases were confirmed by operation or pathological biopsy and took purulent secretions for bacterial culture and drug sensitivity test during or after operation. All cases were examined by neck CT or MRI before operation. The previous history of surgical incision or puncture and the rupture of cervical space infection were excluded. Results In 22 cases of necrotizing fasciitis, there were 19 cases had air accumulation in the fascial space (86.4%); In 34 cases of non necrotizing fasciitis, 2 cases had air accumulation in the fascial space (5.9%). There was significant difference between the two groups (χ2 = 36.9141, p < .01). Bacterial culture results were positive in 18 (81.8%) patients in the necrotizing fasciitis group. In the non necrotizing fasciitis group, 12 (35.3%) patients had positive bacterial culture results. There was significant difference in the positive rate of bacterial culture between the two groups (χ2 = 11.6239, p < .01). Except one death in necrotizing fasciitis group, all other patients were cured. There was no recurrence after follow-up for 3–6 months. Conclusions and Significance The pneumatosis of necrotizing fasciitis in the neck is dramatically more than that of other infectious diseases. It is suggested that pneumatosis in cervical fascial space is of great significance in the diagnosis of cervical necrosis, the gas production of bacteria may be closely related to the pathogenesis and development of necrotizing fasciitis of the neck, and early measures to block the generation and dissemination of gas is of great significance for treatment.

Natural occurrences and characterization of Elizabethkingia miricola infection in cultured bullfrogs (Rana catesbeiana).

The bacterium Elizabethkingia miricola is a multispecies pathogen associated with meningitis-like disease that has been isolated from several amphibian species, including the bullfrog, but this is the first isolation in Guangxi. In the present study, the dominant bacteria were isolated from the brains of five bullfrogs with meningitis-like disease on a South China farm in Guangxi. The NFEM01 isolate was identified by Gram staining; morphological observations; 16S rRNA, rpoB, and mutT-based phylogenetic tree analysis; and physiochemical characterization and was subjected to drug sensitivity and artificial infection testing. As a result of identification, the NFEM01 strain was found to be E. miricola. An artificial infection experiment revealed that NFEM01 infected bullfrogs and could cause symptoms of typical meningitis-like disease. As a result of the bacterial drug sensitivity test, NFEM01 is highly sensitive to mequindox, rifampicin, enrofloxacin, nitrofural, and oxytetracycline and there was strong resistance to gentamicin, florfenicol, neomycin, penicillin, amoxicillin, doxycycline, and sulfamonomethoxine. This study provides a reference to further study the pathogenesis mechanism of E. miricola-induced bullfrog meningitislike disease and its prevention and treatment.

Analysis of Cumulative Antibiotic Sensitivity Testing Data (Antibiogram) of Anwer Khan Modern Medical College Hospital

Background: Monitoring of antimicrobial resistance at local level is a very crucial aspect for clinical decision making, infection control interventions and antimicrobial-resistance containment strategies in this era of rising superbugs. The hospital antibiogram constructed by standardized method is a summary of antimicrobial susceptibilities of local bacterial isolates, with periodic review.&#x0D; Methods: This is a prospective observational study conducted in Microbiology Laboratory of Anwer Khan Modern Medical College Hospital (AKMMCH) over a period of three months from January to March 2021. All the samples which were received in the microbiology laboratory for aerobic bacterial culture and antibiotic sensitivity testing were considered in this study. The bacterial isolates from diagnostic clinical samples were subjected to culture in appropriate media for isolation of pathogens by standard methods and antibiotic sensitivity test (AST) was performed according to CLSI guidelines by modified Kirby Bauer disk diffusion techniques.&#x0D; Results: A total of 2917 samples were analysed in the microbiology department of AKMMCH for a period of three months of which 513(17.59%) were culture positive.Among the cultured samples of urine, respiratory sample, blood and pus, wound swabs, the rate of bacterial isolation was 266 (51.85%) ,161 (31.38%), 31 (6.04%) and 33 (6.4%) respectively. Most of the clinical isolates were Gram-negative bacilli404 (78.75%). The predominant isolate was Escherichia coli 186(36.26%) followed by Pseudomonas spp 102 (19.88%), Klebsiellaspp 79 (15.4%) and S. aureus 66 (12.87%). Antibiotic sensitivity in case of Gram-negative bacteria ranges from 30%-61% to amoxicillin-clavulanic acid, 18%-94% to third generation cephalosporin, 47%-75% to aminoglycosides, 27% -70% to ciprofloxacin, 26-70% to cotrimoxazole, 33-73% to nitrofurantoin, 27-69% to piperacillin- tazobactam and 100% to colistin. However, 53% of Escherichia coli and 58% of Klebsiella spp. were resistant to 3rd generation cephalosporins due to extended-spectrum beta-lactamase (ESBL) production. The carbapenem resistance in Escherichia coli was found 12%, Klebsiella spp 26%, Pseudomonas spp 29% and highest in Acinetobacter 46%. No superbug was detected in this study period.&#x0D; Conclusions: Antimicrobial susceptibility of various pathogen for different antibiotic is variable. Prompt antimicrobial therapy in an infection makes a lot of difference between recovery and death and most of the time prevents long term disability. Hence, antibiotic policy is one of the mandatory requirements and making an antibiogram is the first step before framing antibiotic policy.&#x0D; AKMMC J 2021; 12(2): 70-75

Clinical Characteristics and Microbial Profiles of Paediatric Patients with Methicillin-Resistant Staphylococcus aureus Pneumonia in China

Background: Staphylococcus aureus can cause fatal pneumonia. The evolution of bacteria and the overuse of antibiotics have enhanced the drug resistance of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA). Objectives: This study aimed to recapitulate the microbiological profile and clinical characteristics of paediatric patients with MRSA. Methods: This retrospective study was conducted to investigate 1372 paediatric patients with S. aureus pneumonia from January 2017 to December 2021. Sputum specimens were collected and processed for performing bacterial culture and drug sensitivity tests. Medical records of patients were reviewed for clinical characteristics and laboratory examination results. Results: The MRSA and MSSA pneumonia mainly occurred in infants; however, comparisons of sex, age, and sampling time between patients with MRSA and MSSA pneumonia showed no significant differences (P &gt; 0.05). The results of drug sensitivity in sputum culture revealed that all MRSA and MSSA isolates were susceptible to vancomycin, tigecycline, linezolid, teicoplanin, and ceftaroline. Methicillin-sensitive Staphylococcus aureus was completely sensitive to rifampicin and oxacillin. Methicillin-resistant Staphylococcus aureus was completely resistant to penicillin and oxacillin, while MSSA was less sensitive to penicillin. Methicillin-resistant Staphylococcus aureus and MSSA both maintained high sensitivity rates to gentamicin, sulfamethoxazole-trimethoprim, levofloxacin, and moxifloxacin, with the exception of clindamycin and erythromycin. According to our results, moreover, the sensitivity of MRSA to gentamicin and sulfamethoxazole-trimethoprim was significantly higher than that of MSSA (P &lt; 0.05). The common symptoms of patients with S. aureus pneumonia were fever, cough, and wheezing. patients with MRSA pneumonia had significantly higher counts of white blood cells (WBCs), C-reactive protein (CRP), and procalcitonin (PCT) than patients with MSSA pneumonia (P &lt; 0.05). Conclusions: The results of antimicrobial sensitivity test in sputum culture of MRSA and MSSA isolates can reflect the sensitivity of antibiotics and guide the use of clinical antibiotics. Infectious biomarkers can reflect the severity of infection and guide prognosis.

Prevalence of Extended Spectrum Betalactamase and Metallobetalactamase Producing Acinetobacter baumannii Isolated from Different Infections in Baghdad City of Iraq

Introduction: Acinetobacter baumannii is an important pathogen related to hospital-acquired infections worldwide. This study was designed to isolate A. baumannii from different clinical specimens, investigate the presence of antibiotic resistants’ and detect the prevalence of extended spectrum betalactamase (ESBL) and metallobetalactamase (MBL) production among A. baumannii isolates. Methods: Over a 6-months period, 500 different clinical samples were collected from four hospitals in Baghdad. Identification of bacterial isolates and antibiotic sensitivity test were performed using Vitek 2 system. A. baumannii isolates were screened for MBL and ESBL production. Results: Among the collected clinical samples, (424) were bacterial isolates. Of these, 69 samples (16.27%) were identified as A. baumannii. A largest number of A. baumannii isolates were isolated from sputum (at a percentage of (50.72%) followed by blood (30.43%), urine (13.04%), cerebrospinal fluid (CSF) (2.89%) and wound (2.89%). Antimicrobial susceptibility test showed that A. baumannii isolates displayed different resistance rates to the applied antibiotics. It was resistant to β-lactam antibiotics: ceftazidime, piperacillin/tazobactam, cefepime and imipenem at a percentage of (90, 87, 85.5 and 74%), respectively. It was resistant to aminoglycosides (gentamycin and amikacin) at 80 and 81%, respectively. The resistance rate to trimethoprim/sulfamethoxazole was 87, and 80% to Ciprofloxacin. In the present study, all imipenemresistant A. baumannii isolates 51 (74%) were positive for MBL production. 57 (82.6%) β-lactam resistant isolates were ESBL producers.