Drug Susceptibility Patterns Research Articles

Genotypic and phenotypic comparison of drug resistance profiles of clinical multidrug-resistant Mycobacterium tuberculosis isolates using whole genome sequencing in Latvia

BackgroundMultidrug-resistant tuberculosis (MDR–TB) remains a major public health problem in many high tuberculosis (TB) burden countries. Phenotypic drug susceptibility testing (DST) take several weeks or months to result, but line probe assays and Xpert/Rif Ultra assay detect a limited number of resistance conferring gene mutations. Whole genome sequencing (WGS) is an advanced molecular testing method which theoretically can predict the resistance of M. tuberculosis (Mtb) isolates to all anti-TB agents through a single analysis.MethodsHere, we aimed to identify the level of concordance between the phenotypic and WGS-based genotypic drug susceptibility (DS) patterns of MDR–TB isolates. Overall, data for 12 anti-TB medications were analyzed.ResultsIn total, 63 MDR–TB Mtb isolates were included in the analysis, representing 27.4% of the total number of MDR–TB cases in Latvia in 2012–2014. Among them, five different sublineages were detected, and 2.2.1 (Beijing group) and 4.3.3 (Latin American-Mediterranean group) were the most abundant. There were 100% agreement between phenotypic and genotypic DS pattern for isoniazid, rifampicin, and linezolid. High concordance rate (> 90%) between phenotypic and genotypic DST results was detected for ofloxacin (93.7%), pyrazinamide (93.7%) and streptomycin (95.4%). Phenotypic and genotypic DS patterns were poorly correlated for ethionamide (agreement 56.4%), ethambutol (85.7%), amikacin (82.5%), capreomycin (81.0%), kanamycin (85.4%), and moxifloxacin (77.8%). For capreomycin, resistance conferring mutations were not identified in several phenotypically resistant isolates, and, in contrary, for ethionamide, ethambutol, amikacin, kanamycin, and moxifloxacin the resistance-related mutations were identified in several phenotypically sensitive isolates.ConclusionsWGS is a valuable tool for rapid genotypic DST for all anti-TB agents. For isoniazid and rifampicin phenotypic DST potentially can be replaced by genotypic DST based on 100% agreement between the tests. However, discrepant results for other anti-TB agents limit their prescription based solely on WGS data. For clinical decision, at the current level of knowledge, there is a need for combination of genotypic DST with modern, validated phenotypic DST methodologies for those medications which did not showed 100% agreement between the methods.

Evaluating the Bacteria Profile and Drug Susceptibility Patterns of Urinary Tract Infectious Pathogens in Pregnant Women in Abakaliki Metropolis, Nigeria

Patient’s demographic data were obtained from a well-structured questionnaire administered before sample collection. A total of two hundred (200) early morning mid-stream urine samples were collected from pregnant women attending Mile 4 hospital to determine the prevalence of UTIs among pregnant women. The collected samples were analysis using Standard Microbiology protocol for isolation and identification of uropathogens. Antibiogram studies of uropathogens were determined using the Kirby–Bauer disk diffusion method and the results were analyzed and were compared with the Clinical Laboratory Standard Institute (CLSI) zone diameter breakpoints. Results of isolation and characterization revealed an overall occurrence rate of 68(34.0%) bacteria consisting of a high distribution of E. coli 27(13.5%) followed by S. aureus 22 (11.0%) and Klebsiella pneumoniae 19 (9.5%). Socio-demographic data of patients revealed that those aged 42-49 years had a high frequency of bacteria 7(70.0%) followed by those aged 34-41 years 50.0%, 18-25 years 31.1% while those aged 26-33 year had the least isolation rate of 26.3%. The occurrence of UTI was highly predominant among patients with no formal level of Education 24(64.9%) than those with formal level of education 17(26.9%). The result of antibiogram studies shows that the isolates exhibited a high percentage of resistance to colistin 100%, azetronam 100% clindamycin 100%, and tetracycline 77.3% but were 92.6%-100% susceptible to cefoxitin, imipenem and amikacin. However, with substantial evidence in this study, cefoxitin, imipenem, and amikacin as drugs of choice could be used for the treatment of UTI, and further studies should be conducted by using highly sensitive and specific techniques such as Polymerase Chain Reaction (PCR), which is the technique used to make numerous copies of a specific segment of the deoxyribonucleic acid quickly and accurately, including genotypic characterization of resistant determinant in bacteria causing UTI among pregnant patients in a larger sample size.

Clinical characteristics and drug susceptibility profiles of Mycobacterium abscessus complex infection at a medical school in Thailand

ObjectivesThis study investigated the differences in epidemiological and clinical data, and antimicrobial susceptibilities among different subspecies of Mycobacterium abscessus complex (MABSC) clinical isolates at a medical school in Thailand.MethodsA total of 143 MABSC clinical isolates recovered from 74 patients were genotypically analyzed for erm(41), rrl, and rrs mutations, and antimicrobial susceptibilities were determined using a broth microdilution method. Patient characteristics and clinical outcomes were reviewed from the medical records.ResultsSeventy-four patients were infected with 28/74 (37.8%) M. abscessus subspecies abscessus (MAB), 43/74 (58.1%) M. abscessus subsp. massiliense (MMA), and 3/74 (4.1%) M. abscessus subsp. bolletii (MBO). The clinical findings and outcomes were generally indistinguishable between the three subspecies. All three subspecies of MABSC clinical isolates exhibited high resistance rates to ciprofloxacin, doxycycline, moxifloxacin, TMP/SMX, and tobramycin. MAB had the highest resistance rates to clarithromycin (27.8%, 20/72) and amikacin (6.9%, 5/72) compared to MBO and MMA, with p < 0.001 and p = 0.004, respectively. In addition, the rough morphotype was significantly associated with resistance to amikacin (8.9%, 5/56), clarithromycin (26.8%, 15/56), and imipenem (76.8%, 43/56) (p < 0.001), whereas the smooth morphotype was resistant to linezolid (57.1%, 48/84) (p = 0.002). In addition, T28 of erm(41), rrl (A2058C/G and A2059C/G), and rrs (A1408G) mutations were detected in 87.4% (125/143), 16.1% (23/143), and 9.1% (13/143) of MABSC isolates, respectively.ConclusionsThree MABSC subspecies caused a variety of infections in patients with different underlying comorbidities. The drug susceptibility patterns of the recent circulating MABSC strains in Thailand were different among the three MABSC subspecies and two morphotypes.

Phenotypic and genotypic drug susceptibility patterns of Mycobacterium tuberculosis isolates from pulmonary tuberculosis patients in Central and Southern Ethiopia.

The persistence of tuberculosis (TB) infection in some patients after treatment has highlighted the importance of drug susceptibility testing (DST). This study aimed to determine the drug susceptibility patterns of Mycobacterium tuberculosis (M. tuberculosis) isolates from pulmonary TB (PTB) patients in Central and Southern Ethiopia. A health institution-based cross-sectional study was conducted between July 2021 and April 2022. Sputum samples were collected from newly diagnosed smear microscopy and/or Xpert MTB/RIF-positive PTB patients. The samples were processed and cultivated in Lowenstein-Jensen (LJ) pyruvate and glycerol medium. M. tuberculosis isolates were identified using polymerase chain reaction (PCR) based region of difference 9 (RD9) deletion typing. Phenotypic DST patterns of the isolates were characterized using the BACTEC MGIT™ 960 instrument with SIRE kit. Isoniazid (INH) and Rifampicin (RIF) resistant M. tuberculosis isolates were identified using the GenoType® MTBDRplus assay. Sputum samples were collected from 350 PTB patients, 315 (90%) of which were culture-positive, and phenotypic and genotypic DST were determined for 266 and 261 isolates, respectively. Due to invalid results and missing data, 6% (16/266) of the isolates were excluded, while 94% (250/266) were included in the paired analysis. According to the findings, 14.4% (36/250) of the isolates tested positive for resistance to at least one anti-TB drug. Gene mutations were observed only in the rpoB and katG gene loci, indicating RIF and high-level INH resistance. The GenoType® MTBDRplus assay has a sensitivity of 42% and a specificity of 100% in detecting INH-resistant M. tuberculosis isolates, with a kappa value of 0.56 (95%CI: 0.36-0.76) compared to the BACTEC MGIT™ DST. The overall discordance between the two methods was 5.6% (14/250) for INH alone and 0% for RIF resistance and MDR-TB (resistance to both INH and RIF) detection. This study reveals a higher prevalence of phenotypic and genotypic discordant INH-resistant M. tuberculosis isolates in the study area. The use of whole-genome sequencing (WGS) is essential for gaining a comprehensive understanding of these discrepancies within INH-resistant M. tuberculosis strains.

Prevalence, drug-susceptibility pattern and associated factors of Mycobacterium tuberculosis infection among prisoners in western Arsi zonal prisons, Oromia, South West Ethiopia

ObjectivesEach year, tuberculosis (TB) in prisons is a major worldwide health concern that results in millions of diseases. It is particularly prevalent in low socio-economic countries like Ethiopia because of the poverty, overcrowding, starvation, lack of access to basic healthcare services, and high prevalence of HIV infection in these countries. MethodsA cross-sectional study with 259 prisoners was carried out in the western Arsi zonal prison from November to January 2021. The sputum samples were taken from suspected TB patients and evaluated using the Gene Xpert Mycobacterium tuberculosis/rifampcine test. Line probe assay was used to assess the molecular drug susceptibility of isolates from positive sputum. A bivariate and multivariate logistic regression was analyzed using SPSS version 24 packages. Odds ratio (OR) and corresponding 95% CI were used to quantify the degrees of association between target potential risk factors and Mycobacterium tuberculosis positivity. P-value of less than 0.05 was considered statistically significant. ResultsThe prevalence of undiagnosed pulmonary TB (PTB) verified positive cases was 5.4% (95% CI 2.7, 8.5) out of 259 research participants that were recruited in this study. One (0.38%) occurrence of mono-drug resistance to isoniazid was found among them. In this study, variables that were significantly linked with PTB positive were age ≥30 years, smoking (adjusted OR [AOR] = 0.087, 95% CI = 0.01-0.93, P = 0.043), body mass index 18.5 kg/m2, cough duration 4 weeks (AOR = 0.03, 95% CI = 0.1-0.13 P = 0.001), and coughing before incarceration (AOR = 6.2, 95% CI = 3.6-10.59, P = 0.004). ConclusionIn West Arsi zonal prisons, PTB and mono-drug resistance for isoniazid were found to be more common than in the general population.

Bacterial ventriculoperitoneal shunt infections: changing trends in antimicrobial susceptibility, a 7-year retrospective study from Pakistan

BackgroundVentriculoperitoneal (VP) shunt infections in adults represent a severe complication and make treatment more challenging. Therefore, drug susceptibility patterns are crucial for therapeutic decisions and infection control in neurosurgical centers. This 7-year retrospective study aimed to identify the bacteria responsible for adult VP shunt infections and determine their drug susceptibility patterns.MethodsThis single-center study was performed from 2015 to 2021 in Lahore, Pakistan, and included CSF cultures from VP shunt infections. Demographic data, causative organisms, and antimicrobial susceptibility testing results were collected. Multivariate analysis of variance (MANOVA) and two-sample t-tests were used to analyze and compare the antibiotic sensitivity trends over the study period.Results14,473 isolates recovered from 13,937 CSF samples of VP shunt infections were identified and analyzed for their susceptibility patterns to antimicrobials. The proportion of Gram-negative and Gram-positive bacteria were 11,030 (76%) and 3443 (24)%, respectively. The predominant bacteria were Acinetobacter species (n = 5898, 41%), followed by Pseudomonas species (n = 2368, 16%) and coagulase-negative Staphylococcus (CoNS) (n = 1880, 13%). 100% of Staphylococcus aureus (S.aureus) and CoNS were sensitive to vancomycin and linezolid (n = 2580). However, 52% of S. aureus (719/1,343) were methicillin-resistant Staphylococcus aureus (MRSA). Acinetobacter showed maximum sensitivity to meropenem at 69% (2759/4768). Pseudomonas was 80% (1385/1863 sensitive to piperacillin-tazobactam, Escherichia coli (E. coli) showed 72% to amikacin (748/1055), while Klebsiella spp. was 57% (574/1170) sensitive to piperacillin-tazobactam. The sensitivity of piperacillin-tazobactam and meropenem for Gram-negative bacteria decreased significantly (p < 0.05) over 7 years, with 92.2% and 88.91% sensitive in 2015 and 66.7% and 62.8% sensitive in 2021, respectively.ConclusionThe significant decrease in the effectiveness of carbapenem and beta-lactam/beta-lactamase inhibitor combination drugs for the common Gram-negative causative agents of VP shunt infections suggests that alternative antibiotics such as colistin, fosfomycin, ceftazidime/avibactam, ceftolozane/tazobactam, and tigecycline should be considered and in consequence included in testing panels. Additionally, it is recommended to adopt care bundles for the prevention of VP shunt infection.

Phenotypic Drug Resistance Pattern and Mutation Characteristics of Mycobacterium tuberculosis from Different Body Fluids Among Extra Pulmonary Patients Presented in Selected Hospitals in Addis Ababa, Ethiopia.

Drug resistance in tuberculosis poses challenges to both the control and prevention of the disease. The extent of resistance is not well known in developing countries, including Ethiopia. This study was conducted to determine the drug resistance patterns and mutation characteristics of Mycobacterium tuberculosis among extra pulmonary tuberculosis patients in selected health facilities in Addis Ababa. A cross-sectional study was conducted from February 2022 to August 2022 in selected hospitals in Addis Ababa. Socio-demographic and clinical data were collected using structured questionnaire. Mycobacterium tuberculosis complex (MTBC) isolates were tested for phenotypic drug susceptibility patterns using the Mycobacterium growth indicator tube (MGIT) method for first-line drugs and mutation characteristics using the Line Probe Assay (LPA) method. The data were analyzed using: SPSS version 23, and a P-value ≤ 0.05 was considered statistically significant. From a total of 308 patient samples from presumptive extra pulmonary patients, 44 (14.3%) were positive for MTBC. Any drug resistance was discovered in 25% of 44 MTBC isolates evaluated for five first-line drugs phenotypically, with isoniazid (INH) and pyrazinamide (PZA) resistance accounting for a greater proportion with 13.6% and 11.4% of the isolates, respectively. Two (4.5%) of the isolates were MDR-TB. Out of 44 isolates tested using the Geno Type MTBDRplus assay, 5 (11.4%) showed mutations at katG and 2 (4.5%) showed mutations in the rpoB genes. Both the phenotypic and genotypic drug susceptibility test results showed a high proportion of INH resistance. All INH resistance-conferring mutations were identified from katG gene. The overall prevalence of MDR-TB was also high. For early case detection and treatment, expanding diagnostic capacity for first-line DST is a vital step to limit further spread of drug resistant TB strains in the study area.

Clinical and bacteriological profile of primary pyoderma: A cross sectional study

Objectives: To evaluate the clinical and bacteriological profile and antibiotic susceptibility pattern in primary pyodermas. Materials and Methods: A descriptive cross-sectional study was carried out in patients with clinically diagnosed primary pyodermas and who attended the outpatient department of dermatology of a tertiary care center in South India from December 2017 to June 2019. Results: During the study period, 180 patients received a clinical diagnosis of primary pyoderma. Most common clinical type was impetigo followed by folliculitis. Most common age group affected was children below ten years of age (74 cases, 41.1%). Sixty five patients (36.1%) had lesions confined to lower limbs. Among the study participants, 26 (14.4%) were on prolonged treatment with systemic corticosteroids. Gram stain study helped in the diagnosis in 115 (63.9%) patients. Staphylococcus aureus (S. aureus) was the predominant pathogen (92 cases, 51.1%). A significant proportion of S. aureus isolates showed resistance to penicillin (90/92, 97.8%) and erythromycin (36/92, 39.1%). The pathogen isolated was methicillin resistant S. aureus (MRSA) in 28 cases (28/92, 30.4%). All isolates of Group A Streptococcus were sensitive to penicillins and first generation cephalosporins. Limitations: It was a single center study, conducted in a tertiary referral hospital; hence did not reflect the status of the disease in the community. Complete information on prior antibiotic treatment was not available in all patients. Conclusion: Pyodermas showed a predilection for younger age group. Impetigo was the leading primary pyoderma. Gram stain is a valuable, but an often neglected tool to diagnose a bacterial infection. Many isolates of S. aureus showing resistance to penicillin and erythromycin and identification of MRSA as the pathogen in many patients highlight the need for periodic assessment of pathogens and drug susceptibility patterns in different population groups to ensure judicious use of antibiotics.

Clinical Outcomes and Associated Factors for Mortality among Pediatric Patients with Carbapenem-Resistant Acinetobacter baumannii

Background: Acinetobacter baumannii bacteremia is a hospital-acquired infection with a high mortality rate. Up to 80% of hospital-acquired A. baumannii infections are caused by carbapenem-resistant Acinetobacter baumannii (CRAB) strains. Objective: To determine the overall 30-day mortality rate, factors associated with mortality, and antibiotic drug susceptibility patterns of CRAB isolates among children with hospital-acquired CRAB bloodstream infections. Materials and Methods: A retrospective review was conducted among hospitalized pediatric patients between January 2017 and September 2022 at King Chulalongkorn Memorial Hospital, Bangkok. The inclusion criteria were CRAB bacteremia in children under 18 years of age. Thirty-day mortality after CRAB bacteremia was analyzed using Kaplan-Meier estimates. Associated factors were analyzed by Poisson regression. Antibiotic susceptibility patterns of nine antimicrobial agents were summarized. Results: Fifty-eight patients with 66 episodes of CRAB bacteremia were identified. The median age was 7.5 months (IQR 0.8 to 60.0), and 86.4% of the patients were admitted to the intensive care unit. Central line-associated bloodstream infections (CLABSI) were identified in 90.9% of cases. Most patients (74.2%) received colistin combination with sulbactam regimen. The 30-day mortality rate was 19.7% (95% CI 10.9 to 31.3). Associated factors for mortality rate were septic shock (aRR 7.6, 95% CI 2.3 to 25.0) and underlying congenital heart disease (aRR 3.4, 95% CI 1.0 to 11.7). Drug susceptibility of colistin and tigecycline were 93% and 48%, respectively. Sulbactam was not susceptible. Conclusion: One-fifth of children with CRAB bacteremia died within 30 days. Associated factors with mortality were septic shock and congenital heart disease. Colistin had the highest in vitro drug susceptibility rate. The common regimen used in the present study was colistin combination with sulbactam therapy. Keywords: Acinetobacter baumannii; Bacteremia; Carbapenem resistance; Susceptibility; Mortality; Pediatrics

Clinical characteristics and drug resistance profile of patients with endobronchial tuberculosis in South Korea: single-center experience.

Tuberculosis (TB) is a major infectious disease worldwide; there has been a significant increase in the number of elderly patients with TB, largely contributing to TB-related mortality. Although endobronchial tuberculosis (EBTB) is a unique form of pulmonary TB, available data on the clinical characteristics and drug susceptibility (DST) patterns of patients with EBTB are scarce. We evaluated the clinical characteristics of patients with EBTB in South Korea and the culturebased DST patterns of EBTB. Further, the DST patterns were compared between elderly (≥65 years) and young (<65 years) patients. We retrospectively reviewed data of patients with EBTB who had the results of DST and were diagnosed between January 2013 and December 2019 at a tertiary referral hospital in South Korea. Phenotypic DST of 15 first-line and second-line anti-TB drugs was performed using Mycobacterium tuberculosis isolates prior to treatment. Of the 230 patients with EBTB, 69% were in elderly patients (≥65 years). Any-resistance occurred in 24 patients (10.4%), while multi-drug resistance (MDR) and extensive drug resistance (XDR) were observed in six patients (2.6%). Compared to that of the elderly treatment-naïve patients, previously treated elderly patients had a significantly higher proportion of resistance to rifampin (14.3% vs. 2.2%; P=0.031), ethambutol (9.5% vs. 0.7%; P=0.046), and pyrazinamide (9.5% vs. 0.7%; P=0.046). Further, MDR/XDR was observed more frequently in the previously treated elderly patients than that in the treatment-naïve elderly patients (14.3% vs. 1.4%; P=0.017). A relatively small number of drug-resistant cases (5.6%) were observed in young patients. Elderly EBTB patients with previous Anti-tuberculous medications had a significantly higher proportion of drug-resistant TB. These patients should be carefully assessed using DST analysis before treatment.

Drug Resistance Patterns in Tubercular Meningitis patients from North India (S25.007)

<h3>Objective:</h3> We aim to study the extensiveness of drug resistance in patients of Tubercular Meningitis (TBM) in our population. <h3>Background:</h3> Drug-resistant TBM is a potentially underrecognized entity, and delay in the institution of appropriate therapy may pave the way for development of further drug resistance by facilitating selective growth of resistant bacilli. Due to the paucibacillary nature of CNS-TB, it is difficult to isolate mycobacteria from the CSF. Thus, there is limited data regarding drug susceptibility in TBM. <h3>Design/Methods:</h3> All suspected TBM patients from across North India presenting to the emergency and those hospitalized in our institute were screened and recruited if they fulfilled the inclusion and exclusion criteria. CSF samples were processed by putting up smear for Ziehl-Neelsen staining and inoculation into the LJ culture media (solid culture) and MGIT 960 (liquid culture). Drug susceptibility patterns of MTB isolates from CSF samples were assessed for first and second-line drugs by phenotypic (MGIT 960) liquid culture method. <h3>Results:</h3> Out of 309 CSF samples processed, 11.65% (36/309) were culture positive. MDR-TB was detected in 16.66% (6/36) of isolates. However, the prevalence of Pre-XDR-TB and XDR-TB among isolates was 5.55% (2/36) and 2.77% (1/36), respectively. Fluoroquinolone (FQ) resistance was observed in 16.66% (6/36) isolates. Of the 6 FQ-resistant isolates, 2/6 were Pre-XDR and 4/6 were mono-FQ resistant. Resistance to second-line injectables was observed in 8.33% (3/36) isolates. Mono-resistance to isoniazid was observed in 8.33% (3/36) of isolates. <h3>Conclusions:</h3> The prevalence of MDR in culture positive TBM patients was observed to be high (16.66%) in our study. Fluoroquinolone resistance was observed both in MDR-TB and sensitive TBM. Rapid detection of drug resistance is essential in a clinically relevant time frame for the timely initiation of appropriate treatment and better patient outcomes. <b>Disclosure:</b> Mr. Modi has nothing to disclose. Kusum Sharma has nothing to disclose. Dr. SINGLA has nothing to disclose. Ms. Sood has nothing to disclose.

Trends in Antibiotic Resistance of Nosocomial and Community-Acquired Infections in Italy.

The World Health Organization has recently identified three categories of pathogens, namely: critical, high, and medium priority, according to the need for new antibiotics. Critical priority pathogens include carbapenem-resistant microorganism (CPO) such as A. baumannii and P. aeruginosa, K. pneumoniae, and Enterobacter spp., whereas vancomycin-resistant E. faecium (VRE), methicillin and vancomycin-resistant S. aureus (MRSA) are in the high priority list. We compared the trend of antimicrobial resistants (AMRs) in clinical isolates, divided by year and bacteria spp., of samples obtained from nosocomial and community patients. Patient records were collected, including age, sex, site of infection, isolated organisms, and drug susceptibility patterns. From 2019 to 2022, a total of 113,635 bacterial isolates were tested, of which 11,901 resulted in antimicrobial resistants. An increase in the prevalence of several antibiotics resistant bacteria was observed. Specifically, the percentage of CPO cases increased from 2.62% to 4.56%, the percentage of MRSA increased from 1.84% to 2.81%, and the percentage of VRE increased from 0.58% to 2.21%. AMRs trend resulted in increases in CPO and MRSA for both community and nosocomial. Our work aims to highlight the necessity of preventive and control measures to be adopted in order to reduce the spread of multidrug-resistant pathogens.

Changing Trend in the Antibiotic Resistance Pattern of Klebsiella Pneumonia Isolated From Endotracheal Aspirate Samples of ICU Patients of a Tertiary Care Hospital in North India.

Introduction Klebsiella pneumonia is one of the most prevalent bacteria that cause nosocomial infections, particularly in critically ill patients in the intensive care unit (ICU). Multi-drug-resistant Klebsiella pneumoniae (MDRKP) has become an urgent risk to public health as its prevalence has sharply surged around the globe in recent decades. Therefore, this research was conducted to evaluate shifts over a four-year period in drug susceptibility patterns among Klebsiella pneumoniae isolates from mechanically ventilated intensive care unit patients. Materials and methods This is a retrospective observational study conducted in a tertiary care multi-specialty hospital and teaching institute in North India and was approved by the institutional ethics committee. The research comprised Klebsiella pneumoniae isolates from endotracheal aspirates (ETA) of patients on mechanical ventilation admitted to the general intensive care unit (ICU) of our tertiary care facility. The data from January to June 2018 and January to June 2022 were collected. According to the antimicrobial resistance profile of the strains, they were categorized as susceptible, resistant to one or two antimicrobial categories, multidrug-resistant (MDR), extensively drug-resistant (XDR), or pan-drug-resistant (PDR). The criteria for MDR, XDR, and PDR were proposed by the European Centre for Disease Prevention and Control (ECDC). IBM Statistical Package for the Social Sciences (SPSS) for Windows, Version 24.0, Armonk, NY, IBM Corp., was used for data input and analysis. Results A total of 82 cases of Klebsiella pneumonia were included in the study. Of these 82 isolates, 40 were isolated over a period of six months from January to June 2018, and the remaining 42 were isolated from January to June 2022. Among the 2018 group, five strains (12.5%) were classified as susceptible, three (7.5%) as resistant, seven (17.5%) as MDR, and 25 (62.5%) as XDR. The highest percentages of antimicrobial resistance in the 2018 group were observed with amoxicillin/clavulanic acid (90%), ciprofloxacin (100%), piperacillin/tazobactam (92.5%), and cefoperazone/sulbactam (95%). In comparison, the 2022 group showed no strain as susceptible; nine strains (21.4%) were classified as resistant; three strains (7%) as MDR; and 30 strains (93%) were classified as XDR. There was a significant increase in resistance to amoxicillin, from 10% in 2018 to nil in 2022. Overall, the rate of resistant Klebsiella pneumonia (K. pneumonia) increased from 7.5% (3/40) in 2018 to 21.4% (9/42) in 2022, while XDR Klebsiella pneumonia among the mechanically ventilated ICU patients significantly increased from 62.5% (25/40) in 2018 to 71% (30/42) in 2022. Conclusion K. pneumoniae antibiotic resistance is a real threat in Asia and requires close monitoring to be controlled. More careful attempts should be made to create a new generation of antimicrobials since the prevalence of resistance to existingmedications is rising. Antibiotic resistance should be monitored and reported by healthcare institutions regularly.

Treatment outcome of drug-resistant tuberculosis (DR-TB) following uptake of universal drug susceptibility testing: A record review from a nodal DR-TB center

Background: There has been delay evident in diagnosing the drug resistance and non-initiation of appropriate treatment based on drug susceptibility pattern resulting in poor treatment outcome of drug-resistant tuberculosis (DR-TB). Aims and Objectives: The aims of this study were to examine the treatment outcomes for DR-TB patients following universal drug susceptibility testing (UDST) and to examine the association of sociodemographic, behavioral factors, or comorbidities with outcome. Materials and Methods: A retrospective study at a nodal DR-TB center was done for the past 2 years (2018–2019) following the district’s adoption of UDST. The study comprised patients registered between January 2018 and December 2019. Transferred out cases were excluded from the analysis. Cured or treatment completed were assigned as successful, whereas the treatment failed, lost to follow-up or died were adverse treatment outcome. Results: A total of 201 patients were initiated on suitable DOTS regime and they continued the treatment from the center, during the study period. Altogether 129 (64.2%) patients had successful treatment outcome. None of the examined variable (age, sex, SES, Body mass index, and comorbidity) is found to have statistically significant association with outcome (P&gt;0.05). Conclusion: The UDST may be the reason for success rate shown here, higher than in literature published. Although a better stance is possible only by comparing the treatment outcome of pre- and post-uptake of UDST from same setting.

Antifungal Resistance of Clinical Candida albicans Isolates in Iran: A Systematic Review and Meta-Analysis.

The present systematic review aimed to investigate the drug susceptibility patterns of Iranian clinical Candida albicans isolates to antifungal drugs (azoles, polyenes, and echinocandins). Six electronic databases including "PubMed," "Scopus," "Web of Science," "IranDoc", "SID", and "Magiran" were searched from May 2000 to June 2021. The susceptibility of 6322 C. albicans strains from 19967 patients against 14 antifungal drugs was evaluated according to CLSI method. The pooled prevalence of antifungal resistance ranged from 0% to 26%. The lowest resistance levels among azoles were observed in luliconazole with a frequency of 0% and voriconazole of 3.94%. Due to the emergence of multi-drug resistant C. albicans, rational drug prescription based on the anti-fungal stewardship strategy and therapeutic drug monitoring is warranted.

Virulence gene detection and antimicrobial resistance analysis of Enterococcus faecium in captive giant pandas (Ailuropoda melanoleuca) in China

BackgroundThe emergence of multidrug resistance among enterococci makes effective treatment of enterococcal infections more challenging. Giant pandas (Ailuropoda melanoleuca) are vulnerable to oral trauma and lesions as they feast on bamboo. Enterococci may contaminate such oral lesions and cause infection necessitating treatment with antibiotics. However, few studies have focused on the virulence and drug resistance of oral-derived enterococci, including Enterococcus faecium, in giant pandas. In this study, we analyzed the prevalence of 8 virulence genes and 14 drug resistance genes in E. faecium isolates isolated from saliva samples of giant pandas held in captivity in China and examined the antimicrobial drug susceptibility patterns of the E. faecium isolates.ResultsTwenty-eight isolates of E. faecium were successfully isolated from the saliva samples. Four virulence genes were detected, with the acm gene showing the highest prevalence (89%). The cylA, cpd, esp, and hyl genes were not detected. The isolated E. faecium isolates possessed strong resistance to a variety of drugs; however, they were sensitive to high concentrations of aminoglycosides. The resistance rates to vancomycin, linezolid, and nitrofurantoin were higher than those previously revealed by similar studies in China and other countries.ConclusionsThe findings of the present study indicate the drugs of choice for treatment of oral E. faecium infection in the giant panda.

SG-APSIC1155: Drug susceptibility patterns of fulminant group G Streptococcus (GGS) infection as a re-emerging infectious disease in Japan

Objectives: Severe streptococcal infections are invasive, re-emerging infections that rapidly worsen and lead to death. Not only group A Streptococcus (GAS) but also group g Streptococcus (GGS) are the causative agents of this infection. Moreover, GGS produces hemolytic toxins, proteolytic toxins, and other toxins like GAS. Furthermore, drug-resistant Streptococcus spp, like other pathogenic bacteria, are on the rise worldwide. However, drug resistance has not been studied extensively in invasive GGS. Therefore, we investigated the drug susceptibility of GGS clinical isolates that are closely related to fulminant streptococcal infections. Methods: We used GGS strains isolated from sterile sites of invasive infections at a hospital in Nagoya City, Japan, from 2017 to 2021. Bacterial identification and drug-susceptibility testing were performed using a VITEK-2 system. Results: Overall, 53 strains were included in the study. The GGS strains examined in this study were resistant to 3 different antibiotics (erythromycin, clindamycin, and minocycline). Also, 18 strains (34%) were resistant to erythromycin, 9 (17%) were resistant to clindamycin, and 18 (34%) were resistant to minocycline. Moreover, there were 5 strains (9.4%) of 2-drug–resistant bacteria and 8 strains (15.1%) of 3-drug–resistant bacteria. Conclusions: Acquired resistance not only to individual antibiotics but also to multiple antibiotics suggests that GGS tends to become multidrug resistant. Continued surveillance of the drug susceptibility of GGS as a potential cause of fulminant streptococcal infections will be necessary in the future.

First and Second-Line Anti-Tuberculosis Drug-Resistance Patterns in Pulmonary Tuberculosis Patients in Zambia.

Drug-resistant tuberculosis has continued to be a serious global health threat defined by complexity as well as higher morbidity and mortality wherever it occurs, Zambia included. However, the paucity of information on drug-susceptibility patterns of both first-line and second-line anti-tuberculosis (anti-TB) drugs, including the new and repurposed drugs used in the management of drug-resistant tuberculosis in Zambia, was the major thrust for conducting this study. A total of 132 bacteriologically confirmed TB isolates were collected from patients with pulmonary TB during the period from April 2020 to December 2021 in Southern and Eastern Provinces of Zambia. Drug-resistance profiles were determined according to four first-line and five second-line anti-TB drugs. Standard mycobacteriological methods were used to isolate and determine phenotypic drug susceptibility. Data on the participants' social-demographic characteristics were obtained using a pre-test checklist. Overall, the prevalence of resistance to one or more anti-TB drugs was 23.5% (31/132, 95% CI: 16.5-31.6%). A total of 9.8% (13/132, 95% CI: 5.3-16.2%) of the patients had multidrug-resistant TB and 1.2% were new cases, while 25.5% had a history of being previously treated for TB. Among those with mono-resistant TB strains, isoniazid (INH) resistance was the highest at 9.8% (13/132, 95% CI: 5.3-16.2%). Two (2/31) (6.5%) XDR-TB and one (1/31) (3.2%) pre-XDR-TB cases were identified among the MDR-TB patients. Previously treated patients were 40 times more likely (OR; 40.3, 95% CI: 11.1-146.5%) to have drug-resistant TB than those who had no history of being treated for TB. This study has established a high rate of multidrug-resistant TB and has further identified both pre-XDR- and XDR-TB. There is a need to intensify surveillance of MDR- and XDR-TB to inform future guidelines for effective treatment and monitoring.

Clinicobacteriological profile and antibiotic susceptibility pattern of chronic dacryocystitis in adults

Abstract Background: Chronic dacryocystitis is a constant menace to delicate ocular structures. If left untreated, it can lead to sight as well as life-threatening complications. However, such complications may be prevented by timely intervention along with appropriate antibiotic prophylaxis. The objectives are to investigate the current bacterial community profile in adult patients with chronic dacryocystitis attending a referral eye care center in Odisha and to determine their drug susceptibility pattern to commonly used antimicrobial agents. Materials and Methods: An observational study was conducted on 70 adult patients with chronic dacryocystitis. The discharge from the punctum was collected by doing a regurgitation test or lacrimal passage irrigation and sent for microbiological analysis. Results: Out of 70 samples collected, 54 (77.1%) samples showed bacterial growth after 24–48 h of incubation. Among various isolates recovered, 68.5% were gram-positive and 27.8% were gram-negative organisms. Staphylococcus aureus was found to be the most common isolate among gram-positive, and Pseudomonas aeruginosa was most common among gram-negative organisms. Among all drugs used in the susceptibility test; amikacin, piperacilin + tazobactam, and netilmycin were found to be most sensitive and cefixime, and amoxycilin + clavulinic acid was found to be most resistant to gram-positive as well as for gram-negative organisms. Conclusion: Knowledge about the microbiological profile and the drug susceptibility pattern responsible for chronic dacryocystitis in a geographical area is important and should be kept in mind while treating these patients.

Prevalence of Lower Respiratory Tract Fungal Infection at a Tertiary Care Hospital in Central Madhya Pradesh, India: A Cross-sectional Study

Introduction: The incidence of fungal infections and resistant isolates has risen exponentially due to multiple factors. This makes the isolation of fungi, performing identification, and susceptibility testing a necessary routine microbiological procedure. Assessing the burden and analysing the epidemiologic trends of fungal infections is critical for patient management. Aim: To determine the prevalence of various fungal infections affecting the lower respiratory tract. Materials and Methods: In this cross-sectional study conducted at Department of Microbiology, Netaji Subhash Chandra Bose (NSCB) Medical College Jabalpur, Madhya Pradesh, India specimens from 400 patients with suspected Lower Respiratory Tract Infection (LRTI) were processed following standard microbiological methods for fungal culture and sensitivity testing. All the fungal isolates were obtained and their antifungal susceptibility pattern were recorded. The data entry was done in a Microsoft Excel spreadsheet, and the final analysis was performed using the Statistical Package for Social Sciences (SPSS) software, version 25.0, developed by IBM in Chicago, USA. Results: The majority of the assessed specimens were sputum (285, 71.2%). Out of the 115 Candida isolates, C.albicans (61, 53%) was the most common species isolated. Among the Non- Candida albicans Candida (NCAC) group, C. tropicalis (32, 27.8%) was the predominant isolate, followed by C. glabrata (16, 13.9%) and C. krusei (6, 5.2%). C. albicans was found to be the most prevalent in the elderly population (&gt;60 years of age), whereas NCAC was prevalent in the 46-60 years age group. Regarding the antifungal drug susceptibility pattern, significantly higher drug resistance was seen in the NCAC group compared to C. albicans towards agents such as ketoconazole, fluconazole, itraconazole, voriconazole, amphotericin-B, and nystatin. None of the fungal isolates demonstrated resistance to caspofungin. Conclusion: Fungal aetiology is a significant problem in patients with LRTI, which often remains underdiagnosed, increasing morbidity and mortality. Therefore, it should be kept in mind while managing a patient with LRTI.