British Society For Antimicrobial Chemotherapy Research Articles

Identification and Speciation of Non-diphtheritic Corynebacteria (NDC) and their Antimicrobial Susceptibility Pattern by Broth Microdilution

Non-diphtheritic Corynebacteria (NDC), originally considered contaminants in clinical samples, have now emerged as nosocomial pathogens, emphasising the importance of their identification and prompt reporting. 120 non-diphtheritic corynebacteria isolated from pus were chosen for examination. A battery of tests identified isolates and minimum inhibitory concentration (MIC) was detected by broth micro-dilution and interpreted as per Clinical & Laboratory Standards Institute (CLSI) and British Society for Antimicrobial Chemotherapy (BSAC) guidelines. C. amycolatum 28 (31%), followed by C. striatum 18 (20.5%) was the predominant isolate. Cephalosporins were least effective followed by Gentamycin. However, all isolates were sensitive to Vancomycin and Linezolid. Our research highlights the necessity of implementing clinical antimicrobial therapy protocols for Corynebacterium spp. Empirical treatment with vancomycin or linezolid is recommended until in vitro susceptibility results become accessible.

Outpatient parenteral antibiotic treatment for infective endocarditis: A retrospective observational evaluation

BackgroundInfective endocarditis (IE) requires long courses of intravenous (IV) antibiotics. Outpatient parenteral antibiotic therapy (OPAT) saves resources, improves the patient experience and allows care in their preferred place; however, questions remain about safety when treating IE patients. This study evaluates OPAT management of IE patients in our region between 2006 and 2019. MethodsThis is a retrospective observational evaluation and description of outcomes and adherence to suitability criteria, according to British Society for Antimicrobial Chemotherapy (BSAC) guidelines. ResultsWe identified five models of OPAT delivery. The number of patients treated expanded significantly over time. Of 101 patients, six (6%) suffered poor outcomes, but each patient had contributing factors outside of the primary infection. Median OPAT duration was 12 days and 1,489 hospital bed days were saved. ConclusionsIn a setting where there was good adherence to BSAC criteria, treating IE patients using OPAT services was safe. Complications observed were likely independent of treatment location. Significant bed days were saved.

Modulation of multidrug-resistant clone success in Escherichia coli populations: a longitudinal, multi-country, genomic and antibiotic usage cohort study

The effect of antibiotic usage on the success of multidrug-resistant (MDR) clones in a population remains unclear. With this genomics-based molecular epidemiology study, we aimed to investigate the contribution of antibiotic use to Escherichia coli clone success, relative to intra-strain competition for colonisation and infection. We sequenced all the available E coli bloodstream infection isolates provided by the British Society for Antimicrobial Chemotherapy (BSAC) from 2012 to 2017 (n=718) and combined these with published data from the UK (2001-11; n=1090) and Norway (2002-17; n=3254). Defined daily dose (DDD) data from the European Centre for Disease Prevention and Control (retrieved on Sept 21, 2021) for major antibiotic classes (β-lactam, tetracycline, macrolide, sulfonamide, quinolone, and non-penicillin β-lactam) were used together with sequence typing, resistance profiling, regression analysis, and non-neutral Wright-Fisher simulation-based modelling to enable systematic comparison of resistance levels, clone success, and antibiotic usage between the UK and Norway. Sequence type (ST)73, ST131, ST95, and ST69 accounted for 892 (49·3%) of 1808 isolates in the BSAC collection. In the UK, the proportion of ST69 increased between 2001-10 and 2011-17 (p=0·0004), whereas the proportions of ST73 and ST95 did not vary between periods. ST131 expanded quickly after its emergence in 2003 and its prevalence remained consistent throughout the study period (apart from a brief decrease in 2009-10). The extended-spectrum β-lactamase (ESBL)-carrying, globally disseminated MDR clone ST131-C2 showed overall greater success in the UK (154 [56·8%] of 271 isolates in 2003-17) compared with Norway (51 [18·3%] of 278 isolates in 2002-17; p<0·0001). DDD data indicated higher total use of antimicrobials in the UK, driven mainly by the class of non-penicillin β-lactams, which were used between 2·7-times and 5·1-times more in the UK per annum (ratio mean 3·7 [SD 0·8]). This difference was associated with the higher success of the MDR clone ST131-C2 (pseudo-R2 69·1%). A non-neutral Wright-Fisher model replicated the observed expansion of non-MDR and MDR sequence types under higher DDDregimes. Our study indicates that resistance profiles of contemporaneously successful clones can vary substantially, warranting caution in the interpretation of correlations between aggregate measures of resistance and antibiotic usage. Our study further suggests that in countries with low-to-moderate use of antibiotics, such as the UKand Norway, the extent of non-penicillin β-lactam use modulates rather than determines the success of widely disseminated MDR ESBL-carrying E coli clones. Detailed understanding of underlying causal drivers of success is important for improved control of resistant pathogens. Trond Mohn Foundation, Marie Skłodowska-Curie Actions, European Research Council, Royal Society, and Wellcome Trust.

Antibiotic resistance determination using Enterococcus faecium whole-genome sequences: a diagnostic accuracy study using genotypic and phenotypic data

DNA sequencing could become an alternative to invitro antibiotic susceptibility testing (AST) methods for determining antibiotic resistance by detecting genetic determinants associated with decreased antibiotic susceptibility. Here, we aimed to assess and improve the accuracy of antibiotic resistance determination from Enterococcus faecium genomes for diagnosis and surveillance purposes. In this retrospective diagnostic accuracy study, we first conducted a literature search in PubMed on Jan14,2021, to compile a catalogue of genes and mutations predictive of antibiotic resistance in E faecium. We then evaluated the diagnostic accuracy of this database to determine susceptibility to 12 different, clinically relevant antibiotics using a diverse population of 4382 E faecium isolates with available whole-genome sequences and invitro culture-based AST phenotypes. Isolates were obtained from various sources in 11 countries worldwide between 2000 and 2018. We included isolates tested with broth microdilution, Vitek 2, and disc diffusion, and antibiotics with at least 50 susceptible and 50 resistant isolates. Phenotypic resistance was derived from raw minimum inhibitory concentrations and measured inhibition diameters, and harmonised primarily using the breakpoints set by the European Committee on Antimicrobial Susceptibility Testing. A bioinformatics pipeline was developed to process raw sequencing reads, identify antibiotic resistance genetic determinants, and report genotypic resistance. We used our curated database, as well as ResFinder, AMRFinderPlus, and LRE-Finder, to assess the accuracy of genotypic predictions against phenotypic resistance. We curated a catalogue of 228 genetic markers involved in resistance to 12 antibiotics in E faecium. Very accurate genotypic predictions were obtained for ampicillin (sensitivity 99·7% [95% CI 99·5-99·9] and specificity 97·9% [95·8-99·0]), ciprofloxacin (98·0% [96·4-98·9] and 98·8% [95·9-99·7]), vancomycin (98·8% [98·3-99·2] and 98·8% [98·0-99·3]), andlinezolid resistance (after re-testing false negatives: 100·0% [90·8-100·0] and 98·3% [97·8-98·7]). High sensitivity was obtained for tetracycline (99·5% [99·1-99·7]), teicoplanin (98·9% [98·4-99·3]), and high-level resistance to aminoglycosides (97·7% [96·6-98·4] for streptomycin and 96·8% [95·8-97·5] for gentamicin), although at lower specificity (60-90%). Sensitivity was expectedly low for daptomycin (73·6% [65·1-80·6]) and tigecycline (38·3% [27·1-51·0]), for which the genetic basis of resistance is not fully characterised. Compared with other antibiotic resistance databases and bioinformatic tools, our curated database was similarly accurate at detecting resistance to ciprofloxacin and linezolid and high-level resistance to streptomycin and gentamicin, but had better sensitivity for detecting resistance to ampicillin, tigecycline, daptomycin, and quinupristin-dalfopristin, and better specificity for ampicillin, vancomycin, teicoplanin, and tetracycline resistance. In a validation dataset of 382 isolates, similar or improved diagnostic accuracies were also achieved. To our knowledge, this work represents the largest published evaluation to date of the accuracy of antibiotic susceptibility predictions from E faecium genomes. The results and resources will facilitate the adoption of whole-genome sequencing as a tool for the diagnosis and surveillance of antimicrobial resistance in E faecium. A complete characterisation of the genetic basis of resistance to last-line antibiotics, and the mechanisms mediating antibiotic resistance silencing, are needed to close the remaining sensitivity and specificity gaps in genotypic predictions. Wellcome Trust, UK Department of Health, British Society for Antimicrobial Chemotherapy, Academy of Medical Sciences and the Health Foundation, Medical Research Council Newton Fund, Vietnamese Ministry of Science and Technology, and European Society of Clinical Microbiology and Infectious Disease.

International consensus recommendations for the use of prolonged-infusion beta-lactam antibiotics: Endorsed by the American College of Clinical Pharmacy, British Society for Antimicrobial Chemotherapy, Cystic Fibrosis Foundation, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America, Society of Critical Care Medicine, and Society of Infectious Diseases Pharmacists.

Intravenous β-lactam antibiotics remain a cornerstone in the management of bacterial infections due to their broad spectrum of activity and excellent tolerability. β-lactams are well established to display time-dependent bactericidal activity, where reductions in bacterial burden are directly associated with the time that free drug concentrations remain above the minimum inhibitory concentration (MIC) of the pathogen during the dosing interval. In an effort to take advantage of these bactericidal characteristics, prolonged (extended and continuous) infusions (PIs) can be applied during the administration of intravenous β-lactams to increase time above the MIC. PI dosing regimens have been implemented worldwide, but implementation is inconsistent. We report consensus therapeutic recommendations for the use of PI β-lactams developed by an expert international panel with representation from clinical pharmacy and medicine. This consensus guideline provides recommendations regarding pharmacokinetic and pharmacodynamic targets, therapeutic drug-monitoring considerations, and the use of PI β-lactam therapy in the following patient populations: severely ill and nonseverely ill adult patients, pediatric patients, and obese patients. These recommendations provide the first consensus guidance for the use of β-lactam therapy administered as PIs and have been reviewed and endorsed by the American College of Clinical Pharmacy (ACCP), the British Society for Antimicrobial Chemotherapy (BSAC), the Cystic Fibrosis Foundation (CFF), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the Infectious Diseases Society of America (IDSA), the Society of Critical Care Medicine (SCCM), and the Society of Infectious Diseases Pharmacists (SIDP).

International consensus recommendations for the use of prolonged-infusion beta-lactam antibiotics: Endorsed by the American College of Clinical Pharmacy, British Society for Antimicrobial Chemotherapy, Cystic Fibrosis Foundation, European Society of Clinical Microbiology and Infectious Diseases, Infectious Diseases Society of America, Society of Critical Care Medicine, and Society of Infectious Diseases Pharmacists: An executive summary.

Intravenous β-lactam antibiotics remain a cornerstone in the management of bacterial infections due to their broad spectrum of activity and excellent tolerability. β-lactams are well established to display time-dependent bactericidal activity, where reductions in bacterial burden are directly associated with the time that free drug concentrations remain above the minimum inhibitory concentration (MIC) of the pathogen during the dosing interval. In an effort to take advantage of these bactericidal characteristics, prolonged (extended and continuous) infusions (PI) can be applied during the administration of intravenous β-lactams to increase time above the MIC. PI dosing regimens have been implemented worldwide, but implementation is inconsistent. We report consensus therapeutic recommendations for the use of β-lactam PI developed by an expert international panel with representation from clinical pharmacy and medicine. This consensus guideline provides recommendations regarding pharmacokinetic and pharmacodynamic targets, therapeutic drug monitoring considerations, and the use of PI β-lactam therapy in the following patient populations: severely ill and nonseverely ill adult patients, pediatric patients, and obese patients. These recommendations provide the first consensus guidance for the use of β-lactam therapy administered as PIs and have been reviewed and endorsed by the American College of Clinical Pharmacy (ACCP), the British Society for Antimicrobial Chemotherapy (BSAC), the Cystic Fibrosis Foundation (CFF), the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the Infectious Diseases Society of America (IDSA), the Society of Critical Care Medicine (SCCM), and the Society of Infectious Diseases Pharmacists (SIDP).

Antibiotic susceptibility and prevalence of Methicillin-resistant Staphylococcus aureus in different clinical isolates in a tertiary care hospital

Background: Staphylococcus aureus is a Gram-positive cocci bacterium responsible for variety of infections. Emergence of Methicillin-resistant S. aureus (MRSA) strains has led to a greater threat in different clinical settings. Early identification of MRSA in different infections is an effective measure to prevent and treat such systemic infections. Aims and Objectives: This study aims to isolate and identify MRSA with their antibiotic sensitivity in different clinical samples. Materials and Methods: A total of 2041 clinical samples from January to June 2021were collected and processed at the Microbiology Department of Burdwan Medical College and Hospital. S. aureus was identified and their antibiotic susceptibility testing was determined. MRSA/methicillin-sensitive S. aureus (MSSA) were identified by cefoxitin disc (30 mcg/disc) and their susceptibility to vancomycin and MIC determined by Etest following British Society for Antimicrobial Chemotherapy (BSAC) guidelines. Results: Of 2041 samples, 358 (13.36%) isolates were S. aureus, of which 207 (57.82 %) MRSA and 151 (42.18%) MSSA. Among the 207 MRSA isolates, 40% were from patients with sepsis, 18.36% from pyrexia of unknown origin, 12.56% from surgical site infection, and 10.62% from ventilator-associated events. The highest number (55.55%) of MRSA was isolated from blood followed by 27.05% of isolates were from pus. All the isolates were sensitive to vancomycin with MICs of 0.5 μg, 0.75 μg, 1.0 μg, and 1.5 μg according BSAC and also very good sensitivity to levofloxacin and piperacillin/tazobactam. Conclusion: The increasing prevalence of MRSA is posing a real threat to the health-care system. Careful detection and judicious use of antibiotics are the only answer.

Prevalence of asymptomatic bacteriuria among pregnant women and changes in antibiotic resistance: a 6-year retrospective study

Objective: Asymptomatic bacteriuria (ASB) during pregnancy is a risk factor for development of urinary tract infections and pyelonephritis, which can lead to maternal and foetal consequences. This study aimed to determine the prevalence of ASB during pregnancy, the most common causative pathogens and their resistance patterns. Methods: A retrospective analysis was performed using microbiology laboratory data from urine sample cultures from pregnant women collected at our University hospital over a 6-year period (2014–2019). Identification and susceptibility testing were performed using standard microbiology procedures based on British Society of Antimicrobial Chemotherapy and European Committee on Antimicrobial Susceptibility Testing. Results: From a total of 18,938 urine samples, 1522 (8.04%) were positive for bacteriuria, the most common isolates were Escherichia coli and Coliform (lactose fermenters) ( n = 1171, 76.9%), followed by Enterococcus faecalis and other enterococci ( n = 191, 12.5%). In 2019, the resistance of E. coli was 56.8%, 25.3% and 4.7% to amoxicillin, trimethoprim and gentamicin, respectively, with an increasing pattern of resistance to trimethoprim and gentamicin from 2014 to 2019. The resistance rates to nitrofurantoin were 1% and 5.5% for E. coli and Group B Streptococcus, respectively. Conclusion: Our study shows the trends of antimicrobial resistance in this vulnerable group and will help confirm treatment effectiveness and direct guideline recommendations locally and internationally. Level of Evidence: 2b

Survey of delivery of parenteral antimicrobials in non-inpatient settings across Europe

Delivery of parenteral antimicrobials in non-inpatient settings (DPANS) may be through a dedicated outpatient parenteral antimicrobial therapy (OPAT) service, co-ordinated by hospital- or community-based specialised teams, or via an infusion service involving community-based health professionals (nurses, general practitioners) without centralised hospital oversight, or through ad hoc arrangements. DPANS varies among countries. Our objective was to describe how DPANS is organised at a national level in European countries. A survey (65-item self-administered questionnaire) was conducted from February-June 2019 among infection specialists in 34 European countries on behalf of the ESCMID Study Group for Antimicrobial Stewardship (ESGAP) and the British Society for Antimicrobial Chemotherapy (BSAC) OPAT initiative. Most countries (28/34; 82.4%) participated in the survey. DPANS was available in almost all (27/28; 96.4%) responding countries. DPANS was predominantly provided either via specialised OPAT services (17/28; 60.7%) or via infusion services (16/28; 57.1%), with 11 countries (39.3%) providing both services. A formal OPAT team structure with specifically trained staff was reported in only six countries (6/17; 35.3%). Some countries (4/28; 14.3%) had no structured services but practiced DPANS via ad hoc arrangements. The costs of all stages of the process were covered for patients managed by specialised OPAT/infusion services, either completely, partially or for specific patient groups in the majority (20/28; 71.4%) of countries. The main barriers to implement OPAT/infusion services were lack of organisational structure or guidelines. In conclusion, DPANS with respect to availability and organisation is highly heterogeneous in Europe. National/European guidelines may help improve and standardise DPANS.

Microbiological Studies on Clostridium Perfringens Type (A)

Background:Clostridium perfringens, a rapid-growing pathogen known to secrete an arsenal of >20 virulent toxins, has been associated with intestinal diseases in both animals and humans throughout the past century. Gas gangrene is synonymous with myonecrosis and is a highly lethal infection of deep soft tissue, caused by Clostridium species, with Clostridium perfringens being the most common. Clostridium perfringens is one of the most common cause’s gas gangrene that is associated with broadspectrum antibiotic treatment. The objectives of the present article were focusing on the diagnosis of Clostridium perfringens from wound swabs from patients suffering from gas gangrene associated with antibiotics treatment and determining the best antibiotics that can inhibit the growth of Clostridium perfringens.Materials and methods: Four hundred isolates were collected from Fever Abbassia hospital in Cairo, Egypt. Clinical samples were collected from swab wounds of limbs. Samples were taken during the period of the first of Oct 2017 till the end of Oct 2018. From four hundred cases collected, Two hundred twenty-eight identified as gas gangrene (57%), One hundred twenty-eightidentified as Clostridium perfringens type(A) (56.1%) confirmed by biochemical tests (Gram stain, Catalase test, Motility test, Skim milk test, Urease test, Indole test, Nagler reaction.) and Multiplex PCR. In this study, we are used different media such as (Thioglycalate broth, Reinforced Clostridial Agar, Blood agar, TryptoseSulfiteCycloserine Agar, Robertson's cooked meat media). The antibiotic sensitivity against CL.perfringens is assayed by two methods, disc diffusion Method and Determination of (MIC) using E-Test by following the reference standards established by the Clinical and Laboratory Standards Institute ( CLSI) and British Society for Antimicrobial Chemotherapy (BSAC). The antimicrobial susceptibility test was performed for all of the isolates (128) by disc diffusion method using antibiotics (Chloramphenicol (30 μg /disc), Cefoxitin (10 μg /disc), Clindamycin (2 μg /disc), Metrondiazole (5 μg /disc), Tetracyclin (30 μg /disc), Rifampin (5 μg /disc), Penicillin (10 μg /disc) and Piperacillin (30 μg /disc) and by E- test (MIC) (0.016- 256µg/1ml) method using antibiotics (Chloramphenicol, Cefoxitin, Clindamycin, Penicillin G, Tetracycline and Piperacillin) on blood agar and incubate anaerobically in Anaerobic jar for 24 hrs. at 37 ˚C. As Rifampin and Metrondiazole breakpoints (E-Test) for Clostridium perfringenhave not yet been established by either EUCAST or CLSI.Results and conclusion: In this study, isolates Clostridium perfringens from selective media TSC Agar or Blood agar and doing biochemical tests, the antibiotics susceptibility test showing that disc diffusion method and MIC method give the same result. Susceptibility tests were done on (128) isolates of CL.perfringens by E-Test to determine MIC.Our results revealed that the percentage of sensitivity of CL.perfringens to( Chloramphenicol , Cefoxitin, Clindamycin, Rifampin, Penicillin G, Metrondiazole and Tetracyclin) are (53.9% , 53.1% , 52.3 % , 41.4 % , 35.9 % , 21.1 % , 14.1 % ) respectively . On the other hand, the data revealed that CL.perfringens was resistant to PRL ( 100%). Future advanced research should participate in the prevention of C. perfringens gas gangrene outbreaks

Validating clinical practice guidelines for the management of febrile infants presenting to the emergency department in the UK and Ireland

ObjectiveTo report the performance of clinical practice guidelines (CPG) in the diagnosis of serious/invasive bacterial infections (SBI/IBI) in infants presenting with a fever to emergency care in the UK and...

Clinical relevance, Speciation, and Antibiogram of Non -Diphtherial Corynebacteria isolated from various clinical samples in a tertiary care hospital in Zagazig, Egypt

Background: The non-diphtherial Corynebacteria, also called “Coryneforms” bacteria are a diversified group of gram positive non sporing bacilli belonging to the genus Corynebacteria. Such bacteria are considered members of human microbiota (skin, respiratory and genital mucus membranes). Coryneform bacteria's pathogenic capacity has been undervalued until recently. Despite of frequently deemed as contaminants, these bacteria have been correlated to diverse clinical infections recently. Objectives: To isolate, speciate, and determine antimicrobial susceptibility pattern of clinically relevant non-diphtherial Corynebacteria from various clinical samples. Methodology: Different clinical samples (blood, urine, sputum, wound swabs, pus) collected from hospitalized patients attending at Zagazig University Hospital. The samples were processed and cultured as per conventional bacteriological methods. A total of 75 clinically relevant corynebacterial isolates exhibited speciation utilizing matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) analysis and their antibiogram was done by disc diffusion method by means of combined guidelines of Clinical and Laboratory Standards Institute (CLSI) as well as British Society for Antimicrobial Chemotherapy (BSAC) because of lack of definite CLSI guidelines. Results: The mean age of the studied patients was 64.6 ± 14.9 years, 60% were male and 40% female. A total 75 clinically relevant Corynebacteria species were obtained from different clinical samples, including wound swabs and pus (53%), sputum (20%), and blood (17%). Forty two percent were isolated from ICUs. The most prevalent isolated species was C.amycolatum (27%), C. striatum (20%), and C.jeikieum (16%). Beta lactam antibiotics showed least activity against Corynebacteria species with resistance rate against penicillin 76% and ceftriaxone 72%, while all isolates exhibited uniform sensitivity (100%) against vancomycin as well as linezolid. Conclusion: This study showed isolation of different clinically relevant non-diaphterial Corynebacteria from different clinical samples with pus and wound swabs as the most common samples from which Corynebacteria were isolated. In particular, C.amycolatum was the most common isolated species. Beta lactam antibiotics (penicillin, ceftriaxone) showed the least activity while vancomycin and linezolid were the most active agents against nondiapdhterial Corynebacteria isolates. Herein, we confirm diphtheroids’ clinical importance among different infections that necessitate evaluating their susceptibility patterns to some common antibacterial agents for guide the best antibiotic to treat infections caused by these species.

Resistance trends among Enterobacterales from bacteraemias in the UK and Ireland, 2007 - 2017

Background The British Society for Antimicrobial Chemotherapy (BSAC) Bacteraemia Resistance Surveillance Programme monitors the antimicrobial susceptibility of organisms causing bacteraemias in the UK and Ireland. We review data for Escherichia coli, Klebsiella, Enterobacter, Proteeae, and Serratia collected between 2007-2017. Methods Consecutive isolates causing clinically significant bacteraemia were tested; participating laboratories (n=24-40) collected 7-20 isolates/species per year. Minimum inhibitory concentrations were determined centrally by BSAC agar dilution. Results Rates of resistance in the UK and Ireland remained largely stable over the 11-year period, during which 14,206 isolates were tested [(E. coli, n=5364; Klebsiella, n=3016; Proteeae, n=2423; Enterobacter, n=1819, and Serratia, n=1584)]. A decrease in resistance to piperacillin/tazobactam was noted among all species, except K. aerogenes. A decrease in resistance to ciprofloxacin was seen among E. coli and Enterobacter. Average rates of resistance to ceftolozane/tazobactam ranged from 0.2% (E. coli)to 9.2%(E. cloacae), whereas rates of resistance to ceftobiprole were higher [10% (E. coli) and 20% (E. cloacae)]. Rates of colistin resistance were low among E. coli (0.5%), and Klebsiella (1.2%); however, rates were higher, and increasing among Enterobacter (6.1% in 2011 to 13.4% in 2017). Rates of ESBL production were stable over time; higher among E. coli (9.6%), Enterobacter (10.4%), and Klebsiella (14.7%), compared with &lt;1% among Proteeae and Serratia. Carbapenemase producers remained rare (n=16 over 11 years, without trend). Conclusion The largely unchanging or reducing resistance rates among Enterobacterales causing bacteraemia are reassuring and may reflect interventions to reduce inappropriate use of antimicrobials implemented across the countries surveyed.

Pattern of antibiotic prophylaxis practice for dental procedures in children with congenital heart disease.

Various antibiotic prophylaxis guidelines have been published such as the American Heart Association 2007, British Society for Antimicrobial Chemotherapy 2006, National Institute for Health and Clinical Excellence 2008, European Society of Cardiology 2015, and in Malaysia, the National Antibiotic Guideline 2014 and Clinical Practice Guidelines for the Prevention, Diagnosis and Management of Infective Endocarditis 2017. The aim of the study is to determine the pattern of antibiotic prophylaxis practice for dental procedure in children with congenital heart disease (CHD) at the Department of Paediatric Dentistry, Kuala Lumpur Hospital. A comparative cross-sectional study of dental records from 2010 to 2015 was done by collecting data on the source and reason of referral, types of heart condition, dental procedure, and antibiotic given. There were 210 patients; 69.5% had acyanotic CHD, 21.9% cyanotic CHD, 6.7% repaired CHD with residual defects, and 1.9% with previous infective endocarditis. Slightly more than 58% were referred from government doctors (pediatric cardiologist and National Heart Institute). The common cause for referral was dental assessment (47.6%). Antibiotics were prescribed to 23.3% (49/210) patients, of which, 34.7% was given ampicillin or amoxicillin/clavulanic acid. About 96% of cyanotic heart cases undergoing invasive dental procedures were prescribed antibiotic prophylaxis. Almost 31% were prescribed with antibiotic prophylaxis even though it was not indicated. This study shows that there is variability in prescribing antibiotic prophylaxis, and it is important for dental clinicians to standardize the practice of giving antibiotic prophylaxis.

Isolation, characterization and antibiotic resistance profile studies of bacteria from an excavated pond in Port Harcourt Metropolis, Nigeria

The Antibiotic Resistance profile of bacteria isolated from Rumuola pond water in the Port Harcourt metropolis, Rivers State, Nigeria was investigated. Total of 48 bacterial species were isolated on Nutrient Agar and a set of selective diagnostic media. The isolates were identified as Escherichia coli , Staphylococcus sp.; Shigella sp.; Klebsiella sp.; Vibrio sp.; and Salmonella sp. The total culturable heterotrophic bacterial count (TCHB) and faecal coliform count of the water samples ranged from 1.02 x 10 6 – 1.90 x 10 6 cfu/ml and 3.70x 10 5 – 8.15x10 5 cfu/ml respectively. The sensitivity of the isolates from the water samples to 12 different antibiotics selected was ascertained on Muller-Hinton agar using the Kirby-Bauer disc diffusion method. The zone diameter obtained was interpreted using the Clinical Laboratory Standard International (CLSI) and British Society for Antimicrobial Chemotherapy (BSAC) zone diameter breakpoints. Isolates were recorded as susceptible (S), intermediate susceptible (I) or resistant (R) based on the guidelines. The level of resistance exhibited by the isolates to specific antibiotics used were; Lincocin 74.8%, Rifampicin 71.4%, Augumentin 71.2%, Chloramphnicol 68.2%, Erythromycin 64.3%, Cotrimoxazole 55.8%, Streptomycin 50.2%, Pefloxacin 48.6%, Gentamycin 43%, Norfloxacin 42.9%, Ofloxacin 16.2%, Ciprofloxacin 13%. The resistance to Lincocin (74.8%) was the highest followed by Rifampicin (71.4%). The highest level of bacterial resistance pattern to all tested antibiotics was observed in sites with highest human activities. The result showed multiple antibiotic resistance patterns among the bacterial isolates suggesting a pool of resistance genes among isolates in the pond. Most of the bacterial isolates are potential pathogens. Modern health services for effective disease management for this community would include antibiotic/drug mapping for individuals. Keywords: Antibiotic Resistance, Rumuola Pond, Port Harcourt

\u03b2-Lactamase production and antibiotic susceptibility pattern of Moraxella catarrhalis isolates collected from two county hospitals in China

BackgroundMoraxella catarrhalis (M. catarrhalis) is an important bacterial pathogen. However, its antibiotic susceptibility patterns in different areas are difficult to compare because of the use of different methods and judgement criteria. This study aimed to determine antimicrobial susceptibility and β-lactamase activity characteristics of M. catarrhalis isolates collected from two county hospitals in China, and to express the results with reference to three commonly used judgement criteria.ResultsNasopharyngeal swabs were obtained from child inpatients with respiratory tract infections at the People’s Hospital of Zhongjiang County and Youyang County from January to December 2015. M. catarrhalis strains were isolated and identified from the swabs, and susceptibility against 11 antimicrobials was determined using the E-test method or disc diffusion. Test results were interpreted with reference to the standards of the European Committee on Antimicrobial Susceptibility Testing (EUCAST), the Clinical and Laboratory Standards Institute (CLSI), and the British Society for Antimicrobial Chemotherapy (BSAC). Detection of β-lactamase activity was determined by the chromogenic cephalosporin nitrocefin. M. catarrhalis yield rates were 7.12 and 9.58% (Zhongjiang County, 77/1082 cases; Youyang County, 101/1054 cases, respectively). All isolates were susceptible to amoxicillin–clavulanic acid. The susceptibility rate to meropenem was 100% according to EUCAST; no breakpoints were listed in CLSI or BSAC. The non-susceptibility rate to sulfamethoxazole-trimethoprim differed significantly between the two hospitals regardless of the judgemnet criteria used, with isolates from Zhongjiang showing higher susceptibility to those from Youyang (Fisher’s exact test, P < 0.05). According to CLSI, the total non-susceptibility rate to erythromycin was 70.8% (Zhongjiang County, 79.2%; Youyang County, 64.3%), and the rate reached 92.1% (Zhongjiang County, 90.9%; Youyang County, 93.1%) on the basis of EUCAST or BSAC. The total positive rate of β-lactamase was 99.4% (177/178 cases) (Zhongjiang County, 100%, 77/77 cases; Youyang County, 99.0%, 100/101 cases).ConclusionsNinety nine percent of M. catarrhalis isolates produce β-lactamase. The isolates showed poor susceptibility to ampicillin and erythromycin, and high susceptibility to the third- and fourth-generation cephalosporins and amoxicillin–clavulanic. Significant discrepancies between different antimicrobial susceptibility judgemnet criteria were noted.

Comparative activity of ceftobiprole against coagulase-negative staphylococci from the BSAC Bacteraemia Surveillance Programme, 2013\u20132015

Coagulase-negative staphylococci (CoNS) are a significant cause of bacteraemia, the treatment of which is becoming increasingly complex due to the emergence of multidrug-resistant strains. This study aimed to evaluate the in vitro activity of ceftobiprole, an advanced-generation cephalosporin, as compared with other antimicrobial agents against CoNS from patients with bacteraemia. As part of the British Society for Antimicrobial Chemotherapy (BSAC) Bacteraemia Surveillance Programme, 650 blood isolates of CoNS were obtained from patients with bacteraemia at 74 centres throughout the UK and Ireland for the years 2013–2015. Minimum inhibitory concentrations (MICs) of ceftobiprole and other antimicrobial agents were determined using the BSAC agar dilution method. Susceptibility was assessed by European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. The majority of the isolates (63.2%) were Staphylococcus epidermidis. Overall, methicillin resistance, as determined by oxacillin susceptibility testing, was observed in 64.2% of isolates. The MIC50/90 of ceftobiprole was 1/2 mg/L, and 100% of CoNS isolates were inhibited at the EUCAST ceftobiprole non-species-specific pharmacokinetic/pharmacodynamic breakpoint of 4 mg/L. Only one isolate was resistant to vancomycin. Overall rates of resistance to ciprofloxacin, clindamycin, erythromycin and teicoplanin were 50.5, 25.1, 68.2 and 20.9%, respectively. In S. epidermidis, resistance to oxacillin was associated with increased resistance to other antimicrobials. Ceftobiprole demonstrated in vitro activity against all CoNS species isolated from patients with bacteraemia and was active against species resistant to other antistaphylococcal antimicrobials. The collection of clinical data regarding the efficacy of ceftobiprole in treating CoNS bacteraemia is warranted.

OPAT: proof of concept in a peripheral Belgian hospital after review of the literature

ABSTRACTSince its introduction in the 1970s in the United States, outpatient parenteral antibiotic/antimicrobial therapy (OPAT) has been adopted internationally for long-term intravenous (IV) treatment of stable infectious diseases. The aim is to provide a safe and successful completion of IV antimicrobial treatment at the ambulatory care center or at home without complications and costs associated with hospitalization. OPAT implementation has been accelerated by progress in vascular access devices, newly available antibiotics, the emphasis on cost-savings, as well as an improved patient comfort and a reduced incidence of health care associated infections with a similar outcome. OPAT utilization is supported by an extensive published experience and guidelines of the British Society of Antimicrobial Chemotherapy and the Infectious Diseases Society of America for adults as well as for children. Despite these recommendations and its widespread adoption, in Belgium OPAT is only fully reimbursed and established for cystic fibrosis patients. Possible explanations for this unpopularity include physician unfamiliarity and a lack of uniform funding arrangements with higher costs for the patient. This article aims to briefly review benefits, risks, indications, financial impact for supporting OPAT in a non-university hospital as standard of care. Our experience with OPAT at the ambulatory care center of our hospital and its subsequent recent introduction in the home setting is discussed.

Comparison of risk factors for, and prevalence of, antibiotic resistance in contaminating and pathogenic urinary Escherichia coli in children in primary care: prospective cohort study

BackgroundAll-cause antibiotic prescribing affects bowel flora antimicrobial susceptibility, and may increase risk of urinary autoinoculation with antibiotic-resistant microbes. However, little is known about relative prevalence of, or risk factors for, antimicrobial resistance among potentially pathogenic microbes thought to be contaminating and infecting urine.MethodsSecondary analysis of 824 children under 5 years of age consulting in primary care for an acute illness and their Escherichia coli isolates cultured at ≥103 cfu/mL from the Diagnosis of Urinary Tract infection in Young children (DUTY) study. Multivariable logistic regression investigating risk factors for resistance to amoxicillin, co-amoxiclav, cefalexin, ciprofloxacin, trimethoprim, nitrofurantoin and cefpodoxime in microbes meeting the laboratory criteria for urinary tract infection: ‘pathogens’ (>105 cfu/mL, n = 79) and ‘contaminants’ (103 to 105 cfu/mL, n = 745).ResultsForty-three percent of E. coli were resistant to at least one tested antibiotic, with resistance highest to amoxicillin (49.37% pathogenic versus 37.32% contaminant, P = 0.04), trimethoprim (27.85% versus 16.52%, P = 0.01) and co-amoxiclav (16.46% versus 21.48%, P = 0.30). Multidrug resistance (to ≥3 antibiotic groups) was present in 17.07% of pathogens and 30.13% of contaminants (P = 0.04). No isolates were resistant to nitrofurantoin. Recent (0–3 months) exposure to antibiotics was associated with resistance in both pathogens (aOR: 1.10, 95% CI: 1.01–4.39) and contaminants (1.69, 1.09–2.67).ConclusionsPrevalence of resistance (including multidrug) was high, but there was no consistent relationship between isolate pathogen/contamination status and resistance. Recent all-cause antibiotic prescribing increased the probability of antimicrobial resistance in both pathogenic and contaminating urinary E. coli in children in primary care.

Philip Howard takes up presidency of British Society for Antimicrobial Chemotherapy

Philip Howard takes up presidency of British Society for Antimicrobial Chemotherapy