Multidrug-resistant Cases Research Articles

Doripenem, Ertapenem, and Meropenem Sensitivity in Salmonella Typhi: A Cross-Sectional Study From Pakistan.

Background Salmonella Typhi (S. Typhi) is increasingly resistant to multiple antibiotics, posing a challenge in treatment, particularly in multidrug-resistant (MDR) cases. Carbapenems, including doripenem, ertapenem, and meropenem, have been considered last-resort options. This study evaluates the effectiveness of these carbapenems against S. Typhi isolates in a clinical setting in Peshawar, Pakistan. Objective To assess the effectiveness of the carbapenem antibiotics, doripenem, ertapenem, and meropenem, against S. Typhi. Methods This study collected data from blood cultures of patients diagnosed with S. Typhi infections at the Hayatabad Medical Complex in Peshawar, Pakistan for two years: from January 1, 2022, to December 31, 2023. Sensitivity testing was performed using the disk diffusion method in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines.The analysis examined the sensitivity rates of the three antibiotics and compared their effectiveness. Results A total of 626 S. Typhi isolates were tested. Only 11.98% of the isolates were sensitive to doripenem, while 88.02% were resistant to it. In contrast, 35.5% of the isolates responded to ertapenem, with 64.5% being resistant. Meropenem showed the highest efficacy, with 42.7% of the isolates demonstrating sensitivity. These findings highlight the growing challenge of managing multidrug-resistant (MDR) S. Typhi infections, especially in regions where resistance to carbapenems is becoming prevalent. Conclusion Meropenem proved to be more effective against S. Typhi compared to doripenem and ertapenem. The study emphasizes the need for ongoing monitoring of resistance patterns and the exploration of alternative or combination treatment options. These findings have immediate clinical implications for empiric therapy choices and highlight the urgent need for antibiotic stewardship programs in endemic regions.

Prevalence and Risk Factors of Multidrug-Resistant Urinary Tract Infections among Critically Ill Patients in Ain Shams University Hospitals

Abstract Background Multidrug-resistant infections are becoming a major source of in-hospital mortality and morbidity in ICU patients, numerous independent risk factors for infections by MDR bacteria have been identified, ICUs are often considered the epicenter of development, amplification and dissemination of drug-resistant microorganisms Aim and Objectives To determine the prevalence, possible risk factors and outcome in critically ill patients in ICU with multidrug resistant urinary tract infections in Ain Shams University Hospitals. Subjects and Methods This was cross-sectional study that included 383 patients who were admitted to different intensive care units in Ain Shams university hospitals during a period of Six months (March 2022 – August 2022). Patients were identified by review of urine specimens sent to the microbiology laboratory for urine cultures, for patients suspected clinically of UTI or in those with urinalysis demonstrating increased white blood cells count, Multidrug resistant (MDR) was defined as isolates that were resistant or intermediate susceptible to ≥ 3 of the following antimicrobial categories: (a1) penicillin (b) cephalosporins (c) carbapenems; (d) fluoroquinolones; (e) gentamicin or amikacin; (f) TMP-SMX; and (g) nitrofurantoin Results The prevalence of multi- drug resistant UTI was about 45.2%. Hypertension and Diabetes mellitus were the most common medical comorbidities. The presence of chronic indwelling urinary catheters was the most common healthcare-associated risk factor for MDR UTI. Klebsiella and enterococcus were significantly more prevalent among MDR cases (41.6 % and 46.8% respectively). Penicillin had the most common antimicrobial resistance in our study. 59% of the patients with MDR UTI presented with septic shock, 18.5% presented with AKI as the second most common cause of hospital admission in MDR UTI patients. MDR UTI patients had higher mean serum creatinine and lower eGFR in comparison to non-MDR group. Conclusion Multi- drug resistant UTI had 45.2% prevalence among critically ill patients in Ain Shams university hospitals with many risk factors. In addition, higher CRP, lower eGFR and lower haemoglobin level are associated with MDR urinary tract infections.

Escherichia coli, an important Uropathogen: Characteristics and antimicrobial susceptibility pattern at Prof. Dr. I.G.N.G. Ngoerah General Hospital, period January 2020 – December, 2021

Background: Urinary tract infections (UTIs) are among the most common infections globally, often treated empirically with broad-spectrum antibiotics without prior culture and sensitivity testing. This practice has contributed to the rise in antibiotic resistance. Escherichia coli (E. coli) is the primary pathogen in uncomplicated UTIs, accounting for 70–90% of cases. However, other bacteria such as Klebsiella pneumoniae, Proteus mirabilis, and Enterococcus faecalis are also significant, especially in complicated or healthcare-associated UTIs. This study examines the resistance patterns of E. coli in UTI cases. Method: A descriptive cross-sectional study was conducted using secondary data from medical records of UTI patients treated at Prof. Dr. I.G.N.G. Ngoerah General Hospital from January 2020 to December 2021. E. coli isolates were identified, and antibiotic sensitivity tests were performed using the VITEK® 2 compact automatic system, with antimicrobial sensitivity and resistance determined according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Result: Analysis of 639 UTI patients revealed that E. coli exhibited high resistance to cefixime (13.3%), ciprofloxacin (23.8%), and trimethoprim-sulfamethoxazole (35.2%). The highest levels of susceptibility were observed with Tigecycline, Meropenem, and Ertapenem, with rates ranging from 99.2% to 99.8%. The demographic data showed a higher incidence of UTIs in female patients (70.9%) compared to males (29.1%), with the majority of cases occurring in adults (94.52%). Additionally, 52.26% of the E. coli isolates were ESBL-producing strains, complicating treatment options. Conclusion: The study underscores the urgent need for judicious antibiotic use, guided by culture and sensitivity testing, to combat the rising threat of antibiotic-resistant UTIs. Tigecycline, Meropenem, and Ertapenem should be prioritized in treatment protocols for multidrug-resistant cases. Continuous surveillance and the development of new antimicrobial agents are essential to address this escalating public health challenge

Prediction of structure of mycobacterial efflux pump protein Rv0194 and molecular dynamics simulation of the predicted structures

Tuberculosis is a major cause of morbidity and mortality primarily in developing nations. The rising number of cases of multidrug resistance and extensive drug resistance are a critical concern for the management of the condition. Even though new antibiotics are being developed, eventually there are also strains that are resistant to them. The evolution of resistance in Mycobacterium tuberculosis is significantly influenced by drug efflux caused by efflux pumps. Rv0194 is an important efflux pump associated with resistance to multiple drugs like beta lactam antibiotics like ampicillin and also erythromycin and novobiocin. The introduction of efflux inhibitors for Rv0194 could shorten the course of current therapy and improve the efficacy of second-line medications. Building a trustworthy molecular model of this efflux pump is the goal of this study. We created 3 models using different modeling tools. These models were then subjected to a 20 ns molecular dynamics simulation in a lipid bilayer. We find that the model built by Swiss Model shows the best results in molecular modeling and validation and the structure is also stable throughout the 20 ns MD simulations. Consequently, this model is reliable and can be used for further studies.

Pathobiology of Fungal Endophthalmitis: A Major Review.

Fungal endophthalmitis is a chronic inflammatory condition of the eye's posterior segment that can lead to irreversible vision loss. While relatively rare in western countries, its incidence is notably higher in Asia, particularly India. The condition's prevalence is exacerbated by factors such as intravenous drug use, antibiotics, and ocular surgeries. Fungal endophthalmitis can be categorized as endogenous, arising from systemic infection, or exogenous, linked to external sources such as trauma or surgery. The fungal agents responsible vary by region, with Candida species common in the West and Aspergillus and Fusarium species more prevalent in India. Management typically involves vitrectomy and intravitreal antifungal drugs such as amphotericin B and voriconazole, though treatment is often complicated by multidrug resistance and culture-negative cases. Recent proteomic and transcriptomic analyses have highlighted the early and sustained activation of the host immune response during infection involving key inflammatory and oxidative stress-related proteins. Given the potential for excessive inflammation to cause retinal damage, targeted immunotherapies are crucial. Immunomodulation, which aims to balance the immune response, shows promise in preserving vision while effectively combating the infection. Key targets for immunomodulation include pro-inflammatory cytokines (TNF-α, IL-1β, IL-6, IL-17), chemokines (CCL2, CXCL8), Toll-like receptors (TLR2, TLR4), and the complement system. Additionally, modulating the activity of macrophages, neutrophils, regulatory T cells, and Th17 cells, as well as targeting inflammasomes, can help control inflammation. Biologic agents and small molecule inhibitors offer further avenues for precise immune response modulation. This review underscores the importance of a comprehensive understanding of host-pathogen interactions in the development of effective therapies for fungal endophthalmitis.

FDA, CDC, and NIH Co-sponsored Public Workshop Summary-Development Considerations of Antimicrobial Drugs for the Treatment of Gonorrhea.

There is an unmet need for developing drugs for the treatment of gonorrhea, due to rapidly evolving resistance of Neisseria gonorrhoeae against antimicrobial drugs used for empiric therapy, an increase in globally reported multidrug resistant cases, and the limited available therapeutic options. Furthermore, few drugs are under development. Development of antimicrobials is hampered by challenges in clinical trial design, limitations of available diagnostics, changes in and varying standards of care, lack of robust animal models, and clinically relevant pharmacodynamic targets. On April 23, 2021, the U.S. Food and Drug Administration; Centers for Disease Control and Prevention; and National Institute of Allergy and Infectious Diseases, National Institutes of Health co-sponsored a workshop with stakeholders from academia, industry, and regulatory agencies to discuss the challenges and strategies, including potential collaborations and incentives, to facilitate the development of drugs for the treatment of gonorrhea. This article provides a summary of the workshop.

Blood Culture Isolates and Antibiogram for Salmonella at Tertiary Care Hospital

Objective: To determine the pattern of blood culture isolates and antibiogram for salmonella at tertiary care hospital and identify frequency of multi-drug resistance and XDR. Methodology: This descriptive, cross-sectional analysis was carried out on enteric fever/salmonella infected patients from 1-02-2020 to 31-10-2020 at Pediatrics Unit – II (Liaquat University Hospital). Children of either gender, aged 1 to 15 years, who presented with fever lasting more than 3 days, abdominal pain, headache, diarrhea, vomiting, or constipation, and who had a positive blood culture for Salmonella, were included. Data was collected into a structured questionnaire, containing enquiries pertaining to basic biodata, sociodemographic details, clinical presentation, and culture sensitivity (type of microbe and its drug sensitivity). The data obtained was analyzed using SPSS v. 21.0. Results: Mean age of the children was 9.12 years, with males comprising 63.4%. Fever and abdominal pain were the most common clinical symptoms. In terms of antibiotic sensitivity, Cefixime and Ceftriaxone were effective in 83.9% and 85.7% of cases, respectively, while Ciprofloxacin showed 81.3% sensitivity. Both Meropenem and Azithromycin were 100% effective. Among the 14 multidrug-resistant cases, Ciprofloxacin had the highest resistance rate (11 cases), while Cefixime and Ceftriaxone were resistant in 9 and 8 cases, respectively. Meropenem and Azithromycin showed no resistance in any case. Conclusion: Enteric fever remains a serious threat to child health, with rising multidrug resistance. While some drugs like Meropenem and Azithromycin are still 100% effective, they must be used carefully to prevent further resistance development.

Enterococcus spp. in fish: Analysis of the presence and resistance in samples from Tri-City, Poland.

The growing concern over antibiotic resistance in foodborne pathogens necessitates comprehensive assessments of its prevalence and associated risks in various food products. The present study aimed to assess the occurrence of Enterococcus spp. in samples of fish purchased at various points of sale in the Tricity region. The selection of products (n = 74) was based on their availability and included both fish caught in the Baltic region and products imported from, Vietnam, China, Norway, and European Union (EU) countries. For bacterial isolation, samples were inoculated into selective broth, and the growth of enterococci was assessed based on turbidity. Positive cultures were confirmed by a change in color in bromocresol purple broth and were isolated on Slanetz-Bartley agar. Bacteria were present in all tested samples regardless of the degree of raw material processing as follows: frozen (F)- 55%, fresh/raw (FS)- 70.6%, thawed (DF)- 30%, smoked (S)- 50%, and the packaging methods, modified atmosphere packaging (MAP)- 34.4%, unit packaging (UP)- 75%, and sold in bulk (SB)- 76.9%, with an overall frequency of occurrence of 58.1%. The number of bacteria ranged from not detected to 4.28-log cfu/g, with the lowest mean values for thawed fish and those packed in MAP. Tests conducted on 24 strains isolated from samples showed their varied sensitivity to tetracyclines. Single cases of multidrug resistance of the tested strains were also observed. The conducted statistical analysis did not show statistically significant differences in the count of enterococci based on the origin, degree of processing, or packaging (p < 0.05). Moreover, differences in strain sensitivity to ampicillin were observed. Detected cases of resistance, especially to tetracycline, require careful monitoring and action to limit the health risks associated with resistant bacterial strains in food products.

Molecular analysis of bedaquiline resistance and genetic variations in clinical isolates of multidrug and fluoroquinolones-resistant Mycobacterium tuberculosis

BackgroundMycobacterium tuberculosis developing resistance to anti-tubercular therapy leads to pioneering innovative treatment protocols featuring carefully curated combinations of potent medications. The aim of this study was to analyze the frequency and pattern of fluoroquinolone (FQ) resistant mutations among the first-line drug-resistant specimens. By employing an elective sampling strategy, we deliberately focused our investigation on a targeted subset of multidrug resistant (MDR) and FQ resistant (FQR) TB cases. MethodSputum samples from first-line drug-resistant patients were subjected to a GenoType MTBDRsl VER 2.0 assay to determine FQR. To investigate the effect of bedaquiline (BDQ) on these mutation-conferring genes (Rv0678, pepQ, and atpE), sanger sequencing was carried out on the MDR + FQR subset that was obtained. We have also conducted a computational analysis of the gene products of Rv0678 and pepQ with BDQ using molecular docking methods. ResultsEighty-three samples were observed to have FQR, and the majority of these specimens were associated with naïve and treatment failure cases. Among them, 64 isolates exhibited mutations in gyrA gene, while 19 isolates showed mutations in gyrB gene. The predominant occurrence of genetic variations, particularly in D94G and A90V, was observed within the specimens displaying resistance in gyrA gene, and the same has been confirmed by PCR-based detection. And the sequence analysis of BDQ genes among MDR + FQR subset indicated that the majority of the samples did not exhibit mutations in pepQ and atpE genes. However, only 2 samples were found to have the genetic variant G337A, which involves replacing the amino acid glutamic acid (E) at codon position 113 of Rv0678 gene with lysine (K). ConclusionsMost of the mutations were harbored in rpoB + katG + gyrA gene pattern. These findings pave the way for the development of databases and rapid diagnostic probes.

Genetic analysis of pyrazinamide resistance: mutations in the pncA gene among clinical isolates of multi-drug resistant Mycobacterium Tuberculosis

Pyrazinamide (PZA) resistance presents a significant challenge in tuberculosis (TB) management, particularly in multi-drug resistant (MDR) cases. Understanding the genetic basis of PZA resistance is crucial for effective treatment strategies. This review provides a comprehensive overview of recent advancements in molecular characterization of PZA resistance, focusing on mutations in the pncA, rpsA, and panD genes. We discuss the prevalence of PZA resistance, mechanisms of resistance, and the utility of genetic analysis in early diagnosis. Key findings from studies investigating PZA resistance in clinical isolates are summarized, highlighting the predominant role of pncA mutations. Additionally, we explore the significance of mutations in rpsA and panD genes, elucidating alternative pathways to PZA resistance. Insights from genetic analysis have implications for personalized treatment approaches and TB control programs. Future directions in research and the potential of molecular methods in enhancing PZA susceptibility testing are also discussed.

Silver nanoparticles conjugated amoxicillin: A promising nano-suspension for overcoming multidrug resistance bacteria and preservation of endotracheal tube

Growing cases of multi-drug resistance (MRS) among microorganisms pathogenic have rendered antibiotics incompetent. For that reason, present research endeavors are focused on devising ground-breaking solutions to this pressing problem, together with the progression of new antibiotics and the increase of their effectiveness. In our study, we produced silver nanoparticles (AgNPs) and antibiotics Amoxicillin (AMO) separately, also, we used a combination of amoxicillin with Ag NPs (AMO@AgNPs) by co-friendly method of Pulsed laser ablation (PLAL). UV/Vi spectrophotometer, XRD, TEM, and FTIR were used to investigate characterizations of Amoxicillin conjugated AgNPs. To evaluated their antibacterial activity, we study activity of silver nanoparticles, Amoxicillin, and their conjugated AMO@AgNPs against two types of human pathogen using a well diffusion method. The results showed AMO @Ag nanoparticles were spherical in shape, with a size distribution between 12 and 97 nm, with an average diameter of 32 nm. Conjugates of AgNPs and amoxicillin have anti-bacterial properties against Streptococcus pyogenes bacteria more than Haemophilus influenzae bacteria. Moreover, the results confirmed that the AMO@AgNPs was more active than either AgNPs alone or Amoxicillin alone. Furthermore, studied on biofilm formation and endotracheal tube effects via AFM thickness measurement evaluation showed properties of AMO@AgNPs in preventing biofilm formation in endotracheal tubes. This study's conclusion emphasizes the creation of Amoxicillin-conjugated silver nanoparticles as a critical strategy for dealing with bacterial strains that are resistant to antibiotics. The study highlights the benefits of AMO-AgNPs as a potentially effective treatment against bacteria. Moreover, our findings suggests that AMO@AgNPs may be useful as breathing tube preservative.

Clinical, phenotypic, and genotypic characteristics of ESBL-producing Salmonella enterica bloodstream infections from Qatar

BackgroundResistant Salmonella infections are a major global public health challenge particularly for multidrug-resistant (MDR) isolates manifesting as bloodstream infections (BSIs). ObjectivesTo evaluate clinical, phenotypic, and genotypic characteristics of extended-spectrum beta-lactamase (ESBL) producing Salmonella enterica BSIs from Qatar. MethodsPhenotypic ESBL Salmonella enterica from adult patients presenting with positive BSIs were collected between January 2019 to May 2020. Microbiological identification and characterization were performed using standard methods while genetic characteristics were examined through whole genome sequencing studies. ResultsOf 151 episodes of Salmonella enterica BSI, 15 (10%) phenotypic ESBL isolates were collected. Recent travel was recorded in most cases (80%) with recent exposure to antimicrobials (27%). High-level resistance to quinolines, aminoglycosides, and cephalosporins was recorded (80-100%) while meropenem, tigecycline and colistin demonstrated universal susceptibility. Genomic evaluation demonstrated dominance of serotype Salmonella Typhi sequence type 1 (93%) while antimicrobial resistance genes revealed dominance of aminoglycoside resistance (100%), qnrS1 quinolones resistance (80%), blaCTX-M-15 ESBLs (86.7%), and paucity of AmpC resistance genes (6.7%). ConclusionsInvasive MDR Salmonella enterica is mainly imported, connected to patients from high prevalent regions with recent travel and antimicrobial use caused by specific resistant clones. In suspected cases of multidrug resistance, carbapenem therapy is recommended.

Whole-genome sequencing of clinical isolates from tuberculosis patients in India: real-world data indicates a high proportion of pre-XDR cases.

The current study is based on real-world data on the TB drug-resistance profile by whole-genome sequencing of 600 clinical samples from patients with TB in India. This study indicates the clinicians' reasons for sending samples for WGS, which is for difficult-to-treat cases and/or relapse and treatment failure. The study reports a significant proportion of cases with pre-XDR-TB strains that warrant policy makers' attention. It reflects the current iterative nature of the diagnostic tests under programmatic conditions that leads to delays in appropriate diagnosis and empirical treatment. India had an estimated burden of 2.95 million TB cases in 2020 and 135,000 multidrug-resistant cases. However, WGS profiles of M.tb from India remains disproportionately poorly represented. This study adds a significant body of data on the mutation profiles seen in M.tb isolated from patients with TB in India, mutations outside the RRDR, disputed mutations, and resistance-conferring mutations to newer drugs such as bedaquiline and linezolid.

To Isolate and Identify the Etiological Agents and Establish the Co-Relation between Pyuria and Significant Bacteriuria among Patients Suspected of Urinary Tract Infection

Urinary tract infection (UTI) one of the most common infectious diseases has been seen as a global burden. Escherichia coli (E. coli) is responsible for causing majority of the UTIs. This study was conducted at Kantipur Hospital Pvt. Ltd. Kathmandu from July 2016 to December 2017.The research was conducted to study about the relation between pyuria and bacteriuria among patients suspected of urinary tract infection. A total of 464 mid-stream urine samples were collected. Out of total processed sample 97/464 was positive while 263 were culturally negative. E. coli accounted for 76.28 %( 74) of the growth while K. pneumoniae accounted for 9.27% (9) of the total bacterial growth. Other organism which were found were P. vulgaris 8.24 (8) S. aureus 3.09 %( 3), Coagulase negative staphylococcus (CoNS) 1.03% (1), E. facealis1.03% (1) and P. aeruginosa 1.03% (1). Amikacin was most susceptible drugs for E. coli with 90.54% (67) success followed by gentamicin 81.08 %( 60). Both amikacin and gentamicin proved susceptible for other gram negative isolates too. Among the total isolates 73 of them were found to Multi Drug Resistant (MDR) were E. coli 92.85% (66) has most number of MDR cases followed by 3.96 %( 4).It was found that female patient were more affected (79) than male patient (18).While on age group basis people aging between 21-30 years mostly had infection (31). Among the 464 samples, 78.67% (365) of samples showed insignificant pyuria. However, 4.12% of samples gave positive culture results. The highest Culture positivity, 28 (75.67%) samples out of 37 was detected in urine samples having pus cells of 6-10/hpf, whereas 5(33.33%) urine samples with more han 50 pus cells/hpf was culture positive. Female are more susceptible for UTI than Male and presence of pyuria can be good indicator of urine infection, though Culture should always be considered as gold standard.

Cross Sectional Study on the Prevalence of Tuberculosis among the District of Sudhnuti, Azad Jammu and Kashmir

Globally, tuberculosis (TB) is a major health risk that is mostly caused by Mycobacterium tuberculosis, a member of the Mycobacterium Tuberculosis Complex (MTC). Ten million cases of tuberculosis and 1.3 million deaths from the disease occur each year, making Mycobacterium tuberculosis one of the leading causes of death globally. Pakistan is ranked fifth among high-burden countries for tuberculosis (TB) and is expected to rank fourth for the prevalence of multi-drug resistant (MDR) TB. As a result, tuberculosis poses a serious threat to public health in Pakistan. Tuberculosis is a common occurrence in Azad Jammu and Kashmir. Aims: The current study aimed to find out the prevalence of tuberculosis in the defined population. Study Design: The study was conducted in the District and Tehsil Headquarters Hospitals of District Sudhnuti AJK. Place and Duration of Study: Samples were collected from all the District and Tehsil headquarters hospitals of Sudhnuti district from January 2019 to December 2019. Methodology: Samples of sputum from suspected cases were gathered from district Sudhnuti hospitals and TB centers from January 2019 to December 2019. All the suspected cases were examined by sputum smear microscopy and then bacteriologically positive cases were further confirmed by GeneXpert. All positive cases were examined for multi-drug resistance by using GeneXpert. Results: In the current study during the year 2019, 201 TB cases were reported from district Sudhnuti out of which 107 (53.23%) were males and 94 (46.76%) were females. The value of P=0.51 which is &gt;0.05 is insignificant shows that Tuberculosis has no selective effect on a specific gender. Pulmonary cases were 131 in number with 81 bacteriologically positive and 50 clinically diagnosed negative cases. Extra Pulmonary cases were 70 in number with 1 bacteriologically positive and 69 clinically diagnosed negative cases. Only 2 (0.99%) MDR cases were diagnosed and the case notification rate during 2019 was 66. Conclusion: The current study shows that males are slightly more prone to TB in district Sudhnuti AJK as compared to females. Individuals with age &gt;64 are more susceptible to TB when compared to individuals with age &lt;15. The CNR during 2019 is 66 which is far away from the WHO set criteria. The CNR indicates that there is a need for improvement in the surveillance system.

FOLLOW-UP CASES OF BEDAQUILINE IN XDR-TB PATIENTS: A CASE SERIES

Tuberculosis has consistently maintained its lead position in being among the top 10 causes by means of single-cause etiology for death among infectious disease patients. On top of it, now multi-drug resistant cases of tuberculosis (MDR-TB) are raising concern. The vision of tuberculosis eradication gets a major setback with a total of 206,030 million cases being reported worldwide with MDR or rifampicin-resistance MDR-TB in 2019. Bedaquilline a relative recent drug is being made available for the treatment of MDR and extensive drug resistance (XDR) TB under NTEP. It is being provided as a part of 2nd line of drug therapy. Regarding the drug’s efficacy and safety profiling Bedaquiline has been under extensive clinical trials at medical institutes and hospitals of reputation at national level. The treatment options available to treat XDR-TB remain extremely limited at the cost of being less effective, expensive and with more side effects. Even after the availability of potent anti-tubercular drugs, XDR Tuberculosis is proving to be more resistant to all possible drugs available to work against it.

Trends of Drug-Resistant Tuberculosis in an Urban and a Rural Area in China: A 10-Year Population-Based Molecular Epidemiological Study.

Drug resistance is the critical determinant for appropriate tuberculosis (TB) treatment regimens and an important indicator of the local TB burden. We aimed to investigate and compare trends in TB drug resistance in the urban Songjiang District of Shanghai from 2011 to 2020, and the rural Wusheng County of Sichuan Province from 2009 to 2020, to assess the effectiveness of local TB control and treatment programs. Whole-genome sequencing data of Mycobacterium tuberculosis were used to predict drug-resistance profiles and identify genomic clusters. Clustered, retreated cases of drug-resistant TB with identical resistance mutations, as well as all new resistant cases, were defined as transmitted resistance. The Cochran-Armitage trend test was used to identify trends in the proportions. Differences between groups were tested using the Wilcoxon rank sum or chi-square tests. The annual proportions of rifampicin-resistant (RR), isoniazid-resistant (INH-R) and multidrug-resistant (MDR) TB cases did not change significantly in Songjiang. In Wusheng, however, the percentage of total TB cases that were RR decreased from 13.2% in 2009 to 3.7% in 2020, the INH-R cases decreased from 16.5% to 7.3%, and the MDR cases decreased from 10.7% to 3.7%. In retreated cases, the percentage of drug resistance decreased in both Songjiang and Wusheng, suggesting improved treatment programs. Transmitted resistance accounted for more than two thirds of drug-resistant cases over the entire study periods, and in recent years this proportion has increased significantly in Songjiang. In both urban Songjiang and rural Wusheng, drug-resistant TB is mostly the result of transmission of drug resistant strains and the percentage of transmitted resistance will likely increase with on-going improvements in the TB treatment programs. Reducing the prevalence of drug resistance depends principally upon decreasing transmission through the prompt diagnosis and effective treatment of drug-resistant TB cases.

Differences in pulmonary nodular consolidation and pulmonary cavity among drug-sensitive, rifampicin-resistant and multi-drug resistant tuberculosis patients: the Guangzhou computerized tomography study.

Pulmonary nodular consolidation (PN) and pulmonary cavity (PC) may represent the two most promising imaging signs in differentiating multidrug-resistant (MDR)-pulmonary tuberculosis (PTB) from drug-sensitive (DS)-PTB. However, there have been concerns that literature described radiological feature differences between DS-PTB and MDR-PTB were confounded by that MDR-PTB cases tend to have a longer history. This study seeks to further clarify this point. All cases were from the Guangzhou Chest Hospital, Guangzhou, China. We retrieved data of consecutive new MDR cases [n=46, inclusive of rifampicin-resistant (RR) cases] treated during the period of July 2020 and December 2021, and according to the electronic case archiving system records, the main PTB-related symptoms/signs history was ≤3 months till the first computed tomography (CT) scan in Guangzhou Chest Hospital was taken. To pair the MDR-PTB cases with assumed equal disease history length, we additionally retrieved data of 46 cases of DS-PTB patients. Twenty-two of the DS patients and 30 of the MDR patients were from rural communities. The first CT in Guangzhou Chest Hospital was analysed in this study. When the CT was taken, most cases had anti-TB drug treatment for less than 2 weeks, and none had been treated for more than 3 weeks. Apparent CT signs associated with chronicity were noted in 10 cases in the DS group (10/46) and 9 cases in the MDR group (10/46). Thus, the overall disease history would have been longer than the assumed <3 months. Still, the history length difference between DS patients and MDR patients in the current study might not be substantial. The lung volume involvement was 11.3%±8.3% for DS cases and 8.4%±6.6% for MDR cases (P=0.022). There was no statistical difference between DS cases and MDR cases both in PN prevalence and in PC prevalence. For positive cases, MDR cases had more PN number (mean of positive cases: 2.63 vs. 2.28, P=0.38) and PC number (mean of positive cases: 2.14 vs. 1.38, P=0.001) than DS cases. Receiver operating characteristic curve analysis shows, PN ≥4 and PC ≥3 had a specificity of 86% (sensitivity 25%) and 93% (sensitivity 36%), respectively, in suggesting the patient being a MDR cases. A combination of PN and PC features allows statistical separation of DS and MDR cases.

Extensively and multidrug-resistant bacterial strains: case studies of antibiotics resistance.

The development of antibiotic resistance compromises the effectiveness of our most effective defenses against bacterial infections, presenting a threat to global health. To date, a large number of research articles exist in the literature describing the case reports associated with extensively drug-resistant (XDR) and multidrug-resistant (MDR) bacterial strains. However, these findings are scattered, making it time-consuming for researchers to locate promising results and there remains a need for a comparative study to compile these case reports from various geographical regions including the Kingdom of Saudi Arabia. Additionally, no study has yet been published that compares the genetic variations and case reports of MDR and XDR strains identified from Saudi Arabia, the Middle East, Central Europe, and Asian countries. This study attempts to provide a comparative analysis of several MDR and XDR case reports from Saudi Arabia alongside other countries. Furthermore, the purpose of this work is to demonstrate the genetic variations in the genes underlying the resistance mechanisms seen in MDR and XDR bacterial strains that have been reported in Saudi Arabia and other countries. To cover the gap, this comprehensive review explores the complex trends in antibiotic resistance and the growing risk posed by superbugs. We provide context on the concerning spread of drug-resistant bacteria by analyzing the fundamental mechanisms of antibiotic resistance and looking into individual case reports. In this article, we compiled various cases and stories associated with XDR and MDR strains from Saudi Arabia and various other countries including China, Egypt, India, Poland, Pakistan, and Taiwan. This review will serve as basis for highlighting the growing threat of MDR, XDR bacterial strains in Saudi Arabia, and poses the urgent need for national action plans, stewardship programs, preventive measures, and novel antibiotics research in the Kingdom.

Socio-Demographic Profile of Patients with Pulmonary Tuberculosis, Including Multi-Drug Resistant Cases, at Chest Diseases Hospital, Rajshahi

Tuberculosis (TB) remains a significant global public health concern, with Pulmonary Tuberculosis (PTB) constituting a substantial burden. This study aimed to assess the socio-demographic profile of PTB patients, with a focus on Multi-Drug Resistant Tuberculosis (MDR-TB) cases, at Chest Diseases Hospital in Rajshahi, Bangladesh. Data from 299 patients were analyzed, considering variables such as age, gender, education, income, and urban or rural residence. The study revealed that the majority of patients were aged 30-44 years, with a mean age of 38.06 years. Gender distribution showed 54.18% males and 45.82% females. Most patients had primary education, and a significant portion were illiterate. Housewives were the largest occupational group, and the majority had a monthly family income of less than Taka 10,000. Furthermore, the study found a significant relationship between MDR-TB and the type of family and monthly family income, with higher MDR-TB prevalence in nuclear families and among those with lower income. This study provides critical insights into the socio-demographic characteristics of PTB patients, especially those with MDR-TB, in Rajshahi, contributing to tailored TB control strategies.