High Percentage Of Resistance Research Articles

Monitoring antimicrobial resistance trends in Salmonella spp. from poultry in Eastern Spain

Salmonella spp. is one of the most important zoonotic pathogens with economic impact in public health worldwide. The relevance of Salmonella increases with the appearance of resistant strains. The aim of this study was to determine the level of antimicrobial resistance in 332 Salmonella isolates selected from 3 different poultry productive orientations in Eastern Spain during 3 yr (2015–2017). Antimicrobial susceptibly was evaluated by broth microdilution method using 14 antibiotics. Epidemiological cut-off values (ECOFF) were used to evaluate the microbiological resistance to antibiotics. The rates of Salmonella resistance at least to one antibiotic were 96, 98, and 56% in broilers, turkeys, and layers, respectively. Regarding multidrug resistance, all productive orientations seems to present a decreasing trend along the study, being the mean rates 80% in turkeys followed by broilers (40%) and layers (6%). Throughout the study, the highest percentage of resistance was found to sulfamethoxazole in all productive orientations. Strains from broilers showed the highest resistance rates to sulfamethoxazole (73%), gentamicin (57%), ciprofloxacin (50%), nalidixic acid (29%), and tetracycline (24%). Relative to turkeys the highest resistance rates were to sulfamethoxazole (76%), ciprofloxacin (69%), tetracycline (75%), nalidixic acid (63%), and ampicillin (63%). Layers presented the most elevated resistance rates to sulfamethoxazole (39%) and tetracycline (13%). Regarding serovars the most MDR common serovars to the 3 productive orientations were S. Kentucky and S. Hadar. In the other hand, high MDR rates were found in other serovars like S. Infantis and S. Typhimurium in broilers and turkeys. Results shown in the present study suggest that the reduction in the use of antibiotics begins to be reflected in the reduction of the number of MDRs, especially in layers, with no MDR Salmonella strains in the last period. However, the level of resistances found in this study suggests the necessity of continuing working on the limitation of the use of antimicrobials in poultry to achieve (as in layers) the control of MDRs.

Frequency of microbial isolates and pattern of antimicrobial resistance in patients with hematological malignancies: a cross-sectional study from Palestine

BackgroundInfections are the main cause of death in patients with hematologic malignancies. This study aims to determine the microbial profile of infections in patients with hematologic malignancies and to determine the antimicrobial resistance patterns for these pathogens.MethodsA retrospective descriptive cross-sectional study was conducted from January 2018 to December 2019 at a large hematological center in Palestine. The medical data of hematologic malignancy patients with positive cultures were collected from the hematology/oncology department using the hospital information system, and data regarding the microbial isolates and their antimicrobial resistance were collected from the microbiology laboratory.ResultsA total of 144 isolates were identified from different types of specimens, mostly blood samples. Of all isolates, 66 (45.8%) were gram-negative bacteria (GNB), 57 (39.6%) were gram-positive bacteria (GPB), and 21 (14.6%) were fungal isolates. The GNB that were most frequently isolated were Pseudomonas aeruginosa (27, 40.9%), followed by Escherichia coli (E. coli) (20, 30.3%). Fourteen isolates (24.6%) of GPB were Staphylococcus epidermidis followed by Enterococcus faecium (10, 17.5%) and Staphylococcus hemolyticus (10, 17.5%). The most frequent fungal pathogens were Candida species (20, 95.2%). GNB were found to be resistant to most antibiotics, mainly ampicillin (79.3%). Pseudomonas aeruginosa exhibited high resistance to ciprofloxacin (60%) and imipenem (59.3%). Among GPB, high resistance rates to oxacillin (91.1%) and amikacin (88.8%) were found. All isolated strains of Staphylococcus epidermidis were resistant to cephalosporins and oxacillin. Approximately half of the GNB isolates (34, 51.5%) were multi-drug resistant organisms (MDRO), and 16.7% (11 isolates) were difficult-to-treat resistance (DTR). Furthermore, 68.4% (39 isolates) of GPB were MDRO. The proportion of staphylococci (CoNS and S. aureus) resistant to oxacillin was 91.7%, while 88.6% of enterococci were resistant to vancomycin.ConclusionsThe findings of this study confirm the predominant microorganisms seen in patients with hematologic malignancies, and show a high percentage of antibiotic resistance. Policies regarding antibiotic use and proper infection control measures are needed to avert the ever-growing danger of antimicrobial resistance. This may be achieved by developing antibiotic stewardship programs and local guidelines based on the hospital's antibiogram.

An Epidemiological and Multidrug Resistance Study for E. coli Isolated from Urinary Tract Infection (Three Years of Study)

Uropathogenic E. coli (UPEC) is problematic and still the leading cause of urinary tract infections worldwide. It is developed resistance against most antibiotics. The investigation, surveillance system, and efficient strategy will facilitate selecting an appropriate treatment that could control the bacterial distribution. The present study aims to investigate the epidemiology and associated risk factors of uropathogenic E. coli and to study their antibiotic resistance patterns. 1585 midstream urine specimens were collected from symptomatic urinary tract infections (UTI) patients (225 males and 1360 females) admitted to Zakho emergency hospital, Zakho, Kurdistan Region, Iraq from January 2016 until the end of December 2018. Specimens were inoculated on blood and MacConkey plates and incubated at 37оC for 24 hours. Uropathogenic E. coli was diagnosed based on gram staining, colony characteristics, and standard biochemical tests in accordance with local standards and guidelines. All isolates were screened for their antibiogram pattern using the disk diffusion method based on the Clinical and Laboratory Standards Institute guidelines. The results showed that out of 1585 urine specimens, 1026 (64.7%) were UTIs positive with a statistically higher rate in 2016 (83.6%) (P< 0.0001). The UTIs frequency in females was significantly higher than males (P< 0.0001). Generally, the uropathogenic E. coli represented 21.1% with the highest level in 2016 (22.9%). The uropathogenic E. coli rate was higher, statistically not significant, in females (21.4%) than males (18.5%) (P=0.4946). Additionally, through the three years of study, uropathogenic E. coli (UPEC) was in high frequency in February and May 2016. The female’s age group from 20 to 39 years was the most vulnerable (46%) form total infected females, while those from 70-74 years (1%) were the least susceptible in males and females. A high percentage (80.56 %) of multidrug resistance E. coli isolates was observed with high resistance against -lactamase and macrolides antibiotics. However, higher sensitivity was towards imipenem and meropenem. In conclusion, the wrong and overuse of antibiotics will increase the resistance rate of E. coli. For this reason, proper use of available antibiotics is necessary. Also, the educational programs and periodic monitoring of antimicrobial suscep­tibility are essential for reducing the antibiotic resistance rate.

Methicillin-resistant Staphylococcus epidermidis infectious keratitis: Clinical and microbiological profile

IntroductionStaphylococcus epidermidis (SE) is a common cause of bacterial keratitis in certain geographic areas. A high percentage of resistance to methicillin is shown, which gives it cross resistance to beta-lactams and sometimes resistance to other antibacterial groups. We analyzed clinical and microbiological variables in patients with infectious keratitis due to SE.MethodsMedical records of 43 patients with suspected infectious keratitis and microbiological confirmation for SE, between October 2017 and October 2020, were retrospectively studied. Clinical characteristics (risk factors, size of lesions, treatment, evolution) and microbiological (susceptibility to antibiotics) were analyzed, and groups of patients with methicillin-resistant (MRSE) and methicillin-susceptible (MSSE) infection were compared.ResultsMRSE was present in 37.2% of infectious keratitis. All isolates were sensitive to vancomycin and linezolid. Rates of resistance to tetracyclines and ciprofloxacin were 50% and 56% in the MRSE group, and 11% and 7% in the MSSE group. The clinical characteristics, including size of lesion, visual axis involvement, inflammation of anterior chamber, presence of risk factors and follow-up time, did not show statistically significant differences between groups.ConclusionsMRSE is a common cause of infectious keratitis caused by SE and shows a high rate of multidrug resistance. Clinically, it does not differ from MSSE keratitis. Additional work is needed to confirm these findings.

Parasitological, microbiological, and antimicrobial resistance profiles of raw and drinking water in a tourist city in the tri-border region of South America.

Despite the large amounts of freshwater available in Brazil, the deterioration of surface water can represent a risk of waterborne disease for national and international tourists. The main goal of this study was to assess the quality of drinking water in the triple border region of Brazil before and after being treated in water treatment plants (WTPs) and in Municipal Early Childhood Education Centers (MECECs), in terms of parasitological, microbiological, and physical-chemical aspects. Different water samples were monitored: raw water (RW), treated water (TW), and tap water from the MECECs, giving 60 samples in total, to investigate the presence of Giardia and Cryptosporidium, microbiological indicators, Pseudomonas aeruginosa, and antimicrobial resistance profiles using conventional microbiological assays and parasitological, immunological, and molecular techniques. The results obtained were compared with the reference values recommended by the legislation of drinking water in Brazil. For the first time, contamination by Cryptosporidium and Giardia was demonstrated in RW used to supply WTPs, in TW of Foz do Iguaçu, and in water destined for consumption by children. A total of 52 bacterial isolates were obtained, with high percentages of multidrug resistance to antibiotics, including a carbapenem-resistant profile, highlighting the need to improve quality control standards.

Tertiary hospital sewage as reservoir of bacteria expressing MDR phenotype in Brazil.

High doses of antibiotics used in hospitals can affect the microbial composition of sewers, selecting resistant bacteria. In this sense, we evaluated the antibiotic resistance profile and the multiresistant phenotype of bacteria isolated in sewage from a tertiary hospital in the interior São Paulo state, Brazil. For bacteria isolation, 10 µL of sewage samples were sown in selective culture media and the isolates were identified using VITEK-2 automatized system. The antibiotic sensitivity test was performed by disk diffusion. High percentages of resistance were found for amoxicillin, ampicillin, ceftazidime, clindamycin, vancomycin and the multidrug-resistant phenotype (MDR) was attributed to 60.7% of the isolates. Our results show bacteria classified as critical/high priority by WHO List of Priority Pathogens (Enterococcus and Staphylococcus aureus resistant to vancomycin and Enterobacteriaceae resistant to carbapenems) in hospital sewage. Therefore, the implementation of disinfection technologies for hospital sewage would reduce the bacterial load in the sewage that will reach urban wastewater treatment plants, minimizing superficial water contamination and bacterial resistance spread in the environment.

Environmental risk quotient of the antibiotic, phenotypic, and genotypic profiles for antibiotic resistance of Escherichia coli collected from manure and wastewater at swine farms in Prachinburi Province, Thailand

Currently, antimicrobial drug resistance is a problem that deserves thoughtful consideration. Especially in the swine production industry, many pig farms tend to release wastewater into natural water sources, which villagers use for their livelihood. This study aimed to demonstrate the occurrence of phenotypic and genotypic resistance characteristics of E. coli, as well as antibiotic residues in manure and wastewater on swine farms in Prachinburi Province, Thailand. Samples were collected in 2020 and 2021 during the rainy and summer seasons. The results of a questionnaire showed that farmers used antibiotics for disease treatment and prevention at a ratio of 2/4 (50%). The most common antibiotic used was amoxicillin (4/4, 100%), followed by Enrofloxacin (75%) and colistin (25%). The analysis of antibiotic residue in wastewater by Liquid Chromatography-Mass Spectrometry (LCMS, LC-MS) during the rainy season revealed that amoxicillin (54%) was the highest, followed by florfenicol (14%) and tiamulin (13%). While oxytetracycline (59%), amoxicillin (20%), and florfenicol (11%) were the highest in the summer. The study of Risk Quotient (RQ) indicated that water resources present a risk of antibiotic contamination by sulfonamides, trimethoprim, β-lactam, quinolones, and tetracycline at high levels (ΣRQ >1) during both seasons. The minimal inhibitory concentrations (MICs) were determined by an antibiotic susceptibility test (AST), analyzed by microdilution technique, and VITEK® 2 Compact. The test result indicated that a total of 143 isolates were found in manure (45/143), pre-treatment (51/143), and final effluent (post-treatment, 47/143). ESBL-positive resistance was detected at 13%. However, an immensely high percentage of antimicrobial resistance was found for ampicillin (90%), whereas imipenem did not show any drug resistance (0%). The average MIC value towards colistin in all samples was 2.71 μg/ml, while mcr1 was not found in any samples. Furthermore, MDR was expressed in E. coli at as high as 76.22% (109/143). The highest MDR pattern detected was AMP-TET–FFC–SXT.The PCR technique detected that the diversity and abundance of AMR genes were not significantly different from animal manure and wastewater at the swine farms. The bla-TEM was found more frequently than bla-PS. While the tetracycline group (tetA, tetB) and aminoglycoside (aadA1, aadA2, aadB) represented a major proportion, respectively. The PFGE study revealed the possibility of similar genetic morphology from the different isolates found in this study.

Prevalence of multidrug-resistant, extensively drug-resistant, and pandrug-resistant phenotypes among Klebsiella pneumoniae collected from referral therapeutic centers in Sari, North Iran

Aims: Klebsiella pneumoniae is an important cause of nosocomial infections. The present study sought to detect resistance status and the frequency of multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) K. pneumoniae strains isolated from hospitalized patients. Materials and Methods: Confirmation of K. pneumoniae isolates was performed by polymerase chain reaction (PCR) for rpoB fragment. Drug susceptibility was done by disk diffusion method based on the Clinical and Laboratory Standards Institute. According to the susceptibility pattern, the strains were categorized as MDR, XDR, and PDR. Results: On the basis of PCR results, rpoB gene was identified in all 100 K. pneumoniae isolates. Most K. pneumoniae strains showed a high percentage of resistance against ampicillin-sulbactam (93%). On the other hand, tigecycline and fosfomycin were active against 100% and 90% isolates, respectively. The multiple resistance analysis of the strains showed that 58% and 13% of isolates were identified as MDR and XDR, respectively. Overall, no PDR isolate was detected in any tested strains. Conclusion: Our results demonstrated that the vast majority of K. pneumoniae strains indicated the MDR phenotype including a high resistance rate to common antibiotics. Therefore, it is suggested to implement antimicrobial susceptibility testing before prescribing, to assist in selecting the most effective agents within the antimicrobial categories for the treatment of infections with multiple antibiotic-resistant K. pneumoniae strains in hospitalized patients.

Phenotypical and genotypical assessment of resistance of carbapenemase producing Klebsiella pneumoniae strains

Introduction. The emergence and global spread of antimicrobial resistance genes, such as genes for extended-spectrum beta-lactamases and carbapenemases in Klebsiella pneumoniae strains, poses a significant threat to public health. The reason for this is that carbapenems are the latest therapeutic agent used to treat diseases caused by multi-resistant gram-negative bacteria. The detection of carbapenemases is epidemiologically important because ESBL-genes are plasmid-mediated and can be transmitted horizontally among different bacterial species. The aim of this research was to assess the spectrum of antibiotic resistance of carbapenemase-producing strains of K. pneumoniae circulating in hospitals in St. Petersburg using phenotypic and genotypic methods. Materials and methods. The susceptibility of K. pneumoniae strains (n=182), isolated from samples from patients admitted to hospitals in St. Petersburg in the period from 2016 to 2018, was assessed with 16 antimicrobials. Resistance to antibiotics was assessed by the gradient diffusion method. Carbapenemase genes were detected by molecular (PCR) and phenotypic (CIM) methods. Results. Most of the strains demonstrated a high percentage of resistance to ticarcillin/clavulanate (96.7%), quinolones (nalidixic acid (91.8%), norfloxacin (91.2%), ciprofloxacin (90.1%), ofloxacin (89%)), III and IV generation cephalosporins (cefotaxime (92.9%), ceftazidime (88.5%), cefoperazone (87.9%), ceftriaxone (86.8%), cefepime (91.2%)), netilmicin (83.5%) and gentamicin (80.2%). The investigated strains showed moderate resistance to amikacin (74.2%), meropenem (72.5%) and imepenem (65.9%). The main type of carbapenemases produced by the studied isolates of K. pneumoniae were NDM metallo-beta-lactamases (60.4%) and OXA-48 serine carbapenemases (49.5 %). KPC carbapenemases were found in only 1.1% of the strains. Discussion. The results of the study demonstrate a high resistance level of K. pneumoniae nosocomial isolates to various antibiotics. Therefore, the range of antimicrobials for treatment of Klebsiella infections is significantly reduced, which can lead to a decrease in the effectiveness of clinical therapy. Acknowledgments. The study had no sponsorship. Conflict of interest. The authors declare no apparent or potential conflicts of interest related to the publication of this article.

Antimicrobial resistance in Libya: A systematic literature review of two decades

Background: In low- and middle-income countries, antimicrobial resistance (AMR) imposes a significant burden on patients and health-care systems. Due to a lack of data, the overall impact of AMR in Libya is not well known or documented. As a result, this study presents the results of a review of available data on AMR in Libya over the past 20 years (from 2002 to 2021) to aid understanding of the current AMR situation in this portion of the continent. Methods: Articles related to the topic were researched using databases and search engines such as PubMed, Google Scholar, and ResearchGate websites. These articles were selected based on predetermined inclusion and exclusion criteria. The total number of tested isolates for each of the reported Bacterial spp. was used to calculate antibiotic resistance to a specific bacterium. Results: Studies published in the past 20 years, representing reports of 18,160 AMR tests, showed that Urinary Tract Infection (UTI) was the most reported clinical diagnosis in Libya (61.3%). Out of 43 articles, Staphylococcus aureus was the most common Gram-positive bacteria documented in (31, 61.3%) studies, and was most common in 59.78% of skin infections. Whereas, Pseudomonas spps., were the most common Gram-negative bacteria presented in (23, 53.48%) studies, and were commonly isolated in respiratory infection (9.39%). Among Gram-negative bacteria, Pseudomonas spp. reported a high resistance percentage for penicillin beta-lactam antibiotic, i.e., piperacillin (10.4%) and to the first-generation cephalosporins antibiotics, i.e., cefazolin (7.7%). However, they are susceptible to metronidazole, vancomycin, and colistin. Gram-positive bacteria, S. aureus shows high resistance to oxacillin, followed by gentamycin and cefoxitin (8.5%, 8.3%, and 8.3%, respectively). Effective antibiotics against S. aureus were azithromycin, clarithromycin, and metronidazole, whose susceptibility was 99.9% each, while 1% of S. aureus were vancomycin-resistant S. aureus. Conclusion: This study gives a comprehensive analysis of the state of AMR in Libya with respect to the most regularly prescribed antibiotics. The findings of the research show the alarmingly persistent occurrences of AMR in Libya, as well as the critical need to establish national action, plans to combat AMR and improve surveillance programs.

Occurrence and Antimicrobial Susceptibility Profiles of Streptococcus equi subsp. zooepidemicus Strains Isolated from Mares with Fertility Problems.

Streptococcus equi subsp. zooepidemicus (S. zooepidemicus), is a β-hemolytic Streptococcus belonging to the Lancefield group C; it is a rare human pathogen, but in horses, it is frequently associated with endometritis. This study aimed to isolate S. zooepidemicus strains, associated with bacterial endometritis in mares, and to define their antimicrobial resistance profile. Twenty-three isolates were recovered from one hundred ninety-six equine uterine swabs (11.7%). Bacterial identification was carried out by Api 20 Strep and confirmed by matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF-MS), while antimicrobial susceptibility testing was performed by disk diffusion method on Muller Hinton agar plates. The antibiotic resistance profiles of the isolates revealed a high percentage of resistance to amikacin (95.6%), ampicillin (73.9%) and tetracycline (69.6%), while ceftiofur and ceftriaxone were highly effective with 82.6% and 78.3% of the isolates inhibited, respectively. An intriguing value of resistance to penicillin (34.8%), which represents the first-choice antibiotic in equine S. zooepidemicus infections, was observed. Furthermore, a high prevalence of multidrug-resistant strains (82.6%) was recorded. Continuous surveillance of this potential zoonotic pathogen and an appropriate antimicrobial stewardship program with the promotion of correct use of antimicrobials, after a proper diagnosis, are needed to allow an effective therapy.

Genetic diagnosis of some root nodule bacteria isolated from leguminous Plants in Nineveh Governorate

The importance of atmospheric nitrogen-fixing bacteria The study aimed to isolate bacteria from the roots of plants From four areas of the city of Mosul the winter agriculture, season 2020-2021 and using biochemical tests and phenotypic and agricultural characteristics to diagnose bacterial isolates and study sensitivity and resistance of bacterial isolates to ten antibiotics. if the results showed that the highest percentage of resistance was to the two antibiotics, Trimethoprim, and streptomycin, at 100%, while The least resistance was to the two antivirals Gentamycin and Rifampicin by 20%. In addition to Studying The sensitivity and resistance of bacterial isolates to four heavy Metals, namely Mercury chloride (HgCl), Cobalt chloride (CoCl), Cadmium Chloride (CdCl), and nickel chloride (NiCl). The resistance was high with Cadmium chloride salt (CdCl) and the lowest salt Mercury Chloride (HgCl). PCR techniques were used to diagnose samples based on 16S rRNA sequence analysis and comparison of sequences resulting from DNA amplification with standard isolates within NCBI to detect new bacterial isolates

Characterization of commensal Escherichia coli isolates from slaughtered sheep in Mexico.

Commensal Escherichia coli is defined as bacteria without known virulence factors that could be playing a specific role in some diseases; however, they could be responsible to disseminate antimicrobial resistance genes to other microorganisms. This study aimed to characterize the commensal E. coli isolates obtained from slaughtered sheep in the central region of Mexico. Isolates were classified as commensal E. coli when distinctive genes related to diarrheagenic pathotypes (stx1, stx2, eae, bfp, LT, stp, ipaH, and aggR) were discarded by PCR. Identification of serotype, phylogenetic group, and antimicrobial resistance was also performed. A total of 41 isolates were characterized. The phylogenetic groups found were B1 in 37 isolates (90.2%), A in 2 (4.8%), and 1 isolate (2.4%) for C and D groups. Serotypes associated with diarrhea in humans (O104:H2 and O154:NM) and hemolytic uremic syndrome (O8:NM) were detected. Thirty-three isolates (80%) were resistant to ceftazidime, 23 (56%), to tetracycline 8 (19.5%) to ampicillin, and 1 to amikacin. Six isolates (14.6%) were multidrug-resistant. This study provides new information about commensal E. coli in slaughtered sheep, high percentages of resistance to antibiotics, and different profiles of antimicrobial resistance were found, their dissemination constitute a risk factor towards the consuming population.

Potential of Lactic Acid Bacteria From Tape and Jember Tempeh as a Probiotic Candidate

Probiotics are microbes in fermented foods that have beneficial effects on health. Microbes that act as probiotics are lactic acid bacteria (LAB) that can produce metabolites such as lactic acid, hydrogen peroxide, and bacteriocins. This study aimed to obtain lactic acid bacterial isolates from tape and tempeh, and to test the potential of LAB as a probiotic candidate by activity test as an antidiarrhea and its resistance to gastric pH and bile salts. The fermentation products used as a source of LAB isolates are tempeh sumber mas merk, and yellow cassava tape, sari madu merk from Jember. The results of the first stage regarding the isolation of LAB using GYP media showed that there were 2 LAB isolates (TaJ.14 and TaJ.15) from the tape and 4 LAB isolates (TeJ.18, TeJ.22, TeJ.24, and TeJ.25) from tempeh. The results of the antidiarrheal test using the disc diffusion method (oxoid) showed that TaJ.14 and TaJ.15 isolates were able to inhibit Bacillus subtilis, Escherichia coli, and Shigella dysentriae, while TeJ.18, TeJ.22, TeJ.24, TeJ.25, and Lactobacillus casei (control) was only able to inhibit B. subtilis and E. coli. The results of LAB resistance to gastric pH showed that the TeJ.25 isolate had the highest percentage of pH 3 and 2.5 resistance (51.13 and 33.03%) compared to other isolates and controls. LAB resistance test results against bile salts (oxgal) showed that the TeJ.22 isolate had the highest percentage of resistance (75.10%) compared to other isolates although was still higher in control (75.99%).

Bacterial Etiology of Bloodstream Infections and Antimicrobial Resistance Patterns from a Tertiary Care Hospital in Malé, Maldives.

Background Bloodstream infections pose a significant health problem worldwide and is a major cause of morbidity and mortality in many countries. It is important to have country-specific data for major pathogens causing bloodstream infections, in light of emerging resistance patterns of common bacterial isolates. Due to the scarcity of reports in this area, the aim of this study was to identify bacterial pathogens causing bloodstream infections among the study population. Methods A retrospective analysis of blood culture samples received at the Department of Laboratory Medicine, Indira Gandhi Memorial Hospital, Malé, Maldives, was performed for reports between January 2016 and December 2017. Results Out of the 471 culture-positive samples, 278 (59%) were males and 193 (41%) were females. Amongst the culture-positive samples, 338 (71.8%) Gram-positive organisms were isolated and 133 (28.2%) Gram-negative organisms were isolated. Coagulase-negative Staphylococcus (CoNS) was the most frequently isolated blood-borne bacterial pathogen in this study, accounting for 53.6% and 50.9% of the isolates in 2016 and 2017, respectively. Other frequently isolated pathogens included Staphylococcus aureus (15.9% and 10.3%), Klebsiella spp. (10.5% and 16.4%), and Escherichia coli (7.1% and 10.8%). Coagulase-negative Staphylococcus (CoNS) revealed high percentage of resistance among the tested antimicrobials, ampicillin, cephalexin, cefotaxime, and gentamicin. Over the two years, a significant difference between the percentage resistance among paediatric and adult patients was observed for coagulase-negative Staphylococcus (CoNS) isolate resistance to ampicillin (p ≤ 0.001), cephalexin (p ≤ 0.001), cefotaxime (p ≤ 0.001), gentamicin (p=0.008), and cotrimoxazole (SXT) (p ≤ 0.001). When comparing the significant antimicrobial resistance trends, it can be seen that Enterobacteriaceae isolates also demonstrated high resistance to ampicillin and gentamicin as well as second- and third-generation cephalosporins. Conclusions This study highlights the major bacterial pathogens involved in bloodstream infections in the healthcare setting of Malé, Maldives, and antibiotic resistance patterns. The results indicate that further characterization of bacteremia and its resistance patterns is needed to combat bloodstream infections.

STAPHYLOCOCCUS AUREUS RESISTANCE AGAINST CEPHALOSPORIN ANTIBIOTIC IN ADEN-YEMEN

The study was carried out to determine antibacterial resistance profiles of methicillin-resistant Staphylococcus aureus (MRSA), isolated from clinical samples (n: 352) of patients during the period, from January 2019 to July 2020 in five governmental and private medical laboratories of Aden governorate, Yemen. The results showed the percentage for resistance ratio is differentiated between samples and the category of cephalosporin antibiotic groups. The highest percentage of resistance was in the wound sample for Cefadroxil, Cefuroxime, and Ceftriaxone at (100%), in addition to 100% in the pus, CSF, and sputum samples for Ceftriaxone antibiotic. Moreover, Cefadroxil has 100 % of resistance in semen, ear, and sputum samples. However, the Staphylococcus aureus isolated from the pharyngeal sample not showed any resistance to all cephalosporin antibiotic groups.

Monitoring of Antimicrobial Susceptibility of Bacteria Isolated from Poultry Farms from 2014 to 2018.

The current situation of antibiotic resistance of most bacterial pathogens was a threat to the poultry and public health with increasing economic losses. Regarding this problem, monitoring of the circulating microorganisms occurred with the antibiotic resistance profile. A total of 657 different samples from internal organs (liver, heart, lung, and yolk) and paper-lining chick boxes were collected from native chicken farms which were submitted to the Reference Laboratory for Veterinary Quality Control on Poultry Production in the period from 2014 to 2018 for the detection of Salmonella, Escherichia coli (E. coli), and Staphylococcus. The bacterial isolates were tested for their antimicrobial susceptibility by disk diffusion technique. Salmonella was isolated from 128 out of 657 (19.5%), E. coli was isolated from 496 out of 657 (75.5%), and Staphylococcus species was isolated from 497 out of 657 (75.6%). All Salmonella positive samples were examined for antibiotic resistance against 10 different antibiotics, and the highest percentage all over the five years was against penicillin, ampicillin, and tetracycline. All E. coli positive samples were examined for antibiotic resistance against 14 different antibiotics, and the highest percentage all over the five years was with ampicillin, tetracycline, norfloxacin, streptomycin, and danofloxacin. All Staphylococcus positive sample species were examined for antibiotic resistance against 14 different antibiotics, and the highest percentage of resistance all over the five years was shown with tetracycline, streptomycin, ampicillin, and nalidixic acid.

Phenotypic and genetic analysis of virulence factors in multidrug- sensitive and multidrug-resistant clinical isolates of Pseudomonas aeruginosa

This study aimed to correlate the pattern of antimicrobial susceptibility, phenotypic production of virulence factors, the occurrence of virulence factors genes and the clonal profile of clinical isolates of Pseudomonas aeruginosa of a tertiary hospital in Recife-PE. The 30 clinical isolates (15 multidrug-sensitive (MDS) and 15 multidrug-resistant (MDR)) were analyzed using phenotypic methods to detect virulence factors (alkaline protease, hemolysin, phospholipase C, lipase, and pigments). The detection of the aprA, lasA, lasB, plcH, and toxA genes was performed through specific PCRs, and the clonal profile was assessed using ERIC-PCR. The results revealed cephalosporins being the class eliciting the highest percentage of resistance; the MDR isolates were all resistant. Among the MDS isolates, all were sensitive to carbapenems and quinolones. The MDR isolates produced less virulence factors such as pyocyanin and lipase, and exhibited lower expression of toxA and lasA genes, whereas the MDS isolates produced less hemolysin and phospholipase C. There was no difference between the groups for alkaline protease production and aprA gene expression. All the isolates produced pyocyanin and expressed lasB and plcH genes. A great genetic diversity was found, and it was possible to observe 28 genetic profiles. Clones were present among the MDR isolates. The occurrence of virulence factors in almost all the isolates studied suggests their high level of pathogenicity, demonstrating that this pathogen is capable of accumulating numerous virulence factors, and in some cases, is associated with multidrug resistance, which makes it difficult to treat these infections.

Antibiotic resistance of Enterococcus species: 3-year data

Aim: The aim of this study is to investigate the prevalence of Enterococcus species and to evaluate susceptibilities to antimicrobial agents in a state (secondary) hospital.
 Material and Methods: A total of 1676 enterococci strains (490 E.faecium, 1146 E.faecalis, 10 E.casseliflavus/E.gallinarum and 30 other Enterococcus species) isolated from cultures obtained from January 2017 to December 2019 in XXX Hospital were included. Blood cultures were incubated in automated device (Render Biotech Co.Ltd., PRC). Other cultures were incubated with conventional methods. Grown colonies were identified by PhoenixTM 100 automated system (Becton Dickinson, USA). Identifications that need confirmation or strains identified to genus level were further evaluated with conventional techniques. Antimicrobial susceptibility testing were performed by same system, Kirby-Bauer disc diffusion and gradient strip method according to EUCAST guidelines.
 Results: 43.1%, 27.1%, 14.7% and 15.1% of enterococci were isolated from urine, blood/sterile body fluids, wound/abscess and other samples. Majority of the strains were ciprofloxacin (72.0%) and levofloxacin (74.1%) resistant, and more than 40% showed ampicillin and high-level gentamicin resistance. Glycopeptide resistance was relatively high (5.4%), especially when considering E.faecium (12.1%). There was not any tigecycline and linezolid resistance. 
 Conclusions: Antimicrobial resistance is a serious and growing public health problem affecting all countries, which is not just a topic of medicine, but multiple sectors such as commercial companies, food industry, veterinarians, etc. High percentages of resistance strongly indicate to get a local action, which should be followed by national and global one.

The face of hypervirulent Klebsiella pneumoniae isolated from clinical samples of two Iranian teaching hospitals

Hypervirulent Klebsiella pneumoniae (hvKp) has emerged as a pathogen of global concern. In this study, both phenotypic and genotypic tests were used to detect hvKp. Antimicrobial resistance profiles and clonal relatedness of clinical isolates were also determined. We found that 34.2% (163/477) of the isolates were tellurite resistant, and among them 102 hvKp isolates detected with iucA or iutA or peg-344 as molecular markers. The blaSHV (80.4%), followed by blaCTX-M-15 (76.5%) and blaTEM (67.6%), blaOXA-48 (53.9%), and blaNDM-1 (32.3%) were detected, while blaKPC-1 was not present in any hvKp isolates. It was found that the majority of hvKp isolates belonged to capsular serotype K20 and ompK36 group C, which is related to clonal group (CG) 23 (e.g. ST23). A high percentage of multidrug-resistant hvKp (76.6%) and high resistance to imipenem (67%) indicated a serious problem that should be addressed in the clinical setting.