History Of Antibiotic Use Research Articles

Is routine screening for Candida auris necessary in ICU?

The capability to cause invasive infection, multi-drug resistance, and health care-associated outbreaks of Candida auris have made it a pathogen of great concern. Estimating how many patients in our intensive care unit had C. auris colonization and what characteristics put patients at risk for having Candida spp. colonization were the primary goals of the study. Swabs from axilla and groin were collected from 229 patients getting admitted to the ICU. Samples were inoculated into CHROMagarTM Candida Plus medium. Colonies presumptively identified as C. auris by the presence of light blue with blue halo and were confirmed by VITEK-2. Our study showed that only one patient was colonized with C. auris. A total of 47 (20.5%) patients were colonized with Candida spp., of which Candida parapislosis was the predominant organism. History of antibiotic use and cerebrovascular accident were independent risk factors in Candida colonization. Active screening for Candida auris in all patients is not required in our hospital as the prevalence was very low and not cost-effective. Therefore we plan to modify our screening strategy and use risk factors based surveillance strategy as it may serve as an ideal strategy.

Unmasking bocavirus: is it a co-infectious agent or an actual respiratory pathogen?

ABSTRACT Objectives Although human bocavirus (HBoV) is primarily linked to respiratory tract infections, its exact role as a respiratory pathogen remains unclear. This study aims to investigate HBoV detection rates, as well as clinical, laboratory, microbiological, and radiological characteristics, length of stay in the emergency department (ED), rate of hospitalization, and severity of illness in cases where HBoV is detected in respiratory secretions. Methods We conducted a retrospective analysis of all consecutive patients under 18 years who visited a large-volume tertiary pediatric ED from January to December 2023 and tested positive for HBoV in their respiratory viral panel (RVP). Results Among the 14,315 patients who underwent RVP testing during the study period, 591 (4%) tested positive for HBoV. After excluding those with incomplete data, 528 patients (57% male) were included in the analyses. The median age was 2.8 [1.2–4.9] years. The most common symptoms were cough (67%), fever (58%), runny nose/nasal congestion/sore throat (34%), and respiratory distress (24%). Thirty percent of the patients had a history of antibiotic use before admission. Thirteen percent of the patients had at least one chronic illness. Co-infection with HBoV occurred in 37% of the patients, with respiratory syncytial virus (RSV) being the most frequently co-detected virus (45%). Lymphopenia was documented in 12% of patients, and 36% had elevated C-reactive protein levels (median 21 [12–38] g/dl). Abnormal chest X-rays were noted in 85% of patients. The management approach included outpatient care for more than half of the patients (69%). Clinical severity was classified as high in 11% of patients (n = 60), necessitating ICU admission. Conclusion Although typically mild, HBoV infections can escalate to severe respiratory illnesses, requiring respiratory support and intensive care.

Vaginal candidiasis prevalence, associated factors, and antifungal susceptibility patterns among pregnant women attending antenatal care at bule hora university teaching hospital, Southern Ethiopia

BackgroundVulvovaginitis is common in women of reproductive age group characterized by purulent white discharge. The incidence of vulvovaginitis has risen recently due to the resistance of Candida species to commonly used antifungal agents and recurrent infections.ObjectiveThe study aimed to determine the prevalence, associated factors, and antifungal susceptibility patterns of vaginal candidiasis among pregnant women attending Bule Hora University Teaching Hospital.MethodsA hospital-based cross-sectional study was conducted from May 2023 to August 2023. Using systematic random sampling, 317 pregnant women participated in the study. Sabouraud Dextrose Agar and Chromogenic Candida Differential Agar were used to isolate and identify Candida species from clinical samples. Antifungal susceptibility was performed using a modified disc diffusion method. Epi data version 4.6 was used for data entry and Statistical Packages for Social Sciences version 25 was used for statistical analysis. A P-value < 0.05 was declared statistically significant.ResultThe prevalence of vaginal candidiasis was 26.8% (95%, CI 21.9–31.72%). History of using contraceptives (AOR = 5.03, 95%CI, 1.21–11.37), past vaginal candidiasis (AOR = 6, 95%CI, 1.61–12.92), pregnant women infected with human immunodeficiency virus (HIV) (AOR = 4.24, 95%CI, 1.23–14.14), diabetic mellitus (AOR = 2.17, 95%CI, 1.02–4.64), history of antibiotic use (AOR = 3.55, 95%CI, 1.67–12.75), pregnant women in third trimester (AOR = 8.72, 95%CI, 1.30–23.07), were the significantly associated factors for vaginal candidiasis. The study revealed that itraconazole, amphotericin B, and miconazole were the most effective antifungal drugs for all Candida isolates.ConclusionThe present study has identified a high prevalence of vaginal candidiasis among pregnant women. The isolated Candida species showed resistance to fluconazole, ketoconazole, and clotrimazole. Therefore, healthcare providers should increase awareness of the risks of Candida infections to reduce Candida species among pregnant women. Physicians should prescribe suitable medications based on antifungal drug test outcomes to treat pregnant women with vaginal candidiasis.

The bacterial microbiome and resistome of house dust mites in Irish homes

Dust samples were collected from Irish homes. House Dust Mite and storage mites were separated from the dust. The microbiome and resistome of mites and originating dust were assessed using a culture-independent approach. The bacterial microbiome of mites and dust were predominantly populated by Staphylococci. There was a highly significant (P = 0.005; Spearman’s rank test) correlation between the bacterial microbiome of mites and the dust. One-hundred and eighteen antimicrobial resistance genes (ARGs) were associated with mites and 176 with dust. Both contained ARGs encoding resistance for multi drug resistances, macrolide-lincosamide-streptogramin B, mobile genetic elements, Beta-lactam, Tetracycline and Aminoglycosides. By contrast, 15 ARGs were found for a laboratory-grown strain of Dermatophagoides pteronyssinus. A significant difference (P = 0.03; t test) was found in means between the resistome of mites and the household dust from which they emanated. No significant correlations (P = 0.23 and P = 0.22; Mantel test) were observed between the microbiome and resistome of mite and dust samples. There was not a significant difference (P = 0.54; t-test) between the means of ARGs for homes with and without a history of antibiotic use.

Risk Factors for Pulmonary Mycosis in Immunocompromised Patients in Surakarta, Indonesia

&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;Recent evidence shows that there is an increase in the incidence of pulmonary mycosis globally. In clinical settings, pulmonary mycosis is commonly misdiagnosed as pulmonary tuberculosis (PTB). Identifying risk factors can ease the diagnosis of pulmonary mycosis. This study aimed to determine the risk factors for pulmonary mycosis in immunocompromised patients in Surakarta.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;This was an analytic observational study with a retrospective cohort study method. This study used purposive sampling technique on 218 medical records of immunocompromised patients during January 2019–September 2022 at a referral hospital in Surakarta. The correlation of sociodemographic, health status, health behavior, history of diseases, medications, and transplantations with the incidence of pulmonary mycosis was analyzed using Chi-Square test or Fisher’s exact test as its alternative.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;There was a significant correlation between educational level (p=0.018), nutritional status (p=0.001), smoking habit (p=0.000), history of corticosteroid use (p=0.031), history of antibiotic use (p=0.006), history of chemotherapy (p=0.003), history of PTB (p=0.047), and history of chronic obstructive pulmonary disease (COPD) (p=0.001) with the incidence of pulmonary mycosis. Meanwhile, there was no significant correlation between occupation (p=0.057), neutrophil level (p=1.000), history of human immunodeficiency virus (HIV) infection (p=1.000), history of diabetes mellitus (DM) (p=0.070), and history of organ transplantation (p=1.000) with the incidence of pulmonary mycosis.&lt;/p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Low educational level, malnutrition, smoking habit, history of pulmonary diseases, and medications are the risk factors for pulmonary mycosis in immunocompromised patients in Surakarta. It is important to identify these risk factors when examining patients with respiratory disorder symptoms.

Causative Microorganisms in Community-Acquired Urinary Tract Infections and Risk Factors for the Development of Infection with Extended-Spectrum β-Lactamase-Producing Species.

This study aimed to determine the microorganisms grown in the urine cultures of patients followed up with the diagnosis of community-acquired urinary tract infection (CA-UTI), their antibiotic susceptibility, and the risk factors that cause extended-spectrum β-lactamase (ESBL) production in microorganisms. Patients diagnosed with CA-UTI in the Yıldırım Beyazıt University City Hospital Infectious Diseases and Clinical Microbiology Clinic between February 2019 and February 2020 were prospectively analyzed. The microorganisms grown in the urine cultures and antibiotic susceptibility rates were examined. The clinical and demographic characteristics of the patients were compared in terms of the isolated agent producing ESBL. Escherichia coli (63.8%) and Klebsiella pneumoniae (22.0%) were the most common microorganisms detected in the urine cultures; the rate of those producing ESBL was 46.6%. Antibiotics with high resistance rates were ampicillin (74.2%), cefuroxime (49.6%), and ceftriaxone (49%). Male gender, complicating factors, immunosuppression, kidney transplantation and history of antibiotic use were determined as significant risk factors for ESBL production. Male gender, immunosuppression, and history of antibiotic use were also independent risk factors. ROC analysis of risk factors showed ESBL-producing bacteria were isolated at a high rate in patients having ≥3 risk factors. The resistance rates in our study are quite high. Male gender, history of antibiotic use and immunosuppression status were found to be independent risk factors for ESBL positivity in patients with CA-UTI, and the more risk factors a patient has, the higher the risk of ESBL positivity.

Atypical Presence of Leuconostoc pseudomesenteroides in a Lower Respiratory Tract Infection

Introduction: Leuconostoc species are gram-positive microorganisms typically isolated from dairy and brewing industries. Infections in humans are extremely rare. They are vaguely associated with patients who have co-morbidities and a history of antibiotic use. The rise of inadvertent microbiota complicates treatment delivery. Case Presentation: We report a rare case of Leuconostoc pseudomesenteroides in a patient with a lower respiratory tract infection. The patient suffered from diffuse axonal injury with bilateral subdural hematoma following a road traffic accident. An emergency tracheostomy was performed, and the patient was managed conservatively. The patient developed symptoms clinically, such as fever, and radiographically exhibited bilateral lung infiltrates. Endotracheal aspirate samples were sent for microbiological evaluation. Conclusions: The bacterial culture was identified as L. pseudomesenteroides. Bacterial identification and antibiotic susceptibility testing were verified. Antibiotics were administered empirically and intravenously until the patient achieved normal clinical status.

Factors influencing necrotizing enterocolitis in premature infants in China: a systematic review and meta-analysis

BackgroundNecrotizing enterocolitis (NEC) is a multifactorial gastrointestinal disease with high morbidity and mortality among premature infants. However, studies with large samples on the factors of NEC in China have not been reported. This meta-analysis aims to systematically review the literature to explore the influencing factors of necrotizing enterocolitis in premature infants in China and provide a reference for the prevention of NEC.MethodsPubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), Wanfang and VIP databases were systematically searched from inception to February 2023. We used Stata14.0 software to perform the systematic review and meta-analysis. We used fixed or random effects models with combined odds ratios (ORs) and 95% confidence intervals (CIs), and quality was evaluated using the Newcastle‒Ottawa Scale (NOS).ResultsThe total sample was 8616 cases, including 2456 cases in the intervention group and 6160 cases in the control group. It was found that 16 risk factors and 3 protective factors were related to necrotizing enterocolitis in premature infants. Septicemia (OR = 3.91), blood transfusion (OR = 2.41), neonatal asphyxia (OR = 2.46), pneumonia (OR = 6.17), infection (OR = 5.99), congenital heart disease (OR = 4.80), intrahepatic cholestasis of pregnancy (ICP) (OR = 2.71), mechanical ventilation (OR = 1.44), gestational diabetes mellitus (GDM) (OR = 3.08), respiratory distress syndrome (RDS) (OR = 3.28), hypoalbuminemia (OR = 2.80), patent ductus arteriosus (PDA) (OR = 3.10), respiratory failure (OR = 7.51), severe anemia (OR = 2.86), history of antibiotic use (OR = 2.12), and meconium-stained amniotic fluid (MSAF) (OR = 3.14) were risk factors for NEC in preterm infants in China. Breastfeeding (OR = 0.31), oral probiotics (OR = 0.36), and prenatal use of glucocorticoids (OR = 0.38) were protective factors for NEC in preterm infants.ConclusionsSepticemia, blood transfusion, neonatal asphyxia, pneumonia, infection, congenital heart disease, ICP, GDM, RDS, hypoproteinemia, PDA, respiratory failure, severe anemia, history of antibiotic use and MSAF will increase the risk of NEC in premature infants, whereas breastfeeding, oral probiotics and prenatal use of glucocorticoids reduce the risk. Due to the quantity and quality of the included literature, the above findings need to be further validated by more high-quality studies.

Knowledge, attitudes, and practices regarding antibiotic use in Bangladesh: Findings from a cross-sectional study.

Escalating antibiotic resistance presents a notable worldwide dilemma, pointing a large involvement of general population. The objective of this study was to assess knowledge, attitudes, and practices regarding the utilization of antibiotics among Bangladeshi residents. A cross-sectional study, conducted from January 01 to April 25, 2022, included 1,947 Bangladeshi adults with a history of antibiotic use, via online surveys and face-to-face interviews using a pretested semi-structured questionnaire. Descriptive statistics, Chi-square tests, and multivariate linear regression models were employed. Mean scores for knowledge, attitudes, and practices were 6.59±1.20, 8.34±1.19, and 12.74±2.59, with correct rates of 73.22%, 92.67%, and 57.91%. Positive predictors for knowledge included being unmarried (β = 0.10, p = 0.001), higher education (College: β = 0.09, p = 0.025; Bachelor: β = 0.22, p<0.001; Master or above: β = 0.14, p<0.001), various professions (student: β = 0.57, p<0.001; housewife: β = 0.33, p<0.001; employee: β = 0.53, p<0.001; businessman: β = 0.31, p<0.001; unemployed: β = 0.15, p<0.001), and residing in semi-urban (β = 0.32, p<0.001) or urban areas (β = 0.15, p<0.001). Positive predictors for attitudes included being married (β = 0.18, p<0.001), specific professions (student: β = 1.06, p<0.001; housewife: β = 0.33, p<0.001; employee: β = 0.86, p<0.001; businessman: β = 0.37, p<0.001; unemployed: β = 0.47, p<0.001), higher SES (Lower-middle: β = 0.22, p<0.001; Middle: β = 0.26, p<0.001), and residing in semi-urban areas (β = 0.18, p<0.001); negative predictors included higher education (College: β = -0.12, p = 0.001; Master or above: β = -0.09, p = 0.008) and being rich (β = -0.13, p<0.001). Positive predictors for practices included being married (β = 0.18, p<0.001), specific professions (student: β = 0.32, p<0.001; employee: β = 0.43, p<0.001; businessman: β = 10, p = 0.034; unemployed: β = 0.11, p = 0.009), and higher SES (Lower-middle: β = 0.14, p = 0.009; Middle: β = 0.38, p<0.001; Higher-middle: β = 0.15, p = 0.008); negative predictors included higher education (College: β = -0.21, p<0.001), being rich (β = -0.12, p<0.001), residing in semi-urban (β = -0.14, p<0.001) or urban areas (β = -0.16, p<0.001). Participants exhibited adequate knowledge and positive attitudes but lagged behind in proper practice of antibiotic use. Proper initiatives should be tailored to enhance prudent antibiotic use and mitigate the risk of antimicrobial resistance.

Epidemiology and clinical characteristics of patients with healthcare-acquired multidrug-resistant Gram-negative bacilli: a retrospective study from a tertiary care hospital

The numbers of infections caused by Gram-negative bacteria (GNB) that produce extended-spectrum beta-lactamases (ESBLs) and those that are carbapenem resistant, especially Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae), are increasing, and these infections are becoming a global public health problem. The aim of this study was to assess the prevalence of infections caused by ESBL-producing and carbapenem-resistant Gram-negative bacilli in patients hospitalized at An-Najah National University Hospital in Nablus, Palestine, and to provide healthcare workers with valuable information on the treatment of these infections. A retrospective cross-sectional investigation was conducted at a large tertiary care teaching hospital. The study included patients admitted to the hospital between January and December 2021, from whom ESBL-producing and carbapenem-resistant Gram-negative bacilli were isolated. The patients' clinical and demographic information was obtained from the hospital information system. In addition, information regarding the bacterial isolates and antibiotic resistance was obtained from the hospital's microbiology laboratory. This study included a total of 188 patients—91 males (48.4%) and 97 females (51.6%). The general surgical ward accounted for the highest proportion of infections (30.9%), followed by the surgical ICU (12.2%). The most common infections were caused by ESBL-producing E. coli, which accounted for 62.8% of the cases. Among them, urinary tract infections caused by this microorganism were the most prevalent (44.7% of patients). Over 50% of the patients (54.2%) had a history of antibiotic use, and 77.8% had been hospitalized within the past three months. ESBL-producing E. coli was significantly isolated from blood cultures (p-value = 0.000), and CR-K. pneumoniae was significantly isolated from endotracheal isolates (p-value = 0.001). This study emphasizes the concerning frequency of healthcare-acquired infections caused by ESBL-producing and carbapenem-resistant GNB in a tertiary care hospital. The substantial prevalence of antibiotic resistance presents considerable obstacles to the successful administration of routinely employed antibiotics. The results highlight the immediate need for improved antimicrobial stewardship and the implementation of infection control strategies to reduce the effects of multidrug-resistant GNB on patient well-being and public health.

Microbial variations in sputum cultures among hospitalized patients with community-acquired pneumonia: differences in sputum microbiota between asthma and COPD patients.

To assess differences in the sputum microbiota of community-acquired pneumonia (CAP) patients with either COPD or asthma, specifically focusing on a patient population in Turkey. This retrospective study included hospitalized patients > 18 years of age with a diagnosis of pneumonia between January of 2021 and January of 2023. Participants were recruited from two hospitals, and three patient groups were considered: CAP patients with asthma, CAP patients with COPD, and CAP patients without COPD or asthma. A total of 246 patients with CAP were included in the study, 184 (74.8%) and 62 (25.2%) being males and females, with a mean age of 66 ± 14 years. Among the participants, 52.9% had COPD, 14.2% had asthma, and 32.9% had CAP but no COPD or asthma. Upon analysis of sputum cultures, positive sputum culture growth was observed in 52.9% of patients. The most commonly isolated microorganisms were Pseudomonas aeruginosa (n = 40), Acinetobacter baumannii (n = 20), Klebsiella pneumoniae (n = 16), and Moraxella catarrhalis (n = 8). CAP patients with COPD were more likely to have a positive sputum culture (p = 0.038), a history of antibiotic use within the past three months (p = 0.03), utilization of long-term home oxygen therapy (p < 0.001), and use of noninvasive ventilation (p = 0.001) when compared with the other patient groups. Additionally, CAP patients with COPD had a higher CURB-65 score when compared with CAP patients with asthma (p = 0.004). This study demonstrates that CAP patients with COPD tend to have more severe presentations, while CAP patients with asthma show varied microbial profiles, underscoring the need for patient-specific management strategies in CAP.

Study on knowledge, attitude, and practices of general public toward antimicrobial use and antimicrobial resistance

Background: The World Health Organization (WHO) states that antibiotic resistance (AMR) is a serious public health issue that is only getting worse. Antibiotic misuse leads to serious complications such as prolonged hospital admissions, high death rates, and increased financial load. While a number of factors have been identified as contributing to the development of AMR, inappropriate antibiotic usage has been identified as the primary cause. Taking antibiotics more often than prescribed, not taking them to their full recommended dosage, sharing prescription medications, storing medication for later use to treat the same symptoms, and obtaining antibiotics without a prescription are some of the factors that contribute to antimicrobial resistance (AMR). Aims and Objectives: The aims and objectives of the study are to assess the knowledge, attitudes, and practices of public regarding the use of antimicrobial use and antimicrobial resistance; evaluating potential corrective measures to address the problem; selecting effective communication strategies to raise awareness; and to analyzing the factors associated with a higher level of knowledge about antimicrobial resistance. Materials and Methods: A descriptive cross-sectional study was carried out after obtaining approval from the Institutional Ethics Committee from July 28th, 2022, to September 28th, 2022, with a sample size of 488 voluntary participants from general public visiting outpatient departments (OPDs) of Rajiv Gandhi Government General Hospital (RGGGH), Chennai. The participants’ knowledge, attitude, and practices regarding the use of antibiotics and antimicrobial resistance were assessed through a questionnaire in English and translated into the local language (Tamil). Results: A total of 488 responses were received from patients visiting the various OPDs of RGGGH, Chennai. Among the respondents, the majority were females 257 (52.7%) of age groups, 18–25 years (172, 35.2%). The respondents were also grouped based on their level of education and found that most of them had completed class 12, 218 (44.7%). Previous history of antibiotic use was assessed and found that 417 (85.5%) participants had taken antibiotics within the past 12 months before the study. Our study found that the majority of respondents (280, 57.4%) knew that the full course of antibiotics should be taken as directed. Practices of acquiring antibiotics were also assessed in our study and found that 301 respondents (61.7%) said they have never purchased antibiotics without consulting a doctor. The proper use of antibiotics was another question that participants were asked and 288 (59%) participants answered that they had received this explanation health-care workers. The knowledge about antibiotic use was assessed and found that the majority of participants (368, 75.4%) correctly identify urinary tract infection as a disease that can be cured by antibiotics. Our study also revealed that most of the participants (317, 64.9%) had awareness about the antibiotic resistance from the given list of terms related to issue of antibiotic resistance. Conclusion: The majority of the general people who visited the RGGGH’s OPDs revealed good attitudes and awareness regarding the severity of antimicrobial resistance (AMR) and the significance of using antibiotics appropriately. Their knowledge, attitudes, and behaviors are determined to be highly satisfactory. There were a few minor fallacies, such as the idea that antibiotics work well against colds. To more accurately assess the baseline circumstances of the broader population, there is a greater need for research in this field using multicentric approaches and a modified demographic focus.

Risk Factors Associated with Suspected Clostridium difficile Infection (CDI) in Elderly Diarrhea Patients at Prof. Dr. I.G.N.G. Ngoerah Hospital

Clostridium difficile infection (CDI) is a typical healthcare-associated infection that contributes to a significant proportion of morbidity and mortality among hospitalized patients. Anaerobe microbiological laboratory examinations cannot be performed at Prof. Dr. I.G.N.G. Ngoerah Hospital, leading to many undetected cases; therefore, it is crucial to determine the risk factors. Identification of cases may help to prevent, recognize, and appropriately treat CDI, reducing morbidity and mortality. This study aimed to determine the risk factors associated with suspected CDI in elderly patients with diarrhea due to their vulnerability to immunosenescence. This research used medical records as secondary data to determine the risk factors associated with suspected CDI in elderly diarrhea patients at Prof. Dr. I.G.N.G. Ngoerah Hospital during the year period of 2017 to 2021 with total of 70 samples who met inclusion criteria by purposive sampling technique. One hundred percent of all samples had a history of hospitalization for ³ 48 h. There were 53 patients (77.1%) had a history of antibiotic use, 26 (37.1%) proton pump inhibitors (PPIs), 66 (94.3%) chemotherapy, 66 (94.3%) urinary tract infections, 6 (8.6%) kidney disease, and 7 (10%) myocardial infarction. Seven (10%) patients had vascular disease, and 11 (15.7%) had diabetes mellitus. Risk factors associated with suspected CDI in elderly patients with diarrhea at Prof. Dr. I.G.N.G. Ngoerah Hospital include hospitalization ³ for 48 hours, use of antibiotics in the last few months, proton pump inhibitors, decreased immune system, urinary tract infection, kidney disease, myocardial infarction, vascular disease, and diabetes mellitus.

1706. Risk factors for infections caused by extended spectrum beta lactamase (ESBL) producing and Carbapenem-resistant Enterobacterales (CRE) in pediatric critical care settings: A case control study

Abstract Background Infections due to Gram negative resistant bacterial pathogens are a major concern in intensive care units. The purpose of this study is to determine the risk factors for developing ESBL-producing and CRE infections in pediatric patients in critical care settings (PICU and NICU). Methods A retrospective case control study of infections due to ESBL-producing and CRE during a 5-year period (2016-2021) at Children’s Hospital of Michigan, Detroit. All patients had positive cultures during their PICU/NICU stay. Control cases were matched for age, infection site and year of infection but their cultures grew Enterobacterales that were non-ESBL or carbapenemase producers. Results A total of 58 patients with ESBL/Carbapenemase-producing Enterobacterales (cases) and 59 control patients were included. Majority of organisms were E. coli and Klebsiella species recovered from respiratory tract. There was no difference in both groups in regards to age, gender, race or length of hospital stay (p &amp;gt;0.3). There was no difference in prior hospital admission, PICU or NICU stay during the previous 6 months, indwelling devices, comorbid conditions, or surgery in the last 6 months (p &amp;gt;0.3). However, the presence of gastrostomy tube was more frequent in the cases group (29.3%) than the control group (15.3%) (p=0.078). Risk factors by univariate analysis included history of antibiotic use in last 6 months (93% in cases vs 73% in controls; p=0.006), cephalosporins use &amp;gt; 14 days (67% vs 31.2%; p=0.006),Trimethoprim/Sulfamethoxazole treatment duration &amp;gt; 14 days (11.1% vs 0%; p=0.012), carbapenem treatment duration &amp;gt; 14 days (14% vs 1.9%; p=0.027), and vancomycin use &amp;gt; 14 days (43.6% vs 21.6%; p=0.053). However, multivariate logistic regression analysis showed that antibiotic usage in the last 6 months was the single best predictor for cases with odds ratio of 5.02-fold (95% CI 1.56-16.13) (p=0.007). Conclusion Prior broad spectrum antibiotic usage was significantly associated with acquisition of ESBL and carbapenemase producing Enterobacterales. The study further underscores the need for optimizing antimicrobial stewardship practices to limit unnecessary and prolonged use of antibiotics to prevent the emergence of resistant pathogens. Disclosures All Authors: No reported disclosures

Sociodemographic distributions and molecular characterization of colonized Enterococcus faecium isolates from locality hospitals in Khartoum, Sudan.

Enterococcus faecium is an opportunistic pathogen of humans with diverse hosts, encompassing animals as well as human beings. In the past twenty years, there has been a rise in the instances of nosocomial infections that are linked to antibiotic-resistant Enterococcus faecium. The acquisition of diverse antimicrobial resistance factors has driven the global development of robust and convergent adaptive mechanisms within the healthcare environment. The presence of microorganisms in hospitalized and non-hospitalized patient populations has been significantly aided by the facilitation of various perturbations within their respective microbiomes. This study aimed to determine the antimicrobial profile, demographic and clinical characteristics, along with the detection of virulence encoding genes, and to find out the clonal genetic relationship among colonized E. faecium strains. A hospital-based cross-sectional study was carried out between October 2018 and March 2020 at four Khartoum locality hospitals in Sudan. The study comprised a total of 108 strains of E. faecium isolated from patients admitted to four locality hospitals in Khartoum. A self-structured questionnaire was used to gather information on sociodemographic traits. Data were analyzed using chi-square test. In all cases, P value ≤ 0.05 with a corresponding 95% confidence interval was considered statistically significant. Moreover, enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) was utilized to assess the prevalence of clonal relationships, and the gel was analyzed using CLIQS software. In this study, the isolation rate of colonized E. faecium strains was 108/170 (63.5%). The colonization of E. faecium and its association with various sociodemographic and clinical features was examined. 73 (67.6%) of patients had multidrug-resistant (MDR), and 22 (20.4%) had extensively drug-resistant (XDR), 73 (67.6%) of patients engaged in self-medication practices. Eighty patients (74.1%) were non-adherence to prescribed antibiotics, while 70 (64.8%) patients reported recent antibiotic usage within the 3 months. The present study suggests that demographic factors may not be significantly associated with the incidence of E. faecium infection except for patients who had a prior history of antibiotic use (P≤0.005). The analysis of virulence genes showed a high prevalence of asa1 gene (22.2%) among strains. In ERIC-PCR the genetic relatedness of E. faecium showed seven identical clusters (A-G) with 100% genetic similarity. This implies clonal propagation in hospitals and communities. This study found that the incidence of E. faecium isolated from locality hospitals in Khartoum was likely due to the spread of E. faecium clones, thereby highlighting the need for intensifying infection control measures to prevent the spreading of nosocomial infection.

Multidrug-resistant Gram-negative bacterial infections and associated factors in a Kenyan intensive care unit: a cross-sectional study

BackgroundPatients admitted to intensive care units (ICU) are at risk of Gram-negative bacteria (GNB) infections, especially those caused by multidrug-resistant (MDR) isolates, increasing morbidity, mortality, and healthcare costs. However, epidemiological surveillance data on MDR bacteria to inform infection prevention and control (IPCs) interventions is limited in our study setting. Here we assessed the prevalence and factors associated with GNB infections in ICU- patients admitted in our study setting.MethodsThis was a hospital-based cross-sectional study among patients admitted to ICU at the Nairobi West Hospital, Kenya, between January and October 2022. Altogether, we recruited 162 patients, excluding those hospitalized for less than 48 h and declining consent, and collected demographics and clinical data by case report form. Blood, wound and throat swab, ascetic tap, stool, urine, tracheal aspirate, and sputum samples were collected cultured. Isolates identity and antimicrobial susceptibility were elucidated using the BD Phoenix system.ResultsThe prevalence of GNB infections was 55.6%, predominated by urinary tract infections (UTIs). We recovered 13 GNB types, with Escherichia coli (33.3%) and Klebsiella pneumoniae (31.1%) as the most common isolates. Factors associated with GNB infections were a history of antibiotic use (aOR = 4.23, p = 0.001), nasogastric tube use (NGT, aOR = 3.04, p = 0.013), respiratory tract (RT, aOR = 5.3, p = 0.005) and cardiovascular (CV, aOR = 5.7, p = 0.024) conditions. 92% of the isolates were MDR,predominantly Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa.ConclusionWe report a high prevalence of MDR-GNB infections, predominated by UTI, in ICU, whereby patients with a history of antibiotic use, using the NGT, and having RT and CV conditions were at increased risk. To improve the management of ICU-admitted patients, continuous education, training, monitoring, evaluation and feedback on infection prevention and control are warranted in our study setting.

Carriage of β-lactamase and carbapenemase-producing Enterobacteriaceae in hospitalized patients at debre tabor comprehensive specialized hospital

BackgroundAntimicrobial resistance has remained global public health threat. Carriage with drug-resistant bacterial pathogens, particularly beta-lactamase and carbapenemase-producing Enterobacteriaceae is among the most concerning. The purpose of this study was to look into the magnitude, antimicrobial resistance patterns, and associated risk factors among hospitalized patients. MethodsA facility-based cross-sectional study was conducted on 383 hospitalized patients at Debre Tabor Comprehensive Specialized Hospital between September 2022 and May 2023. A pre-tested structured questionnaire was used to collect sociodemographic and clinical data. The data on the etiologic agent was collected using standard bacteriological techniques. Briefly, stool specimens were collected aseptically into sterile, leak-proof stool cups. The stool sample was inoculated onto MacConkey agar and incubated aerobically at 37 °C for 24 h. The species isolation and antimicrobial resistance patterns were then performed adhering to bacteriological procedures. In the analysis, a p-value of <0.05 was considered statistically significant. ResultsThere were 383 study participants, and men made up the majority (55.6%). The study participants' mean age was 33 ± 18 years. Three hundred and seventy-seven (88%) of the study's participants had no previous history of antibiotic use. There were 102 (26.6%) and 21 (5.5%) cases of gastrointestinal carriage caused by Enterobacteriaceae that produce beta-lactamase and carbapenemase, respectively. In total, 175 isolates of Enterobacteriaceae were detected. E. coli (n = 89) and K. pneumoniae (n = 51) were the most frequently recovered. In this study, 46 (79.3%) and 8 (13.8%) isolates of E. coli that produce beta-lactamase were resistant to ampicillin and amoxicillin/clavulanic acid, respectively. Furthermore, participants who had previously used antibiotics experienced a two-fold increase in exposure to gastrointestinal tract carriage by carbapenemase-producing Enterobacteriaceae [AOR, 95% CI (2.01, 1.06–2.98), p = 0.001]. ConclusionsThe emergence of drug-resistant pathogens is a growing concern. An increase in the prevalence of drug-resistant infections in hospitalized patients is warranting further investigation.

Zmena epidemiologického charakteru klostrídiovej kolitídy – rastúci počet komunitných foriem a infekcií u detí

Clostridioides difficile colitis has long been considered an infection associated with hospitalization and concomitant antibiotic treatment. However, the increasing number of community cases in recent years has led to a reassessment of the traditional understanding of its epidemiological characteristics. In addition, community-associated forms have been reported many times in children, young adults, or people without comorbidities and with a negative history of antibiotic use in the pre-disease period. These groups have traditionally been considered low risk for the development of the infection. Thus, many studies have naturally investigated the impact of asymptomatic Clostridioides difficile carriers, including neonates and infants, on the transmission of the causative agent in the community. The prevalence of this bacterium in animals, in food and in the environmental setting has also been the subject of research. The goal was to elucidate the role of these factors in the spread of the agent in community settings. In this article, we summarize the current knowledge on confirmed and potential risk factors for community-acquired Clostridioides difficile infection, together with the results of studies examining patient characteristics. We also provide information on the issue of Clostridioides difficile infection in the paediatric population, which is closely intertwined with the community-acquired form of the infection. Keywords asymptomatic carrier state, Clostridioides difficile, epidemiology, community-acquired infections

Comparative Genomic Analysis of Hypervirulence Carbapenem-Resistant Klebsiella pneumoniae from Inpatients with Infection and Gut Colonization, China.

The emergence and spread of hypervirulent carbapenem-resistant Klebsiella pneumoniae (hv-CRKP) is a potential epidemiological threat that needs to be monitored. However, the transmission and pathogenic characteristics of hv-CRKP in China remain unclear. We investigated the epidemiological characteristics of gut colonized hv-CRKP in a hospital in Guangdong Province, China. A total of 46 gut colonized hv-CRKP isolates were collected from Sun Yat-Sen Memorial Hospital (Guangzhou, China) from August 31st to December 31st, 2021. Minimum inhibitory concentrations (MICs) were obtained for 15 antibiotics for 46 hv-CRKP isolates. BALB/C mice infection model and mucoviscosity assay was used to evaluate the virulence of the isolates. The characteristics of genome, phylogenetic relationship and the structure of the plasmid of 46 gut colonized hv-CRKP isolates were compared with pathogenic isolates from GeneBank based on whole-genome data. The hv-CRKP isolation rate of all gut colonized carbapenem-resistant Klebsiella pneumoniae was 17% (46/270), and the intestinal colonization rate of hv-CRKP was irrelevant to the sex, age, department of hospitalization, and history of antibiotic use of the host. The gut colonized hv-CRKP showed pandrug resistance and hypervirulence. The gut colonized hv-CRKP and pathogenic hv-CRKP prevalent in China were mainly ST11 hv-CRKP and had two major epidemic clades. The similarities in genomic characteristics between gut colonized hv-CRKP and pathogenic hv-CRKP were consistent. The gut colonized hv-CRKP carried an incomplete structure pK2044 virulence plasmid from hypervirulent K. pneumoniae NTUH-K2044 by analyzing the virulence plasmid structure. Our results suggest that the gut colonized ST11 hv-CRKP may serve as a reservoir for the clinical pathogenic ST11 HV-CRKP. It is necessary to further strengthen the monitoring of gut colonized hv-CRKP and research the potential mechanism of infection caused by gut colonized hv-CRKP.

PREVALENCE AND RISK FACTORS OF HELICOBACTER PYLORI INFECTION AMONG INDIVIDUALS WITH TOBACCO CONSUMPTION HABITS IN DISTRICT PESHAWAR: A CROSS-SECTIONAL STUDY

This cross-sectional study aimed to determine the prevalence of Helicobacter pylori infection and its association with tobacco consumption (smoking and snuff use) in Peshawar, Pakistan. 150 blood samples were collected from H. pylori suspected patients in tertiary care hospitals. Demographic data, tobacco consumption habits, and potential risk factors were gathered through a questionnaire. The prevalence of H. pylori among smokers and snuff users was 42%. All participants had a history of tobacco use, with 59% being smokers and 41% being snuff users. Most participants (81%) had not been tested for H. pylori before. Eight risk factors associated with H. pylori infection were investigated, including family history, stomach ulcers or gastritis, consumption of spicy or heavily seasoned food, poor hygiene practices, low socioeconomic status, history of antibiotic use, close contact with infected individuals, and consumption of contaminated food or water. Participants' opinions and beliefs about these risk factors varied. The study demonstrated significant associations between H. pylori antigen detection and smoking, snuff use, overcrowding, and various risk factors such as family history, dietary habits, hygiene practices, socioeconomic status, antibiotic use and exposure to contaminated water or food. The study emphasizes the need for further research to understand these risk factors and their impact on H. pylori infection.