High Resistance Pattern Research Articles

Comparison of Clinical, Etiological and Antibiotic Sensitivity Patterns of UTI in CAKUT and Non CAKUT Children

Background: Urinary tract infections (UTIs) are one of the most common bacterial infections in children. Congenital anomalies of the kidney and urinary tract (CAKUT) are a major cause of UTIs in this population. Objective: To compare clinical, etiological and antibiotic sensitivity patterns of UTIs in CAKUT and non-CAKUT children. Study Design: Prospective comparative study. Place and Duration: The study was conducted at the department of Pediatric Nephrology, The Children's Hospital Lahore from August 2023 to January 2024. Methods: 68 children with and without CAKUT having UTI were evaluated. Data regarding demographics, clinical presentation and antibiotic sensitivity pattern was collected. Susceptibility testing was done according to CLSI recommendations. Results: 34 patients with UTI in CAKUT group (Group A) had male predominance (73.5%) while children without CAKUT (Group B) were predominantly females (55.9%). Mean age in Group A (38.9 months) was less than that in Group B (53.9 months). The common presentations in both the groups were pyelonephritis and cystitis. Vesico-ureteric reflux (32.4%) and posterior urethral valves (29.4%) were the most common CAKUT findings. Majority of patients with CAKUT had Pseudomonas UTI (32.4%) while E. coli (35.3%) was common in children without CAKUT. Fosfomycin, Colistin, Linezolid and Polymyxin B had low resistance amongst both groups. The association between CAKUT and atypical uropathogens was not found to be statistically significant (p = 0.287). Conclusion: Differences exist in clinical presentation, etiology and antibiotic sensitivity patterns specific to UTI in CAKUT and non-CAKUT children. A high resistance pattern was found amongst common antibiotics.

Bacterial co-infections in cancer patients with COVID-19: predictors and antimicrobial resistance trends.

Within the context of the coronavirus disease 2019 (COVID-19) pandemic, this study investigated the multifaceted challenges of bacterial infections in cancer patients with COVID-19. It focuses on clinical predictors, resistance patterns, and microbiological characteristics. Over 18 months, 112 adult cancer patients with coronavirus infection confirmed by reverse transcription polymerase chain reaction (RT-PCR) were enrolled. Bloodstream and respiratory samples were evaluated for bacterial infection using the Phoenix automation system for definitive species identification. In vitro susceptibility testing followed the Clinical Laboratory Standards Institute (CLSI) M100-Ed30 guidelines. Bacterial infections affected 25.0% of patients, encompassing bacteremia (21.4%) and respiratory tract infections (8.0%). Multivariable analysis identified hypertension, age < 60, and critical COVID-19 as significant predictors for bacterial infections (p-values = 0.024, 0.029, and 0.039, respectively). Most patients received antimicrobial therapy (93.8%), including last-resort carbapenems (52.7%) and colistin (8.9%). Thirty-three bacterial isolates were identified, with secondary infections doubling co-infection rates. Escherichia coli, Klebsiella species, and Staphylococcus aureus were the most common co-infecting species, while Klebsiella, Acinetobacter, and Pseudomonas species were more frequently associated with secondary infections. Alarmingly, 84.8% of isolates displayed high resistance patterns. All isolated S. aureus species were methicillin-resistant, and 62.5% of Gram-negative bacteria were exclusively sensitive to colistin. The dominance of highly transmissible hospital-acquired bacterial species, with increased resistance and extensive antibiotic use in COVID-19 patients, necessitates strict infection control and antimicrobial stewardship. Developing customized antimicrobial strategies for cancer patients with COVID-19 is crucial to managing bacterial infections effectively and improving patient outcomes.

Etiology, risk factors and antibiotic resistance in neonatal sepsis.

Objective: To determine the etiology, risk factors and antibiotic resistance in neonatal sepsis. Study Design: Cross-sectional study. Setting: Department of Pediatric Medicine, National Institute of Child Health, Karachi, Pakistan. Period: October 2023 to March 2024. Methods: A total of 174 neonates of both genders, with suspected neonatal sepsis were analyzed. Neonatal and maternal characteristics were noted. Blood sample was collected in aseptic environment and sent to institutional laboratory for blood culture and drug susceptibility testing. Results: In a total of 174 neonates, 101 (58.0%) were boys. The mean age, and weight were 9.61±7.86 years, and 2.25±0.85 kg, respectively. Neonatal sepsis on the basis of positive blood culture was reported in 38 (21.8%) neonates. Preterm birth had significant association with neonatal sepsis (44.7% vs. 26.5%, p=0.019). History of maternal UTI during pregnancy had significant linkage with neonatal sepsis (36.8% vs. 11.0%, p&lt;0.001). History of maternal fever during pregnancy had statistically significant association with neonatal sepsis (34.2% vs/ 19.1%, p=0.049). E. Coli, and Klebsiella were the most commonly found bacterial isolates, noted in 8 (21.1%), and 4 (10.5%) neonates, respectively. Most commonly used antimicrobial drugs were found to have high resistance rates against most frequent bacterial isolates. Conclusion: E. Coli, and Klebsiella were the most commonly found bacterial isolates in neonatal sepsis. Preterm birth, maternal history of UTI, and maternal history of fever were found to be significant factors linked to neonatal sepsis. Most commonly used antimicrobial drugs were found to have high resistance patterns which should raise alarms.

ANTIBIOTIC SENSITIVITY SPECTRUM OF ACUTE BACTERIAL CHOLANGITIS: TRENDS FROM A TERTIARY REFERRAL CENTER IN PAKISTAN.

Significant morbidity can arise from acute bacterial cholangitis. Key to improving outcomes is the implementation of aggressive antibiotic therapy and prompt biliary decompression through either endoscopic or percutaneous means. However, the challenge in treating these infections is amplified by the evolving patterns of antimicrobial resistance, particularly when determining the appropriate empiric therapy. The present study was conducted at Shifa International Hospital in Islamabad. The patients with the diagnosis of Acute bacterial cholangitis between July 2016 and June 2022 were included. Data was analyzed using SPSS-26.0 to identify any significant associations or correlations among the study variables. A total of 144 patients with a diagnosis of acute bacterial cholangitis were included in the study. 51 of these patients had a positive blood culture. The most commonly identified organism was E. coli, followed by Klebsiella pneumonia, Pseudomonas aeruginosa, Proteus, Enterococcus spp and others. Antibiotic sensitivity pattern revealed resistance to Ceftazidime in 87%, Piperacillin-Tazobactam in 63.7%, Ertapenem in 34.4%, Meropenem in 26.1%, Imipenem in 25.0% and Colistin in 16.1%. A high resistance pattern for antibiotics was observed in our study. This might, in turn, represent the prior judicious use of antibiotics in our community hospitals before these patients are referred to a tertiary referral center.

O01 Epidemiology and clinical characteristics of patients with carbapenem-resistant Enterobacterales infections: experience from a large tertiary care centre in a developing country

Abstract Background Carbapenem-resistant (CR) Enterobacterales (CREs) are a significant source of healthcare-associated infections. These bacteria are difficult to treat and have a high mortality rate due to high rates of antibiotic resistance. These pathogens are also linked to major outbreaks in healthcare institutions, especially those with limited resources in infection prevention and control. Objectives To describe the epidemiology and clinical characteristics of patients with carbapenem-resistant Enterobacteriaceae in a referral hospital in a developing country. Methods This was a retrospective cross-sectional study that included 218 patients admitted to An-Najah National University Hospital between 1 January 2021, and 31 May 2022. The target population was all patients with CRE infection or colonization in the hospital setting. Results Of the 218 patients, 135 had CR Klebsiella pneumoniae (61.9%) and 83 had CR Escherichia coli (38.1%). Of these, 135 were male (61.9%) and 83 were female (38.1%), with a median age of 51 years (IQR 24–64). Malignancy was a common comorbidity in 36.7% of the patients. Approximately 18.3% of CRE patients were obtained from patients upon admission to the emergency department, the largest percentage among departments. Most CRE pathogens were isolated from rectal swabs, accounting for 61.3%. Among the 218 patients, colistin was the most widely used antimicrobial agent (13.3%). CR E. coli showed resistance to amikacin in 23.8% of the pathogens tested and 85.7% for trimethoprim/sulfamethoxazole compared with CR K. pneumoniae, for which the resistance to trimethoprim/sulfamethoxazole was 74.1%, while for amikacin it was 64.2%. Regarding meropenem MIC, 85.7% of CR E. coli were greater than 16 mg/L compared with 84% of CR K. pneumoniae isolates. Conclusions This study found that CREs are frequently reported in this tertiary care setting, implying the presence of selective pressure and transmission associated with healthcare setting. The antibiotics tested showed a variety of resistance rates, with CR K. pneumoniae being more prevalent than CR E. coli and exhibiting an extremely high resistance pattern to the available therapeutic options.

2241. Antibiotic Use Before and After Hospital Admission Among Hospitalized Patients with Acute Febrile Illness in Bangladesh

Abstract Background The inappropriate use of antibiotics is common in Bangladesh, contributing to the significant burden of antimicrobial resistance. The WHO has categorized Access, Watch, and Reserve groups of antibiotics (AWaRe classification) to promote optimal use. We explored antibiotic use among hospitalized patients with acute febrile illness (AFI) at five tertiary-level hospitals in Bangladesh. Methods From September 2021 to February 2023, 1544 patients were randomly selected among all hospitalized patients with measured fever (≥100.4°F) or a history of fever in the past 14 days. Blood and urine culture isolates were analyzed for antibiotic sensitivity using the VITEK-2 system. Results Of enrolled AFI patients, 835 (54%) reported the use of antibiotics prior to hospitalization, with 79% of reported antibiotics from the Watch group, 16% from the Access group, and none from the Reserve group. Five percent of the antibiotics prescribed were not recommended by WHO for clinical practice. The top five frequently reported antibiotics before hospitalization were cefixime (24%), azithromycin (19%), ceftriaxone (16%), amoxicillin (6%), and cefuroxime (5%). Bacterial infection was diagnosed among 205 patients (13% of all enrollees) through Rapid diagnostic tests, culture and Rt-PCR. In-hospital, 1385 (90%) patients received at least one antibiotic. The most frequently prescribed antibiotics were from the Watch group (84%), followed by the Access group (15%) and none from the Reserve group. The top five antibiotics prescribed in-hospital were ceftriaxone (64%), amoxiclav (7%), ceftazidime (3.4%), clarithromycin (2.8%), and moxifloxacin (2.6%). Antibiotic susceptibility testing (AST) results from blood and urine culture isolates showed high resistance pattern to ceftriaxone (45% and 56%) and ceftazidime (63% and 50%). Of blood culture isolates 80% were sensitive to amoxiclav, while 46% of urine culture isolates were resistant to amoxiclav. At least one bacterial organism was identified in only 13% of enrolled patients. List of antibiotics that were reported to be received by the enrolled AFI patients before Hospitalization Before hospitalization, 132 patients reported receiving antibiotics from Access group, while 662 patients received antibiotics from WATCH group List of antibiotics received by the enrolled AFI patients during hospitalization During hospitalization, 211 patients received antibiotics from Access group and 1169 patients received antibiotics from Watch Group List of 235 bactrial organisms which were identified from clinical samples of 205 AFI patients (some patient had co-infection) Conclusion In conclusion, antibiotics were used in nine of ten patients. The frequent and inappropriate use of Watch group antibiotics in outpatient settings likely contributes to decreased effectiveness and demonstrates the need for improved antimicrobial stewardship. Disclosures All Authors: No reported disclosures

Prevalence of Extended Spectrum β-Lactamase Producers (ESBLs) with antibiotic resistance pattern of Gram negative pathogenic bacteria isolated from door handles in hospitals of Pokhara, Western Nepal

BackgroundThe presence of drug-resistant Gram-negative pathogenic bacteria and Extended Spectrum β-Lactamase Producers (ESBLs) in hospital associated fomites like door handles can serve as vehicles in transmission and may be the key factor in epidemiology of ESBL producing bacterial infection not only in a hospital setting but also in the community. The aim of this study was to determine the prevalence of ESBLs and antibiotic resistance of Gram-Negative pathogenic Bacteria isolated from door-handles in two selected hospitals in Pokhara Metropolitan City, Nepal. The study was conducted in selected hospitals in Pokhara Metropolitan City, Western Nepal. A cross-sectional study design was used. The hospitals were selected randomly. A total of 100 swab samples were taken from door-handles. Isolation and identification of bacteria were done using standard microbiological procedures. An antibiotic susceptibility test, screening and confirmation of ESBLs were performed using the Clinical Laboratory Standard Institute’s guidelines. ResultsOut of the 100 swab samples cultured, 96 (96%) showed bacterial growth. A total of one hundred and forty isolates were isolated in this study which were further identified based on cultural, morphological and biochemical characteristics. The study also found that door handles/knobs had higher level of contamination in Outpatient Departments (OPDs), Emergency, Laboratory, General wards and Toilets, in that order as compared to Radiology Room, Staff rooms, Intensive Care Unit and Operation Theatre which were lower. The level of contamination varies depending on the traffic exposure and the environment. The most prevalent Gram-negative bacteria identified was Escherichia coli 28.85%, followed by Klebsiella spp 21.15%, Pseudomonas aeruginosa 15.38%, Proteus spp 11.54%, Enterobacter spp 9.62%, Acenetobacter spp 7.69%, Citrobacter spp 5.77%. The most effective drug of choice was Amikacin, Nitrofurantoin, Norfloxacin, Ciprofloxacin, Tetracycline and Imipenem for many Gram-negative isolates. The overall prevalence of ESBLs in this study was 27.14%. Out of total 15 Escherichia coli isolated, 11(73.3%), Klebsiella spp 9/11 (81.8%); Pseudomonas spp 7/8 (87.5%), Proteus spp 4/6 (66.6%); Enterobacter spp 3/5 (60%), Acenetobacter spp 3/4 (75%) and Citrobacter spp 1/3 (33.3%) were found to be Extended β-Lactamase Producers (ESBLs). ConclusionThe isolation of of pathogenic Gram-negative bacteria and ESBLs in hospital environments and subsequent detection of high drug resistance patterns indicates a potentially serious public health challenge that strengthens the need for the effective and routine cleaning of door-handles in hospitals.

Epidemiology and clinical characteristics of patients with carbapenem-resistant enterobacterales infections: experience from a large tertiary care center in a developing country

BackgroundCarbapenem-resistant Enterobacterales (CREs) are a significant source of healthcare-associated infections. These bacteria are difficult to treat and have a high mortality rate due to high rates of antibiotic resistance. These pathogens are also linked to major outbreaks in healthcare institutions especially those with limited resources in infection prevention and control (IPC). Therefore, our study aimed to describe the epidemiology and clinical characteristics of patients with carbapenem-resistant Enterobacteriaceae in a referral hospital in a developing country.MethodsThis was a retrospective cross-sectional study that included 218 patients admitted to An-Najah National University Hospital between January 1, 2021, and May 31, 2022. The target population was all patients with CRE infection or colonization in the hospital setting.ResultsOf the 218 patients, 135 had CR-Klebsiella pneumoniae (61.9%), and 83 had CR-Escherichia coli (38.1%). Of these, 135 were male (61.9%) and 83 were female (38.1%), with a median age of 51 years (interquartile range 24–64). Malignancy was a common comorbidity in 36.7% of the patients. Approximately 18.3% of CRE patients were obtained from patients upon admission to the emergency department, the largest percentage among departments. Most CRE pathogens were isolated from rectal swabs, accounting for 61.3%. Among the 218 patients, colistin was the most widely used antimicrobial agent (13.3%). CR- E. coli showed resistance to amikacin in 23.8% of the pathogens tested and 85.7% for trimethoprim/sulfamethoxazole compared to CR- K. pneumonia, for which the resistance to trimethoprim/sulfamethoxazole was 74.1%, while for amikacin it was 64.2%. Regarding meropenem minimum inhibitory concentration, 85.7% of CR- E. coli were greater than 16 µg/mL compared to 84% of CR- K. pneumonia isolates.ConclusionThis study found that CRE is frequently reported in this tertiary care setting, implying the presence of selective pressure and transmission associated with healthcare setting. The antibiotics tested showed a variety of resistance rates, with CR-K. pneumoniae being more prevalent than CR-E. coli, and exhibiting an extremely high resistance pattern to the available therapeutic options.

IN VITRO ACTIVITY OF CEFTAZIDIME-AVIBACTAM AGAINST CARBAPENEM RESISTANT GRAM NEGATIVE ISOLATES

Introduction: Ceftazidime-Avibactam (CZA) is a β-lactam-β-lactamase inhibitor combination (BL/BLI) that has been given approval by the Food and Drug administration (FDA) for the treatment of different illnesses. However, resistance to Ceftazidime-Avibactam is developing in Carbapenem-resistant Enterobacteriaceae (CRE), Carbapenem-resistant Pseudomonas aeruginosa, and other Gram-negative bacteria, necessitating study of CZAs in vitro activity against these pathogens. Objective: To assess CZAs in vitro activity against CRE, carbapenem-resistant Pseudomonas aeruginosa, and other Gram-negative bacteria. Results: Of the 62 Carbapenem-resistant isolates obtained from various samples, Klebsiella pneumoniae accounted for 22 (35.48%), followed by Escherichia coli 21(33.87%), Pseudomonas aeruginosa 10(16.13%), Acinetobacter baumanii 7(11.30%), Citrobacter freundii 1(1.61%), and Proteus mirabilis 1 (1.61%) and the susceptibility rates against CZA showed Klebsiella pneumoniae-45.45% followed by E.coli-27.27%, Pseudomonas aeruginosa-18.18%, Citrobacter freundii-9.09% and the strains of A.baumanii and P.mirabilis were totally resistant to CZA. Conclusion: Even though CZA is regarded as an alternative form of treatment for infections caused by Carbapenem-resistant organisms (CRO), the higher resistance pattern at our center necessitates additional research involving numerous isolates and at different centers, where the results can be compared in order to ascertain the true prevalence of CZA resistance.

Clinical Profile of Patients and Antibiogram of Acinetobacter baumannii Isolates in a Tertiary Care Hospital, Central India

Acinetobacter baumannii (A. baumannii) is a remarkable opportunistic pathogen responsible for a great proportion of hospital-associated infections and the high prevalence of resistance towards many classes of antibiotics makes the treatment challenging. The present cross-sectional study was conducted in the Department of Microbiology, IMCHRC, Indore. The study was approved by IEC and conducted from October 2019 to September 2021. A total number of 168 Acinetobacter species including 143 A. baumannii were isolated from the various clinical specimens, the majority of the isolates were obtained from the respiratory system (66%), followed by urine, pus/wound swab, blood, fluids and other samples. The majority of the patients who had underlying/diagnosed with a disease such as aspiration pneumonia/pneumonia (35%), cerebrovascular accident/haemorrhagic shock (30.7%), respiratory failure (24%), accelerated HTN/HTN(18%), and less common were septicemia (8.4), acute kidney injury/chronic kidney diseases (7.7%) and trauma/burns (5.5%). The antibiotic susceptibility testing showed higher antibiotic resistance to cefotaxime (94%), ceftazidime (93%), cefepime (92%), imipenem (92%), meropenem (90%) and the resistance was low to doxycycline (39%) Polymyxin B (8%). The association between antibiotic resistance and the clinical profile of patients was found significant (p-value &lt; 0.05). In our study, a remarkably high antibiotic resistance pattern was observed in the classes of antibiotics in A. baumannii isolates, mostly MDR and XDR. To address infection caused by antibiotic-resistant A. baumannii, appropriate antibiotic administration in a clinical setting is essential. Moreover, local and national surveillance data, stringent infection control, and antimicrobial stewardship are required.

PHENOTYPIC DETERMINATION OF INDUCIBLE CLINDAMYCIN RESISTANT AND METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS FROM CLINICAL ISOLATES OF KHYBER TEACHING HOSPITAL, PESHAWAR

Methicillin Resistant Staphylococcus aureus (MRSA) is a major pathogen involved in nosocomial infections and to some extent, in community acquired infections. Among Macrolide Lincosamine Streptogramin B (MLSB) class of drugs, Clindamycin was vigorously preferred for treating staphylococcal infections in the past few decades but, some genetic factors i.e. erm and msrA genes contribute in developing Inducible Clindamycin Resistance (iCR). Sensitivity tests performed on a routine basis cannot detect inducible resistance and may result in the failure of Clindamycin to be used as an effective medication. This study aimed to detect the phenotype of MRSA and iCR S. aureus from the clinical samples of Khyber Teaching Hospital, Peshawar. A total of 204 samples were collected randomly from each gender, 130 (63.72%) samples were isolated as S. aureus, while 74 (36.27%) were other bacterial species. Double disk diffusion (D-test) was performed to detect iCR phenotype, and 80 (61.5%) isolates showed iCR, while 50 (38.4%) were negative in this regard. MRSA phenotype was determined by strains conferring resistance to Cefoxitin antibiotic, which resulted in 84 (64.6%) isolates of MRSA and 46 (35.3%) of Methicillin Sensitive Staphylococcus aureus (MSSA). Antibiogram analysis showed efficient antimicrobial activity by Tigecycline 129 (99.2%), Fusidic Acid 126 (96.9%), and Doxycycline 124 (95.3%), while the highest resistance pattern was recorded against Ciprofloxacin 31(23.8%) and Clindamycin 28(21.5%). Our study concludes that misuse of antibiotics should be avoided to inhibit the spread of MRSA, and implementation of D-test regularly in hospitals is crucial.

Emergence of microbial infections in some hospitals of Cairo, Egypt: studying their corresponding antimicrobial resistance profiles

BackgroundAntimicrobial resistance is one of the ten major public health threats facing humanity, especially in developing countries. Identification of the pathogens responsible for different microbial infections and antimicrobial resistance patterns are important to help clinicians to choose the correct empirical drugs and provide optimal patient care.MethodsDuring the period from November 2020 to January 2021, one hundred microbial isolates were collected randomly from different specimens from some hospitals in Cairo, Egypt. Sputum and chest specimens were from COVID-19 patients. Antimicrobial susceptibility testing was performed according to CLSI guidelines.ResultsMost microbial infections were more common in males and in elderly people over 45 years of age. They were caused by Gram-negative, Gram-positive bacteria, and yeast isolates that represented 69%, 15%, and 16%, respectively. Uropathogenic Escherichia coli (35%) were the most prevalent microbial isolates and showed high resistance rates towards penicillin, ampicillin, and cefixime, followed by Klebsiella spp. (13%) and Candida spp. (16%). Of all microbial isolates, Acinetobacter spp., Serratia spp., Hafnia alvei, and Klebsiella ozaenae were extremely multidrug-resistant (MDR) and have resisted all antibiotic classes used, except for glycylcycline, in varying degrees. Acinetobacter spp., Serratia spp., and Candida spp. were secondary microbial infections in COVID-19 patients, while H. alvei was a bloodstream infection isolate and K. ozaenae was recorded in most infections. Moreover, about half of Staphylococcus aureus strains were MRSA isolates and reported low rates of resistance to glycylcycline and linezolid. In comparison, Candida spp. showed high resistance rates between 77 and 100% to azole drugs and terbinafine, while no resistance rate towards nystatin was reported. Indeed, glycylcycline, linezolid, and nystatin were considered the drugs of choice for the treatment of MDR infections.ConclusionThe prevalence of antimicrobial resistance in some Egyptian hospitals was high among Gram-negative, Gram-positive bacteria, and candida spp. The high resistance pattern —especially in secondary microbial infections in COVID-19 patients— to most antibiotics used is a matter of great concern, portends an inevitable catastrophe, and requires continuous monitoring to avoid the evolution of new generations.

Executive Summary: Guidelines for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: Neurology, Peri-Transplant Medicine, Infectious Disease, and Gastroenterology Considerations.

Executive Summary: Guidelines for the Management of Adult Acute and Acute-on-Chronic Liver Failure in the ICU: Neurology, Peri-Transplant Medicine, Infectious Disease, and Gastroenterology Considerations.

Effect of shoeing horses with eggbar shoes and shoes with wedge pads on blood flow parameters in the lateral digital artery in the Doppler ultrasound.

A sound knowledge of horseshoe impact on blood flow parameters is required for making shoeing decisions and selecting the most appropriate types of shoes. The aim of this study was to determine the effect of horse shoeing with egg bar shoes and shoes with wedge pads on blood flow parameters in the lateral palmar digital artery measured by Doppler ultrasound. The study was conducted on 16 horses divided into two groups. Horses from group 1 were shod with egg bar shoes. Horses from group 2 were shod with shoes with wedge pads. Doppler ultrasound parameters of the lateral palmar digital artery at the level of the metacarpophalangeal joint were evaluated. Doppler tests were performed before and after shoeing within a monthly interval. The results of the study indicate that egg bar shoes have a greater impact on blood circulation in the distal part of the equine limb than shoes with wedge pads. However, the only parameters to have changed substantially after shoeing with egg bar shoes were end-diastolic velocity (EDV) and mean velocity (Vmn) in the lateral palmar digital artery. A low-resistance blood flow pattern was noted before shoeing. After shoeing in group 1, it remained unchanged in 5 horses, whereas a high-resistance pattern was observed in 3 animals. A low-resistance blood flow pattern was noted in all group 2 horses after shoeing. The difference between the analyzed shoeing techniques could be attributed to increased pressure in the heel bulb area in horses shod with egg bar shoes. Wedge pads shift the load away from the heel bulbs, which might reduce the pressure on the palmar digital vessels and exert a smaller influence on the parameters measured in the Doppler ultrasound test.

Evaluation of the bacterial contamination of face masks worn by personnel in a center of COVID 19 hospitalized patients: A cross-sectional study

BackgroundDuring the Coronavirus Pandemic, the use of masks has increased significantly. The lack of control on hygiene protocols and the need to use PPE properly increases the spread of bacterial infection. The purpose of this study was to investigate the degree of contamination and frequency of bacterial species isolated from surgical and N95 masks used by hospital personnel. MethodsA total number of 175 masks were collected from staff working in Sina hospital (Hamadan province, Iran) during the first six months of 2022. The bacterial contamination of masks were evaluated and identified using biochemical kits. Antimicrobial susceptibility testing of the isolates were done using Kirby-Bauer methods and MIC were assessed for each isolate against different disinfectants (Sodium hypochlorite 5%, Hydrogen Peroxide 3%, Ethanol 70% and Deconex). ResultsOf 175 masks, 471 bacterial isolates were detected including 9 species. The most prevalent strain were Coagulase negative Staphylococcus (28%) followed by Acinetobacter (20.8%) and Pseudomonas (13.8%), while, Klebsiealla and Enterococcus were the least frequent species with the rate of 3.8% and 1.2%, respectively. The results of MIC methods indicated that all 471 strains were resistant to ehtanol70% and sensitive to hydrogen peroxide 3%. Furthermore, the mean average of Deconex inhibitory effect is lower than Sodium hypochlorite 5%. ConclusionsAccording to the results of this study, there was a high prevalence of CoNS, Acinetobacter and Pseudomonas in hospital with a high resistance pattern against antibiotics especially Ampicillin and disinfectants.

In-silico design and evaluation of an epitope-based serotype-independent promising vaccine candidate for highly cross-reactive regions of pneumococcal surface protein A

BackgroundThe pathogenicity of pneumococcus with high morbidity, mortality, and multi-drug resistance patterns has been increasing. The limited coverage of the licensed polysaccharide-based vaccines and the replacement of the non-vaccine serotypes are the main reasons for producing a successful serotype-independent vaccine. Pneumococcal surface protein A (PspA) is an extremely important virulence factor and an interesting candidate for conserved protein-based pneumococcal vaccine classified into two prominent families containing five clades. PspA family-elicited immunity is clade-dependent, and the level of the PspA cross-reactivity is restricted to the same family.MethodsTo cover and overcome the clade-dependent immunity of the PspAs in this study, we designed and tested a PspA1-5c+p vaccine candidate composed of the highest immunodominant coverage of B- and T-cell epitope truncated domain of each clade focusing on two cross-reactive B and C regions of the PspAs. The antigenicity, toxicity, physicochemical properties, 3D structure prediction, stability and flexibility of the designed protein using molecular dynamic (MD) simulation, molecular docking of the construct withHLADRB1*(01:01) and human lactoferrin N-lop, and immune simulation were assessed using immunoinformatics tools. In the experimental section, after intraperitoneal immunization of the mice with Alum adjuvanted recombinant PspA1-5c+p, we evaluated the immune response, cross-reactivity, and functionality of the Anti-PspA1-5c+p antibody using ELISA, Opsonophagocytic killing activity, and serum bactericidal assay.ResultsFor the first time, this work suggested a novel PspA-based vaccine candidate using immunoinformatics tools. The designed PspA1-5c+p protein is predicted to be highly antigenic, non-toxic, soluble, stable with low flexibility in MD simulation, and able to stimulate both humoral and cellular immune responses. The designed protein also could interact strongly with HLADRB1*(01:01) and human lactoferrin N-lop in the docking study. Our immunoinformatics predictions were validated using experimental data. Results showed that the anti-PspA1-5c+p IgG not only had a high titer with strong and same cross-reactivity coverage against all pneumococcal serotypes used but also had high and effective bioactivity for pneumococcal clearance using complement system and phagocytic cells.ConclusionOur findings elucidated the potential application of the PspA1-5c+p vaccine candidate as a serotype-independent pneumococcal vaccine with a strong cross-reactivity feature. Further in-vitro and in-vivo investigations against other PspA clades should be performed to confirm the full protection of the PspA1-5c+p vaccine candidate.

Phenotypic and Genotypic Characterization of Klebsiella pneumoniae isolated from Clinical Mastitis in Buffaloes

Mastitis is the most common serious and economical disease affecting the dairy industry. The current study aimed to determine the molecular characterization of K. pneumoniae isolated from buffaloes with clinical mastitis as well as determine the antimicrobial pattern and virulence associated genes. Out of examination one hundred and fifty dairy buffaloes at Beheria governorate, 57 (38%) showed clinical mastitis signs. All samples are submitted to bacteriological examination and confirmed by biochemical tests. The result showed that K.pneumoniae was identified in only five (8.7%). Regarding to the antibiogram profile, K. pneumoniae isolates exhibited high resistance pattern against Carbenicillin, Cefotaxime, Flumequine, Gentamicin, Kanamycin (100%) followed by Neomycin, Nitrofurantoin, Penicillin (80%) and Oxytetracycline, Sulfamethoxazole / trimethoprim (60%). Meanwhile, higher susceptibility to Ampicillin (100%), followed by Chloramphenicol, Colistin Sulphate, Erythromycin, and Streptomycin (80%). Molecular identification using the mPCR approach applied efficiently to detect the K. pneumoniae virulence genes (mrkA, mrkD, iutA) at 475, 226, 300bp respectively. In addition, the successfully detection of blaTEM and blaSHV for β lactams resistance genes at 516 and 392 bp. In conclusion, the phenotypic and genotypic resistance pattern of K. pneumoniae isolates indicates the portability of transmission of resistance genes through milk and food chain with public health concern.

Prevalence and whole-genome analysis of multidrug-resistant Salmonella isolated from chicken carcasses in Hanoi

Salmonella enterica is one of the most dangerous food-borne pathogens posing a significant global concern especially to travelers returning from developing countries. Given that chicken is the main reservoir for Salmonella, the emergence and spread of multi-drug resistant Salmonella from chicken have not been fully described in Vietnam. The present study aimed to evaluate the phenotypic and genotypic antimicrobial resistances of Salmonella from chicken carcasses. Among 104 raw chickens collected from 5 districts in Hanoi city, 65 samples were contaminated with Salmonella of which the highest contamination rate was found in Thanh Xuan. A total of 63/65 (96.9%) of Salmonella isolates were resistant to at least one antibiotic and 61/65 (93.9%) of the isolates were found to be multidrug resistant. Whole-genome sequencing was employed to analyze 4 strains with high (12_S2 and 61_S18) and low (19_S4 and 8_S1) antimicrobial resistance patterns. Genomic analysis indicated the presence of 27 genes conferring antibiotic resistance. Genotypes were highly correlated to observed phenotypes in 4 strains. Importantly, extended-spectrum β-lactamase blaCTX-M-55 and colistin resistance mcr-3 were reported in isolates of Salmonella enterica serovar Typhimurium. This is the first report showing the prevalence and genome sequences of Salmonella from chicken carcasses collected in Hanoi, Vietnam. The results represented herein provided the basis to understand the dynamics of antibiotic resistance of Salmonella in Vietnam and to spot antimicrobial resistance determinants for early diagnosis.

Antibiotic Resistance Profile of Listeria monocytogenes Recovered from Ready-to-Eat Foods Surveyed in South Africa

In recent decades, there has been an increase in the reports of antimicrobial resistance of Listeria monocytogenes, which constitutes a serious threat to the therapeutic management of listeriosis infection. Our study profiled the antibiogram fingerprint of L. monocytogenes isolates (n = 194) recovered from common South African ready-to-eat foods. L. monocytogenes isolates recovered from foods were tested against a panel of 22 antibiotics using the disk diffusion method. Antimicrobial resistance (>50%) against ceftriaxone (53.1%), trimethoprim (56.2%), streptomycin, cefotetan (59.3%), sulfamethoxazole (61.9%), vancomycin, and oxytetracyclines (62.9%) were observed. Thirty of the isolates (15.5%) were resistant against only one or two antibiotics, whereas 162 (83.5%) exhibited phenotypic multiple antibiotic resistance. Only two (1%) of the isolates did not exhibit phenotypic resistance against any antibiotics screened. Multiple antibiotic phenotypes revealed high resistance patterns, and the multiple antibiotic indices were greater than the Krumperman permissible (>0.2) benchmark. Of the 44 genes screened, 22 antimicrobial resistance genes were detected among ready-to-eat food isolates, including resistance determinants that encode sulfonamides (n = 125, 64.4%), β-lactams (n = 86, 44.3%), phenicols (n = 25, 12.9), and aminoglycosides (n = 93, 47.9%) resistance. We conclude that the presence of resistant L. monocytogenes isolates harboring corresponding antimicrobial resistance genes in foods could compromise safety and constitute severe health consequences if consumed.

Prevalence and Antibiogram of Escherichia coli and Staphylococcus spp. Isolated from Cattle Milk Products Sold in Juja Sub-County, Kenya

Dairy ruminant milk provides a conducive environment for bacterial proliferation. In animals, these bacteria are exposed to antibiotics, whose overuse has led to increased cases of drug resistance. A cross-sectional study was conducted on milk and milk products vended in Juja Sub-County, Kenya to determine the prevalence of bacteria and antibiogram of Staphylococcus spp. and Escherichia coli. A total of 169 milk samples were obtained from various outlets in the study area. Milk samples were cultured and isolated bacteria were identified using standard bacteriological procedures. Various bacteria (15 species) were isolated in different proportions. Staphylococcus spp. and E. coli were isolated from 25.4% and 11.8% of the collected samples, respectively. The highest number of Staphylococcus spp. were isolated from raw milk (n = 34) while the highest number of E. coli where isolated from fermented milk (n = 15). Staphylococcus spp. and E. coli isolates were subjected to antimicrobial susceptibility tests using CLSI guidelines. The Staphylococcus spp. isolates were highly resistant to penicillin G (93%) but susceptible to norfloxacin (100%), gentamicin (90.6%), and chloramphenicol (86%). The E. coli isolates were highly resistant to cephalexin (85%) and ceftazidime (60%) but susceptible to chloramphenicol (100%), norfloxacin (95%), gentamicin (95%), azithromycin (95%) and cefepime (80%). Furthermore, 44.3% of Staphylococcus spp. and 50% of E. coli isolates had a Multiple Antibiotic Resistance (MAR) Index greater than 0.2. This implies that these bacteria were high-risk bacteria whose treatment with current antibiotics would be challenging. The high prevalence and multidrug resistance patterns shown by the Staphylococcus spp. and E. coli isolated from milk products in Juja Sub-county highlights the importance of proper handling and processing of milk from the farm to consumers. This will in turn reduce the possibility of zoonotic transfer of multidrug-resistant bacteria.