Minimum Inhibitory Concentrations Of Ciprofloxacin Research Articles

In Vitro Evaluation of Rosemary Essential Oil: GC-MS Profiling, Antibacterial Synergy, and Biofilm Inhibition

Background: Antimicrobial resistance (AMR) has become precarious, warranting investments in antimicrobial discovery. Aim: To investigate the antibacterial activity of rosemary essential oil (REO), alone and in combination with selected conventional antibiotics. Methods: REO was subjected to antimicrobial susceptibility testing (including minimum bactericidal concentration (MBC) and minimum inhibitory concentration (MIC) determination) and investigation of anti-pre-biofilm and antibiofilm activities. Results: The phytochemical composition of the REO was eucalyptol (42.68%), bornanone (33.20%), endo-borneol (9.37%), α-terpeneol (7.95%), linalool (2.10%), bornyl acetate (1.81%), caryophyllene (1.09%), 4-terpeneol (0.94%), and anethole (0.87%). The antibacterial inhibition zones generally increased with increasing REO concentration (i.e., 10, 20, 50, 100, and 200 mg/mL). The MIC and MBC ranges of REO for all bacteria were 3.13–6.25 mg/mL and 3.12–12.5 mg/mL, respectively. The MICs (in µg/mL) of ciprofloxacin, chloramphenicol, streptomycin, tetracycline, and ampicillin, respectively, were Escherichia coli (0.98, 3.92, 1.96, 7.81, and 250), Klebsiella pneumoniae (1.25, 7.81, 125, 7.81, and 1000), MRSA (62.5, 7.81, 3.91, 7.81, and 250), Streptococcus mutans and Bacillus subtilis (125, 15.68, 250, 31.25, and 1000), Pseudomonas aeruginosa (125, 31.25, 500, 31.25, and 1000), and Salmonella Typhi (0.98, 15.68, 125, 1.96, and 1000). The MBC-MIC ratios of REO against all bacteria were in the range 1–2, indicating bactericidal effects. Mainly synergy (FICI = 0.16–0.37) was observed between REO and the conventional antibiotics. The IC50 values (in µg/mL) of REO against the bacteria, pre-biofilm vs. biofilm formation, were E. coli (1342.00 vs. 4.00), K. pneumoniae (106.00 vs. 3.00), MRSA (134.00 vs. 6.00), S. mutans (7259.00 vs. 7.00), B. subtilis (120.00 vs. 7.00), P. aeruginosa (4989.00 vs. 7.00), and S. Typhi (10.00 vs. 2.00). Conclusions: Rosemary essential oil had significant bactericidal effects on the bacteria tested, and its MIC and MBC values were low. Overall, it was synergistic with known conventional antibiotics and, thus, has encouraging prospects in combination therapy involving conventional antibiotics, even in the treatment of infections with multidrug-resistant bacteria, including biofilm-forming ones.

Biofilm formation and polar lipid biosynthesis in Mycobacterium abscessus are inhibited by naphthylmethylpiperazine.

Mycobacterium abscessus is a biofilm-forming, non-tuberculous mycobacterium that is highly resistant to antibiotics. Bacterial efflux pumps contribute to biofilm formation, export of biofilm-associated lipids and antibiotic tolerance. The Resistance Nodulation Cell Division (RND) and ATP-Binding Cassette (ABC) families of efflux pumps export lipids to the mycobacterial cell surface. 1-(1-naphthyl methyl)-piperazine (NMP) is a chemosensitizer that causes membrane destabilization and is an inhibitor of RND efflux pumps. The effects of NMP on biofilm formation and lipid metabolism in M. abscessus biofilms have not been investigated. Plumbagin (PLU) is an inhibitor of ABC efflux pumps that has not been studied for its effects on antibiotic tolerance in M. abscessus biofilms. In this study, we report that the efflux pump inhibitors NMP and PLU inhibit biofilm formation by 50% at sub-MIC levels. We show that NMP inhibits the incorporation of the radiolabeled long-chain fatty acid 14C-palmitate into glycopeptidolipids in cell surface lipids of log-phase M. abscessus. NMP also inhibits the utilization of the radiolabel in the biosynthesis of phosphatidylethanolamine in the cell surface and cellular lipids of M. abscessus cells in log-phase and in biofilms. Incorporation of the radiolabel into cardiolipin in the cellular lipids of M. abscessus biofilms was inhibited by NMP. The incorporation of 14C-acetate into cell surface phosphatidylethanolamine in log-phase and biofilm cells was also inhibited by NMP. Triacylglycerol biosynthesis using 14C-palmitate and 14C-acetate in cellular lipids of log-phase and biofilm cells was increased several folds by NMP. Efflux pump activity in M. abscessus cells was inhibited by 97% and 68% by NMP and PLU respectively. NMP and PLU caused 5-fold decreases in the minimum inhibitory concentrations of ciprofloxacin and clarithromycin against M. abscessus. Our results demonstrate that NMP and PLU affect important physiological processes in M. abscessus associated with its pathogenesis.

Potent Antimicrobial Azoles: Synthesis, In Vitro and In Silico Study.

Background/Objectives: The increase in fungal infections, both systemic and invasive, is a major source of morbidity and mortality, particularly among immunocompromised people such as cancer patients and organ transplant recipients. Because of their strong therapeutic activity and excellent safety profiles, azole antifungals are currently the most extensively used systemic antifungal drugs. Antibacterial properties of various topical antifungals, such as oxiconazole, which features oxime ether functionality, were discovered, indicating an exciting prospect in antimicrobial chemotherapy. Methods: In this study, eleven new oxime ether derivatives with the azole scaffold (5a-k) were synthesized and tested for their antimicrobial effects using the microdilution method to obtain broad-spectrum hits. Results: Although the title compounds showed limited efficacy against Candida species, they proved highly effective against dermatophytes. Compounds 5c and 5h were the most potent derivatives against Trichophyton mentagrophytes and Arthroderma quadrifidum, with minimum inhibitory concentration (MIC) values lower than those of the reference drug, griseofulvin. The MIC of 5c and 5h were 0.491 μg/mL and 0.619 μg/mL against T. mentagrophytes (MIC of griseofulvin: 2.52 μg/mL). The compounds were also tested against Gram-positive and Gram-negative bacteria. Briefly, 5c was the most active against Escherichia coli and Bacillus subtilis, with MIC values much better than that of ciprofloxacin (MIC of 5c = 1.56 μg/mL and 1.23 μg/mL, MIC of ciprofloxacin = 31.49 and 125.99 μg/mL, respectively). Molecular docking suggested a good fit in the active site of fungal lanosterol 14α-demethylase (CYP51) and bacterial FtsZ (Filamenting temperature-sensitive mutant Z) protein. Conclusions: As a result, the title compounds emerged as promising entities with broad antifungal and antibacterial effects, highlighting the utility of oxime ether function in the azole scaffold.

Combined antimicrobial activity of short peptide and phage-derived endolysin against antibiotic-resistant Salmonella Typhimurium

This study was designed to evaluate the combination effects of antimicrobial peptides (FK13 and FK16) and phage-encoded endolysin (LysPB32) on the inhibition of growth of polymyxin B-resistant Salmonella Typhimurium ATCC 19585 (STPMB). The inhibitory effects of FK13, FK16, and LysPB32 against STPMB were evaluated by using antimicrobial susceptibility, membrane permeability, biofilm reduction, cross-resistance, and mutant frequency assay. The minimum inhibitory concentrations (MICs) of FK13 and FK16 treated with LysPB32 (FK13+LysPB32 and FK16+LysPB32) against STPMB were decreased from more than 512 to 128 μg/ml and from 64 to 32 μg/ml, respectively. Compared to the control, the number of STPMB in the growing culture was reduced by 4.2 and 5.2 log CFU/ml, respectively, for FK13+LysPB32 and FK16+LysPB32 after 12-h incubation at 37 °C. All treatments (FK13, FK16, FK13+LysPB32, FK16+LysPB32) significantly increased the permeability of the outer membrane of STPMB. Biofilms were significantly decreased from OD600 of 0.6 to 0.16 for FK13+LysPB32 and from 0.6 to 0.13 for FK16+LysPB32. The ratios of MICs of erythromycin, ceftriaxone, polymyxin B, and ciprofloxacin to MIC of the control against STPMB were decreased to 0.50 for FK13+LysPB32 and FK16+LysPB32. The bactericidal activities of amikacin and gentamicin were enhanced for FK13+LysPB32 and FK16+LysPB32 (2-fold < MBC/MIC ratio). The mutant frequencies of STPMB to antibiotics were decreased when treated with FK13+LysPB32 and FK16+LysPB32. The results suggest that the combination of antimicrobial peptides and endolysins can be a promising strategy to control polymyxin B-resistant S. Typhimurium.

Exploring Plasmid-Mediated Quinolone Resistance Gene Diversity among Ciprofloxacin-Resistant Proteus Species in a Tertiary Care Hospital of Bangladesh

Background: Increased resistance to fluoroquinolones has been observed in members of the Enterobacteriaceae, including Proteus species. The extensive use of fluoroquinolones and the presence of plasmid-mediated quinolone resistance (PMQR) genes are believed to contribute significantly to fluoroquinolone resistance. This study highlights the prevalence of ciprofloxacin-resistant Proteus species and the presence of specific PMQR genes among them, emphasizing their potential role in quinolone resistance. Method: The study included 30 ciprofloxacin-resistant Proteus isolates collected from wound swab, pus, urine, and blood samples. Identification of Proteus species was performed using culture and biochemical tests. Antibiotic susceptibility test was conducted using the Kirbey-Bauer disc-diffusion method. The minimum inhibitory concentration (MIC) of ciprofloxacin among ciprofloxacin-resistant Proteus species was determined using the agar dilution method. The study aimed to detect specific PMQR genes, namely aac(6´) lb-cr, qnrA, qnrB, qnrD, and qnrS, using polymerase chain reaction (PCR). Result: A total of 42 Proteus species were isolated from 310 various samples. Among the Proteus isolates, 71.43% were ciprofloxacin resistant. The study found that 30% of ciprofloxacin-resistant isolates were positive for aac(6´) lb-cr gene, 13.33% for qnrA and qnrS respectively and 10% for qnrD gene. In total, 60% of ciprofloxacin-resistant Proteus isolates were positive for at least one PMQR gene. The qnrB gene was not detected among ciprofloxacin-resistant Proteus species. The MIC of ciprofloxacin ranged from 8 μg/ml to 128 μg/ml among ciprofloxacin-resistant Proteus isolates. Conclusion: This study suggests aac(6´) lb-cr, qnrA, qnrS, and qnrD genes are emerging in Proteus species, potentially contributing to the development of quinolone resistance and has implications for clinical management and public health. J MEDICINE 2024; 25: 149-154

Lactobacillus acidophilus VB1 co-aggregates and inhibits biofilm formation of chronic otitis media-associated pathogens

This study aims to evaluate the antibacterial activity of Lactobacillus acidophilus, alone and in combination with ciprofloxacin, against otitis media-associated bacteria. L. acidophilus cells were isolated from Vitalactic B (VB), a commercially available probiotic product containing two lactobacilli species, L. acidophilus and Lactiplantibacillus (formerly Lactobacillus) plantarum. The pathogenic bacterial samples were provided by Al-Shams Medical Laboratory (Baqubah, Iraq). Bacterial identification and antibiotic susceptibility testing for 16 antibiotics were performed using the VITEK2 system. The minimum inhibitory concentration of ciprofloxacin was also determined. The antimicrobial activity of L. acidophilus VB1 cell-free supernatant (La-CFS) was evaluated alone and in combination with ciprofloxacin using a checkerboard assay. Our data showed significant differences in the synergistic activity when La-CFS was combined with ciprofloxacin, in comparison to the use of each compound alone, against Pseudomonas aeruginosa SM17 and Proteus mirabilis SM42. However, an antagonistic effect was observed for the combination against Staphylococcus aureus SM23 and Klebsiella pneumoniae SM9. L. acidophilus VB1 was shown to significantly co-aggregate with the pathogenic bacteria, and the highest co-aggregation percentage was observed after 24 h of incubation. The anti-biofilm activities of CFS and biosurfactant (BS) of L. acidophilus VB1 were evaluated, and we found that the minimum biofilm inhibitory concentration that inhibits 50% of bacterial biofilm (MBIC50) of La-CFS was significantly lower than MBIC50 of La-BS against the tested pathogenic bacterial species. Lactobacillus acidophilus, isolated from Vitane Vitalactic B capsules, demonstrated promising antibacterial and anti-biofilm activities against otitis media pathogens, highlighting its potential as an effective complementary/alternative therapeutic strategy to control bacterial ear infections.

Quorum-sensing regulation of phenazine production heightens Pseudomonas aeruginosa resistance to ciprofloxacin.

Quorum sensing is a type of cell-cell communication that modulates various biological activities of bacteria. Previous studies indicate that quorum sensing contributes to the evolution of bacterial resistance to antibiotics, but the underlying mechanisms are not fully understood. In this study, we grew Pseudomonas aeruginosa in the presence of sub-lethal concentrations of ciprofloxacin, resulting in a large increase in ciprofloxacin minimal inhibitory concentration. We discovered that quorum sensing-mediated phenazine biosynthesis was significantly enhanced in the resistant isolates, where the quinolone circuit was the predominant contributor to this phenomenon. We found that production of pyocyanin changed carbon flux and showed that the effect can be partially inhibited by the addition of pyruvate to cultures. This study illustrates the role of quorum sensing-mediated phenotypic resistance and suggests a strategy for its prevention.

Ciprofloxacin and Azithromycin Susceptibility in Salmonella Causing Bloodstream Infection in a Tertiary Care Hospital in South India

Enteric fever is a major health concern worldwide, especially in tropical countries. Enteric fever caused by Salmonella enterica is a gastrointestinal tract disease to begin with and later involving many systems,. After the advent of multidrug resistant Salmonellae, ciprofloxacin became the focus of its treatment. Azithromycin is widely being used for the prevention and treatment of Enteric fever. Of late, there are reports in literature to support that Salmonella have regained susceptibility to Ampicillin, Cotrimaxazole and Chloramphenicol. Therefore, this study undertaken aims to find out the antimicrobial susceptibility of Salmonella isolates to conventional drugs like Ampicillin, Cotrimaxazole and Chloramphenicol and find out susceptibility pattern of Ciprofloxacin that is over used for treatment of enteric fever and Azithromycin, most often used in children. As there is no disc diffusion method as per CLSI 2019 guidelines to detect the susceptibility to ciprofloxacin, ciprofloxacin resistance was determined by minimum inhibitory concentration(MIC)by E-test.Kirby-Bauer disk diffusion technique was used to monitor Azithromycin resistance among Salmonella entericaserovarTyphi as per CLSI 2019 guidelines. METHODS:The Prospective study was conducted over a period of 8 months (May 2019- December 2019) with the clinical samples yielding the growth of Salmonella from blood. These strains were screened for Ciprofloxacin susceptibility by E-test. Azithromycin,Ampicillin, Co-Trimaxazole and Chloramphenicol susceptibility were detected by Kirby-Bauer disc diffusion technique. RESULTS: Of the 80 isolates that were screened, 52 (65%) were resistant, 24 (30%) were intermediate susceptible and remaining 4(5%) were sensitive to ciprofloxacin by MIC detection. 69 (86.25%) of the isolates were sensitive and 11 (13.75%) were resistant to Azithromycin by disc diffusion technique. All isolates (100%)were found to be susceptible to Ampicillin, Co-Trimaxazole and Chloramphenicol CONCLUSION:The current study shows a high prevalence of resistance to ciprofloxacin in Salmonella species isolated in and around Mysuru district in southern India. Detection of ciprofloxacin resistance by the Kirby Bauer disk diffusion method is less effective, so it is advised that MIC of ciprofloxacin must be regularly done in the diagnostic laboratories for all strains. The findings from our study also showed low level resistance (13.75%) to Azithromycin. It is advised that Azithromycin can be used as a therapeutic agent only if it is reported to be sensitive by the susceptibility test. Conventional agents like Ampicillin, Co-Trimaxazole and Chloramphenicol can be reconsidered for treatment of Enteric fever.

Prevalence, antibiotic resistance, and genomic characterisation of Campylobacter spp. in retail chicken in Hanoi, Vietnam.

Campylobacter spp. are a leading cause of bacterial foodborne zoonosis worldwide, with poultry meat and products recognised as a significant source of human infection. In Vietnam there are few data regarding the occurrence, antimicrobial resistance, and genomic diversity of Campylobacter in poultry and poultry meat. The aim of this study was to estimate the prevalence of Campylobacter in chicken meat at retail in Hanoi, determine antimicrobial sensitivities of the Campylobacter isolated, and assess their genetic diversity. A total of 120 chicken meat samples were collected from eight traditional retail markets (n=80) and four supermarkets (n=40). Campylobacter was isolated following ISO 10272-1 : 2017 and identification verified by PCR. The prevalence of Campylobacter was 38.3 % (46/120) and C. coli was the most prevalent species in both retail markets (74 %) and supermarkets (88 %). The minimum inhibitory concentrations for ciprofloxacin, erythromycin, gentamicin, nalidixic acid, streptomycin, and tetracycline were determined by broth microdilution for 32 isolates. All characterised Campylobacter were resistant to ciprofloxacin, nalidixic acid, and tetracycline, with corresponding resistance determinants detected in the sequenced genomes. Most C. coli were multidrug resistant (24/28) and two harboured the erythromycin resistance gene ermB on a multiple drug-resistance genomic island, a potential mechanism for dissemination of resistance. The 32 isolates belonged to clonal complexes associated with both poultry and people, such as CC828 for C. coli. These results contribute to the One Health approach for addressing Campylobacter in Vietnam by providing detailed new insights into a main source of human infection and can inform the design of future surveillance approaches.

A New Case of Fournier's Gangrene Caused by Actinotignum schaalii

Actinotignum schaalii (formerly known as Actinobaculum schaalii) is an anaerobic or facultative anaerobic gram-positive bacillus that can be found commensally in the urogenital region. It can be overlooked because it grows slowly and is difficult to identify with classical microbiology laboratory techniques. Colonies become visible after 48-72 hours of incubation on blood agar in anaerobic or CO₂-rich media. While it typically causes urinary tract infection in older individuals, cases of bacteremia, vertebral osteomyelitis, endocarditis and cellulitis have been reported. Fournier's gangrene caused by A.schaalii has been reported very rarely so far. Fournier's gangrene has been defined as necrotizing fasciitis of the external genitalia, perineal and perianal region. Diabetes, immunosuppression, peripheral vascular disease, urethral anomalies, chronic alcoholism and smoking are important predisposing factors. In addition, approximately 25% of the cases have no known or identifiable etiology. The bacteria causing the infection may originate from skin, urogenital or intestinal microbiota. In this case report, a new case of Fournier's gangrene caused by A.schaalii was presented. A 65-year-old male patient admitted to the emergency department with the complaints of pain, swelling, redness in the left testis and also nausea, vomiting and chills that started three days ago. Physical examination revealed increased diameter of the scrotum, intense hyperemia of the skin and foci of necrosis. It was learned that the patient had no known chronic disease other than benign prostatic hyperplasia. The patient reported smoking of 25 packs of cigarettes per year. Routine laboratory tests revealed leukocyte= 32.41 x 109/L, neutrophil= 89.9%, procalcitonin= 1.62 ug/L, CRP= 265.07 mg/L and the patient was operated with the diagnosis of Fournier's gangrene. Gram staining of the abscess specimen obtained during the operation showed gram-positive bacilli both inside and outside the leukocytes. After 24 hours, grampositive bacilli were detected in the Gram staining of thin, transparent/gray colonies grown on 5% sheep blood and chocolate agar. The isolate was identified as A.schaalii by matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) VITEK® MS (bioMérieux, France) microbial identification system. VITEK®2 ID ANC (bioMérieux, France) bacterial identification card was also used for comparison but the bacteria could be identified. As a result of the sequence analysis performed for confirmation, it was shown to be 100% homologous with Actinobaculum schaalii (GenBank accession no: FJ711193.1). For susceptibility tests, 5% sheep blood Schaedler agar was used and incubated in anaerobic environment. According to the minimal inhibitory concentration (MIC) results evaluated after 48 hours, penicillin was found to be 0.032 mg/L, clindamycin 0.125 mg/L, ciprofloxacin 0.19 mg/L, ceftazidime 4 mg/L, and amoxicillin 0.19 mg/L. The primary cause that initiated the infection in the case could not be identified, but it was thought that the presence of prostatic hyperplasia and smoking history may have contributed to the occurence or the progress of the disease. It is noteworthy that the ciprofloxacin MIC result was quite low compared to other studies. In addition, this study revealed the value of MALDI-TOF MS based methods in identification. In conclusion, it is thought that a significant proportion of A.schaalii infections may be overlooked due to the difficulty in growth and identification. Increasing the diagnostic power of clinical microbiology laboratories for poorly identified bacteria and renewing the databases of commercial identification systems are important for the early and accurate diagnosis and treatment of serious infections that may occur with such agents.

Dynamic responses of Salmonella Typhimurium to re-exposure to sublethal ciprofloxacin.

This study was designed to evaluate the history-dependent behaviors of Salmonella Typhimurium re-exposed to sublethal levels of ciprofloxacin. The S. Typhimurium cells were pre-exposed to 0 (CON), 1/16 (LOW), 1/8 (MED), and 1/4 (HIGH) minimum inhibitory concentrations (MICs) of ciprofloxacin, followed by re-exposure to the same concentrations. The bacterial growth, postantibiotic effect (PAE), relative fitness, and swimming motility of treatments were evaluated in the absence of ciprofloxacin. The lag phase duration (LPD) was estimate to assess bacterial recovery under ciprofloxacin exposure. A disk diffusion assay was used to determine the cross-resistance and collateral sensitivity of CON, LOW, MED, and HIGH treatments to ciprofloxacin (CIP), ceftriaxone (CEF), erythromycin (ERY), gentamicin (GEN), and polymyxin B (POL). The S. Typhimurium cells pre-exposed to ciprofloxacin were susceptible in antibiotic-free media, showing delayed growth. The highest PAE (>1h) and bacterial fluctuation (CV=5%) were observed at the High treatment compared to the CON. The HIGH treatment had the lowest relative fitness levels (0.87) and swimming motility (55mm). The LPD was significantly decreased at the LOW treatment (1.8h) when re-exposed to 1/16×MIC of ciprofloxacin. The LOW, MED, and HIGH treatments showed the cross-resistance to POL and the collateral sensitivity to CEF, ERY, and GEN. The pre-exposure to ciprofloxacin could induce phenotypic diversity, corresponding to the history-dependent behaviors. These results provide important insights for the dynamic nature of bacterial populations when re-exposed to sublethal concentrations of antibiotics.

The effect of carbonyl cyanide m-chlorophenyl-hydrazine on antibiotic susceptibility in MDR Enterobacteriaceae isolates in Babylon, Iraq

Abstract Background: One of the efflux pump inhibitors is carbonyl cyanide 3-chlorophenylhydrazone (CCCP) that has often been found to increase the susceptibility of a number of multi-drug resistant (MDR) MDR bacteria, isolated from human clinical specimens. Objectives: To investigate the role of active efflux system to aminoglycoside and quinolones resistance in clinical isolates of Enterobacteriaceae using the efflux pump inhibitor CCCP. Materials and Methods: Enterobacteriaceae isolates were recovered from different clinical samples from hospitalized patients. The minimum inhibitory concentrations (MICs) of antibiotics (levofloxacin, ciprofloxacin, and gentamycin) were compared with and without the efflux pump inhibitor (CCCP) in order to confirm the effective role of the efflux pump in our isolates. Results: The results found that out of 280 clinical samples, only 134 (47.1%) isolates belonged to Enterobacteriaceae. Polymerase chain reaction (PCR) results showed that six (42.8%) out of 14 selected MDR isolates were positive for efflux pump gene oqxA. However, no isolates showed positive results for the efflux pump oqxB. The results of MIC for 14 Enterobacteriaceae isolates against these three antibiotics showed that all isolates had MIC ≥128 μg/mL in the absence of CCCP for levofloxacin, ciprofloxacin, and gentamycin. The results showed the MIC of levofloxacin and ciprofloxacin were reduced for isolates, and the growth of bacteria was inhibited in presence of the CCCP. However, all Enterobacteriaceae isolates showed high MIC values (≥128) even in the presence of the CCCP which indicates no effect the inhibitor in reducing the MIC of the isolates for Gentamycin. Conclusion: From this study, we can conclude that high prevalence of efflux pumps gene (oxqA) was detected among MDR and XDR Enterobacteriaceae isolates and the efflux pump inhibitor (CCCP) has a positive effect and improves the sensitivity of MDR isolates to ciprofloxacin, levofloxacin but not gentamicin.

Non-pathogenic Neisseria species of the oropharynx as a reservoir of antimicrobial resistance: a cross-sectional study.

Commensal Neisseria species of the oropharynx represent a significant reservoir of antimicrobial resistance determinants that can be transferred to Neisseria gonorrhoeae. This aspect is particularly crucial in 'men having sex with men' (MSM), a key population in which pharyngeal co-colonization by N. gonorrhoeae and non-pathogenic Neisseria species is frequent and associated with the emergence of antimicrobial resistance. Here, we explored the antimicrobial susceptibility of a large panel of non-pathogenic Neisseria species isolated from the oropharynx of two populations: a group of MSM attending a 'sexually transmitted infection' clinic in Bologna (Italy) (n=108) and a group of males representing a 'general population' (n=119). We collected 246 strains, mainly belonging to N. subflava (60%) and N. flavescens (28%) species. Their antimicrobial susceptibility was evaluated assessing the minimum inhibitory concentrations (MICs) for azithromycin, ciprofloxacin, cefotaxime, and ceftriaxone using E-test strips. Overall, commensal Neisseria spp. showed high rates of resistance to azithromycin (90%; median MICs: 4.0 mg/L), and ciprofloxacin (58%; median MICs: 0.12 mg/L), whereas resistance to cephalosporins was far less common (<15%). Neisseria strains from MSM were found to have significantly higher MICs for azithromycin (p=0.0001) and ciprofloxacin (p<0.0001) compared to those from the general population. However, there was no significant difference in cephalosporin MICs between the two groups. The surveillance of the antimicrobial resistance of non-pathogenic Neisseria spp. could be instrumental in predicting the risk of the spread of multi-drug resistant gonorrhea. This information could be an early predictor of an excessive use of antimicrobials, paving the way to innovative screening and prevention policies.

Characterization of Transferrable Mechanisms of Quinolone Resistance (TMQR) among Quinolone-resistant Escherichia coli and Klebsiella pneumoniae causing Urinary Tract Infection in Nepalese Children

BackgroundTransferrable mechanisms of quinolone resistance (TMQR) can lead to fluoroquinolone non-susceptibility in addition to chromosomal mechanisms. Some evidence suggests that fluoroquinolone resistance is increasing among the pediatric population. We sought to determine the occurrence of TMQR genes among quinolone-resistant E. coli and K. pneumoniae causing urinary tract infections among Nepalese outpatient children (< 18 years) and identify molecular characteristics of TMQR-harboring isolates.MethodsWe performed antimicrobial susceptibility testing, phenotypic extended-spectrum β-lactamase (ESBL) and modified carbapenem inactivation method tests, and investigated the presence of six TMQR genes (qnrA, qnrB, qnrS, aac(6’)-Ib-cr, oqxAB, qepA), three ESBL genes (blaCTX−M, blaTEM, blaSHV), and five carbapenemase genes (blaNDM, blaOXA−48, blaKPC, blaIMP, blaVIM). The quinolone resistance-determining region (QRDR) of gyrA and parC were sequenced for 35 TMQR-positive isolates.ResultsA total of 74/147 (50.3%) isolates were TMQR positive by multiplex PCR [aac(6’)-Ib-cr in 48 (32.7%), qnrB in 23 (15.7%), qnrS in 18 (12.3%), qnrA in 1 (0.7%), and oqxAB in 1 (0.7%) isolate]. The median ciprofloxacin minimum inhibitory concentration of TMQR-positive isolates (64 µg/mL) was two-fold higher than those without TMQR (32 µg/mL) (p = 0.004). Ser-83→Leu and Asp-87→Asn in GyrA and Ser-80→Ile in ParC were the most common QRDR mutations (23 of 35). In addition, there was a statistically significant association between TMQR and two β-lactamase genes; blaCTX−M (p = 0.037) and blaTEM (p = 0.000).ConclusionThis study suggests a high prevalence of TMQR among the quinolone-resistant E. coli and K. pneumoniae isolates causing urinary tract infection in children in this area of Nepal and an association with the carriage of ESBL gene. This is a challenge for the management of urinary infections in children. Comprehensive prospective surveillance of antimicrobial resistance in these common pathogens will be necessary to devise strategies to mitigate the emergence of further resistance.

Prevalence and mechanisms of ciprofloxacin resistance in Escherichia coli isolated from hospitalized patients, healthy carriers, and wastewaters in Iran

BackgroundThis study was aimed to evaluate the prevalence and molecular characteristics of ciprofloxacin resistance among 346 Escherichia coli isolates collected from clinical specimens (n = 82), healthy children (n = 176), municipal wastewater (n = 34), hospital wastewater (n = 33), poultry slaughterhouse wastewater (n = 12) and livestock (n = 9) slaughterhouse wastewater in Iran.MethodsCiprofloxacin minimum inhibitory concentration (MIC) was determined by agar dilution assay. Phylogroups and plasmid-mediated quinolone resistance (PMQR) genes were identified using PCR. Mutations in gyrA, gyrB, parC, and parE genes and amino acid alterations were screened through sequencing assay. The effect of efflux pump inhibitor (PAβN) on ciprofloxacin MICs in ciprofloxacin-resistant isolates was investigated using the microdilution method.ResultsIn total, 28.03% of E. coli isolates were phenotypically resistant to ciprofloxacin. Based on sources of isolation, 64.63%, 51.51%, 33.33%, 14.70%, 10.22% and 8.33% of isolates from clinical specimens, hospital wastewater, livestock wastewater, municipal wastewater, healthy children and poultry wastewater were ciprofloxacin-resistant, respectively. Eighty-one point eighty-one percent (Ser-83 → Leu + Asp-87 → Asn; 78.78% and Ser-83 → Leu only; 3.03% (of ciprofloxacin-resistant E. coli isolates showed missense mutation in GyrA subunit of DNA gyrase, while no amino-acid substitution was noted in the GyrB subunit. DNA sequence analyses of the ParC and ParE subunits of topoisomerase IV exhibited amino-acid changes in 30.30% (Ser-80 → Ile + Glu-84 → Val; 18.18%, Ser-80 → Ile only; 9.10% and Glu-84 → Val only; 3.03%0 (and 15.38% (Ser-458 → Ala) of ciprofloxacin-resistant E. coli isolates, respectively. The PMQR genes, aac(6')-Ib-cr, qnrS, qnrB, oqxA, oqxB, and qepA were detected in 43.29%, 74.22%, 9.27%, 14.43%, 30.92% and 1.03% of ciprofloxacin-resistant isolates, respectively. No isolate was found to be positive for qnrA and qnrD genes. In isolates harboring the OqxA/B efflux pump, the MIC of ciprofloxacin was reduced twofold in the presence of PAβN, as an efflux pump inhibitor. The phylogroups B2 (48.45%) and A (20.65%) were the most predominant groups identified in ciprofloxacin-resistant isolates.ConclusionsThis study proved the high incidence of ciprofloxacin-resistant E. coli isolates in both clinical and non-clinical settings in Iran. Chromosomal gene mutations and PMQR genes were identified in ciprofloxacin resistance among E. coli population.

Investigation of Delafloxacin Resistance in Multidrug-Resistant Escherichia coli Strains and the Detection of E. coli ST43 International High-Risk Clone.

Delafloxacin is a novel fluoroquinolone agent that is approved for clinical application. In this study, we analyzed the antibacterial efficacy of delafloxacin in a collection of 47 Escherichia coli strains. Antimicrobial susceptibility testing was performed by the broth microdilution method and minimum inhibitory concentration (MIC) values were determined for delafloxacin, ciprofloxacin, levofloxacin, moxifloxacin, ceftazidime, cefotaxime, and imipenem. Two multidrug-resistant E. coli strains, which exhibited delafloxacin and ciprofloxacin resistance as well as extended-spectrum beta-lactamase (ESBL) phenotype, were selected for whole-genome sequencing (WGS). In our study, delafloxacin and ciprofloxacin resistance rates were 47% (22/47) and 51% (24/47), respectively. In the strain collection, 46 E. coli were associated with ESBL production. The MIC50 value for delafloxacin was 0.125 mg/L, while all other fluoroquinolones had an MIC50 value of 0.25 mg/L in our collection. Delafloxacin susceptibility was detected in 20 ESBL positive and ciprofloxacin resistant E. coli strains; by contrast, E. coli strains that exhibited a ciprofloxacin MIC value above 1 mg/L were delafloxacin-resistant. WGS analysis on the two selected E. coli strains (920/1 and 951/2) demonstrated that delafloxacin resistance is mediated by multiple chromosomal mutations, namely, five mutations in E. coli 920/1 (gyrA S83L, D87N, parC S80I, E84V, and parE I529L) and four mutations in E. coli 951/2 (gyrA S83L, D87N, parC S80I, and E84V). Both strains carried an ESBL gene, blaCTX-M-1 in E. coli 920/1 and blaCTX-M-15 in E. coli 951/2. Based on multilocus sequence typing, both strains belong to the E. coli sequence type 43 (ST43). In this paper, we report a remarkable high rate (47%) of delafloxacin resistance among multidrug-resistant E. coli as well as the E. coli ST43 international high-risk clone in Hungary.

Ascorbate and Antibiotics, at Concentrations Attainable in Urine, Can Inhibit the Growth of Resistant Strains of Escherichia coli Cultured in Synthetic Human Urine.

There are conflicting reports on the antibacterial activity of ascorbate; all at concentrations much higher than the typical in human plasma, but that can be reached in urine. The effect of 10 mM ascorbate (in itself not inhibitory) along with antibiotics, was tested both in Mueller-Hinton broth (MHb) and in synthetic human urine (SHU), against resistant isolates of Escherichia coli from lower urinary infections. The activity of nitrofurantoin and sulfamethoxazole was higher in SHU than in MHb; minimal inhibitory concentrations (MICs) in SHU with ascorbate were below typical urinary concentrations. For other antibiotics, MICs were the same in MHb vs. SHU, with no effect of ascorbate in MHb; but in SHU with ascorbate, MICs of ciprofloxacin and gentamicin also went below reported urinary concentrations, with a lesser effect with norfloxacin and trimethoprim, and none with ampicillin. The effect of ascorbate was independent of oxygen and not related to the susceptibility of each strain to oxidative stress. Ascorbate oxidizes during incubation in SHU, and bacterial growth partially prevented oxidation. These results suggest that 10 mM ascorbate can enhance the inhibitory activity of antibiotics upon resistant strains in urine. Clinical experimentation with ascorbate-antibiotic combinations against urinary infections caused by resistant bacteria is warranted.

Drug repurposing in the context of common bacterial pathogens

The clinical problem of multidrug resistance (MDR) in bacteria is due to the lack of novel antibiotics in development and the dwindling pipeline of drugs receiving market authorization. Repurposing of non-antibiotic pharmacological agents may be an attractive pathway to provide new antimicrobial drugs. The aim of the present study was to ascertain the antibacterial and adjuvant properties of a wide range of pharmaceuticals against antibiotic-susceptible and drug-resistant bacteria. Sixty-five (n = 65) pharmacological agents were included in our experiments. For Gram-positive bacteria, Staphylococcus aureus ATCC 43300 (methicillin-resistant), S. epidermidis ATCC 12228, Streptococcus pyogenes ATCC 12384 and Enterococcus faecalis ATCC 29212 were used, while for Gram-negative bacteria, Enterobacter cloacae ATCC 13047 (extended-spectrum β-lactamase-positive), Klebsiella pneumoniae ATCC 49619, Serratia marcescens ATCC 29632 and Pseudomonas aeruginosa ATCC 27853 were included as representative strains. The minimum inhibitory concentrations (MICs) of the tested compounds were determined using the standard broth microdilution method, while a MIC reduction assay was included to ascertain the effect of the tested compounds on the MICs of standard antibiotics (ceftriaxone, ciprofloxacin and gentamicin). Seventeen and twelve drug molecules tested showed measurable antibacterial activities (MIC: 32-512 µg/mL) against Gram-positive and Gram-negative bacteria, respectively. Several compounds decreased the MICs of ciprofloxacin and gentamicin. Although there are increasing number of studies in this field, there are still significant gaps in the evidence to the potential use of non-antibiotic drugs in antimicrobial drug repurposing.

Plasmid-mediated quinolone resistance genes detected in Ciprofloxacin non-susceptible Escherichia coli and Klebsiella isolated from children under five years at hospital discharge, Kenya

BackgroundThe increasing spread of fluoroquinolone resistant enteric bacteria is a global public health concern. Children recently discharged from the hospital are at high risk of carriage of antimicrobial resistance (AMR) due to frequent exposure to antimicrobials during inpatient stays. This study aimed to determine the prevalence, correlates of ciprofloxacin (CIP) non-susceptibility, and distribution of plasmid-mediated quinolone resistance (PMQR) genes in Escherichia coli (E. coli) and Klebsiella spp isolated from children under five years being discharged from two Kenyan Hospitals.MethodsE. coli and Klebsiella spp were isolated from fecal samples from children discharged from hospital and subjected to antimicrobial susceptibility testing (AST) by disc diffusion and E-test. CIP non-susceptible isolates were screened for seven PMQR genes using multiplex polymerase chain reaction (PCR). Poisson regression was used to determine the association between the carriage of CIP non-susceptible isolates and patient characteristics.ResultsOf the 280 CIP non-susceptible isolates: 188 E. coli and 92 Klebsiella spp isolates identified among 266 discharged children, 195 (68%) were CIP-non-susceptible with minimum inhibitory concentrations (MICs) of ≥ 1 µg/mL. Among these 195 isolates, 130 (67%) had high-level CIP MIC = ≥ 32 µg/mL). Over 80% of the isolates had at least one PMQR gene identified: aac(6’)lb-cr (60%), qnrB (24%), oqxAB (22%), qnrS (16%), and qepA (6%), however, qnrA was not identified in any isolates tested. Co-carriage of qnrB with acc(6’)-lb-cr was the most predominant accounting for 20% of all the isolates. Ceftriaxone use during hospital admission and the presence of extended spectrum beta-lactamase (ESBL) production were significantly associated with the carriage of CIP non-susceptible E. coli and Klebsiella spp.ConclusionCIP non-susceptibility is common among E. coli and Klebsiella spp isolated from hospital discharged children in Kenya. Carriage and co-carriage of PMQR, including the newly identified qepA gene, were frequently observed. These findings suggest that children leaving the hospital may serve as an important reservoir for transmission of resistant E. coli and Klebsiella spp to the community. Enhanced surveillance for AMR determinants is critical to inform interventions to control antimicrobial-resistant bacteria.

Quinoxaline-based membrane-targeting therapeutic material: Implications in rejuvenating antibiotic and curb MRSA invasion in an in vitro bone cell infection model.

Manifestation of resistance in methicillin-resistant Staphylococcus aureus (MRSA) against multiple antibiotics demands an effective strategy to counter the menace of the pathogen. To address this challenge, the current study explores quinoxaline-based synthetic ligands as an adjuvant material to target MRSA in a combination therapy regimen. Amongst the tested ligands (C1-C4), only C2 was bactericidal against the MRSA strain S. aureus 4s, with a minimum inhibitory concentration (MIC) of 32μM. C2 displayed a membrane-directed activity and could effectively hinder MRSA biofilm formation. A quantitative real-time polymerase chain reaction (qRT-PCR) analysis indicated that C2 downregulated expression of the regulator gene agrC and reduced the fold change in the expression of adhesin genes fnbA and cnbA in MRSA in a dose-dependent manner. C2 enabled a 4-fold reduction in the MIC of ciprofloxacin (CPX) and in presence of 10μM C2 and 8.0μM CPX, growth of MRSA was arrested. Furthermore, a combination of 10μM C2 and 12μM CPX could strongly inhibit MRSA biofilm formation and reduce biofilm metabolic activity. The minimum biofilm inhibitory concentration (MBIC) of CPX against S. aureus 4s biofilm was reduced and a synergy resulted between C2 and CPX. In a combinatorial treatment regimen, C2 could prevent emergence of CPX resistance and arrest growth of MRSA till 360 generations. C2 could also be leveraged in combination treatment (12μM CPX and 10μM C2) to target MRSA in an in vitro bone cell infection model, wherein MRSA cell adhesion and invasion onto cultured MG-63 cells was only ~17% and~0.37%, respectively. The combinatorial treatment regimen was also biocompatible as the viability of MG-63 cells was high (~ 91%). Thus, C2 is a promising adjuvant material to counter antibiotic-refractory therapy and mitigate MRSA-mediated bone cell infection.