Effective Antibiotics Research Articles

Predictive modeling of mortality in carbapenem-resistant Acinetobacter baumannii bloodstream infections using machine learning.

Acinetobacter baumannii, a notable drug-resistant bacterium, often induces severe infections in healthcare settings, prompting a deeper exploration of treatment alternatives due to escalating carbapenem resistance. This study meticulously examined clinical, microbiological, and molecular aspects related to in-hospital mortality in patients with carbapenem-resistant A. baumannii (CRAB) bloodstream infections (BSIs). From 292 isolates, 153 cases were scrutinized, reidentified through matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS), and evaluated for antimicrobial susceptibility and carbapenemase genes via multiplex polymerase chain reaction (PCR). Utilizing supervised machine learning, the study constructed models to predict 14- and 30-day mortality rates, revealing the Naïve Bayes model's superior specificity (0.75) and area under the curve (0.822) for 14-day mortality, and the Random Forest model's impressive recall (0.85) for 30-day mortality. These models delineated eight and nine significant features for 14- and 30-day mortality predictions, respectively, with "septic shock" as a pivotal variable. Additional variables such as neutropenia with neutropenic days prior to sepsis, mechanical ventilator support, chronic kidney disease, and heart failure were also identified as ranking features. However, empirical antibiotic therapy appropriateness and specific microbiological data had minimal predictive efficacy. This research offers foundational data for assessing mortality risks associated with CRAB BSI and underscores the importance of stringent infection control practices in the wake of the scarcity of new effective antibiotics against resistant strains. The advanced models and insights generated in this study serve as significant resources for managing the repercussions of A. baumannii infections, contributing substantially to the clinical understanding and management of such infections in healthcare environments.

Infections following rattlesnake envenomation and use of antibiotics.

There are 7000-8000 venomous snake bites annually in the USA. Antibiotics are commonly administered to bite victims because infection is difficult to differentiate from local tissue injury following envenomation. The Arizona Poison and Drug Information Center (APDIC) in Tucson oversees antivenom administration for 14 Arizona counties. Records (1999-2021) were searched for antibiotic use and confirmed infections after a rattlesnake bite. There were 4160 calls to APDIC regarding rattlesnakes. After excluding bites to animals, 'dry bites', prisoners and records with missing data, 2059 records were evaluated. Systemic antibiotics were administered to 206 patients (10% of bite victims). Twenty patients (0.97%) had confirmed infections, including cellulitis (n=10), fasciitis (n=4), abscess (n=3) and osteomyelitis (n=3). Five of the victims had positive blood cultures. The presence of tissue necrosis, leukocytosis, fever and elevated fibrinogen levels did not discriminate between toxic effects of venom and infection. Confirmed infections following a rattlesnake bite are uncommon (0.97% of bites). Physicians should refrain from prescribing antibiotics, as they are not justified for most rattlesnake bite victims and the variety of pathogens encountered precludes use of any single effective antibiotic.

Antibiotic Efficacy against Methicillin-Susceptible Staphylococcus aureus Biofilms on Synthetic and Biological Vascular Grafts

Biofilm formation is one of the greatest challenges encountered in vascular graft infections. Our aim is to compare the efficacy of 5 antibiotics against methicillin-susceptible Staphylococcus aureus (MSSA) biofilms on the surface of 4 vascular grafts. Invitro study of 2 clinical MSSA strains (MSSA2 and MSSA6) and 4 vascular grafts (Dacron, Dacron-silver-triclosan (DST), Omniflow-II, and bovine pericardium). After a 24-hr incubation period, the graft samples were divided into 6 groups: growth control (no treatment), ciprofloxacin 4.5mg/L, cloxacillin 100mg/L, dalbavancin 300mg/L, daptomycin 140mg/L, and linezolid 20mg/L. Quantitative cultures were obtained and results expressed as log10colony-forming units per milliliter (CFU/mL). Analysis of variance was performed to compare biofilm formation between the different groups. The mean±standard deviation MSSA2 count on the growth control Dacron graft was 10.05±0.31CFU/mL. Antibiotic treatment achieved a mean reduction of 45%; ciprofloxacin was the most effective antibiotic (64%). Baseline MSSA2 counts were very low on the DST (0.50±1.03CFU/mL) and Omniflow-II (0.33±0.78CFU/mL) grafts. On the bovine pericardium patch, the count was 9.87±0.50CFU/mL, but this was reduced by a mean of 45% after antibiotic treatment (61% for ciprofloxacin). The mean MSSA6 count on the growth control Dacron graft was 9.63±0.53CFU/mL. Antibiotics achieved a mean reduction of 48%, with ciprofloxacin performing best (67% reduction). The baseline MSSA6 count on the DST graft was 8.54±0.73CFU/mL. Antibiotics reduced biofilm formation by 72%; cloxacillin was the most effective treatment (86%). The MSSA6 count on the untreated Omniflow-II graft was 1.17±1.52CFU/mL. For the bovine pericardium patch, it was 8.98±0.67CFU/mL. The mean reduction after antibiotic treatment was 46%, with cloxacillin achieving the greatest reduction (68%). In this invitro study, ciprofloxacin and cloxacillin performed best at reducing biofilms formed by clinical MSSA strains on the surface of biological and synthetic vascular grafts.

Phenotypic and Genotypic Characterization of AmpC Beta-Lactamase in Clinical Isolates of Pseudomonas aeruginosa Findings From a Tertiary Care Hospital.

Background and aim Pseudomonas aeruginosa is an opportunistic pathogen responsible for various healthcare-related infections, which are difficult to treat due to intrinsic and acquired resistance. This study aimed to investigate AmpC β-lactamase production using phenotypic and genotypic methods in Pseudomonas aeruginosa strains isolated from a tertiary care hospital in Karad, Maharashtra, India. Material and methods Over one year, a descriptive cross-sectional study was conducted at the Department of Microbiology, Krishna Institute Medical Sciences, Krishna Vishwa Vidyapeeth, Karad. Phenotypic detection of AmpC beta-lactamase was performed using the Cefoxitin-Cloxacillin Double-Disc Synergy Test method, and genotypic detection was conducted using conventional polymerase chain reaction (PCR) targeting the bla Pseudomonas-derived cephalosporinases (PDC) and bla cephamycinase (CMY) genes. Results Out of 205 clinical isolates of Pseudomonas aeruginosa, 110 (53.66%) showed AmpC production phenotypically, while 86 (41.95%) were positive genotypically. The blaPDC gene was detected in 36.10% of isolates, and the blaCMY gene in 10.73% ofisolates. Conclusions The study findings indicate that AmpC-β-lactamase stands out as the primary resistance mechanism in strains of Pseudomonas aeruginosaisolated from the hospital. PCR study concluded that blaPDC (36.10 %) was the leading gene responsible for AmpC synthesis among study isolates. Early detection of AmpC beta-lactamase production by employing phenotypic and genotypic methods is crucial for detecting antibiotic resistance. This dual approach enables healthcare professionals to decide on the most effective antibiotics and mitigate the development of resistance.

Methicillin-Resistant Staphylococcus aureus (MRSA): Prevalence and Antimicrobial Susceptibility Profile among Patients Attending Tertiary Care Hospital in Northern India

Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most important causative agents of hospital and community associated bacterial infections. The increasing rate of prevalence indicates the need to study the antimicrobial susceptibility profile patterns. This study was aimed to determine the prevalence and antibiotic susceptibility profile pattern of methicillin-resistant Staphylococcus aureus (MRSA) isolates among patients attending a tertiary care hospital in northern India. 150 clinical isolates of S. aureus were included in the study. Kirby–Bauer disc diffusion method was performed to identify antibiotic susceptibility profile, phenotypically methicillin-resistant Staphylococcus aureus (MRSA) was identified by using cefoxitin disc (30 μg). Characteristics of the isolates in this study were determined by traditional biochemical tests including catalase, coagulase, and test for DNAse, and fermentation of mannitol. Antibiotic susceptibility tests were carried out by disc agar diffusion test. Staphylococcus aureus ATCC 25923 was used as a reference control organism. Out of 150 clinical isolates of S. aureus, 97 (64.67%) were methicillin-resistant Staphylococcus aureus (MRSA), and 53 (35.33%) were methicillin-sensitive Staphylococcus aureus (MSSA). 21-30 years age group has the highest percentage of the isolates (28.00%) and the age group with lowest percentage was found in the age groups 71-80 years. The source of isolates with the highest frequency was pus (56.67%), followed by urine (20.00%), and the source with the least number of isolates was serous fluid (0.67%). Teicoplanin, Linezolid, Vancomycin, Gentamicin and Tetracycline were found to be the most effective antibiotics against MRSA isolates. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 64.67%. Teicoplanin, Linezolid, Vancomycin, Gentamicin and Tetracycline found to be the most effective antibiotics against the MRSA isolates. Thus, it is believed that these antibiotics can be used in the treatment of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in the study area.

The correlation between PtfA, PfhA, and TadD fimbriae genes and biofilm formation in Pasteurella multocida virulence and multidrug-resistant nature

Pasteurella multocida is a bacterium that has gotten a lot of attention because of the genetic differences between its strains. This study aimed to find out how the fimbrial gene of P. multocida affects biofilm formation and how it is related to antibiotic resistance. We isolated 20 (8 %) strains of P. multocida from 250 collected samples using PCR; these included 12 strains of serotype A, 2 strains of serotype B, and one strain of serotype E. Five spp. Strains were not categorized. Fimbrial genes PtfA, PfhA, and TadD were detected in all samples with different ratios; PtfA was found in 17 (85 %) samples and TadD in 12 (60 %) samples, while PfhA was expressed in 11 (55 %). In most cases, these three genes coexisted and led to a strong correlation between strains harboring them and biofilm formation. The majority of P. multocida strains demonstrated the ability to form weak and moderate biofilms, despite statistical analysis revealing no distinction between aerobic and microaerophilic conditions in biofilm formation; we observed a slight rise in OD values for strains grown in 5 % CO2. Most strains demonstrated resistance to at least two antibiotics, with a positive correlation between resistance to different antibiotics and the formation of weak and moderate biofilms. Penicillin-G exhibited the highest resistance, while azithromycin proved to be the most effective antibiotic, with 17 strains demonstrating varying levels of susceptibility to it. This study found that fimbrial genes play a decisive role in virulence by facilitating attachment, colonization, and assessing biofilm formation, leading to antibiotic resistance.

High drug-pathogen mismatch in the management of invasive carbapenem-resistant Enterobacteriaceae infections at a tertiary hospital in Nigeria

ObjectivesThis study aims to provide lacking data on antibiotics and treatment strategies used in the management of carbapenem-resistant Enterobacteriaceae (CRE) infections in Nigeria. MethodsA cross-sectional study was carried out at the University College Hospital in Ibadan. CRE isolated from routine culture of specimens from hospitalized patients from December 2021 to September 2022 was identified. Treatment information and other data were collected from the patients’ medical records. ResultsThe hospital laboratory isolated CRE from 55 patients during the study period and 27 (49.1%) of them had data available for the study. The most frequently isolated CRE was Klebsiella spp. (13 of 27, 48.1%). Of the 24 patients who received empiric antibiotics, only two (8.3%) of their CRE isolates were susceptible. After receiving culture results, 18 (66.7%) patients were treated with at least one antibiotic, to which resistance was documented. Only three (11.1%) patients overall commenced or remained on an antibiotic, to which their CRE isolate was susceptible. ConclusionsDespite culture data, we found a high prevalence of drug-pathogen mismatch in CRE treatment, including new or persistent use of antibiotics, to which resistance was documented. Antimicrobial stewardship efforts need to be strengthened to specifically address CRE treatment and effective antibiotics need to be made accessible.

Comparison of Different Methods for Assaying the In Vitro Activity of Cefiderocol against Carbapenem-Resistant Pseudomonas aeruginosa Strains: Influence of Bacterial Inoculum.

Carbapenem-resistant Pseudomonas aeruginosa infections represent a critical public health concern, highlighting the need for the development of effective antibiotics. Cefiderocol demonstrated potent in vitro activity against Pseudomonas aeruginosa, particularly in strains that are resistant to other drugs. However, concerns regarding the emergence of drug-resistant strains persist. This study, conducted with 109 carbapenem-resistant Pseudomonas aeruginosa strains from the Spanish Hospital (Dr. Balmis, Alicante). The study evaluated susceptibility to cefiderocol in comparison to alternative antibiotics and including their susceptibility to bacterial inoculum, while assessing various testing methods. Our findings revealed high susceptibility to cefiderocol against carbapenem-resistant strains, with only 2 of 109 strains exhibiting resistance. Comparative analysis demonstrated superiority of cefiderocol towards alternative antibiotics. Both the E-test and disk-diffusion methods showed 100% concordance with the microdilution method in classifying strains as susceptible or resistant. However, 4.6% (5/109) of disc zone diameters fell within the technical uncertainty zone, so the E-test technique was found to be more useful in routine clinical practice. Additionally, escalating bacterial inoculum correlated with decreases in vitro activity, so this parameter should be adjusted very carefully in in vivo studies. This study underscores cefiderocol's potential as a therapeutic option for carbapenem-resistant Pseudomonas aeruginosa infections. However, the emergence of drug-resistant strains emphasizes the critical need for a wise use of antibiotics and a continuous monitoring of resistance to antibiotics. Based on our in vitro data, further investigation concerning the impact of bacterial inoculum on drug efficacy is warranted in order to detect resistance mechanisms and optimize treatment strategies, thereby mitigating the risk of resistance.

Influences of Bacillus pumilus SA388 as an environmentally friendly antibiotic alternative on growth performance, blood biochemistry, immunology, cecal microbiota, and meat quality in broiler chickens

The widespread use of antibiotics causes the development of antibiotic-resistant bacterial strains, which have a severe impact on poultry productivity and human health. As a result, research is continuing to develop safe natural antibiotic alternatives. In the current study, Bacillus pumilus SA388 was isolated from the chicken feces and confirmed to be a probiotic. The selected strain was tested for its antimutagenic and antioxidant capabilities before being employed as a probiotic food supplement and antibiotic alternative. The effect of B. pumilus SA388 impact on broiler chickens' growth performance, gut microbiome, blood biochemical markers, immunological response, and meat quality was also studied. B. pumilus SA388 showed significant bactericidal activity against Streptococcus pyogenes, Listeria monocytogenes, Staphylococcus aureus, Escherichia coli, Salmonella typhi, and Klebsiella pneumonia. A total of 200 chickens were used in the present study, divided equally among four experimental groups (ten birds per group with 5 replicates): group 1 (control, G1) received a basal diet without B. pumilus SA388, group 2 (G2) received a basal diet supplemented with 0.4 mg/kg of B. pumilus SA388, group 3 (G3) received a basal diet supplemented with 0.8 mg/kg of B. pumilus SA388, and group 4 (G4) received a basal diet supplemented with 1.6 mg/kg of B. pumilus SA388. Over 35 d, the B. pumilus SA388-supplemented groups outperformed the G1 in terms of body weight gain, performance index, and feed conversion ratio, with a preference for the G4 treatment. The levels of alanine aminotransferase (ALT), aspartate transaminase (AST), low-density lipoprotein (LDL), and total cholesterol decreased significantly (P < 0.05) with increasing B. pumilus SA388 dosages compared to the control G1 group. Dietary supplementation of B. pumilus SA388 at 1.6 mg/kg (G4) significantly (P < 0.05) resulted in improved lipid profile, immunological response, thyroid function, and gut microbiota compared to the control group (G1). Compared to the broilers in the control treatment (G1), the addition of B. pumilus SA388 to broilers in G4 significantly (P < 0.05) enhanced juiciness, tenderness, aroma, and taste. Adding B. pumilus SA388 to chicken feed at different doses significantly (P < 0.05) decreased average feed intake while increasing economic and relative efficiency measures. In conclusion, B. pumilus SA388 has been proven to be an effective antibiotic and nutritional supplement.

Efficacy of epetraborole against Mycobacteroides abscessus in a mouse model of lung infection.

Mycobacteroides abscessus (Mab or Mycobacterium abscessus) is a fast-growing mycobacterium that is ubiquitous in the environment and can cause opportunistic disease in people with lung comorbidity and immunodeficiency. There are no Food and Drug Administration-approved drugs for this disease, and repurposed antibiotics have a poor microbiological response. To address the need for effective new antibiotics, we determined the efficacy of epetraborole (EBO) against three Mab clinical isolates in a mouse model of lung Mab infection. Reduction in lung Mab burden over 4 weeks of treatment was the study end point. EBO was administered orally once daily at doses of 25 and 50 mg/kg, which achieved exposures approximating the once-daily dosing of 250 mg and 500 mg, respectively, in humans. EBO administration led to a gradual reduction in the lung Mab burden. After 4 weeks of treatment, the efficacies of 25 and 50 mg/kg EBO against isolates ATCC 19977 and M9501 were comparable. However, against isolate M9530, 50 mg/kg EBO was more efficacious than 25 mg/kg and comparable with parenteral imipenem, one of the most efficacious antibiotics against Mab. We also undertook a dose-ranging study by evaluating the efficacies of once-daily oral administration of 0.5, 5, 10, 25, and 100 mg/kg EBO against M9501 over 4 weeks. Once-daily oral 100 mg/kg EBO was as effective as twice-daily 100 mg/kg imipenem injection. Our study suggests that EBO could address the unmet need for effective oral treatment options for Mab lung disease, given the high rates of Mab drug resistance and limited tolerable intravenous options.

Probing the interaction between the metallo-β-lactamase SMB-1 and ampicillin by multispectral approaches combined with molecular dynamics.

Metallo-β-lactamases (MβLs) hydrolyze and inactivate β-lactam antibiotics, are a pivotal mechanism conferring resistance against bacterial infections. SMB-1, a novel B3 subclass of MβLs from Serratia marcescens could deactivate almost all β-lactam antibiotics including ampicillin (AMP), which has posed a serious threat to public health. To illuminate the mechanism of recognition and interaction between SMB-1 and AMP, various fluorescence spectroscopy techniques and molecular dynamics simulation were employed. The results of quenching spectroscopy unraveled that AMP could make SMB-1 fluorescence quenching that mechanism was the static quenching; the synchronous and three-dimensional fluorescence spectra validated that the microenvironment and conformation of SMB-1 were altered after interaction with AMP. The molecular dynamics results demonstrated that the whole AMP enters the binding pocket of SMB-1, even though with a relatively bulky R1 side chain. Loop1 and loop2 in SMB-1 undergo significant fluctuations, and α2 (71-73) and local α5 (186-188) were turned into random coils, promoting zinc ion exposure consistent with circular dichroism spectroscopy results. The binding between them was driven by a combination of enthalpy and entropy changes, which was dominated by electrostatic force in agreement with the fluorescence observations. The present study brings structural insights and solid foundations for the design of new substrates for β-lactamases and the development of effective antibiotics that are resistant to superbugs.

Aerobic Bacteria and Their Antibiotic Resistance Profile in Neonatal Septicaemia: A cross Sectional Study in a Tertiary Care Hospital of Rajshahi, Bangladesh

Objective: Neonatal sepsis is an infection of the bloodstream in infants younger than 28 days old. It continues to be the major cause of morbidity and mortality among newborns, particularly in middle- and low-income nations. The objective of this study was to isolate and identify aerobic bacteria of neonatal sepsis by blood culture using FAN method followed by subculture and relevant biochemical tests. Methods: It was a cross sectional type of descriptive study where the sample size was 95 and data were collected purposively from the clinically suspected neonatal septicaemia cases from inpatient Pediatric department in Rajshahi Medical College Hospital, Rajshahi. Results: Most 34 (35.79%) of the cases were culture positive, whereas 61 (64%) were culture negative. 7 (21%) of the 34 positive cases were Gram-positive, while 27 (79%) were Gram-negative. S. aureus was found in 6 (17.65%) of the culture-positive isolates, followed by CoNS with 1 (02.94%), E. coli with 14 (41.17%), Klebsiella spp. with 6 (17.65%), P. aeruginosa with 6 (17.65%), and Acinetobacter with 1 (02.94%). Gram-positive bacteria were extremely susceptible to Vancomycin (90%), Gentamicin (90%), and Ciprofloxacin (80%) based on antibacterial susceptibility testing. Colistin (100%) and ampicillin (100%) exhibited the greatest resistance. Meropenem (90%), Amikacin (90%), and Colistin (89%) were the most effective antibiotics against Gram-negative bacteria, whereas Ceftazidime (60%) was the least effective. Vancomycin (100%) and ampicillin (100%) exhibited the highest degree of resistance. Conclusion: Both Gram-positive and Gram-negative aerobic bacteria were related with newborn septicaemia, and a significant proportion of them were resistant to multiple medicines. CME J 2024; 3(2); 4-11

Microbiological Profile of Ear Infection in Patients with Chronic Suppurative Otitis Media

Ear infections occur in all age groups. Chronic Suppurative Otitis Media (CSOM) is the most common illness in ear, nose and throat (ENT) practice. It may even cause hearing impairment especially sensory – neural deafness if not treated properly and with caution. The aim from the present study is to assess the frequency of microbial agents in chronic suppurative otitis media and the antibiotic susceptibility patterns of isolates among patients. A total of 65 patients clinically diagnosed with chronic suppurative otitis media, the samples were collected using sterile swabs. All bacterial and fungal isolate were identified by conventional microbiological methods. Antibiotic susceptibility patterns of the bacterial isolate were determined by Kirby–Bauer disc diffusion method. Out of total 65 samples 45 (69.2%) positive culture was Pseudomonas aeruginosa (28.8%) were the most prevalent bacteria isolated, followed by Staphylococcus aureus (22.2%) Proteus mirabilis (11.1%) Klebsiella (6.6%), E. coli (4.4%), Staphylococcus epidermidis (4.4%) and Streptococcus pyogenic (4.4%). Candida albicans (13.3%) was the most common fungus causing CSOM. The most effective antibiotic for treatment of bacterial chronic suppurative otitis media was ceftriaxone, meropenem and amikacin. It is important to know the major microbial etiologies of CSOM and their antibiotic susceptibility patterns, both for selection of the most appropriate treatment regimen and prevention of the emergence of resistant strains.

Antimicrobial susceptibility of Pasteurella multocida strains isolated from different host species.

The spread of antibiotic resistance is one of the biggest challenges of our time, making it difficult to treat bacterial diseases. Pasteurella multocida is a widespread facultative pathogenic bacterium, which causes a wide range of diseases in both mammals and birds. In the present study, antibiotic susceptibility of 155 P. multocida strains were tested using the broth microdilution method to obtain the minimum inhibitory concentration (MIC) values for 15 antibiotics. The most effective antibiotics against pasteurellosis were ceftiofur, tetracycline, doxycycline, florfenicol and tilmicosin. Of the strains, 12 proved to be multi-drug resistant (MDR). To combat antibiotic resistance, it is important to establish a pre-treatment antibiotic susceptibility profile. A well-chosen antibiotic would not only make the treatment more successful but may also slow down the spread of resistance and the evolution of MDR strains.

A Comparative Study of Community-acquired Acute Kidney Injury and Hospital-acquired Acute Kidney Injury from a Tertiary Care Hospital in North India.

In this observational study, clinical characteristics, etiologies, and outcomes of patients admitted to the hospital with community-acquired acute kidney injury (CAAKI) have been compared in contrast to those who hospital-acquired Acute Kidney Injury (HAAKI). This was a prospective study of adults aged 18 years or above diagnosed with acute kidney injury (AKI) over a period of 17 months at a tertiary care hospital. 230 patients had AKI with the mean age of the study population being 45.33 ± 12.68 years. 178 (77.4%) patients were enrolled from medical unit, 25 (10.7%) from surgical unit, and 27 (11.7%) from obstetrical unit. The observed incidence of AKI was 15/1000 admissions. About 58.2% had CAAKI and 96 (43.7%) had HAAKI. Out of 230 patients, 170 (73.9%) patients were male and 60 (26.1%) were female. Sepsis was the most common (52.1%) etiology of AKI among the medical cases. Urosepsis, scrub typhus, and pneumonia were the most common causes of AKI. Sixty percent of AKI was Kidney Disease Improving Global Outcomes Stage 1 or 2 and 40% was in Stage 3. Oliguria was seen in 56.5%, hyperkalemia in 34.7%, fluid overload in 6.1%, and metabolic acidosis in 22.6%. The majority of patients had multiple organ involvement (52.1%) at the time of enrollment. About 116 (50.4%) had lung injury requiring mechanical ventilation and 95 (41.3%) were on inotropes. Mortality occurred in 19.5%. Anemia, the use of vasopressor drugs, and the need for intensive care support were independent predictive factors for mortality. AKI was common in hospitalized patients and leads to significant inhospital mortality. AKI is largely a CAAKI, and the lesser extent is due to HAAKI. Many causes are potentially preventable. Early fluid resuscitation, effective antibiotics, appropriate antidotes, and timely referral of established AKI patients to centers with dialysis facilities can improve AKI outcomes.

Antimicrobial Sensitivity of Pseudomonas aeruginosa to Aztreonam, Amoxicillin, Erythromycin, Carbenicillin, Norfloxacin, Chloramphenicol, Gentamycin and Azithromycin after Exposure to Radiation Emitted from Radioactive Sources, Lasers and Exposure to Magn

Objective: The aim of this study to assess the sensitivity of P. aeruginosa for ATM, AML, E, CAR, NOR, CL, CN and AZM after exposure to radiation emitted from radioactive sources, Lasers and exposure to magnetized water. Study design: Cross-sectional in descriptive study design with case–control in analytical study design Backgrounds: P. aeruginosa gram negative bacteria occasion distinct kinds of contagion including epidermis, optics, ears, respiratory tract, urinary tract, intestines derived sepsis, soft tissues, skeleton and joint contagion. Radiation including ionizing and non-ionization depending on the energy of the radiated particles emitted Alpha, Beta and Gamma rays from different radioactive sources. Methodology: Study populations and bacterial deposition and identification of P. aeruginosa. Exposure P. aeruginosa to radiation at different times and doses. Antimicrobial susceptibility test for ATM, AML, E, CAR, NOR, CL, CN and AZM after exposure to radiation emitted from radioactive sources, Lasers and magnetized water. Results: After exposing P. aeruginosa to the Na23, CO60, Cs137 and Sr90 radioactive source without or without aluminum for (1,2,3) hr., the bacteria were examined for antibiotics and the results are high sensitivity to NOR, ATM, CAR. As well as, exposure to Nd: YAG laser in (10, 20) min. with exposure to magnetized water which show high sensitive to NOR and ATM antibiotics. Conclusions: The radioactive sources, Nd: YAG laser and magnetic water have a strong effect on bacteria and their sensitivity to antibiotics, so that their sensitivity rate increased very significantly compared to before exposure. The most effective antibiotics in killing bacteria after exposure are Aztreonam, Norfloxacin, Carbenicillin and Gentamycin (ATM, NOR, CAR and CN).

Genetic Basis of Biofilm Formation Genes Ebp and Bph (phos) among Multidrug Resistance Enterococcus faecalis Isolates, Iraq

Abstract Background: Biofilm produced by Enterococcus spp. increase their inherent and acquired antibiotic resistance, posing a significant challenge to infection treatment, particularly in virulent strains. Objective: This study aimed to investigate some genes responsible for biofilm formation (Bph (phos) and EbpB) by polymerase chain reaction (PCR) technique. Materials and Methods: A total of 130 clinical samples were collected during this study, which were obtained from patients who were admitted to Feminine and Children Teaching Hospital in Al-Diwaniyah City during a period extending from (November 2022 to March 2023). All samples were subjected to culturing on different media (blood agar, MacConkey, Bile Esculin agar, and M-El chromogenic ager), after which catalase and oxidase tests were conducted biochemically. After cultivation, the VITEK-2 compact system was used to identify the samples. The isolates were investigated genotypically for harboring biofilm formation genes, including EbpB and Bph (phos), by molecular method (PCR). Results: The VITEK-2 compact system revealed that only 12 isolates were identified as E. faecalis. The most effective antibiotics against E. faecalis were (vancomycin, teicoplanin, linezolide, tigecycline, and ampicillin), and the highest resistance was against erythromycin (100%) and tetracycline (91.6%). Enterococcus faecalis isolates were investigated genotypically for harboring biofilm formation genes that include EbpB and Bph (phos) by molecular methods, PCR. The results showed that EbpB and Bph (phos) genes were positive for all isolates with a percentage of 100%. Conclusions: It was found that the presence of biofilm formation genes in E. faecalis EbpB, and phos (Bph) increase the pathogenicity of this pathogen. These genes showed a high percentage among E. faecalis isolates. Also, all isolates had the potential to form a biofilm, which complicates their treatment with antibiotics, confirming the critical need to develop novel antimicrobial agents that control the infection associated with the development.

Development of a Synergistic Nanomaterial Scaffold Combining Silver Nanoparticles, Collagen, and Doxycycline for Enhanced Scar-Free Skin Regeneration.

Introduction The efficacy of wound-healing treatments can be significantly enhanced through innovative combination therapies. This research investigates the wound-healing properties of a combination therapy involving silver nanoparticles (AgNPs) synthesized using Delphinium denudatum (Dd), bovine tendon collagen (BTC), and the antibiotic doxycycline (DOX) in Wistar albino rats. Each component has known therapeutic benefits: AgNPs possess antimicrobial properties, BTC aids in tissue regeneration, and DOX is an effective antibiotic. The synergy between these components is hypothesized to enhance wound closure, reduce inflammation, and promote scar-free healing. Methods The synthesis of DdAgNPs was carried out using Dd. The presence of AgNPs was confirmed by ultraviolet-visible (UV-Vis) spectroscopy and high-resolution transmission electron microscopy (HRTEM). The study was conducted on Wistar albino rats following ethical guidelines for animal research. The rats were divided into different groups to receive various treatments: DdAgNPs alone, BTC alone, DOX alone, combinations of two components, and the triple combination of DdAgNPs: BTC: DOX. Wound closure rates, epithelialization, and collagen deposition were monitored and recorded over time. Tissue samples from the wound sites were collected for histological analysis. Hematoxylin and eosin (H&E) staining was used to evaluate epithelialization and overall tissue architecture. Collagen deposition was assessed using Masson's trichrome staining. Additionally, the expression of cyclooxygenase-2 (COX-2) was measured as an indicator of inflammation. Results UV-Vis spectroscopy provided the characteristic surface plasmon resonance peak indicative of AgNPs, while HRTEM revealed the morphology and size of the nanoparticles, showing spherical particles with an average size of 35±10.42 nm. The combination therapy of DdAgNPs: BTC: DOX significantly enhanced wound closure compared to individual and dual-component treatments. This was evidenced by faster epithelialization and increased collagen deposition. The histological analysis showed that the triple combination treatment resulted in more organized tissue architecture and denser collagen fibers. Furthermore, the treatment led to a marked decrease in COX-2 expression, indicating reduced inflammation and potential for lower scar formation. Conclusion The synergistic application of DdAgNPs, BTC, and DOX presents a promising strategy for advanced wound healing and tissue regeneration. The combination therapy not only accelerates wound closure but also enhances the quality of healing by promoting epithelialization and collagen deposition while reducing inflammation. These findings offer a potential pathway for developing effective, scar-free healing solutions, highlighting the benefits of integrating multiple therapeutic agents in wound care.

The Pharmaceutical Role of Silver Nanoparticles in Treating Multidrug- Resistant Bacteria and Biofilms

Background: According to the WHO, antimicrobial resistance has recently become worrisome and constitutes an international public health crisis. The advent of multidrug-resistant bacteria has been implicated in the rise in morbidity and death caused by microbial diseases. However, the lack of new and effective antibiotics has been associated with the emergence of drug resistance. This has resulted in worldwide endeavors to advance innovative drugs with higher efficiency and more sophisticated drug delivery technologies. In addition, the utilization of nanoparticles as innovative biological substances is considered a worldwide issue of interest. : Nanoparticles have the potential to become a vital and viable treatment alternative for treating drug-resistant illnesses. Nanoparticles contain metallic substances and their oxides, which have the highest possibility among all nanoparticles and have piqued the curiosity of numerous experts. Furthermore, using silver nanoparticles in photothermal treatment has attracted much interest. Purpose: This review includes knowledge about the problems of drug resistance and the mechanism of action of silver nanoparticles. Results: This review comprehensively assesses the current discoveries for using silver nanoparticles as antimicrobial medicines in infections caused by resistant microorganisms. Also being explored as nanomaterials that can react with light (photothermal treatment) to destroy bacteria and promote improved medication administration and release. Furthermore, it focuses on the synergy between nanoparticles with antimicrobial action and other nanoparticles, microbial adaptation mechanisms to nanoparticles, and existing obstacles and future possibilities that were thoroughly examined.

Inoculation of pleural fluid in blood culture bottles could be a routine practice in pleural infection

Background Worldwide, pleural infections are becoming more common. Overuse of empirical antibiotics has been linked to longer hospital stays and higher death rates, causing the emergence of antibiotic-resistant pathogens. So, proper care requires the identification of the pathogenic bacteria using pleural fluid culture. In addition to normal culture, pleural fluid inoculation in blood culture bottles enhances the proportion of patients with detectable infections in less time. Aim To assess whether inoculating pleural fluid into a blood culture bottle will increase the yield of isolated pathogens compared to routine culture techniques in evaluating pleural infection. Also, to compare the time of pathogen detection when comparing the detection by blood culture bottle versus the routine microbiological culture technique. Recognize the distribution of isolated bacteria from our center and their susceptibility profile to different antibiotics and predict the most effective empirical antibiotics. Patients and methods Cross-sectional analytical prospective study conducted at the Department of Pulmonology and Clinical Pathology in Cairo University Hospitals. It included 70 patients with infected pleural effusion. Under ultrasound supervision, pleural fluid was extracted and transported to the laboratory for routine microbiological culture. At the same time, an automated blood culture bottle was inoculated with 5–10 ml to be incubated. All the detected pathogens were identified and tested for antimicrobial susceptibility according to CLSI. Results The mean age of our patients was 47.1 ± 15.6 years. Empyema was documented in 16 (22.9%) of our patients, whereas 54 (77.1%) had exudative pleural effusion. Positive aerobic infection in blood culture bottle was seen in 37 patients, compared to 21 patients in direct pleural culture. A statistically significant difference was found between the culture positive rate in aerobic blood culture bottles and direct pleural culture (P=0.001). Conclusion Blood culture bottle inoculation of infected pleural fluid increases the sensitivity of microbial yield in a shorter time than standard culture.