ESBL-producing Enterobacteriaceae Research Articles

Persistent effects of intramammary ceftiofur treatment on the gut microbiome and antibiotic resistance in dairy cattle

BackgroundIntramammary (IMM) ceftiofur treatment is commonly used in dairy farms to prevent mastitis, though its impact on the cattle gut microbiome and selection of antibiotic-resistant bacteria has not been elucidated. Herein, we enrolled 40 dairy (Holstein) cows at the end of the lactation phase for dry-cow therapy: 20 were treated with IMM ceftiofur (Spectramast®DC) and a non-antibiotic internal teat sealant (bismuth subnitrate) and 20 (controls) received only bismuth subnitrate. Fecal grab samples were collected before and after treatment (weeks 1, 2, 3, 5, 7, and 9) for bacterial quantification and metagenomic next-generation sequencing.ResultsOverall, 90% and 24% of the 278 samples had Gram-negative bacteria with resistance to ampicillin and ceftiofur, respectively. Most of the cows treated with ceftiofur did not have an increase in the number of resistant bacteria; however, a subset (25%) shed higher levels of ceftiofur-resistant bacteria for up to 2 weeks post-treatment. At week 5, the antibiotic-treated cows had lower microbiota abundance and richness, whereas a greater abundance of genes encoding extended-spectrum β-lactamases (ESBLs), CfxA, ACI-1, and CMY, was observed at weeks 1, 5 and 9. Moreover, the contig and network analyses detected associations between β-lactam resistance genes and phages, mobile genetic elements, and specific genera. Commensal bacterial populations belonging to Bacteroidetes most commonly possessed ESBL genes followed by members of Enterobacteriaceae.ConclusionThis study highlights variable, persistent effects of IMM ceftiofur treatment on the gut microbiome and resistome in dairy cattle. Antibiotic-treated cattle had an increased abundance of specific taxa and genes encoding ESBL production that persisted for 9 weeks. Fecal shedding of ESBL-producing Enterobacteriaceae, which was classified as a serious public health threat, varied across animals. Together, these findings highlight the need for additional studies aimed at identifying factors associated with shedding levels and the dissemination and persistence of antibiotic resistance determinants on dairy farms across geographic locations.

Prevalence of Enterobacteriaceae Producing Extended Spectrum Beta-Lactamase (ESBL) in Broiler Meat (Gallus domesticus) Sold in Regional Markets of West Surabaya

Broiler meat is a foodstuff that is easily damaged by bacterial growth. Several pathogenic bacteria from the Enterobacteriaceae family have also been found as contaminants in chicken meat. While Extended Spectrum Beta-Lactamases (ESBL) are enzymes that have the ability to hydrolyze antibiotics of the penicillin class, first, second, and third generation cephalosporins as well as the monobactam group. Based on this phenomenon, the researchers wanted to examine the prevalence of the ESBL-producing Enterobacteriaceae family in broiler chicken (Gallus domesticus) meat sold in the West Surabaya market. This research is a descriptive observational type using a cross-sectional approach. The population in this study was broiler chicken meat taken from broiler traders in several markets in West Surabaya which had met the inclusion and exclusion criteria with a large sample of 50 samples. Then the data were analyzed using the chi-square test. The results of the analysis showed that 13 samples produced ESBL. The prevalence of Enterobacteriaceae bacteria producing ESBL in broiler chicken (Gallus domesticus) meat in several markets in West Surabaya is 26% of the 50 samples used. The results of the chi-square test showed that there was no significant difference between locations where ESBL was found.

High incidence of catheter-associated urinary tract infections and related antibiotic resistance in two hospitals of different geographic regions of Sierra Leone: a prospective cohort study

ObjectiveCatheter-associated urinary tract infections (CAUTI) are common worldwide, but due to limited resources, its actual burden in low-income countries is unknown. Currently, there are gaps in knowledge about CAUTI due to lack of surveillance activities in Sierra Leone. In this prospective cohort study, we aimed to determine the incidence of CAUTI and associated antibiotic resistance in two tertiary hospitals in different regions of Sierra Leone.ResultsThe mean age of the 459 recruited patients was 48.8 years. The majority were females (236, 51.3%). Amongst the 196 (42.6%) catheterized patients, 29 (14.8%) developed CAUTI. Bacterial growth was reported in 32 (84%) patients. Escherichia coli (14, 23.7%), Klebsiella pneumoniae (10, 17.0%), and Klebsiella oxytoca (8, 13.6%) were the most common isolates. Most isolates were ESBL-producing Enterobacteriaceae (33, 56%) and WHO Priority 1 (Critical) pathogens (38, 71%). Resistance of K. pneumoniae, K. oxytoca, E. coli, and Proteus mirabilis was higher with the third-generation cephalosporins and penicillins but lower with carbapenems, piperacillin-tazobactam and amikacin. To reduce the high incidence of CAUTI and multi-drug resistance organisms, urgent action is needed to strengthen the microbiology diagnostic services and develop and implement catheter bundles that provide clear guidance for catheter insertion, care and removal.

Antibiotic Prescriptions in Critically Ill Patients with Bloodstream Infection Due to ESBL-Producing Enterobacteriaceae: Compliance with the French Guidelines for the Treatment of Infections with Third-Generation Cephalosporin-Resistant Enterobacteriaceae-A Multicentric Retrospective Cohort Study.

National and international guidelines were recently published regarding the treatment of Enterobacteriaceae resistant to third-generation cephalosporins infections. We aimed to assess the implementation of the French guidelines in critically ill patients suffering from extended-spectrum β-lactamase-producing Enterobacteriaceae bloodstream infection (ESBL-E BSI). We conducted a retrospective observational cohort study in the ICU of three French hospitals. Patients treated between 2018 and 2022 for ESBL-E BSI were included. The primary assessment criterion was the proportion of adequate empirical carbapenem prescriptions, defined as prescriptions consistent with the French guidelines. Among the 185 included patients, 175 received an empirical anti-biotherapy within 24 h of ESBL-E BSI onset, with a carbapenem for 100 of them. The proportion of carbapenem prescriptions consistent with the guidelines was 81%. Inconsistent prescriptions were due to a lack of prescriptions of a carbapenem, while it was recommended in 25% of cases. The only factor independently associated with adequate empirical carbapenem prescription was ESBL-E colonization (OR: 107.921 [9.303-1251.910], p = 0.0002). The initial empirical anti-biotherapy was found to be appropriate in 83/98 patients (85%) receiving anti-biotherapy in line with the guidelines and in 56/77 (73%) patients receiving inadequate anti-biotherapy (p = 0.06). Our results illustrate the willingness of intensivists to spare carbapenems. Promoting implementation of the guidelines could improve the proportion of initial appropriate anti-biotherapy in critically ill patients with ESBL-E BSI.

Detection of Enterobacteriaceae Lactose Fermenter Bacteria Producing Extended Spectrum Beta-Lactamase (ESBL) in Food Samples at Surabaya

Snacks sold on the side of the road are often purchased because they are practical and cheap. The condition of food sold in the open causes a decrease in food hygiene, so bacteria will easily contaminate, both due to flies infesting it and direct contact with the hands of people around it. One group of bacteria that can cause infection and often contaminate food is Enterobacteriaceae. These bacteria can produce Extended Spectrum Beta Lactamase (ESBL) enzymes that cause resistance to various antibiotics (MDR). This research aims to detecting ESBL-producing Enterobacteriaceae lactose fermenter bacteria in street food sold on the side of the road in the Dukuh Kupang market area, Surabaya. This study is descriptive observational research with a cross-sectional research design. A total of 50 snack food samples were grown on MacConkey agar containing cefotaxime at four micrograms per milliliter. Then an ESBL confirmation test was carried out using the double disk synergy test (DDST). The Result showed that 13 (26%) samples of snack foods were contaminated. ESBL-producing Enterobacteriaceae Lactose Fermenter bacteria are ubiquitous. The most contaminated snack food was cassava, while the non-contaminated snack food was stuffed tofu.

Proton Pump Inhibitors: Adversaries In Our Fight Against Antibiotic Resistance?

Madam, The proton-pump inhibitors (PPIs) belong to a class of medications that reduce stomach acid production by irreversibly inhibiting the stomach's H+/K+ ATPase pump. These medications are used in the treatment of many conditions, such aspeptic ulcer, gastroesophageal reflux, as part of H. Pylori eradication, gastrinomas, Barrett’s oesophagus and many other conditions. They are considered to be the most potent inhibitors of acid secretion, and have largely supplanted the H2 receptor antagonists and antacids. They are also among the most widely sold medications worldwide. The class of proton pump inhibitors is listed on WHO’s list of essential medicines.1Proton pump inhibitors are generally well tolerated. However, headache, nausea, diarrhoea, abdominal pain, fatigue, and dizziness are identified as some of the common side effects. Due to their efficacies and low risk profile, PPIs are often prescribed for extend than required period. Several recent studies have shown that long-term PPI use is associated with various adverse outcomes. A 2023 study published in JAMA Network Open demonstrated that long-term use of PPIs may lead to an increased risk of acquiring extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing enterobacterales.2Another study3 published in 2022 showed that PPI use was the only modifiable factor associated with the carriage of ESBL producers in residents of long-term care facilities. These studies add to the expanding list of adverse outcomes associated with PPIs. Other adverse events of long-term PPI use, include the risk of fractures, pneumonia, Clostridium difficile diarrhoea, hypomagnesaemia, vitamin B12deficiency, chronic kidney disease, and dementia.4 Proton pump inhibitors are still used widely in Pakistan. These new findings are concerning as ESBL-producing Enterobacteriaceae are highly prevalent in Pakistan. A meta-analysis showed that the overall pooled proportion of ESBLs in Pakistan is 40%5 whereas the German population showed an estimated ESBL proportion in the range of 10 to 15% and a US census reported 4 to 12% resistance due to ESBLs.5 This calls for a strict prescription control of PPIs by Pakistani physicians, and the duration of PPI use should not extend for longer than needed. In addition, the practice of PPI’s over the counter sale by the pharmacists in Pakistan should be stopped. Additional precautions should be taken in hospitalized patients who are using PPIs to prevent them from getting multi-drug resistant infections.

Prevalence of carbapenem-resistant and extended-spectrum beta-lactamase-producing Enterobacteriaceae in a teaching hospital in Ghana.

Carbapenem-resistant Enterobacteriaceae (CRE) and Extended-spectrum beta-lactamase (ESBL) production among Gram-negative Enterobacteriaceae is an increasing global challenge due to the high morbidity and mortality associated with their infections, especially in developing countries where there are little antibiotic treatment options. Despite these challenges, few studies in Ghana have described the burden of CRE. Therefore, this study aimed to determine the prevalence of carbapenem-resistant Enterobacteriaceae isolated from patients at the Cape Coast Teaching Hospital (CCTH) in the Central region of Ghana. Enterobacteriaceae isolates were collected from April to July 2019 at the bacteriology unit of CCTH using a consecutive sampling method. Isolates were identified by standard microbiological techniques and confirmed using API 20E. Kirby Bauer disc diffusion method was used to determine the antibiogram of isolates. Isolates were also subjected to ESBL testing using the single-disc combination method. Carbapenem-resistant isolates were identified by the Kirby Bauer disc diffusion method and then examined genotypically for the presence of blaKPC-1, blaIMP-1, blaVIM-1, blaNDM-1, and blaOXA-48 genes via polymerase chain reaction (PCR). Of the 230 isolates comprising E. coli (40.9%), Citrobacter spp. (32.6%), K. pneumoniae (9.1%), P. mirabilis (6.1%), P. vulgaris (5.2%), Enterobacter spp (3.5%)., K. oxytoca (2.2%), and Serratia marcenses (0.4%). Most isolates were from urine 162(70.4%) and wound samples. The isolates showed high resistance to ampicillin 171 (74.3%) and cefuroxime 134(58.3%). The prevalence of MDR was 35.2% (81), with E. coli 40(42.6%) being the majority that exhibited MDR. Of the 230 isolates, 113(49.1%) were ESBL producers, with E. coli 54(57.5%) accounting for the majority, while Serratia marcenses was the least. Of the 13 (5.7%) CRE isolates that showed resistance towards carbapenem in the disc diffusion method, 11 showed the presence of the blaNDM-1 gene, while all isolates showed the presence of the blaOXA-48 gene. The prevalence of carbapenem resistance and ESBL-producing Enterobacteriaceae pathogens among patients at the Cape Coast Teaching Hospital is high and alarming. Therefore, it is imperative to consider effective infection prevention and control measures should be implemented at the hospital to prevent the rapid spread of these dangerous organisms.

Antimicrobial Resistance in Bacteria from Meat and Meat Products: A One Health Perspective.

According to the 2030 Agenda of the United Nations, one of the sustainable development goals is to ensure sustainable consumption and production patterns. The need to ensure food safety includes, other than microbiological hazards, concerns with antimicrobial-resistant (AMR) bacteria. The emergence of resistant bacteria in the food industry is essentially due to the abusive, and sometimes incorrect, administration of antimicrobials. Although not allowed in Europe, antimicrobials are often administered to promote animal growth. Each time antimicrobials are used, a selective pressure is applied to AMR bacteria. Moreover, AMR genes can be transmitted to humans through the consumption of meat-harbouring-resistant bacteria, which highlights the One Health dimension of antimicrobial resistance. Furthermore, the appropriate use of antimicrobials to ensure efficacy and the best possible outcome for the treatment of infections is regulated through the recommendations of antimicrobial stewardship. The present manuscript aims to give the current state of the art about the transmission of AMR bacteria, particularly methicillin-resistant S. aureus, ESBL-producing Enterobacteriaceae, and vancomycin-resistant Enterococcus spp., along with other ESKAPE bacteria, from animals to humans through the consumption of meat and meat products, with emphasis on pork meat and pork meat products, which are considered the most consumed worldwide.

POTENT ANTIBACTERIAL EFFECTS OF TERMINALIA SUPERBA ENGL. AND DIELS (COMBRETACEAE) BARK EXTRACTS

Antibiotic misuse has caused widespread multi-resistance in Enterobacteriaceae. Our study investigates Terminalia superba (T. superba) extracts against Extended-spectrum beta-lactamases (ESBL)-producing strains. The minimum inhibitory concentration (MIC) and the minimum bactericidal concentration (MBC) were determined using broth microdilution (Mueller-Hinton, 106 CFU/mL). The extract concentrations ranged from 0.078 to 80 mg/mL. We evaluated T. superba extracts β-lactamase inhibition of nitrocefin hydrolysis, estimated inhibition percentages, and IC50 values for each extract. The double-disk test confirmed the presence of ESBLs in the strains, as all of them exhibited hydrolytic activity. The results indicated that the T. superba extracts displayed dose-dependent inhibitory effects on beta-lactamase. Among them, the hydro-ethanolic extract displayed potent inhibitory activity against β-lactamases produced by ESBL-E. coli (IC50 = 0.065 mg/mL), ESBL-K. pneumoniae (IC50 = 0.076 mg/mL), and ESBL-P. mirabilis (IC50 = 0.082 mg/mL). However, following the removal of tannins, the hydro-ethanolic extracts anti-β-lactamase activity was reduced. Our findings highlight the remarkable in vitro activity of T. superba extracts against ESBL-producing Enterobacteriaceae, suggesting their potential clinical utility in addressing infections caused by these drug-resistant pathogens. The exploration of T. superba extracts as a possible source of effective anti-ESBL agents could contribute significantly to combating antibiotic resistance.

ESBL-producing Enterobacteriaceae in a rural Rwandan community: Carriage among community members, livestock, farm products and environment.

Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) are spreading globally. However, respective data from African communities including livestock and environmental specimens are rare. In a rural community of southern Rwanda, we assessed intestinal carriage of ESBL-PE among residents and livestock as well as presence in household specimens and examined associated factors. Samples of humans and livestock (both rectal swabs), soil, water, vegetables and animal products were collected within 312 community households in Sovu, Southern Rwanda. Specimens were screened for ESBL-PE on chromogenic agar, and susceptibility to common antibiotics was determined by disc diffusion assays. Socio-demographic information was collected with questionnaires focusing on the socio-economic background, alimentation, living conditions, hygiene measures and medical history of the participants. Data and specimens from 312 randomly selected households including 617 human beings, 620 livestock and of approximately each 300 kitchen vegetables, animal products, soil and drinking water were analysed. Overall, 14.8% of 2508 collected samples were positive for ESBL-PE; figures were highest for humans (37.9%) and livestock (15.6%), lower for vegetables (3.8%) and animal products (3.3%), and lowest for soil (1.6%) and water (0.6%). Most detected ESBL-PE were Escherichia coli (93.5%) in addition to Klebsiella pneumoniae (6.5%). Cross-resistance to ampicillin-sulbactam, ciprofloxacin and co-trimoxazole was common. Logistic regression identified increasing age, another ESBL-PE positive household member, prolonged time for fetching water, current diarrhoea and the ability to pay school fees as independent predictors of intestinal ESBL-PE carriage among community members. ESBL-PE carriage is common in a rural Rwandan farming community. Carriage in livestock is not associated with human carriage. Associated factors suggest few addressable risk factors. The data indicate that in southern Rwanda, ESBL-PE are no longer primarily hospital-based but circulate in the community.

Prevalence of Esbl-Producing Enterobacteriaceae Strains Isolated to the University Hospital Center of N’djamena and their Sensitivity to Antibiotics

Introduction: The resistance of Enterobacteriaceae to antibiotics is experiencing a worrying worldwide evolution with a growing impact in the community and medical sector. The difficulties encountered in hospitals in treating certain infections resulting from multi-resistant bacteria are a source of great concern in human health. The aim of this study was to determine the prevalence, diversity and antibiotic resistance of Extended-Spectrum Beta-Lactamase (ESBL)-producing Enterobacteriaceae in the hospital setting. Materials and Methods: A total of 830 specimens from hospitalized and outpatients including 341 stools, 257 urine and 232 pus were collected between August 2017 and February 2019. Enterobacteriaceae were identified using the Api 20E gallery and the VITEK® 2TM 15 compact automaton. E. coli and Salmonella serotyping were performed by serum agglutination using the Latex Test Kil and the Kauffmann-White Kit, respectively. Sensitivity tests according to the Antibiogram Committee of the French Society of Microbiology and double disc synergy to detect ESBLs have been carried out. Results: Out of the 830 specimens, 181 (21%) strains were isolated at the N’Djamena National Reference University Hospital between August 2017 and February 2019. 56 strains produced ESBLs, i.e. a prevalence of 30.9% (56/181). Escherichia coli was more common (74%), followed by Klebsiella pneumoniae (6.6%), Proteus spp (14.9%), Salmonella (2.8%) and Shigella (1.7%) (p<0,05). These germs were isolated from urine at 47%, pus at 38% and stool at 15%. Resistance with E. coli was respectively 60.8% and 50% for imipenem and amoxicillin + clavulanic acid. Regarding Klebsiella pneumoniae, these rates were 70% and 55% respectively. Salmonella showed resistance to ciprofloxacin (80%), gentamicin (80%) and ceftriaxone (60%). E. coli, Klebsiella pneumoniae have been the most implicated with strong resistance to the majority of antibiotics. Conclusion: This study highlighted the diversity of enterobacteria causing diarrhea and the emergence of multi-resistant bacteria. It helps to update knowledge for better patient care.

Primary Carrier Status and Alteration in the Colonization of the Extended-Spectrum β-Lactamase Producing Enterobacteriaceae Among Children in Pediatric Intensive Care Unit During the Hospital Stay

Background: Widespread and inappropriate use of antibiotics has led to an increase in antibiotic-resistant bacteria worldwide. Extended-spectrum β-lactamases (ESBLs) are among the most important resistance mechanisms in members of Enterobacteriaceae, which can pose a threat to patients. Objectives: This study aimed to investigate the carrier status and alteration in the fecal transmission of ESBL-producing Enterobacteriaceae (ESBL-E) on admission and during the hospital stay, as well as its correlation with the usage of antibiotics among children in a pediatric intensive care unit (PICU). Molecular typing between the primary and secondary isolates was done to detect the homotypic clonal strains. Methods: Demographic and medical data of PICU children were collected, and the carrier status of ESBL-E was investigated in pairs of their rectal swab samples at the admission and discharge time. Detection of ESBL phenotype and antimicrobial susceptibility to 12 antibiotics were performed by double-disk synergy and disc diffusion methods, respectively. Polymerase chain reaction for detection of blaTEM, blaSHVblaPER, blaCTX-M, and blaVEB genes was performed using specific primers. The phylogenetic relations were analyzed by the enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) method. Results: Extended-spectrum β-lactamase-producing Enterobacteriaceae was detected in 48% of the samples at admission and 42% at discharge time. The highest frequency of resistance was observed in cephazolin, amoxicillin-clavulanic acid, and ampicillin. Children with a history of meropenem administration showed a significantly higher frequency of meropenem resistance Enterobacteriaceae in their samples. Moreover, the administration of metronidazole increased the isolation of ESBL-Escherichia species in hospitalized children. The most common gene associated with the ESBL phenotype was blaCTX-M, while blaPER and blaVEB were not detected in the ESBL-E isolates. The phylogenetic analysis did not confirm the occurrence of the cross-transmission of ESBL-E in the patients during hospitalization. Conclusions: Our results showed a high frequency of ESBL-E in the feces of children upon admission to the PICU, which did not change significantly during the hospital stay. Although the prescription of metronidazole showed an association with the enrichment of ESBL-E due to observed diversity in the molecular types and resistance phenotypes of the isolates, the community seems to be the primary source of ESBL-E transmission in children. Further investigations are needed to understand the role of hospital stay in the colonization and enrichment of ESBL-E in the intestinal tract of children and their association with infections during the medical interventions in the PICU.

High frequency and molecular characterization of ESBL-producing Enterobacteriaceae isolated from wound infections in North Lebanon

ABSTRACT Background Extended-spectrum beta-lactamases producing Enterobacteriaceae (ESBL-PE) represent a major problem in wound infections. Here, we investigated the prevalence and molecular characterization of ESBL-PE associated with wound infections in North Lebanon. Research design and methods A total of 103 non-duplicated E. coli and K. pneumoniae strains isolated from 103 patients with wound infections, were collected from seven hospitals in North Lebanon. ESBL-producing isolates were detected using a double-disk synergy test. In addition, multiplex polymerase chain reaction (PCR) was used for the molecular detection of ESBLs genes. Results E. coli was the predominant bacteria (77.6%), followed by K. pneumoniae (22.3%). The overall prevalence of ESBL-PE was 49%, with a significantly higher rate among females and elderly patients. K. pneumoniae was the common MDR and ESBL-producer bacteria (86.95% and 52.17%) compared to E. coli (77.5% and 47.5%). Most of the isolated ESBL producers harbored multiple resistant genes (88%), where blaCTX-M was the most predominant gene (92%), followed by blaTEM (86%), blaSHV (64%), and blaOXA genes (28%). Conclusions This is the first data on the ESBL-PE prevalence associated with wound infections in Lebanon, showing the emergence of multidrug-resistant ESBL-PE, the dominance of multiple gene producers, and the widespread dissemination of blaCTX-M and blaTEM genes.

Low prevalence of antimicrobial resistant organisms (methicillin resistant Staphylococcus aureus, extended beta-lactamase producing Enterobacteriaceae, and vancomycin resistant enterococci) in bulk tank milk in New South Wales, Australia.

Estimate the presence of methicillin resistant Staphylococcus aureus (MRSA), extended beta-lactamase (ESBL) producing Enterobacteriaceae, and vancomycin resistant enterococci (VRE) in bulk tank milk in dairy herds in New South Wales (NSW), Australia. Bulk tank milk samples (n = 80) were collected from dairy farms (n = 40, i.e. 2 per farm) in NSW during 2021. Bacteria were cultured using selective chromogenic indicator media with isolate identity confirmed using biochemical testing, Gram stain, and MALDI-TOF mass spectroscopy. Antimicrobial resistance (AMR) was confirmed using antibiotic disk diffusion. No samples tested positive to the targeted AMR organisms. The prevalence of MRSA, ESBL-producing Enterobacteriaceae, and VRE is low in NSW dairy herds.

Phenotypic characterization and epidemiology of extended-spectrum β-lactamase-producing Enterobacteriaceae strains from urinary tract infections in Garoua, Cameroon.

The emergence of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) is causing increased morbidity and mortality around the world as a result of therapeutic failures. ESBL-E are priority pathogens due to their multidrug resistance (MDR). In Northern Cameroon, ESBL-producing bacteria, particularly in urinary tract infections (UTIs), are being increasingly isolated. This study aimed to retrospectively determine the prevalence of multi-drug resistant ESBL strains isolated from UTIs in Northern Cameroon and to evaluate the effectiveness of the ATB UR Gallery of BioMérieux in diagnosing ESBL-E in clinical settings. Standard microbiology protocols and statistical tools were utilized to identify ESBL-producing bacteria and characterize their phenotypic susceptibility and resistance profiles in the study population. Out of the 144 enterobacteria isolates successfully cultured, 59 (41%) were identified as MDR strains. The ATB UR EU gallery identified 33 (23%) multi-drug resistant ESBL-producing strains, while the double synergy test identified 35 strains without disc reconciliation and 38 strains after reconciliation. The most prevalent ESBL-E isolate was Escherichia coli, accounting for 77.1% of the isolates, followed by Klebsiella pneumoniae (20%) and Enterobacter aerogenes (2.9%). Additionally, the study revealed the emergence of Imipenem resistance (5.7%), a critical last-resort antibiotic. However, all ESBL strains were sensitive to Fosfomycin (FSF/FOS), demonstrating its potential as an effective therapeutic option. Moreover, 37% of the ESBL producers exhibited co-resistance to over 20 different antibiotics. This study provides valuable insights into the prevalence and susceptibility patterns of ESBL-E associated with UTIs in Northern Cameroon. These insights emphasizes the importance of implementing appropriate treatment guidelines and antimicrobial stewardship measures to mitigate the spread and impact of MDR ESBL-producing strains on public health.

Extended-spectrum β-lactamase-producing Enterobacteriaceae from ready-to-eat foods: Genetic diversity and antibiotic susceptibility.

Ready-to-eat (RTE) foods are widely marketed in China and are important components of everyday diet. In this study, a total of 2000 RTE food samples were analyzed, 252 (12.60%) of which were positive for Enterobacteriaceae, and 48 were identified as containing extended-spectrum β-lactamase (ESBL)-producing Escherichia coli isolates. Furthermore, the antimicrobial resistance patterns of these isolates to 14 antimicrobial agents revealed that most isolates were resistant to aminoglycosides and β-lactam antibiotics. The TEM-type gene was prevalent in our isolates (79.17%). The isolates (n = 48) were classified into three clusters based on the ERIC-PCR results. Forty-eight sequence types were found without duplicates, revealing genetic variation and relatedness among isolates. Thus, the results demonstrated the presence of ESBL-producing Enterobacteriaceae in Chinese RTE foods. The results of this study provide insights into the spread of antibiotic-resistant strains and improve understanding of microbial risks.

Study of Plasmid-Mediated Extended-Spectrum Beta-Lactamase-Producing Clinical Strains of Enterobacteriaceae From Tabuk Region.

Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae threaten infection treatment globally. This study aims to assess ESBLs-E prevalence and multidrug-resistant organisms (MDR) in clinical specimens from Tabuk, KSA. A cross-sectionalresearchwascarriedoutin March-May 2023.Acollectiveof 90 Enterobacteriaceae isolates were identified from clinicalspecimens.The specimen was identified by standard methods. The Enterobacteriaceae member was screed for ESBL production by screening and confirmatory as per the Clinical and Laboratory Standards Institute (CLSI). E. coli was the most common isolate, followed by Proteus mirabilis and Citrobacter sp, Klebsiella oxytoca, Klebsiella pneumonia, Proteus vulgaris and Morganella morganii. Among the sample, the majority of isolates were from urine (47.8%) followed by pus (25.6%) and the least from other body fluids (6.7%). The E. coli showed the highest average antibiotic resistance (73.7%) among all the antibiotics used followed by P. mirabilis (70.4%), K. pneumoniae (70%), P. vulgaris (69.8%), M. morganii and Citrobacter (69.4% both), and K. oxytoca (68.8%). There was a 41.2% average reduction in ESBL positivity from phenotypic to confirmatory test results. The highest reduction was observed among M. morganii (66.7%) and the least was observed in E. coli (17.1%). Most of the ESBL-producing isolates were found mainly in blood and urine samples. The most frequent ESBL-producing Enterobacteriaceae were K. pneumoniae and E. coli. The best options for treating Enterobacteriaceae that produce ESBL are Amoxicillin, Amikacin, and Cefoxitin. ESBL-producing isotopes showed a high resistance rate to cefepimeand cefotaxime compared to non-ESBL producers. It is of utmost importance to implement reliable infection control measures in healthcare institutions nationwide.

Cefotaxime/sulbactam plus gentamicin as a potential carbapenem- and amikacin-sparing first-line combination for neonatal sepsis in high ESBL prevalence settings.

Infection with ESBL-producing Enterobacteriaceae infection is ubiquitous in some neonatal ICUs and increasing levels of antibiotic resistance are a cause for urgent concern. Delineation of bacterial and viral sepsis can be challenging, often leading to patients receiving empirical antibiotics without or whilst waiting for a definitive causal diagnosis. Empirical therapy is often dependent on broad-spectrum 'Watch' antibiotics, contributing to further resistance. ESBL-producing Enterobacteriaceae clinical isolates found to have caused neonatal sepsis and meningitis underwent a detailed in vitro screening including susceptibility testing, chequerboard combination analysis and hollow-fibre infection model dynamic analyses using combinations of cefotaxime, ampicillin and gentamicin in combination with β-lactamase inhibitors. Additivity or synergy was found for all antibiotic combinations against seven Escherichia coli and three Klebsiella pneumoniae clinical isolates. Cefotaxime or ampicillin plus sulbactam combined with gentamicin was able to consistently inhibit the growth of ESBL-producing isolates at typical neonatal doses, and the combination cleared the hollow-fibre infection model system of organisms resistant to each agent alone. The combination of cefotaxime/sulbactam and gentamicin was consistently bactericidal at clinically achievable concentrations (Cmax of 180, 60 and 20 mg/L for cefotaxime, sulbactam and gentamicin, respectively). The addition of sulbactam to cefotaxime or ampicillin to the typical first-line empirical therapy could obviate the need for carbapenems and amikacin in settings with high ESBL-infection prevalence.

Multi-resistant Bacteria to Antibiotics in Hospitals: The Case of Neonatology Services of the University Hospitals Centers of Abidjan, Côte d'Ivoire

Background: Multidrug-resistant bacteria (MDR) represent a global health scourge. Their emergence in hospital services complicates the clinical management of infections caused in particular in immunocompromised persons. The objective of our work was to evaluate the prevalence of MDR in the neonatal services of the University Hospitals Centers of Abidjan.
 Materials and Methods: The present study took place from September to November 2020 and from January to June 2021. The samples collected consisted of venous blood samples for blood cultures, rectal swabs from newborns, nasal and hand swabs from health care workers, and swabs from inert surfaces and neonatal care equipment. Bacterial identification methods, antibiotic susceptibility testing, and Chi-square testing were performed.
 Results: A total of 513 samples were obtained from which 215 organisms were isolated and identified. These bacteria consisted of 52.1% Gram-negative bacilli, of which 77.7% were Enterobacteriaceae and 47.9% Gram-positive cocci. Klebsiella pneumoniae (K. pneumoniae) (25.6%), coagulase-Negative Staphylococcus (CoNS) (24.6%), and Staphylococcus aureus (S. aureus) (23.2%) were the most isolated bacteria. The overall prevalence of MDR was 73.9%. The main antibiotic resistance phenotypes described were the production of Broad Spectrum β-lactamases (ESBL) in 71.9% of Enterobacteriaceae and methicillin resistance (Meti-R) in 75.6% of Staphylococcus. ESBL-producing Enterobacteriaceae (E-ESBL) were mainly observed in rectal carriage and Meti-R strains in blood cultures in newborns in the respective proportions of 45.6% and 56.4%.
 Conclusion: In our work, the results obtained showed a high prevalence of MDR in neonatal services and newborns are the most affected subjects. Improving hygiene rules and control and rationalizing the use of antibiotics are highly recommended control strategies to reduce the hospital dissemination of MDR.

Prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae among clinical isolates in Turaif general hospital, northern borders- Saudi Arabia.

Enterobacteriaceae that produce extended-spectrum beta-lactamase (ESBL) are quickly spreading, posing a threat to world healthcare. 138 gram-negative bacteria were collected from different samples (stool, urine, wound, blood, tracheal aspirate, catheter tip, vaginal swab, sputum, and tracheal aspirate) from hospitalized patients. Samples were subcultured and identified in accordance with their biochemical reactions and culture characteristics. Against all the isolated Enterobacteriaceae, an antimicrobial susceptibility test was performed. VITEK®2 system, phenotypic confirmation, and Double-Disk Synergy Test (DDST) had been utilized to identify the ESBLs. Of the 138 samples studied, the prevalence of ESBL-producing infections among the clinical samples of the present study was 26.8 % (n = 37). E. coli was the commonest ESΒL producer at 51.4% (n = 19) followed by K. pneumoniae at 27% (n = 10). The potential risk factors for the ESBL development that produces bacteria were as follows, patients with the presence of indwelling devices, previous history of hospital admission, and usage of antibiotics. ESBL is statistically (p ≤ 0.05) higher among the patients with indwelling devices, ICU admission, who had a previous hospital admission in the last 6 months as well as who was given antibiotics (quinolones and/or cephalosporins) in the last 6 months. One hundred thirty-two (95.7%) of ESBL isolates were resistant to amoxicillin, while the lowest resistance was for fosfomycin (15.2%). ESBL-producing Enterobacteriaceae are highly prevalent in Turaif General Hospital setting with some potential risk factors. A strict policy to be made available on the usage of antimicrobials in hospitals and clinics should be established.