Extended-spectrum Beta-lactamase Bacteria Research Articles

A Dual Beta Blocker and Calcium Channel Blocker Overdose in a Patient with Substance Abuse

Aim: Nearly 25% of hospital admissions have related adverse drug events with 6-7% of these related to beta blockers (BB) or calcium channel blockers (CCB). Introduction: In some cases, patients do not report their noncompliance at home as well as their illicit substance use leading to worsened outcomes. We present a case of BB and CCB toxicity with concomitant substance abuse, its treatment and general outcome. Case: A 49-year-old woman with history of diabetes mellitus, stroke, and hypertension presented with flu-like symptoms including fever, nausea, vomiting, diarrhea and dysuria. She was admitted for treatment of urinary tract infection and possible left lower lobar pneumonia with guideline-directed antibiotic and IV fluids for acute kidney injury. She was elusive about her substance use history and endorsed compliance with her cardiac and other medications. Unfortunately, after administration of her morning medications, she had cardiac decline including hypotension and bradycardia with a subsequent hypoglycemia and left sided deficits leading to further investigation into her medication adherence and substance use history. History evolved that she was noncompliant with her high dose cardiac medications and a urine drug screen was positive for amphetamines, barbiturates, and nonprescription benzodiazepines. Treatment: The patient’s shock was treated with resuscitative fluids, glucagon, and calcium infusion as well as a short round of vasopressor. She was transferred to a higher acuity center for large vessel occlusion at the distal portion of the left vertebral artery as seen on stroke imaging. Her blood and urine cultures ultimately grew extended spectrum beta lactamase bacteria, meanwhile her shock was deemed medication-induced hypovolemic shock with a depressed heart rate response given a normal transthoracic echocardiogram and quick resolution after reversal agent. Despite the severity and progression of the hospitalization the patient elected to leave against medical advice (AMA) prior to neurosurgical evaluation and completion of antibiotics. She has since been seen well in follow up by her outpatient provider. Discussion: Cardiac medications are associated with adverse cardiac effects and should be prescribed carefully in patients with substance abuse. Further elucidation of substance abuse led to improved treatment outcomes in this patient with polysubstance and alcohol abuse.

Evaluation of canine raw food products for the presence of extended-spectrum beta-lactamase- and carbapenemase-producing bacteria of the order Enterobacterales.

To assess the potential contamination of commercial raw dog food products with bacteria of the Enterobacterales order that produce extended spectrum beta-lactamase (ESBL) and carbapenemase enzymes, determine risk factors for contamination, and understand isolate genetic diversity. A total of 200 canine raw food products. Products were cultured on selective chromogenic agar following enrichment steps. Whole-genome sequencing was performed for isolates that were confirmed to produce an ESBL. Isolates were characterized by antimicrobial resistance genes, and multilocus sequences typing, and compared to other isolates in the NCBI database for clonality. Preservation method and protein sources were assessed as potential risk factors for contamination with ESBL and carbapenemase-producing bacteria of the Enterobacterales order. No carbapenemase-producing Enterobacterales (CPE) were identified, but ESBL-producing Enterobacterales bacteria were isolated from 20/200 products (10.0%; 95% CI, 7.3 to 16.5%), all of which were frozen. Pork-derived protein source products were 8.1 times (P = .001; 95% CI, 2.53 to 26.2) more likely to carry ESBL-producing Enterobacterales bacteria than other protein sources. WGS analysis confirmed the presence of ESBL genes in a total of 25 distinct isolates (19 Escherichia coli, 5 Klebsiella pneumoniae, and 1 Citrobacter braakii). Genes encoding CTX-M type ESBL enzymes were the most common (24/25 isolates, 96.0%) with blaCTX-M-27 being the most common allele (8/25, 32.0%). Frozen, raw food products may serve as a route of transmission of ESBL-producing Enterobacterales bacteria to companion animals. Veterinarians should advise owners about the risks of raw food diets, including potential exposure to antimicrobial-resistant bacteria.

Incidence of nosocomial infections in reanimation unit at the hospital of Constantine (Algeria)

Nosocomial infections (NI) are contracted at the level of a treatment facility after less than 48 hours from admitting the patients initiating health problems all over the world. The objective of this study was to measure the incidence of NI, identify microorganisms, and recognize the main factors related to the acquisition of NI in the reanimation unit (RU) at the hospital of Constantine in Algeria. This study is a longitudinal prospective descriptive survey started from January 23 to April 29, 2019. Among 50 patients included in the survey, six were found nosocomial infected with an incidence of 12% and density incidence of 22.8 NI/1000 days. The average age of patients infected is 54.5 years with a net predominance of women. Several infections have been highlighted with converged percentages, 34% of nosocomial pneumonia (NP), 33% of nosocomial urinary infections (NUI) and 33% of nosocomial septicemia (NS). The long stay of patients in the unit is the risk factor of the acquisition of NI in the RU in which the duration of hospitalization was 20.83 days. The microorganisms responsible for these infections are mainly: Acinetobacter baumannii as multiresistant bacteria (MRB) with a frequency of 34%, 22% each of extended spectrum beta-lactamase bacteria (ESBLB); Escherichia coli and Enterococcus sp. Candida albicans was the only isolated yeast with a percentage of 22%.

DETEKSI E. coli PENGHASIL Extended Spectrum Beta-Lactamase (ESBL) MENGGUNAKAN METODE PCR PADA SAMPEL AIR BERSIH

Escherichia coli is a normal flora in the human body that plays an important role in the digestive process. The presence of Escherichia coli ESBL (Extended Spectrum Beta-Lactamase) bacteria in clean water samples indicates environmental pollution originating from feces. The aquatic environment is the most influential ecosystem in human life. These contaminated ecosystems provide optimal conditions for antibiotic-resistant bacteria from various sources to mix and transfer their resistance genes to clinically important bacteria for the development of human pathogens with novel resistance mechanisms. This study aims to determine the percentage of ESBL-producing E. coli bacteria in clean water samples. This study uses a descriptive observational design. The total sampling is 195 clean water samples. After going through screening in the form of membrane filter tests, KIA, and IMVIC, 25 isolates were found which were declared as E. coli. Analysis of the ESBL-producing E. coli gene using conventional PCR. Analysis of the Molecular Weight value in the sample using the GelAnalyzer 19.1 application. Based on these calculations, it was found that samples of E. coli isolates containing the ESBL gene were 24% of the 25 E. coli isolates. This percentage indicates that there is a large enough contamination in clean water. The results of this study indicate a potential risk to public health. The participation of health workers, government and the community in maintaining sanitary hygiene is needed to avoid greater contamination of antibiotic-resistant bacteria.

UJI AKTIVITAS ANTIBAKTERI EKSTRAK DAN FRAKSI N-HEKSAN, ETIL ASETAT DAN AIR DARI SABUT KELAPA MUDA (Cocos nucifera Linn) TERHADAP Escherichia coli ESBL (Extended Spectrum Beta Lactamase)

Young coconut coir contains flavonoid compounds, phenols, tannins and saponins. The ethanol extract of young coconut coir was studied to have good antibacterial activity. This study aimed to see the inhibitory activity of ethanol extract compared fractions of young coconut coir ethanol extract in inhibiting Escherichia coli ESBL (Extended Spectrum Beta Lactamase) bacteria. Young coconut coir of extracted using 95% ethanol solvent of maceration method and patition using n-hexane and ethyl acetate solvent. Antibacterial activities using the diffusion method with concentrations of 25%, 50% and 75%. The negative control used DMSO 10%, while positve control used was chloramphenikol. Ethanol extract and fractions of ethanol extract of young coconut coir inhibited Escherichia coli ESBL bacteria. The largest radical inhibition zone was found in the ethyl acetate fraction with a concentration of 75% at 10.9 mm.

Occurrence of Antibiotic-Resistant Genes and Bacteria in Household Greywater Treated in Constructed Wetlands

There is a growing body of knowledge on the persistence of antibiotic-resistant genes (ARGs) and antibiotic-resistant bacteria (ARB) in greywater and greywater treatment systems such as constructed wetlands (CWs). Our research quantified ARGs (sul1, qnrS, and blaCTXM32), class one integron (intI1), and bacterial marker (16S) in four recirculating vertical flow CWs in a small community in the Negev desert, Israel, using quantitative polymerase chain reaction (qPCR). The greywater microbial community was characterized using 16S rRNA amplicon sequencing. Results show that CWs can reduce ARG in greywater by 1–3 log, depending on the gene and the quality of the raw greywater. Community sequencing results showed that the bacterial community composition was not significantly altered after treatment and that Proteobacteria, Epsilonbacteraeota, and Bacteroidetes were the most dominant phyla before and after treatment. Pseudomonas, Citrobacter, Enterobacter, and Aeromonas were the most commonly identified genera of the extended spectrum beta lactamase (ESBL) colonies. Some of the ESBL bacteria identified have been linked to clinical infections (Acinetobacter nosocomialis, Pseudomonas fulva, Pseudomonas putida, Pseudomonas monteilii, and Roseomonas cervicalis). It is important to monitor intI1 for the potential transfer of ARGs to pathogenic bacteria.

Asymptomatic bacteriuria and antibiotic resistance profile in children with neurogenic bladder who require clean intermittent catheterization

A retrospective cohort study. To document the prevalence of asymptomatic bacteriuria and to characterize the resistance patterns to antibiotics among children with neurogenic bladder who require clean intermittent catheterization, with an emphasis on multidrug resistance. A national referral pediatric and adolescent rehabilitation facility in Jerusalem, Israel. Routine urine cultures were collected before urodynamic studies in suitable individuals during 2010-2018. None of them had symptoms of urinary tract infection at the time of specimen collection. Cultures were defined as being positive if a single bacterial species was isolated together with a growth of over 105 colony-forming units/ml. Resistance patterns were defined as extended-spectrum beta-lactamase (ESBL) and resistant to 3 antimicrobial groups (multi-drug resistant, MDR). In total, 281 urine cultures were available for 186 participants (median age 7 years, range 0.5-18). Etiologies for CIC included myelomeningocele (n = 137, 74%), spinal cord injury (n = 16, 9%) and caudal regression syndrome (n = 9, 5%). Vesicoureteral reflux was diagnosed in 36 participants (19%), 14 of whom were treated with prophylactic antibiotics. Asymptomatic bacteriuria was present in 217 specimens (77%, 95%CI [0.72-0.82]). The bacteria species were E. coli (71%), Klebsiella (13%), and Proteus (10%). ESBL was found in 11% of the positive cultures and MDR in 9%, yielding a total of 34 (16% of positive cultures) positive for ESBL and/or MDR bacteria. Asymptomatic bacteriuria and resistance to antimicrobials are common in pediatric individuals who require CIC.

Detection of extended spectrum beta-lactamase genes in strains of Escherichia coli and Klebsiella pneumoniae isolated from recreational water and tertiary hospital waste water in Zaria, Nigeria

ABSTRACT Extended spectrum beta-lactamase (ESBL) producing bacteria pose a severe health risk globally. This study focused on detecting ESBL genes in Escherichia coli and Klebsiella pneumoniae isolated from a recreational water source and the waste water from a tertiary hospital in Zaria, Kaduna State, Nigeria. The isolates (twenty-two) were screened phenotypically for extended spectrum beta lactamase production using the double disk synergy test. Of the isolates, 13 (59.1%) were E. coli, while 9 (40.9%) were Klebsiella pneumoniae; 17 (77.3%) were isolated from the waste water and 5 (22.7%) were isolated from the recreational water. Six (27.2%) of them showed ESBL production phenotypically; however, PCR amplification of the ESBL genes showed that only five of them had at least one of the genes. The presence of ESBL bacteria in hospital waste water and surface waters highlights that water matrices are important routes of transmission of antibiotic resistant bacteria.

Acute cholangitis in intensive care units: clinical, biological, microbiological spectrum and risk factors for mortality: a multicenter study

BackgroundLittle is known on the outcome and risk factors for mortality of patients admitted in Intensive Care units (ICUs) for Acute cholangitis (AC).MethodsRetrospective multicenter study included adults admitted in eleven intensive care units for a proven AC from 2005 to 2018. Risk factors for in-hospital mortality were identified using multivariate analysis.ResultsOverall, 382 patients were included, in-hospital mortality was 29%. SOFA score at admission was 8 [5–11]. Biliary obstruction was mainly related to gallstone (53%) and cancer (22%). Median total bilirubin and PCT were respectively 83 µmol/L [50–147] and 19.1 µg/L [5.3–54.8]. Sixty-three percent of patients (n = 252) had positive blood culture, mainly Gram-negative bacilli (86%) and 14% produced extended spectrum beta lactamase bacteria. At ICU admission, persisting obstruction was frequent (79%) and biliary decompression was performed using therapeutic endoscopic retrograde cholangiopancreatography (76%) and percutaneous transhepatic biliary drainage (21%). Adjusted mortality significantly decreased overtime, adjusted OR for mortality per year was 0.72 [0.54–0.96] (p = 0.02). In a multivariate analysis, factors at admission associated with in-hospital mortality were: SOFA score (OR 1.14 [95% CI 1.05–1.24] by point, p = 0.001), lactate (OR 1.21 [95% CI 1.08–1.36], by 1 mmol/L, p < 0.001), total serum bilirubin (OR 1.26 [95% CI 1.12–1.41], by 50 μmol/L, p < 0.001), obstruction non-related to gallstones (p < 0.05) and AC complications (OR 2.74 [95% CI 1.45–5.17], p = 0.002). Time between ICU admission and biliary decompression > 48 h was associated with in-hospital mortality (adjusted OR 2.73 [95% CI 1.30–6.22], p = 0.02).ConclusionsIn this large retrospective multicenter study, we found that AC-associated mortality significantly decreased overtime. Severity of organ failure, cause of obstruction and local complications of AC are risk factors for mortality, as well as delayed biliary drainage > 48 h.

The Gut of Healthy Infants in the Community as a Reservoir of ESBL and Carbapenemase-Producing Bacteria

The recent rapid rise of multi-drug resistant Enterobacteriaceae (MDR-E) is threatening the treatment of common infectious diseases. Infections with such strains lead to increased mortality and morbidity. Using a cross-sectional study, we aimed to estimate the prevalence of gut colonization with extended spectrum beta-lactamase (ESBL) producing Enterobacteriaceae among healthy infants born in Pakistan, a setting with high incidence of MDR-E infections. Stool samples were collected from 104 healthy infants between the ages of 5 and 7 months. Enterobacteriaceae isolates were screened for resistance against several antimicrobial classes. Presence of ESBL and carbapenemase genes was determined using multiplex PCR. Sequence types were assigned to individual strains by multi-locus sequence typing. Phylogenetic analysis of Escherichia coli was done using the triplex PCR method. Forty-three percent of the infants were positive for ESBL-producing Enterobacteriaceae, the majority of which were E. coli. We identified several different ESBL E. coli sequence types most of which belonged to the phylogenetic group B2 (23%) or D (73%). The widespread colonization of infants in a developing country with ESBL-producing Enterobacteriaceae is concerning. The multiple sequence types and reported non-human sources support that multiple non-epidemic MDR lineages are circulating in Pakistan with healthy infants as a common reservoir.

Assessment of Foods and Drinks for the Presence of Extended Spectrum Beta Lactamase (ESBL) Producing Bacteria in Gombe Metropolis, Nigeria

Objectives: To make preliminary screening study for the presence of ESBL producing bacteria, in food and drinks sold in Gombe metropolis. 30 samples of food and drinks were collected and analyzed. Method: Bacterial isolation was performed on nutrient agar and identification started from gram staining; the gram negative isolates obtained, among which ESBL producers were found and further subjected to standard biochemical tests and confirmed to be enterobacteriaceae. They were then screened for ESBLs in accordance with Clinical and Laboratory Standard Institute (CLSI) breakpoint, and the suspected ESBLs bacteria were confirmed using double disc synergy testing (DDST) with standard Augmentin (Amoxycillin/ Clavulanic Acid, 30μg; Oxoid England, CT0223B), Ceftriaxone (CRO 30μg; Oxoid England, CT0417B) and Ceftazidime (CAZ 30μg; Oxoid England, CT0412B). Findings: The fourteen 14(100%) Gram negative bacteria isolated were found to include Pseudomonasaeruginosa 2(14.29%) and members of the family Enterobacteriaceae (enteric gram negative rods): Citrobacterfreundii 2(14.29%), Enterobacterspp. 1(7.14%), Escherichiacoli 4(28.57%), Klebsiellapneumoniae 3(21.43%), Proteusvulgaris 1(7.14%) and Salmonellatyphi 1(7.14%). When screened for ESBL production based on CLSI breakpoint, only 6 (49.99%) were positive and included C.freundii 1(7.14%), E.coli 2(14.29%), K.pneumoniae 1(7.14%), S. typhi 1(7.14%) and 1(7.14%) for Ps. aeruginosa. On subjecting them to DDST, only 2(33.34%) out of them were found to be ESBLs positive by an increase in inhibition zone of 5mm toward the centre disc, Augmentin. They include E. coli 1(16.67%) and S. typhi 1(16.67%). Application: In a nutshell, foods and drinks sold therein could serve as reservoirs for ESBLs producing bacteria.

Analisis Gen Blavim, Blandm dan Blaimp Carbapenemase dengan Alat Otomatis Vitek-2 dan Metode Polymerase Chain Reaction (PCR) pada Isolat Bakteri Enterobacteriaceae di RSUP Dr. Moh. Hoesin Palembang

Enterobacteriaceae is a normal flora in human intestinal tract which the most frequently caused the disease in human. Carbapenem is the last lines of antibiotic which used to treat severe infection that caused by gram-negative bacili bacteria, for example Enterobacteriaceae, but there is an increase prevalency of infection which caused by Carbapenem Resistant Enterobacteriaceae (CRE). The gene that encoding CRE is blaVIM, blaNDM, and blaIMP gene. The detection of these genes are very important to prevent spreading the nosocomial infection at hospital. The samples are from the speciment which has detected as isolate of Extended Spectrum Beta Lactamase (ESBL) Enterobacteriaceae bacteria and has occurred resistant to carbapenem group (meropenem and ertapenem) which detected by automatic equipment, VITEK 2 compact system. These samples will be processed by PCR with multiplex PCR technique to indentify blaVIM, blaNDM, and blaIMP gene. There are 43 samples consist of 33 samples (76,7%) ESBL bacteria isolate and 10 samples (23,3%) Carbapenemase bacteria isolate, 29 samples (67,4%) are Klebsiella pneumonia and 14 samples (32,6%) E. coli. These samples were from blood (5 samples/ 11,6%), sputum (16 samples/ 37,2%), peritoneal fluid (1 sample/ 2,3%), pus (4 samples/ 9,3%), urine (12 samples/ 28%), swab (3 samples/ 7%), tissue (1 sample/ 2,3%), and feces (1 sample/ 2,3%). From the PCR result, the gene was indentified from Enterobacteriaceae bacteria isolate was 28 samples (65,11%) from 43 samples. The indentified samples consist of 9 samples (32,1%) Carbapenemase bacteria isolate and 19 samples (67,9%) ESBL bacteria isolate. The identified of Enterobacteriaceae bacteria isolate consist of 15 samples blaNDM gene, 17 samples blaVIM gene, and 4 sample blaIMP gene.

Prevalence and Antimicrobial Susceptibility Pattern of Extended Spectrum Beta Lactamase Producers in Gram-negative Urine Isolates at MBN Clinical Laboratories, Kampala Uganda

Introduction: Occurrence of Extended Spectrum beta-lactamase (ESBLs) producing bacteria have presented impediment in treatment choices for urinary tract infections. ESBLs embody a major cluster of lactamases accountable for resistance to novel generations of s-lactam drugs worldwide. The study determined prevalence of ESBL organisms in urine isolates and susceptibility patterns to 13 antibacterial agents. Materials and methods: Two hundred samples were cultured on blood agar, MacConkey agar and incubated at 37°C utmost 48 hours. Isolates identified based on standard bacteriological culture and biochemical characteristics. Drug susceptibility centered on Clinical Laboratory Standard Institute recommended and WHO modified Kirby- Bauer disc diffusion methods. Isolates with reduced susceptibility to Ceftazidime were considered to be possible ESBL producers. Phenotypically confirmed ESBL required use of Ceftazidime in combination with Clavulanic acid. A five milimeter increase zone diameter for Ceftazidime in combination with Clavulanic acid versus its zone tested alone was considered as ESBL. Results: Out of 200 samples, 45 (22.5%) had significant growth, majority Escherichia coli 28 (62.2%), Klebsiella pneumonae 11 (24.4%) followed and Citrobacter fruendii 2 (4.4%). Enterobacter species, Morganella morganii, Proteus mirabilis and Seratia marcescens each 1 (2.2%). Prevalence of ESBLs was 56%. Out of 25 (56%) ESBLs, highest prevalence was among Escherichia coli (15/25; 60%) followed by Klebsiella pneumonae (5/25; 24%) while Citrobacter fruendii, Enterobacter species, Morganella morganii and Proteus mirabilis each had (1/25; 4%). Susceptibility was highest to Imipenem 22 (88%) and least to Ampicillin, Amoxicillin-Clavulanic acid and Tetracycline each 1 (4%). No susceptibility to Cefuroxime and Ceftazidime was observed. Conclusion: The study showed that resistant ESBLs generating bacteria were present among urine isolates. We recommend that ESBLs bacteria isolated in urine be treated based on antibiotics susceptibility, continuous surveillance to guide correct treatment for urinary tract infection and to prevent the occurrence of multi drug resistant bacteria. This should be reflected in the policies developed by the Ministries of health to promote rational use of antibiotics.

Fecal carriage of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp. in a Turkish community.

The aim of this study was to determine the prevalence of fecal carriage of extended-spectrum beta-lactamase (ESBL)-producing bacteria, enzyme types, and risk factors affecting colonization. A total of 576 stool samples from outpatients were examined between October 2012 and May 2013. Screening was done with selective EMB plates. ESBL were detected by double-disk synergy and confirmed agar strip gradient methods. Enzyme types were determined by PCR. The prevalence of fecal carriage was found as 30% (173 of 576). Recent use of antibiotics, hospitalization and surgical operation, diabetes, crowded household populations, and old age were associated with higher carriage rates. Of the ESBL-producing bacteria, 87.5% were positive for blaCTX-M genes. Of the blaCTX-M gene-positive isolates, 95.2% were positive for blaCTX-M-1 genes; among these, 82.2% were positive for blaCTX-M-3 and 67.7% were positive for blaCTX-M-15 genes while 62.5% isolates were positive for both blaCTX-M-3 and blaCTX-M-15 genes Conclusions: A high rate (30%) of fecal carriage of ESBL bacteria was found in an adult population. The predominant beta-lactamase enzyme types were CTX-M-3 and CTX-M-15.

Assessment of Foods and Drinks for the Presence of Extended Spectrum Beta Lactamase (ESBL) Producing Bacteria in Gombe Metropolis, Nigeria

Objectives: To make preliminary screening study for the presence of ESBL producing bacteria, in food and drinks sold in Gombe metropolis. 30 samples of food and drinks were collected and analyzed. Method: Bacterial isolation was performed on nutrient agar and identification started from gram staining; the gram negative isolates obtained, among which ESBL producers were found and further subjected to standard biochemical tests and confirmed to be enterobacteriaceae. They were then screened for ESBLs in accordance with Clinical and Laboratory Standard Institute (CLSI) breakpoint, and the suspected ESBLs bacteria were confirmed using double disc synergy testing (DDST) with standard Augmentin (Amoxycillin/ Clavulanic Acid, 30μg; Oxoid England, CT0223B), Ceftriaxone (CRO 30μg; Oxoid England, CT0417B) and Ceftazidime (CAZ 30μg; Oxoid England, CT0412B). Findings: The fourteen 14(100%) Gram negative bacteria isolated were found to include Pseudomonasaeruginosa 2(14.29%) and members of the family Enterobacteriaceae (enteric gram negative rods): Citrobacterfreundii 2(14.29%), Enterobacterspp. 1(7.14%), Escherichiacoli 4(28.57%), Klebsiellapneumoniae 3(21.43%), Proteusvulgaris 1(7.14%) and Salmonellatyphi 1(7.14%). When screened for ESBL production based on CLSI breakpoint, only 6 (49.99%) were positive and included C.freundii 1(7.14%), E.coli 2(14.29%), K.pneumoniae 1(7.14%), S. typhi 1(7.14%) and 1(7.14%) for Ps. aeruginosa. On subjecting them to DDST, only 2(33.34%) out of them were found to be ESBLs positive by an increase in inhibition zone of 5mm toward the centre disc, Augmentin. They include E. coli 1(16.67%) and S. typhi 1(16.67%). Application: In a nutshell, foods and drinks sold therein could serve as reservoirs for ESBLs producing bacteria.

CRISPR/Cas9-Mediated Re-Sensitization of Antibiotic-Resistant Escherichia coli Harboring Extended-Spectrum β-Lactamases.

Recently, the clustered regularly interspaced short palindromic repeats (CRISPR)-associated protein 9 (CRISPR/Cas9) system, a genome editing technology, was shown to be versatile in treating several antibiotic-resistant bacteria. In the present study, we applied the CRISPR/ Cas9 technology to kill extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. ESBL bacteria are mostly multidrug resistant (MDR), and have plasmid-mediated antibiotic resistance genes that can be easily transferred to other members of the bacterial community by horizontal gene transfer. To restore sensitivity to antibiotics in these bacteria, we searched for a CRISPR/Cas9 target sequence that was conserved among >1,000 ESBL mutants. There was only one target sequence for each TEM- and SHV-type ESBL, with each of these sequences found in ~200 ESBL strains of each type. Furthermore, we showed that these target sequences can be exploited to re-sensitize MDR cells in which resistance is mediated by genes that are not the target of the CRISPR/Cas9 system, but by genes that are present on the same plasmid as target genes. We believe our Re-Sensitization to Antibiotics from Resistance (ReSAFR) technology, which enhances the practical value of the CRISPR/Cas9 system, will be an effective method of treatment against plasmid-carrying MDR bacteria.

Resistance Pattern of Antibiotics in Patient Underwent Open Heart Surgery With Nosocomial Infection in North of Iran.

Background:Patients who undergo cardiac surgery appear to be at increased risk for the development of Nosocomial infections (NIs). The development of antibiotic-resistant infections has been associated with significantly greater hospital mortality rates compared to similar infections caused by antibiotic-sensitive pathogens.Objectives:The purpose of this study is survey of Nis and antibiotic resistance patterns of causative bacteria among patients who underwent open heart surgery in the north of Iran during a 2-year period between September 2012 and September 2014.Methods:In this cross-sectional study we evaluated 187 patients that underwent open heart surgery with NIs. Demographic feature, clinical characteristics and risk factors of each infection were recorded. The antibiotic susceptibility test was performed using the Minimum inhibitory concentration (MIC) method according to the standard protocol of Clinical & Laboratory Standards Institute (CLSI). Detection of Extended-spectrum beta-lactamase (ESBL) producing bacteria was performed by the double-disk synergy (DDS) test; also Methicillin-resistant Staphylococcus (MRSA) strains were identified by MRSA Screen Agar. The collected data were analyzed using the SPSS software (ver. 16) and, descriptive statistics were used.Results:Out Of total of 2253 hospitalized patients who underwent open heart surgery, 187(5.05%) patients had NIs. 51.9% of the patients were female. The rates of surgical site infection (SSI), respiratory tract infection, endocarditis, Urinary tract infection (UTI), blood Infection and mediastinitis were 27.80, 25.66%, 17.64, 17.11% 8.55% and 3.20% respectively. E.coli and S.aureus were the most causative agents of NIs. The rate of ESBL-producing bacteria was 14.28- 71.42% among enterobacteriaceae and the rate of MRSA was 54.2% among S.aureus strains. All isolated Acinetobacter.spp were Multi-drug resistance (MDR).Conclusions:We showed that the rate of NIs among these high-risk patients was in the average level. But the emergence of MRSA and ESBL bacteria is increasing in our region.

Antibiotic resistance pattern and clinical outcomes in acute cholecystitis: 567 consecutive worldwide patients in a prospective cohort study

IntroductionPostoperative complications for cholecystitis and cholelithiasis are important causes of intra-abdominal infections (IAIs). There have been no previous reports on intra-abdominal bacteriology in complicated IAIs due to acute cholecystitis (AC). Material and methodsThe data came from two prospective multicenter observational cohort studies (CIAO: the “Complicated Intra-Abdominal infection Observational” study and CIAOW: the “Complicated Intra-Abdominal infection Observational World” study) which involved 116 medical institutions worldwide with consecutive patients who underwent surgery, interventional drainage or conservative treatment for AC. ResultsOf 567 patients, there were 291 males (51.3%). The mean and median age were 62.5 and 64 years respectively. 546 (96.3%) had community-acquired and 21 (3.7%) patients had health-care-associated infections. 267 bacteria were isolated, 21 (7.8%) were resistant bacteria. No resistant Fungi or Anaerobes were isolated. 4 out of the 21 resistant bacteria were health-care-associated. Multivariate analysis demonstrated health-care associated infection (p = 0.03), inadequacy of empiric antimicrobial therapy (p = 0.003) and recent antimicrobial therapy (p < 0.0001) to be factors associated with resistant bacteria. The factors associated with mortality were presence of generalized peritonitis (p < 0.0001) and inadequate source control (p = 0.018). The factors associated with ICU admission were severe sepsis (p < 0.0001), generalized peritonitis (p = 0.001), concomitant malignancy (p = 0.037), inadequate source control (p = 0.025), delay in initial intervention (p < 0.0001) and age over 70 years (p = 0.025). ConclusionThe number of infection caused by Extended Spectrum Beta-Lactamase bacteria (ESBL+) and Klebsiella pneumoniae Carbapenemase-producer bacteria (KPC+) were common in acute cholecystitis and in community-acquired infections. An adequate empirical antimicrobial therapy was fundamental to reduce bacterial resistance and to improve outcomes.

Surveillance of extended-spectrum β-lactamase producing bacteria in an Indian teaching hospital

Abstract To conduct surveillance of a teaching hospital in a period of 15 months, clinical samples from patients were used for the isolation of pathogenic bacteria. Bacterial isolates were isolated and identifies by standard biochemical procedures. Antibiotic sensitivity test were conducted for each isolates by Kirby-Bauer’s/disc diffusion method. Extended spectrum beta lactamase (ESBL) producers were determined by double disc diffusion synergy test (DDST) and iodometric test. 2547 bacterial isolates were found belonging to 12 species namely: Escherichia coli (954), Staphylococcus aureus (661), Klebsiella pneumoniae (301), Enterococcus faecalis (175), Pseudomonas aeruginosa (121), Acinetobacter sp. (110), Citrobacter sp. (69), Klebsiella oxytoca (51), Proteus vulgaris (43), Proteus mirabilis (31), Enterobacter sp. (27), Morganella sp. (4), in descending order. The isolated bacterial strains were further tested for monitoring resistance to cefepime ceftazidime, cefotaxime, ceftriaxone (all 30 μg/disc) and cefoperazone (75 μg/disc) of the third generation cephalosporins (3GCs). Numbers of resistant isolates were in descending order: Proteus vulgaris (76.7%), Morganella sp. (75.0%), Enterococcus faecalis (71.4%), Pseudomonas aeruginosa (68.6%), Proteus mirabilis (67.7%), Klebsiella oxytoca (62.6%) and Citrobacter sp. (52.1%) cefepime (30 μg/disc) and the rest other bacteria were of lesser resistant values with the least percent value, Escherichia coli (7.7%). Similarly, Citrobacter sp. (91.3%) showed resistance to ceftazidime (30 μg/disc) and 76.8% resistant to cefotaxime (30 μg/disc). Proteus mirabilis showed the highest resistance over all other isolates as 90.3% to ceftriaxone (30 μg/disc) and 80.6% to cefoperazone (75 μg/disc). The resistance values to the tested 3GC antibiotics ranged from 43 to 51%. Conclusion Antibiotics inhibiting β-lactamase production were used with a blithesome control over 12 ESBL bacteria. The 3GC antibiotic group was significantly effective in controlling the GN bacterial strains in this study.

A Retrospective Study on Extended Spectrum Beta-Lactamase Bacteria in the Philippines from 1999 – 2013

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