High Rates Of Antibiotic Resistance Research Articles

Clostridioides difficile in Foods with Animal Origins; Prevalence, Toxigenic Genes, Ribotyping Profile, and Antimicrobial Resistance

Clostridioides difficile is an important nosocomial pathogen and is considered as a reason of diarrhea and gastrointestinal infections. As a majority of community-originated C. difficile cases are not related to antibiotic prescription and hospitalization, the food portion as a vector of infection transmission has been raised. An existing survey was aimed evaluating the prevalence, antimicrobial resistance, profile of toxigenic genes, and ribotypes of C. difficile isolated from raw meat and carcass surface swab samples. In total, 485 raw meat and carcass surface swab samples were collected. C. difficile was isolated via culture and a diverse biochemical examination. The assessment of minimum inhibitory concentration (MIC) was addressed to evaluate the antibiotic resistance of isolates. Toxin genes detection and ribotyping were used for isolates characterization. The prevalence of C. difficile contamination in all examined samples was 3.71%. The bacterium was detected in 2.91% of raw meat and 4.48% of carcass surface swab samples. Raw sheep meat (5%) and sheep carcass swab (7.50%) samples harbored the highest C. difficile prevalence. The highest rate of antibiotic resistance was observed toward clindamycin (38.88%), ciprofloxacin (38.88%), metronidazole (44.44%), erythromycin (72.22%), and tetracycline (77.77%). C. difficile bacteria showed the minimum rate of resistance meropenem (16.66%) and chloramphenicol (16.66%). TcdA, tcdB, cdtA, and cdtB toxigenic genes were detected in 22.22%, 44.44%, and 16.66% of isolates, respectively. TcdB + tcdA (27.77%) were the most prevalent combined toxigenic gene profile. Both 027 and 078 ribotypes were identified in C. difficile isolates. The role of raw meat and carcass surface swab samples as toxigenic and antibiotic-resistant C. difficile strains vectors was signified. This study authorizes that food animals, particularly sheep and cattle, are C. difficile carriers at slaughter stages and ribotypes are equal in human cases. Subsequently, contamination of carcasses occurs inside the slaughterhouse.

Hospital-acquired bloodstream infections in patients deceased with COVID-19 in Italy (2020-2021).

In hospitalized patients with COVID-19, bloodstream infections (BSI) are associated with high mortality and high antibiotic resistance rates. The aim of this study was to describe BSI etiology, antimicrobial resistance profile and risk factors in a sample of patients deceased with COVID-19 from the Italian National COVID-19 surveillance. Hospital charts of patients who developed BSI during hospitalization were reviewed to describe the causative microorganisms and their antimicrobial susceptibility profiles. Risk factors were analyzed in univariate and multivariate analyses. The study included 73 patients (71.2% male, median age 70): 40 of them (54.8%) received antibiotics and 30 (41.1%) systemic steroids within 48 h after admission; 53 (72.6%) were admitted to intensive care unit. Early steroid use was associated with a significantly shorter interval between admission and BSI occurrence. Among 107 isolated microorganisms, the most frequent were Enterococcus spp., Candida spp., Acinetobacter baumannii, and Klebsiella pneumoniae. Median time from admission to BSI was shorter for Staphylococcus aureus compared to all other bacteria (8 vs. 24 days, p = 0.003), and longer for Enterococcus spp., compared to all other bacteria (26 vs. 18 days, p = 0.009). Susceptibility tests showed a high rate of resistance, with 37.6% of the bacterial isolates resistant to key antibiotics. Resistance was associated with geographical area [adjusted odds ratio (AOR) for Central/South Italy compared to North Italy: 6.775, p = 0.002], and with early use of systemic steroids (AOR 6.971, p = 0.018). In patients deceased with COVID-19, a large proportion of BSI are caused by antibiotic-resistant bacteria. Early steroid use may facilitate this occurrence.

Virulence Characteristics, Antibiotic Resistance Patterns and Molecular Typing of Enteropathogenic Producing Escherichia coli (EPEC) Isolates in Eastern Province of Saudi Arabia: 2013-2014.

The Kingdom of Saudi Arabia has limited data on enteropathogenic Escherichia coli (EPEC). Therefore, this study was undertaken to contribute to EPEC surveillance and investigate the molecular epidemiology of EPEC strains that have been implicated in human infection in King Fahd Hospital of the University (KFHU) between 2013 and 2014 in the Eastern Province of Saudi Arabia. A total of 60 non-duplicate E. coli isolates associated with human gastroenteritis were included in this study. They were characterized using PCR to determine virulence genes, antimicrobial resistance patterns, and enterobacterial repetitive intergenic consensus (ERIC-PCR). Among the 60 strains, 20% of those examined were positive for the intimin eae and bfpA genes and identified as typical EPEC (tEPEC). Furthermore, 44 of E. coli strains tested positive for the eae gene only and revealed a high occurrence rate of 73.3% of atypical EPEC (aEPEC) within the overall examined strains. All strains were positive for the EAST1 gene, and none tested positive for the stx gene. More than 70% of EPEC strains were multi-drug resistant (MDR) and aEPEC strains with the highest proportion of this feature of MDR. ERIC-PCR fingerprint revealed a total of 19 ERIC types with eight related distinct clusters and a similarity rate cut-off with ≥90% homology from the identified isolates. A high antibiotic resistance rate was reported for first-line antibiotics, such as ampicillin, tetracycline, nalidixic acid, trimethoprim-sulfamethoxazole, noroxin, and ciprofloxacin.

A cross-sectional study of the antibiotic resistant prevalence of ESBL-producing Enterobacteriaceae in Vietnam

Introduction: Antibiotic resistance in Enterobacteriaceae producing extended spectrum beta-lactamase (ESBL) is increasing. Accurate evaluation of antibiotic resistance rates in various categories of bacteria assists medical physicians in recommending suitable indications for their medical problems, improving treatment efficiency, and minimizing dangers for patients. As a result, we undertook this research to assess the prevalence of ESBL-producing Enterobacteriaceae as well as the rate of antibiotic resistance in ESBL-producing Enterobacteriaceae. Methods: A cross-sectional study was conducted on 2716 patients at the An Giang Central General Hospital from June 2020 to June 2021. Data collection was based on interviews and used SPSS 18.0 and GraphPad Prism 9 for data analysis and presentation. Samples included urine, blood, sputum, and pus. Samples were treated with the Phoenix 100 automated machine to separate and identify samples. Results: The highest rate was 64.8% for Escherichia coli, followed by 30.2% for Klebsiella pneumoniae. Proteus mirabilis and Klebsiella oxytoca were found in 4.5% and 0.6% of the samples, respectively. Ampicillin resistance was greatest in E. coli (96.5%), K. pneumonia (92.4%), and K oxytoca (83.3%). The frequency of resistance to the other antibiotics was likewise extremely high, approaching 60%. Tobramycin, Amoxicillin/Clavulanate, Cefoxitin, and Nitrofurantoin were totally resistant to K. oxytoca in the ESBL-producing group. E. coli and K. pneumoniae with ESBL-producing genes also have a high antibiotic resistance rate of more than 50%. Conclusion: E. coli was the most common pathogenic bacteria. Most of the species of bacteria resisted Ampicillin.

Serotype distribution and antibiotic resistance of Streptococcus pneumoniae isolates collected from unvaccinated children with pneumonia at a province in central Vietnam.

Identification of pnemococcal serotypes and antimicrobial resistance provides helpful information for the use of suitable vaccines and antibiotics; however, very limited data is available on these issues in Vietnam. The present study aimed to find the serotype distribution and drug resistance patterns of Streptococcus pneumoniae isolated from unvaccinated children less than 5 years of age with pneumonia at a province in centre Vietnam. A total of 126 clinical pnemococcal strains isolated from unvaccinated children less than 5 years of age with pneumonia at the Nghe An province, Vietnam between Nov 2019 and Mar 2021. All strains were identified using conventional microbiological method, VITEK® 2 Compact system, specific PCR and sequencing. The serotypes and antimicrobial resistance patterns of pnemococcal strains were determined using the multiplex PCR assays and VITEK® 2 Compact system. The results showed that, eight different pneumococcal serotypes were identified. The most common serotypes were 19F (67.46%), followed by 23F (10.32%), 19A (9.52%), 6A/B (3.17%), 15A (2.38%), 9V (3.17%), 11A (1.59%) and 14 (0.80%), respectively. More than half of the pneumococcal strains were non-susceptible to penicillin. The resistance rate to ceftriaxone and cefotaxime were 41.3% and 50.8%. The percentage of pneumococci strains resistant to clarithromycin, azithromycin, erythromycin, cotrimoxazole, tetracyclin, and clindamycin were more than 93% of all strains. All pneumococcal serotypes were highly resistant to clarithromycin, azithromycin, erythromycin, cotrimoxazole, and clindamycin. Our findings showed high antibiotic resistance rates of the strains causing pneumococcal pneumonia, mostly macrolide resistance, among unvaccinated children.

Whole-Genome Sequencing of Neisseria gonorrhoeae Isolates with Antimicrobial Resistance Plasmids from a Homeless Community in Colombia.

Neisseria gonorrhoeae is a pathogenic bacterium causing sexually transmitted infections, and it is associated with high antibiotic resistance rates. Here, we describe the genome sequences of four isolates from a homeless community in Colombia.

Genetic Diversity, Carbapenem Resistance Genes, and Biofilm Formation in UPEC Isolated from Patients with Catheter-Associated Urinary Tract Infection in North of Iran.

Background Infections due to carbapenem-resistant Enterobacteriaceae (CRE) are associated in patients with urinary catheters alarming rate of emergency status. The aim of this study is to investigate the molecular causes of carbapenem resistance among UPEC as well as antimicrobial resistance trends. Additionally, the potential of isolates to produce biofilms, in addition to their clonal and genetic diversity, was investigated. Material and Methods. A cross-sectional study was accomplished on a collection of 76 non-duplicate UPEC isolates obtained from CAUTIs from May 2021 to September 2021. The modified carbapenem inactivation method (mCIM) and EDTA-modified carbapenem inactivation method (eCIM) test was performed for the detection of carbapenemase and metallo-beta-lactamase activity. Also, the presence of carbapenemase genes was determined using PCR assays. In 96-well microtiter plates, biofilm development was evaluated. ERIC-PCR was used to investigate the clonal and genetic variety of isolates. Results A total of 76 confirmed UPEC isolates were obtained from patients mentioned to teaching hospitals in Babol, Iran. The results of antibiotic susceptibility testing revealed a high rate of antibiotic resistance against nalidixic acid (81.6%) and trimethoprim-sulfamethoxazole (80.3%). Among UPEC isolates, 63.2% and 13.2% of UPEC isolates were positive for MBL production. The frequencies of the studied genes are in order of blaNDM (14.5%), blaOXA-23 (2.6%), and blaOXA-48 (2.6%). Forty-two isolates (55.3%) were positive for biofilm formation. ERIC-PCR revealed that UPEC isolates could be categorized into nine clusters A-I and five isolates were categorized as a singleton. Conclusion The high prevalence of MDR and carbapenemase-producing isolates among the UPEC strain in this investigation is concerning. Moreover, the blaNDM was the most frequent cause of producing metallo-beta-lactamase and carbapenemase. Also, analysis revealed a partial genetic similarity among the studied isolates, indicating that the same UPEC clones may have spread to other hospital units.

Ventilator-Associated Pneumonia Caused by Multidrug-Resistant Gram-Negative Bacteria in Vietnam: Antibiotic Resistance, Treatment Outcomes, and Colistin-Associated Adverse Effects.

Background: Ventilator-associated pneumonia (VAP) caused by multidrug-resistant (MDR) gram-negative bacteria (GNB) presents a serious clinical scenario, and there is disagreement regarding the role of colistin in treatment. This study aimed to characterize the antibiotic resistance of MDR GNB and evaluate the treatment outcomes and side effects of colistin in VAP patients caused by MDR GNB, particularly in Vietnam. Methods: A prospective cohort research was undertaken. We enrolled 136 intubated patients diagnosed with VAP according to the Centers for Disease Control and Prevention (CDC) 2019. Sixty-six individuals with an isolated gram-negative bacterium (Acinetobacter baumannii, Klebsiella pneumoniae, or Pseudomonas aeruginosa) satisfied the European Centre for Disease Prevention and Control (ECDC)’s criteria for multi-antibiotic resistance. Results: GNB resistance was categorized as 10.6% MDR, 63.6% XDR, and 25.8% PDR. GNB were resistant to β-lactams 80–100%, aminoglycosides 50–86.7%, fluoroquinolones 100% and colistin 2.8–20%. The 28-day mortality rate was 54.5%, and acute kidney injury occurred at 12.1%. There was no statistically significant difference in mortality rate between groups receiving regimens with or without colistin (58.3% and 73.3%, respectively; OR = 1.964; 95%CI 0.483–7.989). Neither was there a statistically significant difference in acute renal damage rate between groups receiving regimens with or without colistin (14.3% and 9.7%, respectively; OR = 1.556; 95%CI 0.34–7.121). Conclusions: GNB had a high rate of antibiotic resistance to most antibiotics. The addition of colistin to the medication did not show significant differences in renal toxicity or mortality, while colistin resistance was relatively low; larger studies need to be conducted.

Photodegradation of ciprofloxacin antibiotic in water by using ZnO-doped g-C3N4 photocatalyst

Ciprofloxacin antibiotic (CIP) is one of the antibiotics with the highest rate of antibiotic resistance, if used and managed improperly, can have a negative impact on the ecosystem. In this research, ZnO modified g-C3N4 photocatalyst was prepared and applied for the decomposition of CIP antibiotic compounds in water. The removal performance of CIP by using ZnO/g-C3N4 reached 93.8% under pH 8.0 and an increasing amount of catalyst could improve the degradation performance of the pollutant. The modified ZnO/g-C3N4 completely oxidized CIP at a low concentration of 1 mg L−1 and the CIP removal efficiency slightly decreases (around 13%) at a high level of pollutant (20 mg L−1). The degradation rate of CIP by doped sample ZnO/g-C3N4 was 4.9 times faster than that of undoped g-C3N4. The doped catalyst ZnO/g-C3N4 also displayed high reusability for decomposition of CIP with 89.8% efficiency remaining after 3 cycles. The radical species including ·OH, ·O2− and h+ are important in the CIP degradation process. In addition, the proposed mechanism for CIP degradation by visible light-assisted ZnO/g-C3N4 was claimed.

THE SIGNIFICANCE OF METICYLIN-RESISTANT STAPHYLOCOCCUS IN THE DEVELOPMENT OF SEPTIC INFECTIONS (IN THE MODEL OF PULMONARY INFLAMMATION/DESTRUCTION)

Septic infections caused by methicillin-resistant Staphylococcus (MRS) are one of the most important challenges for modern medicine. The results of the study showed that MRS strains isolated from patients with pulmonary inflammation/destruction had much higher rates of antibiotic resistance compared to methicillin-sensitive Staphylococcus strains (MSS). At the same time, the clinical and socio-economic impact of patients with pulmonary inflammation with MRS is more significant compared to that of patients with MSS, requiring more expensive treatment over a longer period of time (13.81 days vs. 7.05 days) and more days of hospitalization (18.4 days vs. 11.3 days), including in the intensive care units (9.23 days vs. 2.25 days), as well as increased lethality (8.6% vs. 2.5 %).

Genotypic and Phenotypic Characteristics of Moraxella catarrhalis from Patients and Healthy Asymptomatic Participants among Preschool Children.

(1)Background: M. catarrhalis can ascend into the middle ear, where it is a prevalent causative agent of otitis media in children, or enter the lower respiratory tract, where it is associated with community-acquired pneumonia (CAP). In this study, we aimed to provide an overview of the prevalence of M. catarrhalis in preschool children. (2) Methods: M. catarrhalis strains were isolated from samples. All isolates were characterized in terms of serotypes (STs), virulence genes, multilocus sequence type, and antibiotic susceptibility. (3) Results: The percentages of strains expressing lipooligosaccharides (LOSs), serotype A, B, C, or unknown were 67.61%, 15.71%, 4.28%, and 12.38%, respectively. Among the strains, 185 (88.10%) carried ompB2, 207 (98.57%) carried ompE, and 151 (71.90%) carried ompCD. The most frequently identified STs were ST449 (n = 13), ST64 (n = 11), and ST215 (n = 10). The resistance rates to the antibiotics cefuroxime, azithromycin, and erythromycin were 43.33%, 28.10%, and 39.05%, respectively. (4) Conclusions: High prevalence of some-specific ST types and high rates of antibiotic resistance indicate the necessity for an increased vigilance of resistant strains, a rational use of antibiotics in preschool children, and most importantly, the surveillance of healthy asymptomatic participants preschool children with M. catarrhalis. Our findings provide a platform for the development of novel M. catarrhalis vaccines.

Antibacterial activity effect of nano-chitosan against Streptococcus Mutans isolated from dental caries

The study investigated the antibacterial activity Effect Of Nano-Chitosan Against Streptococcus Mutans, It was collected from patients with periodontal disease and dental caries, and identification of bacteria and Antibiotic susceptibility tests were performed by using the VITEK2 compact system. This retrospective study was conducted at the Ba'aqubah teaching hospital.in duration February/ 2022 - April 2022 -, Data have been collected from coming patients at Specialized Dental Centers in Diyala, A total of 50 specimens, 35 ( 70%) were males, and 15 (30%)were females, the growth samples appeared in 17 ( 34%) isolates from dental caries and strep. mutans appeared in 10( 20 %) isolates. The highest rate of antibiotic resistance was observed in 3(6%) of Strep. mutans. Then the effect of Nano-chitosan on antibiotic-resistant isolates was studied by determining the value of M I C.

Sonication versus the conventional method for evaluation of the dental microbiome: a prospective pilot study

ObjectivesTo investigate sonication as a new tool in microbiological probing of dental infections.MethodsComparison of a standard probing method: intraoperative swab, with sonication, and vortex of the removed tooth, was performed on 20 carious destructed teeth. Illumina high throughput sequencing of the 16S-rRNA-gene was used for assessing the microbial composition. Antibiotic susceptibility has been assigned based on known resistances of each detected species. Probing procedures were compared using Bland–Altmann-Test, and antibiotic susceptibility using the Friedmann-Test and alpha-adjusted post-hoc-analysis.ResultsIn total, 60 samples were analysed: 20 intraoperative swabs, 20 vortex fluids, and 20 sonication fluids. Sonication fluid yielded the highest number of bacterial sequencing reads in all three procedures. Comparing the operational taxonomic units (OTUs) of the identified bacteria, significantly more OTUs were found in sonication fluid samples. Phylum and order abundances varied between the three procedures. Significantly more Actinomycetales have been found in sonication fluid samples compared to swab samples. The assigned resistance rates for the identified bacteria (1.79–31.23%) showed no differences between the tested probing procedures. The lowest resistance rates were found for amoxicillin + clavulanate (3.95%) and levofloxacin (3.40%), with the highest in amoxicillin (30.21%) and clindamycin (21.88%).ConclusionsBy using sonication on extracted teeth, it is possible to get a more comprehensive image of the residing microbial flora compared to the standard procedure. If sonication is not available, vortexing is a potential alternative. In immunocompromised patients, especially when actinomycosis is suspected, sonication should be considered for a more detailed microbiological evaluation of the potential disease-causing microbiome. Due to the high rates of antibiotic resistance, a more targeted antibiotic therapy is favourable. Levofloxacin should be considered as a first-line alternative to amoxicillin + clavulanate in patients with an allergy to penicillin.

Antibiotic prescription practices amongst veterinarians in Nigeria

The high rate of antibiotic resistance constitutes a global threat to the continuous use of these drugs, because of increasing treatment failures. The aim of this study was to survey antibiotic prescription practices of veterinarians and the possible contribution to antimicrobial resistance (AMR) and antimicrobial stewardship (AMS) in Nigeria during the COVID era.This was a cross-sectional study that used a 33-question survey questionnaire administered to registered veterinarians in Nigeria. The study was both online survey and hard copy administered during the annual meeting of the veterinarians from July to October 2021. Descriptive statistics, bivariate analysis using Chi-square test were also done to analyze the results, while a two-tailed P-value of <0.05 at 95% confidence level was considered statistically significant. IBM SPSS Version 26 was used to analyze the data.A total of 172 respondents completed the online and hard copy questionnaire. Majority of the respondents engaged majorly in mixed veterinary practice (72.1%). A total of 53.5% were aware of the country's policy concerning antibiotic prescription, while majority (64.5%) do not do culture and sensitivity before antibiotic prescription. Majority (34.3%) felt that the risk of potential adverse drug reaction could affect their decision when choosing to prescribe an antibiotic to the owner. Majority (51.2%) felt that some antibiotics were over prescribed, while 26.7% opined that all antibiotics were appropriately prescribed.To improve antibiotic use and practice amongst veterinarians in Nigeria, dependence on laboratory services for antibiotic prescription, enforcement of national guidelines and monitoring of antibiotic prescription amongst the veterinarians is essential to curb over-prescription and strengthen antimicrobial stewardship.

Gram-Positive Bacterial Infections and Antibiotics Resistance in Jordan: Current Status and Future Perspective

Background: Antibiotic resistance is expanding worldwide at alarming rates. Middle East countries including Jordan have high prevalence of antibiotic resistance.&#x0D; Aims: The main aims of this review are to summarize the situation with Gram-positive bacterial infections and antibiotic resistance in Jordan, identify areas where further investigation is required, and suggest strategies to combat antibiotic resistance.&#x0D; Methods: A systematic literature search was conducted by two independent researchers using general and specific combinations of MeSH search terms using Embase, PubMed, Web of Science, and Google Scholar databases.&#x0D; Results: Staphylococci and Streptococci were commonly isolated from environmental, animal, and human samples, while Staphylococci, Enterococci, and Listeria were commonly isolated from food. Staphylococci, Streptococci, and Enterococci human colonization were documented at variable but high rates. Methicillin-resistant S. aureus (MRSA) and methicillin-resistance coagulase-negative Staphylococci (MR-CoNS) infections were common with high rates of antibiotic resistance. S. pneumoniae showed increased resistance rates to most antimicrobials. Enterococci and C. difficile resistance rates were moderate, while group B Streptococci (GBS), viridans group streptococci (VGS), C. perfringens and L. monocytogenes antibiotic susceptibility patterns were not reported. All MRSA and vancomycin-resistant Enterococci (VRE) isolates were mec-A positive, while resistance genes among CoNS, S. pneumoniae, S. pyogenes, S. agalactia, C. perfringens, and L. monocytogenes were not investigated.&#x0D; Conclusions: Gram-positive bacterial infections and antibiotic resistance rates were high in Jordan. Molecular epidemiology studies, a nationwide surveillance program, and action plans are urgently required to combat antibiotic resistance.

Eradication of drug-resistant Acinetobacter baumannii by cell-penetrating peptide fused endolysin.

Antimicrobial agents targeting peptidoglycan have shown successful results in eliminating bacteria with high selective toxicity. Bacteriophage encoded endolysin as an alternative antibiotics is a peptidoglycan degrading enzyme with a low rate of resistance. Here, the engineered endolysin was developed to defeat multiple drug-resistant (MDR) Acinetobacter baumannii. First, putative endolysin PA90 was predicted by genome analysis of isolated Pseudomonas phage PBPA. The His-tagged PA90 was purified from BL21(DE3) pLysS and tested for the enzymatic activity using Gram-negative pathogens known for having a high antibiotic resistance rate including A. baumannii. Since the measured activity of PA90 was low, probably due to the outer membrane, cell-penetrating peptide (CPP) DS4.3 was introduced at the N-terminus of PA90 to aid access to its substrate. This engineered endolysin, DS-PA90, completely killed A. baumannii at 0.25 µM, at which concentration PA90 could only eliminate less than one log in CFU/ml. Additionally, DS-PA90 has tolerance to NaCl, where the ∼50% of activity could be maintained in the presence of 150 mM NaCl, and stable activity was also observed with changes in pH or temperature. Even MDR A. baumannii strains were highly susceptible to DS-PA90 treatment: five out of nine strains were entirely killed and four strains were reduced by 3–4 log in CFU/ml. Consequently, DS-PA90 could protect waxworm from A. baumannii-induced death by ∼70% for ATCC 17978 or ∼44% for MDR strain 1656-2 infection. Collectively, our data suggest that CPP-fused endolysin can be an effective antibacterial agent against Gram-negative pathogens regardless of antibiotics resistance mechanisms.Electronic Supplementary MaterialSupplemental material for this article may be found at 10.1007/s12275-022-2107-y.

Prevalence of algD, pslD, pelF, Ppgl, and PAPI-1 Genes Involved in Biofilm Formation in Clinical Pseudomonas aeruginosa Strains.

Introduction Biofilm formation is one of the main virulence factors in Pseudomonas aeruginosa infections. This study is aimed at investigating the presence of genes involved in biofilm formation in clinical P. aeruginosa isolates. Material and Methods. A cross-sectional study was conducted on 112 P. aeruginosa isolates. The biofilm formation assay was performed on all isolates. Antimicrobial resistance was determined by the disk diffusion method, and the presence of genes was detected by polymerase chain reaction. Isolates were typed with Rep-PCR. Results The results of biofilm formation demonstrated that 85 strains (75.9%) were biofilm producers, and 27 strains (24.1%) were nonproducer isolates. Antibiotic susceptibility pattern in biofilm-positive and biofilm-negative isolates obtained from hospitalized patients showed a high rate of antibiotic resistance to amoxicillin with 95.7% and 92.3%, respectively. Based on PCR amplification results, the frequency of genes involved in biofilm formation among all isolates was as follows: algD (78.6%), pelF (70.5%), pslD (36.6%), Ppgl (0%), and PAPI-1 (77.6%). Rep-PCR typing demonstrated that 112 P. aeruginosa isolates were classified into 57 types according to 70% cut-off. The predominant type was A which contained 15 isolates. Moreover, 7 isolates were clustered in genotype B, followed by C type (6), D (4), E (4), F (4), G (4), H (3), I (3), J (3 isolates), and 12 genotypes, each containing two isolates. Also, 35 isolates were distributed in scattered patterns and showed single types. Conclusion Study results showed significant association between biofilm formation and resistance to antibiotics such as ceftazidime and meropenem. Analysis of Rep-PCR patterns indicated that the evaluated isolates were heterogeneous, relatively.

Microbiologically confirmed infections and antibiotic-resistance in a national surveillance study of hospitalised patients who died with COVID-19, Italy 2020–2021

BackgroundPatients hospitalised for COVID-19 may present with or acquire bacterial or fungal infections that can affect the course of the disease. The aim of this study was to describe the microbiological characteristics of laboratory-confirmed infections in hospitalised patients with severe COVID-19.MethodsWe reviewed the hospital charts of a sample of patients deceased with COVID-19 from the Italian National COVID-19 Surveillance, who had laboratory-confirmed bacterial or fungal bloodstream infections (BSI) or lower respiratory tract infections (LRTI), evaluating the pathogens responsible for the infections and their antimicrobial susceptibility.ResultsAmong 157 patients with infections hospitalised from February 2020 to April 2021, 28 (17.8%) had co-infections (≤ 48 h from admission) and 138 (87.9%) had secondary infections (> 48 h). Most infections were bacterial; LRTI were more frequent than BSI. The most common co-infection was pneumococcal LRTI. In secondary infections, Enterococci were the most frequently recovered pathogens in BSI (21.7% of patients), followed by Enterobacterales, mainly K. pneumoniae, while LRTI were mostly associated with Gram-negative bacteria, firstly Enterobacterales (27.4% of patients, K. pneumoniae 15.3%), followed by A. baumannii (19.1%). Fungal infections, both BSI and LRTI, were mostly due to C. albicans. Antibiotic resistance rates were extremely high in Gram-negative bacteria, with almost all A. baumannii isolates resistant to carbapenems (95.5%), and K. pneumoniae and P. aeruginosa showing carbapenem resistance rates of 59.5% and 34.6%, respectively.ConclusionsIn hospitalised patients with severe COVID-19, secondary infections are considerably more common than co-infections, and are mostly due to Gram-negative bacterial pathogens showing a very high rate of antibiotic resistance.

BACTERIOLOGICAL CHARACTERISTICS OF DIABETIC FOOT INFECTION AND SUSCEPTIBILITY OF MULTIRESISTANT ISOLATES TO HYDRAULIC EXTRACTS FROM ALLIUM SATIVA, ALLIUM CEPA AND CANNABIS SATIVA

Background and objective : Diabetic foot infection is one of the most serious complications of diabetes and its persistence is the result of the ineffectiveness of antibiotic therapy due to the exponentially increasing of antibiotic resistant bacteria. The study aimed at investigating the antibacterial effect of the aqueous extract of some plants on the antibiotic resistant bacteria isolated from diabetic foot wound infections. Methods : A 6-months cross-sectional study from July 2021 to January 2022 at the Yaoundé Central Hospital, was undertaken with diabetic foot wound patients. All samples were appraised to determine presence of infectious agents using standard methods for isolation and identification of bacteria. Subsequently, Antibiotic resistance was done using Kirby-Bauer disc diffusion methods. Finally, extracts of Cannabis sativa leaves, Allium cepa and Allium sativum bulbs were obtained with water and their antibacterial activities were evaluated by the microdillution method on liquid medium. Results : 20 patients whom 14 men were included, with a sex ratio of 2.33, and their mean age was 52.5±9.6 years. 60% of these patients presented wounds in grade III and were of several types : purulent (48.57%), moist (31.43%) and dry (20%). 35 strains were isolated. The predominant GPB were S. aureus (34.29%) followed by Coagulase-negative Staphylococcus (14.29%), and Bacillus Spp (2.86%). Among the GNB, Pseudomonas aeruginosa (11.46%), Serratia Spp. (8.56%), Escherichia coli (8.56%), Enterobacter Spp. (5.71%), Proteus Spp. (5.71%), Klebsiella Spp., Yersinia Spp. and Salmonella Spp. in proportions of 2.86% each. A high rate of antibiotic resistance was recorded for Oxacillin (100%), Vancomycin (83.34%) and Augmentin (55.56%). Sensitivity tests on liquid medium showed that MIC ranged between 3.12-25.00 mg/mL, 6.25-25.00 mg/mL and 1.86-25.00 mg/mL respectivelly for A. sativa, A. cepa and C. sativa. Alliums were much more active on GNB. Although these results are low, they could be an alternative for the diabetic foot infection treatment. Conclusion : Alliums were much more active on GNB Although these results are low, they could be an alternative for the diabetic foot infection treatment. Peer Review History: Received: 28 February 2022; Revised: 15 April; Accepted: 24 April, Available online: 15 May 2022 Academic Editor: Dr. Sally A. El-Zahaby, Pharos University in Alexandria, Egypt, sally.elzahaby@yahoo.com UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.5/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. Sangeetha Arullappan, Universiti Tunku Abdul Rahman, Malaysia, sangeetha@utar.edu.my Prof. Dr. Ali Gamal Ahmed Al-kaf, Sana'a university, Yemen, alialkaf21@gmail.com Similar Articles: THE SCOPING REVIEW OF CHINESE AND WESTERN MEDICINE TREATMENT OF DIABETIC FOOT IN ASIA A SURVEY ABOUT THE CURRENT SCENARIO OF DIABETES IN CHATTOGRAM AREA BY DETERMINING PRACTICE OF THE SELF-CARE ACTIVITIES AMONGST PEOPLE WITH DIABETES

Sustaining Antimicrobial Stewardship in a High–Antibiotic Resistance Setting

There is a lack of studies comparing the intended and unintended consequences of prospective review and feedback (PRF) with computerized decision support systems (CDSS), especially in the longer term in antimicrobial stewardship. To examine the outcomes associated with the sequential implementation of PRF and CDSS and changes to these interventions with long-term use of antibiotics for and incidence of multidrug resistant organisms (MDROs) and other unintended outcomes. This cohort study used an interrupted time series with segmented regression analysis of data from January 2007 to December 2018. Data were extracted from the electronic medical records of patients admitted at a large university teaching hospital with high rates of antibiotic resistance in Singapore. Data were analyzed from June 2019 to June 2020. PRF of piperacillin-tazobactam and carbapenems (intervention 1, April 2009), with the addition of hospital-wide CDSS (intervention 2, April 2011), and lifting of CDSS for half of the hospital wards for 6 months (intervention 3, March 2017). Monthly antimicrobial use was measured in defined daily doses (DDDs) per 1000 patient-days. The monthly incidence of MDROs was calculated as number of clinical isolates detected per 1000 inpatient-days over a 6-month period. Unintended outcomes examined included in-hospital mortality and age-adjusted length of stay (LOS). The number of inpatients increased from 56 263 in 2007 to 63 572 in 2018. During the same period, the mean monthly patient days increased from 33 929 in 2007 to 45 603 in 2018, and the proportion of patients older than 65 years increased from 45.5% in 2007 to 56.6% in 2018. After intervention 1, there were 0.33 (95% CI, 0.18 to 0.48) more DDDs per 1000 patient-days per month of piperacillin-tazobactam and carbapenems and -11.05 (95% CI, -15.55 to -6.55) fewer DDDs per 1000 patient-days per month for other broad-spectrum antibiotics. After intervention 2, there were -0.22 (95% CI, -0.33 to -0.10) fewer DDDs per 1000 patient-days per month of piperacillin-tazobactam and carbapenems and -2.10 (95% CI, -3.13 to -1.07) fewer DDDs per 1000 patient-days per month for other broad-spectrum antibiotics. After intervention 3, use of piperacillin-tazobactam and carbapenem increased by 0.28 (95% CI, 0.02 to 0.55) DDDs per 1000 patient-days per month. After intervention 2, incidence of Clostridioides difficile decreased (estimate, -0.02 [95% CI, -0.03 to -0.01] cases per 1000 patient-days per month). In this cohort study, concurrent PRF and CDSS were associated with limiting the use of piperacillin-tazobactam and carbapenems while reducing use of other antibiotics.