Incidence Of Multidrug-resistant Pathogens Research Articles

Clinical, Bacteriological Profile and Outcome of Neonatal Sepsis.

Sepsis is a major cause of morbidity and mortality among neonates in Nepal. This study was conducted to determine the clinical-bacteriological profile, their antibiotic susceptibility patterns, and clinical outcome of culture-positive neonatal sepsis. This was a prospective study conducted at B.P Koirala Institute of Health Sciences from July 2018 to June 2019. Neonates with clinically diagnosed sepsis having blood culture positive were included in the study. Blood samples culture and antimicrobial susceptibility testing were performed with the standard microbiological method. Demographic, clinical information, and clinical outcomes were documented. The incidence of culture-positive sepsis was 10.3% (183/1773) of neonatal admissions. Poor feeding 85(46%) and fever 68(37%) were the common clinical features at presentation. The incidence of early-onset sepsis and late-onset sepsis were found to be 116 (63%) and 67(37%) respectively. Staphylococcus aureus was the common pathogen in both early-onset 61(49%) and late-onset 34(41%) sepsis. The incidence of multidrug-resistant cases was 41% (75/183) with 20% (15/75) extensively drug-resistant gram-negative bacilli, 36% (20/75) multidrug-resistant gram-negative bacilli, and 44% (33/75) Methicillin-resistant Staphylococcus aureus cases. In-hospital mortality rate was 12 (7%) with a higher frequency in multidrug-resistant sepsis 92% (11/12) than non- multidrug-resistant 8% (1/12). The median hospital days were longer in multidrug-resistant cases than non- multidrug-resistant [11(9-13) verses 3(2-5)]. The incidence of multidrug-resistant pathogens causing neonatal sepsis is high at our hospital and are associated with more in-hospital mortality and longer hospital stay. Implementation of effective preventive strategies to combat the emergence of antimicrobial resistance is immediately needed.

Impact of an infectious diseases pharmacist-led intervention on antimicrobial stewardship program guideline adherence at a Thai medical center.

To evaluate and compare antimicrobial stewardship program (ASP) guideline adherence (primary outcome) as well as length of stay, 30-day all-cause mortality, clinical cure, antimicrobial consumption, and incidence of multidrug-resistant (MDR) pathogens (secondary outcomes) between an infectious diseases (ID) pharmacist-led intervention group and a standard ASP group. A quasi-experimental study was performed at Thammasat University Hospital between August 2019 and April 2020. Data including baseline characteristics and primary and secondary outcomes were collected from the electronic medical record by the ID pharmacist. The ASP guideline adherence in the ID pharmacist-led intervention group was significantly higher than in the standard ASP group (79% vs 56.6%; P < 0.001), especially with regard to appropriate indication (P < 0.001), dosage regimen (P = 0.005), and duration (P = 0.001). The acceptance rate of ID pharmacist recommendations was 81.8% (44/54). The most common key barriers to following recommendations were physician resistance (11/20; 55%) and high severity of disease in the patient (6/20; 30%). Compared to the standard ASP group, there was a trend toward clinical cure in the ID pharmacist-led intervention group (63.6% vs 56.1%; P = 0.127), while 30-day all-cause mortality (15.9% vs 1.5%; P = 0.344) and median length of stay (20 vs 18 days; P = 0.085) were similar in the 2 groups. Carbapenem (P = 0.042) and fosfomycin (P = 0.014) consumption declined in the ID pharmacist-led intervention group. A marginally significant decrease in the overall incidence of MDR pathogens was also observed in the ID pharmacist-led intervention group (coefficient, -5.93; P = 0.049). Our study demonstrates that an ID pharmacist-led intervention can improve ASP guideline adherence and may reduce carbapenem consumption.

New Delhi metallo-\u03b2-lactamase-1 among Escherichia coli strains isolated from leukemia patients in Iran: two case reports

BackgroundEscherichia coli has appeared as an important opportunistic pathogen responsible for nosocomial infections in patients with immunodeficiency, particularly in leukemia patients. New Delhi metallo-beta-lactamase is an enzyme originally found in Enterobacteriaceae.Case presentationIn this study, 80 isolates of Escherichia coli and Klebsiella pneumoniae were collected over the course of 2 years from two medical centers in Tehran, Iran. Production of carbapenemase was detected in the isolates using modified Hodge test. New Delhi metallo-beta-lactamase-1 genes were detected by polymerase chain reaction amplification with specific primers. Two New Delhi metallo-beta-lactamase-1-producing Escherichia coli strains were isolated from two Iranian patients with leukemia. These two patients were 6 and 15 years old, one female and the other male, from two oncology centers in Iran. The isolates were resistant to carbapenems (imipenem, meropenem), and two isolates were positive for carbapenemase production by modified Hodge test.ConclusionsThe emergence of New Delhi metallo-beta-lactamase-1-producing Escherichia coli is a threat for leukemia patients in oncology and hematology departments. We conclude that the incidence of multidrug resistant pathogens has increased among patients with leukemia and is life threatening.

Synthesis and Antimicrobial Properties of Zinc Oxide Nanoparticles.

With increase in incidence of multidrug resistant pathogens, there is a demand to adapt newer approaches in order to combat these diseases as traditional therapy is insufficient for their treatment. Use of nanotechnology provides a promising alternative as antimicrobial agents as against traditional antibiotics. Metal oxides have been exploited for a long times for their antimicrobial properties. Zinc oxide nanoparticles (ZnO NPs) are preferred over other metal oxide nanoparticles because of their bio-compatible nature and excellent antibacterial potentials. The basic mechanism of bactericidal nature of ZnO nanoparticles includes physical contact between ZnO nanoparticles and the bacterial cell wall, generation of reactive oxygen species (ROS) as well as free radicals and release of Zn2+ ions. This review focuses on different synthesis methods of ZnO nanoparticles, various analytical techniques frequently used for testing antibacterial properties, mechanism explaining antibacterial nature of ZnO nanoparticles as well as different factors affecting the antibacterial properties.

Progress and prospects in the management of bacterial infections and developments in Phytotherapeutic modalities.

The advent of antibiotics revolutionized medical care resulting in significantly reduced mortality and morbidity caused by infectious diseases. However, excessive use of antibiotics has led to the development of antibiotic resistance and indeed, the incidence of multidrug-resistant pathogens is considered as a major disadvantage in medication strategy, which has led the scholar's attention towards innovative antibiotic sources in recent years. Medicinal plants contain a variety of secondary metabolites with a wide range of therapeutic potential against the resistant microbes. Therefore, the aim of this review is to explore the antibacterial potential of traditional herbal medicine against bacterial infections. More than 200 published research articles reporting the therapeutic potential of medicinal plants against drug-resistant microbial infections were searched using different databases such as Google Scholar, Science Direct, PubMed and the Directory of Open Access Journals (DOAJ), etc., with various keywords like medicinal plants having antibacterial activities, antimicrobial potentials, phytotherapy of bacterial infection, etc. Articles were selected related to the efficacious herbs easily available to local populations addressing common pathogens. Various plants such as Artocarpus communis, Rheum emodi, Gentiana lutea L., Cassia fistula L., Rosemarinus officinalis, Argemone maxicana L, Hydrastis canadensis, Citrus aurantifolia, Cymbopogon citrates, Carica papaya, Euphorbia hirta, etc, were found to have significant antibacterial activities. Although herbal preparations have promising potential in the treatment of multidrug-resistant bacterial infection, still more research is required to isolate phytoconstituents, their mechanism of action as well as to find their impacts on the human body.

Surveillance of healthcare-associated infections in a Tunisian university hospital

Abstract Introduction Healthcare -associated infections has become a worldwide public health problem. The aim of this study was to estimate the incidence of healthcare- associated infections in a university hospital of Tunisia. Methods This was a cohort study conducted in six intensive care units in a university hospital of Tunisia during three months (from august to October 2018). Data was provided from patients’ files. Data entry and analysis was done using SPSS version 22. Multivariate analysis was used in order to identify independent risk factors for healthcare associated infection. Results A total of 202 patients were enrolled in this study. The incidence rate of healthcare-associated infections was 53,96%(109/202). The ratio infection/infected was estimated to 1.65(109/66). The incidence of multi-drug resistant pathogens was 21,28% (43/202). The most common resistant pathogens included pseudomonas aeruginosa resistant to cefdazidime in 13,76%(15/109) followed by those resistant to extended spectrum cephalosporin 11.92% (13/109), followed by carbapenem-resistant acinetobcater baumanii 6,42%(7/109) then by carbapenem resistant pathogens and enterococcus resistant to vancomycin 2.75%(3/109) and finally staphylococcus aureus resistant to methicillin 2.1%(2/1.83). The multivariate analysis showed that long duration of central line catheterisation (RR = 7.44; 95%CI[2.79-19.82]), tracheotomy(RR = 8.61;95%CI[2.09-35,39]) and length of stay (RR = 1.08; 95%CI[1.04-1.13]) were found as independent risk factors for healthcare -associated infection. Conclusions The emergence of mutli-drug resistant pathogens needs to be deeply studied and effective measures have to be taken in order to detect and prevent transmission of resistant strains and/or their resistance determinants, especially those with phenotypes having the fewest viable treatment options. Key messages The incidence of healthcare associated infection in the intensive care unit was high. Effective measures have to be taken in the intensive care unit to detect and prevent transmission of resistant pathogens.

Harnessing Macrophages for Controlled-Release Drug Delivery: Lessons From Microbes.

With the effectiveness of therapeutic agents ever decreasing and the increased incidence of multi-drug resistant pathogens, there is a clear need for administration of more potent, potentially more toxic, drugs. Alternatively, biopharmaceuticals may hold potential but require specialized protection from premature in vivo degradation. Thus, a paralleled need for specialized drug delivery systems has arisen. Although cell-mediated drug delivery is not a completely novel concept, the few applications described to date are not yet ready for in vivo application, for various reasons such as drug-induced carrier cell death, limited control over the site and timing of drug release and/or drug degradation by the host immune system. Here, we present our hypothesis for a new drug delivery system, which aims to negate these limitations. We propose transport of nanoparticle-encapsulated drugs inside autologous macrophages polarized to M1 phenotype for high mobility and treated to induce transient phagosome maturation arrest. In addition, we propose a significant shift of existing paradigms in the study of host-microbe interactions, in order to study microbial host immune evasion and dissemination patterns for their therapeutic utilization in the context of drug delivery. We describe a system in which microbial strategies may be adopted to facilitate absolute control over drug delivery, and without sacrificing the host carrier cells. We provide a comprehensive summary of the lessons we can learn from microbes in the context of drug delivery and discuss their feasibility for in vivo therapeutic application. We then describe our proposed “synthetic microbe drug delivery system” in detail. In our opinion, this multidisciplinary approach may hold the solution to effective, controlled drug delivery.

Effect of a Probiotic Preparation on Ventilator-Associated Pneumonia in Critically Ill Patients Admitted to the Intensive Care Unit: A Prospective Double-Blind Randomized Controlled Trial.

Ventilator-associated pneumonia (VAP) occurs as a life-threatening complication in critically ill mechanically ventilated patients. Probiotic administration may modify the gut microbiota; however, whether this modification could decrease VAP occurrence is not known. In this study, 100 adult critically ill patients undergoing mechanical ventilation for >48 hours were randomly assigned to either the probiotic or the control group. The patients in the probiotic group received 2 capsules of probiotic preparation containing Lactobacillus, Bifidobacterium, and Streptococcus spp., and those in the control group received placebo daily for 14 days. The patients in the probiotic group had a lower incidence of statistically microbiologically confirmed VAP. The duration of intensive care unit (ICU) and hospital stay was also lower in the probiotic group (P < .05). More than half of the patients in the control group had gastric residuals during ICU stay, compared with only 30% of patients in the probiotic group (P = .004). Probiotic usage led to a nonsignificant decrease in diarrhea, gastric and oropharyngeal colonization, and incidence of multidrug-resistant pathogens. The Kaplan-Meier survival curves for time to the first episode of VAP did not show a significant difference between probiotic and control groups (log-rank test = 1.89; P = .17). The results of probiotic administration for the prevention of VAP remain inconclusive in this trial. However, such an approach can decrease the length of ICU and hospital stay. Well-designed multicenter clinical studies with defined combinations of probiotics and definite end points are necessary in this field.

Prevalence and Antibiotic Susceptibility Patterns of Methicillin Resistant Staphylococcus Aureus in Patients Attending the Laquintinie Hospital Douala, Cameroon

Methicillin Resistant Staphylococcus aureus (MRSA) is a major health problem worldwide. Diseases caused by these microorganisms most often are difficult to treat consequently, present with severe outcomes. Despite the increase association of MRSA in most hospital acquired infections, surveillance systems to control the spread of these infections are lacking especially in the developing countries. The present study is part of a major study developed to trail the incidence of multidrug resistant pathogens in clinical settings using available resources, with the aim to gather relevant data for the management and control of nosocomial infections. The specific objective of the current study is therefore to determine the prevalence and antimicrobial susceptibility of MRSA isolates from one of the largest hospitals in the country. This was a hospital based cross sectional study involving 114 participants, conducted between March and June 2016. Various clinical specimens were inoculated on to blood agar and mannitol salt agar and incubated at 35-37°C aerobically for 18-24 hours for the isolation of S. aureus. Isolates were identified using the catalase and coagulase tests. Sensitivity testing was done using the Kirby Bauer disk diffusion method. Data were analysed using SPSS version 20.0. Out of 114 samples analysed, S. aureus was isolated from 33 (28.95%) while MRSA was detected in 15 (13.16%). Antimicrobial susceptibility testing revealed high resistance (80-100%) to penicillins and no resistance to amikacin, lincomycin and ofloxacin. Multidrug resistance to at least three antibiotics was also observed among MRSA isolates. MRSA and multidrug resistant S. aureus are common in the study site. Therefore, there is a need for the improvement of surveillance systems to monitor and curb the spread of these resistant pathogens.

Antibiotic resistance & pathogen profile in ventilator-associated pneumonia in a tertiary care hospital in India.

Background & objectives:Ventilator-associated pneumonia (VAP) is an important hospital-acquired infection with substantial mortality. Only a few studies are available from India addressing the microbiological aspects of VAP, which have been done with small study populations. This study was carried out in the intensive care units (ICUs) of a tertiary care hospital to assess the profile of pathogens and to determine the pattern of antimicrobial resistance.Methods:This was a retrospective study of clinically suspected cases of VAP. Over a three year period, a total of 247 cases in 2011, 297 in 2012 and 303 in 2013 admitted in ICUs on mechanical ventilation with clinical evidence of VAP were included in our study. The endotracheal aspirate samples from these suspected cases were subjected to quantitative culture technique, and colony count of ≥105 colony forming units/ml was considered significant. Antimicrobial susceptibility test for the isolates was done.Results:VAP rates of 44.1, 43.8 and 26.3 were seen in 2011, 2012 and 2013, respectively. In all the three years, non-fermentative Gram-negative bacilli were the predominant organisms, followed by Pseudomonas spp. and Klebsiella spp. Staphylococcus aureus exhibited a downwards trend in prevalence from 50.0 per cent in 2011 to 34.9 per cent in 2013. An increase in vancomycin-resistant enterococci was seen from 4.3 per cent in 2012 to 8.3 per cent in 2013, while methicillin resistance amongst the S. aureus crossed the 50 per cent mark in 2013. An increasing trend in resistance was shown by Pseudomonas spp. for piperacillin-tazobactam (PTZ), amikacin and imipenem (IPM). For the non-fermenters, resistance frequency remained very high except for IPM (33.1%) and polymyxin-B (2.4%).Interpretation & conclusions:Our findings show VAP as an important problem in the ICU setting. The incidence of multidrug-resistant pathogens was on the rise. The resistance pattern of these pathogens can help an institution to formulate effective antimicrobial policy. To have a comprehensive pan-India picture, multicentric studies are needed.

In vitro characterization of antibacterial potential of Iranian honey samples against wound bacteria

Incidence of multidrug-resistant pathogens is increasing, thus discovery of alternative therapeutic agents is needed. Honey possesses therapeutic potential, including wound-healing properties and antimicrobial activities. Although antimicrobial activity of honey has been effectively established, the antibacterial properties of Iranian honey samples on wound microorganisms have not been conducted and compared with honey gold standards. Using standard methods, the antibacterial activities of 53 Iranian honey samples and two laboratory-synthesized honeys against 16 drug-resistant clinical isolates and four reference strains were determined. Different concentrations of honey were tested against each type of microorganism to determine the minimum inhibitory concentration (MIC) or minimum bactericidal concentration. The selected honeys with high levels of phenolic equivalent were studied for kinetics of bacterial killing. Also, the ability of selected honey samples to prevent biofilm formation was checked by crystal violet assay. The MICs of Iranian honey samples ranged from 3.12 to >50 % (w/v), and their efficacies were also determined. Nine samples with the highest antibacterial activities were selected. Survival of Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa was reduced significantly by selected honeys. Moreover, all selected honey samples were able to prevent biofilm formation of S. aureus and P. aeruginosa strains at concentrations of ≤25 %. The results of the present study have shown that selected Iranian honey samples had lower MIC values than reported standard honeys such as Manuka and Tualang and could be potentially used as alternative medical grade honey, particularly against S. aureus, P. aeruginosa, and E. coli.

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Introduction: Based upon ATS/IDSA guideline recommendations for the management of adults with healthcare-associated pneumonia, patients with early-onset infection (within 4 days of admission) without risk factors for multidrug-resistant (MDR) pathogens should receive empiric monotherapy. However, more recent data suggests that this early- and late-onset classification should be abandoned as similar pathogens and mortality have been identified in the two subgroups of patients. Hypothesis: We hypothesize that there is no difference in the incidence of MDR pathogens between episodes of early-onset and late-onset pneumonia within our institution. Methods: We conducted a retrospective chart review of respiratory cultures (endotracheal aspirates and bronchoalveolar lavages) obtained at our institution between June 2008 and December 2011. Results: Five hundred eighty four cultures were reviewed to include 150 patients. Thirty-nine of 65 (60%) patients with early-onset pneumonia had infection with MDR organisms versus 63 of 85 (74%) patients with late-onset pneumonia (p=0.07). In patients with early-onset pneumonia with and without risk factors, MDR organisms accounted for 24 of 33 (73%) and 15 of 32 (47%) infections, respectively (p=0.04). Compared to the 47% incidence of MDR pathogens in patients without risk factors, MDR organisms were identified in 74% (87 of 118) of all patients with expected risk of MDR pathogens (late onset/other risk factors) (p=0.005). No difference was observed in mechanical ventilator-free days, intensive care unit length of stay, or mortality between the latter two groups described. Conclusions: We observed a similar incidence of infection with MDR pathogens in patients with early- and late-onset pneumonia; however, more MDR pathogens were observed in patients with risk factors for MDR pathogens regardless of timing of onset. While this study confirms the high incidence of pneumonia associated with MDR organisms in patients with risk factors, half of patients with early-onset pneumonia without identified risk factors experienced infection with MDR organisms. Consideration should be given to broad-spectrum empiric antibiotic regimens in patients with early-onset pneumonia in our hospital.

Is healthcare-associated pneumonia a distinct entity needing specific therapy?

Healthcare-associated pneumonia (HCAP) was introduced in 2005 by American Thoracic Society/Infectious Diseases Society of America guidelines as a new entity of pneumonia, resembling nosocomial pneumonia rather than community-acquired pneumonia (CAP) in terms of frequency of multidrug-resistant (MDR) pathogens and outcomes, thus requiring broad spectrum initial antimicrobial coverage in order to prevent inadequate treatment and, as a consequence, excess mortality. This concept continues to be a subject of controversy. Main concerns relate to the definition of HCAP, the true frequency of MDR pathogens, and the impact of MDR pathogens on outcomes. Definitions of HCAP and the relative frequencies of HCAP defining subgroups were highly variable. All studies demonstrated an increased severity of pneumonia at presentation and an excess mortality from HCAP as compared to CAP. The incidence of MDR pathogens in different observational studies was slightly increased but generally low in most studies originating from Europe, South Korea, Canada, and Japan. However, the data do not support a causal relationship of MDR incidence and excess mortality. Instead, after adjustment for confounders, mortality might be related to hidden or documented treatment restrictions in elderly and severely disabled patients. Accordingly, HCAP guideline concordant antimicrobial treatment did not improve outcomes. The HCAP concept is based on varying definitions poorly predictive of MDR pathogens. The incidence of MDR pathogens is far lower than supposed in the original guideline document, and MDR pathogens do not seem to be the main cause of excess mortality. Broad antimicrobial coverage does not alter outcomes. As the HCAP concept results in a tremendous overtreatment without any evidence for improved outcomes, it should not be implemented in clinical practice prior to clear evidence that it is superior to a careful assessment of individual risk factors for MDR pathogens.

Clinical Microbiology in Pharmacy Education: A Practice-based Approach

The increasing incidence of multi-drug resistant pathogenic bacteria, alongside viral and fungal human pathogens, supports the argument that skills in microbiology and infectious disease diagnosis, treatment and prevention are of growing global importance to be held among primary care clinicians. In Canada, inevitable future astronomical health care costs largely due to an aging population, have forced eyes upon pharmacists as one of (if not) the primary clinical professions to accommodate the growing need to accommodate patient access to health care while maintaining lower health care costs. As such, the role of pharmacists in health care is expanding, punctuating the need to enhance and improve Pharmacy education. Accurate assessment of the current gaps in Pharmacy education in Canada provides a unique opportunity for a new Pharmacy School at the University of Waterloo to establish a non-traditional, outcomes-based model to curricular design. We are applying this iterative curriculum assessment and design process to the establishment of a Medical Microbiology program, deemed as a prominent gap in former Pharmacy educational training programs. A PILOT STUDY WAS CARRIED OUT DISTRIBUTING A COMPREHENSIVE SURVEY TO A LOCAL GROUP OF PHARMACISTS PRACTICING IN A VARIETY OF SETTINGS INCLUDING: hospital, clinic, community, independent, industry and government, to assess perceived gaps in Pharmacy microbiology and infectious disease education. Preliminary findings of the surveys indicate that practitioners feel under-qualified in some areas of microbiology. The results are discussed with respect to a curricular redesign model and next steps in the process of curricular design are proposed.