Frequency Of Multidrug-resistant Strains Research Articles

Bacteremia with Multi-drug Resistant Gram-negative Bacteria in Pediatrics and Its Correlation with COVID-19

Background: Bloodstream infection with multi-drug resistant (MDR) bacteria has been introduced as the main risk factor for in-hospital mortality in vulnerable children worldwide. COVID-19 can complicate the treatment process in patients with bacteremia; however, data about this co-infection in children are scant. Objectives: This was a study on the antimicrobial patterns of Gram-negative bacteria (GNB) isolated from blood samples of children with bacteremia and their correlation with COVID-19. Methods: In this cross-sectional study, blood samples of children with bacteremia were analyzed using BACTEC bottles. The bacterial isolates were characterized based on standard microbiology laboratory methods, and MDR strains were detected based on a standard protocol. Real-time PCR tests for COVID-19 were recorded from the patients’ hospital documents. Results: A total of 255 positive blood samples were detected in children with bacteremia. The bacterial isolates included Enterobacteriaceae spp. 43.5% (111/255), Pseudomonas spp. 33.7% (86/255), Acinetobacter spp. 21.6% (55/255), and Stenotrophomonas spp. 1.2% (3/255). Of 255 GNB, 86.66% (221/255) were MDR, and the frequency of MDR strains was as follows: Enterobacteriaceae spp. 91.8% (102/111), Pseudomonas spp. 77.9% (67/86), Acinetobacter spp. 89% (49/55), and Stenotrophomonas spp. 100% (3/3). Of 255 children with GNB-related bacteremia, COVID-19 infection was confirmed in 25.1% (64/255) of them. Nearly 93.7% (60/64) of these patients had both MDR bacteremia and COVID-19. The correlation was significant between MDR bacteremia and COVID-19 (P-value = 0.002). The death rate was 43.33% (26/60) among these children. Conclusions: The results of this study showed that MDR-GNB was the main cause of bacteremia in children. Our findings showed a notable risk of concomitant COVID-19 and GNB-related bacteremia in these patients.

Detection of biofilm-related genes and antibiotic resistance in Acinetobacter baumannii isolated from clinical specimens

Abstract. Saadulla SOK, Muhammed SM. 2023. Detection of biofilm-related genes and antibiotic resistance in Acinetobacter baumannii isolated from clinical specimens. Biodiversitas 24: 1809-1816. A total of 53 Acinetobacter baumannii clinical isolates were collected from patients treated at Shar Hospital in Sulaimani city to determine antibiotic susceptibility patterns and their association between biofilm formation and the distribution of biofilm-related genes. Identification of suspected A. baumannii was carried out by conventional and molecular approaches, including 16S rRNA and blaoxa-51 gene amplification. In addition, disk diffusion and microtiter plate methods determined antibiotic susceptibility and biofilm-forming capability, respectively. Out of 53 A. baumannii clinical isolates 42 (79.24%), were Multidrug-Resistant (MDR), of which 3 (5.66%) were resistant to colistin. Overall, 33 (62.26%) of the clinical isolates were strong biofilm producers, 6 (11.32%) were moderate or weak biofilm producers, and 8 (15.09%) were non-biofilm-forming isolates. The frequency of biofilm-related genes ompA, bap, csuE, blaPER-1, and cpaA among A. baumannii strains was 92.45%, 79.24%, 73.58%, 9.43%, and 7.54%, respectively. The high frequency of multi-drug resistant strains, and their ability to form biofilms, is a potential threat to effective therapy and may increase morbidity and mortality in infected patients. Colistin appeared to be the most effective antibiotic for treating MDR A. baumannii infections.

Results of dynamic monitoring of the spectrum of bacterial causes of acute urinary tract infections in children

The aim of the study: to explore in dynamics the structure of pathogens in children of Zaporizhzhia region with acute urinary tract infections and the possible changes in their antibiotic susceptibility. Materials and methods. We analysed results of urine culture in 439 children aged 4 to 18 years with acute urinary tract infection (293 patients in 2014–2016 and 146 patients in 2018–2020). Determination of bacterial species and susceptibility to antibiotics was performed on a bacteriological analyzer VITEK 2 COMPACT (bioMerieux, France) using AES software: Global CLSI-based + Phenotypic (2014, 2018) in accordance with CLSI and EUCAST tables. The coefficient of antibiotic resistance was additionally calculated for each isolate. Results. According to the analysis of bacteriological monitoring, it was found that in 2018–2020 compared to 2014–2016 among the causative agents of acute urinary tract infections in children, the role of gram-negative bacteria had raised due to increasing the proportion of Escherichia сoli and Proteus mirabilis. Gram-positive microflora has been represented by bacteria of the genus Enterococcus, in 2018–2020 in most samples was isolated Enterococcus faecium (28.1 %), in 2014–2016 among the representatives Enterococcus faecalis prevailed (38.9 %). The analysis of antibiotic resistance showed that in 2018–2020 the number of resistant strains of E. coli to amikacin increased 6.8 times to 2014–2016 (Р < 0.01) and there was a decrease in the sensitivity of Enterococcus to aminopenicillins from 91.4 % to 41.3 % (P < 0.01). Among bacteria of the genus Enterococcus the average values of the coefficient of resistance to antibiotics in 2018–2020 increased 3.75 times compared to 2014–2016 due to a 2.3-fold increase in the frequency of multidrug-resistant strains (P < 0.05). Conclusions. The obtained data are convincing evidence of the need for mandatory bacteriological examination of urine before antibacterial therapy to increase the effectiveness of therapeutic measures, prevention of the emergence and spread of antibiotic resistance. An increase in resistance of E. coli to amikacin and Enterococcus spp. to ampicillin does not allow the use of these drugs as empirical therapy of acute urinary tract infections in children.

Diabetes Mellitus Influencing the Bacterial Species in Surgical Site Infections of Orthopedic Trauma Patients

Objective Diabetes mellitus is a well-known risk factor for delayed wound healing and surgical site infections (SSIs). With the exception of urinary tract infections, information on changes in bacterial etiology and antimicrobial resistance patterns for patients with diabetics is rare. This study compared the prevalence of bacterial species and their antimicrobial resistance in patients with SSI and with or without diabetes mellitus. Methods Patients with a postoperative SSI within 6 weeks after orthopedic surgery due to a fracture or joint injury (in a level 1 trauma center in Germany) were analyzed retrospectively for the time period of 2007 to 2012. Microbiological results were assessed by comparing the prevalence of bacterial species and minimal inhibitory concentration of 34 antimicrobial agents for both patient groups. Results Three hundred three patients (female = 140, male = 163) were analyzed. Seventy nine (26.1%) of them had diabetes mellitus. Diabetic patients were older (mean age, 70.7 vs 60.1 years, P < 0.001) and more obese (48.1% vs 17.4%; odds ratio [OR], 4.40 [2.51–7.70], P < 0.001). Infection associated mortality was higher in the diabetes group (10.1% vs 2.7%; OR, 4.09 [1.37–12.20], P = 0.012). Most frequent isolates from wound specimen were Staphylococcus aureus, Staphylococcus epidermidis, Enterococcus faecalis, Escherichia coli, and Pseudomonas aeruginosa. Enterococcus faecalis was more frequent in diabetic patients (P = 0.030; OR, 1.89 [1.07–3.34]). There was no difference in resistance against cefuroxime and in the frequency of multidrug-resistant strains in both groups. Conclusions Patients with diabetes mellitus and postoperative SSI showed a higher frequency of E. faecalis isolate. However, antibiotic prophylaxis with cephalosporins still seems to be effective in most cases.

Frequency of class I and II integrons in the clinical isolates of Pseudomonas aeruginosa with multidrug resistance in Shahrekord teaching hospitals and Isfahan Shahid Chamran hospital during 2016-2017

Background and aims: Increasing the prevalence of nosocomial infections by multidrug resistant (MDR) Pseudomonas aeruginosa has severely challenged the choice of treatment and led to an increased mortality rate. Thus, this study investigated the frequency of class I and II integrons and its association with MDR. Materials and Methods: A total of 175 P. aeruginosa isolates were collected from Shahrekord teaching hospitals and Isfahan Shahid Chamran hospital during 12 months (from April 2008 to March 2009). Antibiotic susceptibility was determined by disc diffusion according to the Clinical and Laboratory Standards Institute (CLSI) Antimicrobial Susceptibility Testing. The E-test strips of imipenem, ciprofloxacin, and amikacin were used to identify the minimum inhibitory concentration and MDR bacteria. Finally, the frequency of class I and II integrons genes was evaluated by using the polymerase chain reaction test. Results: The highest antibiotic resistance and the highest susceptibility belonged to meropenem (86.9%) and polymyxin B (96.0%) by disc diffusion, respectively. By the E-test, the highest and lowest resistance rates were reported for imipenem (97.2%) and ciprofloxacin (86.8%), respectively. The frequency of MDR strains was 82.3% as well. The frequency of class I and II integrons was 57.7% and 17.7% in all P. aeruginosa isolates, as well as 68.1%and 21.5% in the MDR isolates, respectively. There was also a significant correlation between I and II integrons and MDR. Conclusion: Overall, the resistance to different antibiotics and the frequency of MDR strains among the studied P. aeruginosa isolates were very high. There was also a significant correlation between integrons and multidrug resistance. Regarding the role of integrons in the transfer of drug-resistant genes and the development of MDR strains, the use of appropriate diet and accurate determination of the susceptibility pattern of P. aeruginosa isolates are considered necessary.

High prevalence of multidrug-resistant Escherichia coli isolates from children with and without diarrhoea and their susceptibility to the antibacterial activity of extracts/fractions of fruits native to Mexico.

This paper aims to evaluate the antimicrobial resistance of Esherichia coli isolates from children under 5 years old, with and without diarrhoea, who were hospital outpatients in Culiacan, Sinaloa, Mexico. It also looks at the antimicrobial activity of fruit extracts against selected multidrug-resistant (MDR) E. coli strains. A total of 205 E. coli isolates from stool samples were collected from 94 children under 5 years old who were outpatients from two hospitals in the city of Culiacan, Sinaloa, Mexico, during the autumn/winter of 2003/04; their resistance profiles to 19 commercial antimicrobials were investigated using the Kirby-Bauer method. The antibacterial activities of extracts/fractions of fruits (i.e. uvalama, Vitex mollis; ayale, Crescentia alata; and arrayan, Psidium sartorianum) were evaluated using the broth microdilution method. All E. coli isolates were susceptible to amikacin, nitrofurantoin and meropenem, and approximately 96 % were resistant to at least one antimicrobial, especially carbenicillin (93.2 %), cefuroxime sodium (53.7 %), ampicillin (40 %) and trimethoprim/sulfamethoxazole (35.1 %). Likewise, the frequency of MDR strains (44.9 %) was high, and no significant association with diarrhoea symptoms was found. Remarkably, all fruit extracts/fractions showed antibacterial activity against some, but not all, MDR isolates. The lowest minimal inhibitory concentration values were for the hexane fraction of arrayan (0.25 mg ml-1). A high number of antimicrobial-resistant E. coli (especially to β-lactams and sulfonamides) and MDR isolates were detected in children under 5 years old, irrespective of diarrhoea symptoms; this is novel information for Culiacan, Sinaloa, Mexico. Moreover, our results showed that the studied fruit extracts/fractions are potential alternative or complementary treatments for MDR E. coli strains.

Modern approaches to antibiotic therapy of complicated urinary tract infections given bacterial antibiotic resistance

The aim of the study: improving the efficiency of treatment of patients with urinary tract infections given bacterial antibiotic resistance.Materials and methods. A survey of patients with acute pyelonephritis (n=52) in the aspect of practical application of the modern system of classification of UTI. We determined the sensitivity of the pathogen to different drugs (288 tests for sensitivity test on average of 5.54 per patient).Results. There was a significant increase in the frequency of multidrug resistant strains of bacteria, especially fluoroquinolones and cephalosporins. The least resistance was observed to carbapenems. Measures are proposed to reduce the emergence of resistant strains, including more active use of carbapenems from the start of therapy in patients with complicated pyelonephritis (with appropriate signs by classification).Conclusion. The study shows that the resistance of pathogens of acute pyelonephritis is indeed an important issue of urology. Must actively introduce monitoring of resistance of bacterial pathogens in various departments and use it in everyday clinical practice.

Investigating the frequency of multi-drug resistant strains of escherichia coli isolated from urinary tract infection in children

Investigating the frequency of multi-drug resistant strains of escherichia coli isolated from urinary tract infection in children

Salmonella enterica serovar Typhi in Japan, 2001–2006: emergence of high-level fluoroquinolone-resistant strains

The phage types and antimicrobial susceptibilities of 226 isolates of Salmonella enterica serovar Typhi from imported cases in Japan between 2001 and 2006 were investigated. Most (93.8%) had travelled to Asian countries, particularly South East Asia. Twenty-one phage types were identified with E1 (30.5%), UVS (15.9%) and B1 (9.3%) being the most common. The frequency of multidrug-resistant strains reached 37.0% in 2006 with phage types E1 and E9 predominating. Almost half (48.2%) of the isolates were resistant to nalidixic acid and two isolates displayed high-level fluoroquinolone resistance. Three mutations, two in gyrA and one in parC, were identified in both isolates.

Phenothiazines: an alternative to conventional therapy for the initial management of suspected multidrug resistant tuberculosis. A call for studies

Increased frequency of multidrug resistant strains of Mycobacterium tuberculosis results from inappropriate treatment and lack of patient compliance. The Center for Disease Control/American Thoracic Society (CDC/ATS) guidelines issued for the management of newly diagnosed cases of tuberculosis (TB) will not be totally effective regardless of adherence to the guidelines and patient cooperation. The long interim period between the diagnosis of TB and confirmation of antibiotic susceptibility contributes to the infection rate. Consequently, the use of an adjuvant that is known to inhibit all encountered multidrug resistant strains of M. tuberculosis may be helpful until antibiotic susceptibility is known. Phenothiazines such as chlorpromazine, methdilazine and thioridazine are effective against strains of M. tuberculosis in vitro and in vivo. It is recommended that studies be designed and conducted for the purpose of managing new cases of TB that emanate from areas known to harbour multidrug resistant strains of M. tuberculosis, with phenothiazines as adjuvants to the regimen recommended by the CDC/ATS guidelines until antibiotic susceptibility is defined. Because the normal maximum period for obtaining conventional antibiotic susceptibility results is less than 7 or 8 weeks, the probability of serious side effects from the use of a phenothiazine is remote.