Indiscriminate Use Of Antimicrobials Research Articles

The resistome of the food chain: A One Health perspective.

Antimicrobial resistance (AMR) represents a significant global health problem which challenges Sustainable Development Goal 3 of the United Nations, with growing concerns about the possibility of AMR transmission through the food chain. The indiscriminate use of antimicrobials for the treatment of food production animals and for agricultural crop improvement, in addition to the direct discharge of livestock farm residues to sewage and the use of animal manure in agriculture, are among the factors that can facilitate the selection and transmission of AMR throughout the food chain. The study of food microbiomes has been boosted by the advent of next-generation sequencing techniques, which have enabled gaining in-depth understanding of the diversity of antimicrobial resistance genes present in food and associated environments (the so-called resistome). The aim of this review is to provide an accurate and comprehensive overview of the knowledge currently available on the resistome of the most frequently consumed foods worldwide, from a One Health perspective. To this end, the different metagenomic studies which have been conducted to characterize the resistome of foods are compiled and critically discussed.

High frequency of multidrug-resistant Escherichia coli from cattle in the Cerrado and Pantanal biomes of Brazil

The indiscriminate use of antimicrobials has led to the emergence of resistant bacteria, especially pathogenic strains of Escherichia coli, which are associated with diseases in animals and humans. The aim of the present study was to characterize E. coli isolates in calves with regards to the presence of virulence genes and investigate the resistance of the isolates to different antimicrobials. Between 2021 and 2023, 456 fecal samples were collected from calves in the Pantanal and Cerrado biomes of the state of Mato Grosso do Sul, Brazil. All samples were subjected to microbiological analysis and disc diffusion antibiogram testing. The polymerase chain reaction method was used to detect virulence genes. Bacterial growth was found in 451 of the 456 samples and biochemically identified as Escherichia coli. All 451 isolates (100 %) exhibited some phenotypic resistance to antimicrobials and 67.62 % exhibited multidrug resistance. The frequency of multidrug-resistant isolates in the Cerrado biome was significantly higher than that in the Pantanal biome (p = 0.0001). In the Cerrado, the most common pathotype was Shiga toxin-producing Escherichia coli (STEC) (28 %), followed by toxigenic Escherichia coli (ETEC) (11 %), enterohemorrhagic Escherichia coli (EHEC) (8 %) and enteropathogenic Escherichia coli (EPEC) (2 %). In most cases, the concomitant occurrence of pathotypes was more common, the most frequent of which were ETEC + STEC (33 %), ETEC + EHEC (15 %) and ETEC + EPEC (3 %). The STEC pathotype (30 %) was also found more frequently in the Pantanal, followed by EHEC (12 %), ETEC (9 %) and EPEC (6 %). The STEC pathotype had a significantly higher frequency of multidrug resistance (p = 0.0486) compared to the other pathotypes identified. The frequency of resistance was lower in strains from the Pantanal biome compared to those from the Cerrado biome. Although some factors are discussed in this paper, it is necessary to clarify the reasons for this difference and the possible impacts of these findings on both animal and human health in the region.

Long-Term Co-Circulation of Host-Specialist and Host-Generalist Lineages of Group B Streptococcus in Brazilian Dairy Cattle with Heterogeneous Antimicrobial Resistance Profiles.

Group B Streptococcus (GBS) is a major cause of contagious bovine mastitis (CBM) in Brazil. The GBS population is composed of host-generalist and host-specialist lineages, which may differ in antimicrobial resistance (AMR) and zoonotic potential, and the surveillance of bovine GBS is crucial to developing effective CBM control and prevention measures. Here, we investigated bovine GBS isolates (n = 156) collected in Brazil between 1987 and 2021 using phenotypic testing and whole-genome sequencing to uncover the molecular epidemiology of bovine GBS. Clonal complex (CC) 61/67 was the predominant clade in the 20th century; however, it was replaced by CC91, with which it shares a most common recent ancestor, in the 21st century, despite the higher prevalence of AMR in CC61/67 than in CC91, and high selection pressure for AMR from indiscriminate antimicrobial use in the Brazilian dairy industry. CC103 also emerged as a dominant CC in the 21st century, and a considerable proportion of herds had two or more GBS strains, suggesting poor biosecurity and within-herd evolution due to the chronic nature of CBM problems. The majority of bovine GBS belonged to serotype Ia or III, which was strongly correlated with CCs. Ninety-three isolates were resistant to tetracycline (≥8 μg/mL; tetO = 57, tetM = 34 or both = 2) and forty-four were resistant to erythromycin (2.0 to >4 μg/mL; ermA = 1, ermB = 38, mechanism unidentified n = 5). Only three isolates were non-susceptible to penicillin (≥8.0 μg/mL), providing opportunities for improved antimicrobial stewardship through the use of narrow-spectrum antimicrobials for the treatment of dairy cattle. The common bovine GBS clades detected in this study have rarely been reported in humans, suggesting limited risk of interspecies transmission of GBS in Brazil. This study provides new data to support improvements to CBM and AMR control, bovine GBS vaccine design, and the management of public health risks posed by bovine GBS in Brazil.

Methicillin-resistant coagulase-positive staphylococci in new, middle-aged, and old veterinary hospitals in southern Thailand: A preliminary study.

Methicillin-resistant coagulase-positive staphylococci (MRCoPS) cause pyoderma, dermatitis, and nosocomial infection. Numerous factors, including indiscriminate antimicrobial use (AMU) in veterinary medicine, cleaning practices, and AMU in hospitals, contribute to MRCoPS. However, the relationship between hospital age and MRCoPS has not yet been investigated. This study aimed to estimate the prevalence of MRCoPS in the treatment and operation rooms of new, middle-aged, and old veterinary hospitals. Samples were collected from small animal hospitals in Surat Thani, Nakhon Si Thammarat, and Songkhla in Thailand. Hospitals were defined as those that had been in operation for 5 years (new, n = 5), 5-15 years (middle-aged, n = 6), or >15 years (old, n = 3). Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry was used to identify 280 samples, and duplex polymerase chain reaction was used to identify resistance genes (mecA and blaZ). The VITEK2® automated system was then used to determine the minimum inhibitory concentration. A total of 57 Staphylococcus species were identified and classified as coagulase-positive staphylococci (CoPS) (22/57, 38.60%) or coagulase-negative staphylococci (35/57, 61.40%), respectively. Nine of the 22 CoPS (40.90%) harbored the mecA gene, and 21 isolates (95.45%) harbored the blaZ gene. Interestingly, more MRCoPS was found in new hospitals (six isolates) than in middle-aged (one isolate) and old hospitals (two isolates), although there was no statistically significant difference in the presence of MRCoPS across new, middle-aged, and old veterinary hospitals (p = 0.095), Kruskal-Wallis test. There is a need for further detailed studies, including an increase in the number of hospitals in various locations. MRCoPS is a nosocomial pathogen that causes zoonotic and recurrent infections in veterinary hospitals. The prevalence of MRCoPS tended to be higher in new hospitals. Areas with heavy animal contact, such as hospital floors, are areas of particular concern, and cleaning/disinfection of these areas must be highlighted in hygiene regimens.

The Potential of Wood Vinegar to Replace Antimicrobials Used in Animal Husbandry—A Review

The indiscriminate use of antimicrobials in animal husbandry can result in various types of environmental contamination. Part of the dose of these products is excreted, still active, in the animals’ feces and urine. These excreta are widely used as organic fertilizers, which results in contamination with antimicrobial molecules. The impacts can occur in several compartments, such as soil, groundwater, and surface watercourses. Also, contamination by antimicrobials fed or administrated to pigs, chickens, and cattle can reach the meat, milk, and other animal products, which calls into question the sustainability of using these products as part of eco-friendly practices. Therefore, a search for alternative natural products is required to replace the conventional antimicrobials currently used in animal husbandry, aiming to mitigate environmental contamination. We thus carried out a review addressing this issue, highlighting wood vinegar (WV), also known as pyroligneous acid, as an alternative antimicrobial with good potential to replace conventional products. In this regard, many studies have demonstrated that WV is a promising product. WV is a nontoxic additive widely employed in the food industry to impart a smoked flavor to foods. Studies have shown that, depending on the WV concentration, good results can be achieved using it as an antimicrobial against pathogenic bacteria and fungi and a valuable growth promoter for poultry and pigs.

Phytochemical determination and antimicrobial activity of plant extracts from Cinnamomum amoenum (Ness) Kosterm. (Lauraceae) against salmonella spp. of poultry importance

Salmonellosis is a zoonotic disease that affects commercial birds and causes major economic and productivity losses in the poultry sector. Belonging to the Enterobacteriaceae family, the Gram-negative bacillus of the genus Salmonella has presented itself as a health problem in recent years, as there has been a considerable increase in bacterial resistance, due to the indiscriminate use of antimicrobials as growth promoters. Given this context, bioactives from Brazilian flora, considered one of the most abundant in biodiversity, emerge as an alternative to the use of synthetic products. Thus, this work aimed to determine the chemical compounds of the native species Cinnamomum amoenum (Ness) Kosterm, as well as evaluate the antimicrobial activity of aqueous, ethyl acetate, hexane and ethanolic extracts against different serovars of the genus Salmonella. To obtain the extracts, the plant leaves were dried at 40°C and ground in a knife mill. Subsequently, sterilized by vacuum filtration and roto-evaporated, to completely remove the solvent. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (CBM) were performed using the broth microdilution method, with serial concentrations ranging from 200-0.09 mg/mL of the extract. As a positive control, gentamicin was used at a concentration of 200 mg/mL. Phytochemical tests revealed the presence of flavonoids, steroids and tannins, the latter present only in the aqueous and ethanolic extracts. Regarding antimicrobial activity, the ethanolic, hexane and ethyl acetate extracts showed inhibitory/bactericidal activity for all tested serotypes and the aqueous extract showed no activity on the tested serotypes. The ethanolic extract and ethyl acetate presented MIC ranging between 25 and 50 mg/mL and MBC ranging between 50 and 100 mg/mL. The hexane extract presented MIC ranging between 50 and 100 mg/mL and MBC with 100 mg/mL. The most susceptible serotypes for the ethyl acetate extract were S. Newport, S. Gallinarum, S. Montevideo, while for the ethanolic extract the most susceptible serotypes were S. Typhimurium, S. Mbandaka, S. Infantis, S. Heidelberg and S. Enteritidis. The results suggest that C. amoenum extracts have antimicrobial potential and could be a viable alternative to be used in poultry farms, thus being a more sustainable and less harmful approach to the consumer, who will be free from overdoses of synthetic antimicrobials that are commonly used. Furthermore, it is essential that new studies regarding the biological activities of C. amoenum are carried out, in order to validate its use in the control of poultry Salmonella.

Analysis of antibiotic resistance gene cassettes in a newly identified Salmonella enterica serovar Gallinarum strain in Korea

Antimicrobial resistant pathogens are a global health threat driven by the indiscriminate use of antimicrobials. Antimicrobial resistance can be acquired by resistance genes encoded by mobile genetic elements. In this study, we identified a strain of Salmonella enterica serovar Gallinarum (SG4021) from an infected chicken in Korea and characterized the presence of resistance genes in its plasmid by whole genome sequencing. The sequence was then compared with that of a plasmid (P2) from strain SG_07Q015, the only other strain of S. Gallinarum isolated in Korea for which a genome sequence is available. The results revealed that both strains harbored nearly identical DNA carrying antibiotic resistance gene cassettes inserted into integron In2 of the transposable element Tn21, namely an aadA1 resistance gene conferring resistance to aminoglycosides and a sul1 resistance gene conferring resistance to sulfonamide. Interestingly, despite the presence of sul1 in SG4021, an antibiotic sensitivity test revealed that it was sensitive to sulfonamides. Further analysis revealed that this disparity was due to the insertion of a ~ 5 kb ISCR16 sequence downstream of the promoter driving sul1 expression in SG4021. Using various mutants, we showed that the insertion of ISCR16 blocked the expression of the sul1 gene from the upstream promoter. Therefore, the functionality of antimicrobial resistance genes determines phenotypic antimicrobial resistance.

Oxytetracycline efficacy and preliminary establishment of pharmacokinetic residues in tropical fish, Catla catla (Hamilton, 1822)

Oxytetracycline (OTC) is often used in fish farms as an antibacterial agent to prevent disease outbreaks. Indiscriminate use of antimicrobials is common since many stakeholders are not aware of their potency, public health issues, and residual elimination profile in the tropical environment. The present pilot study evaluated the efficacy of oral oxytetracycline dihydrate (OTCD) at doses including 10, 55, and 82 mg/kg body weight (B·W.) in Catla catla against a pathogenic Aeromonas hydrophila. The initial efficacy study revealed that an oral dose of 55 mg OTCD/kg B.W. recorded the highest relative survival percentage (63.15%) and was selected for the final residual profile and pharmacokinetics (P.K.) study. After 10 days of medication at 55 mg OTCD/kg B.W, fish sampling was carried out at 1, 6, 11, 21, and 31 days and OTCD was determined using reverse phase-high performance liquid chromatography (RP-HPLC). The highest residue concentration (Cmax) of OTC in the tissues was ∼0.1 μg/g at 16 h (1st day). The elimination half-life (t1/2) was observed highest for muscle (10.03 days), followed by the kidney (4.57 days), and serum (4.33 days). On 11th day, the OTC level did not exceed the maximum residue level (MRL) of 0.1 μg/g. However, the residue was not detected on the 31st day in all the samples and these were considered safe for consumption.

Antibacterial Activity of Calycophyllum spruceanum Leaf Extract against Enterococcus faecalis Strains “In vitro” for Endodontic Purposes

Aims: The indiscriminate use of antimicrobials contributed to the selection of multiresistant bacterial strains, mainly Enterococcus faecalis, leading to the search for new strategies for these infections, requiring the identification of new bioactive compounds from medicinal plants, an example is C. spruceanum used in traditional communities in the Amazon.
 In this sense, this study aimed to evaluate the antibacterial activity of C. spruceanum leaf extract against E. faecalis "in vitro" for endodontic purposes.
 Place and Duration of Study: Sample: the study was carried out at the microbiology laboratory of the Federal University of Acre (UFAC), in the city of Rio Branco, state of Acre, Brazil, from July 2021 to January 2022.
 Methodology: For this study, 50mg/mL of the crude extract of C. spruceanum leaf was diluted in Dimethylsulfoxide, as well as 50mg/mL of the extract with 1000mg of calcium hydroxide and 1000mg of calcium hydroxide in 1mL of distilled water. After preparing the extracts, 20µL were deposited in the wells made on Müeler-Hinton agar medium seeded with E. faecalis, incubated for 24 hours at 37°C. After this period, the positive activity of the extracts was obtained from the formation of the inhibition halo in millimeters.
 Results: The best results were for extract associated with calcium hydroxide (20mm), followed by calcium hydroxide solution (17.67mm) and with lower activity, C. spruceanum extract (14.33mm). The best results of the Minimum Inhibitory Concentration with values ​​of 6.25 mg/mL for the extract combined with calcium hydroxide and Minimum Bactericidal Concentration that was 25mg/mL for the association of the extract with calcium hydroxide.
 Conclusion: The C. spruceanum extract has antibacterial activity against E. faecalis and its association with calcium hydroxide potentiated its effect.

Pilot Study on the Action of Thymus vulgaris Essential Oil in Treating the Most Common Bacterial Contaminants and Salmonella enterica subsp. enterica Serovar Derby in Poultry Litter.

The indiscriminate use of antimicrobials in poultry farms is linked to the increase in multi-resistant bacteria. Accordingly, based on the antimicrobial properties of Thyme Essential Oil (TEO), the present study evaluated the effects of TEO on the reduction of common microbial contaminants and Salmonella on poultry litter. A litter bulk sample was collected in a broiler farm and qualitative/quantitative investigations identified Escherichia coli and Mammaliicoccus lentus. The experimental contamination with Salmonella Derby wild strain was also performed. All pathogens showed phenotypic and genotypic resistance to different classes of antibiotics. The litter, split in different units, was treated with aqueous solutions of TEO at different concentrations (5% to 1.25%), demonstrating its effectiveness in reducing the total number of bacteria. The strongest antibacterial action was observed at the lowest concentration against Enterobacteriaceae, with a growth reduction compared to the positive control of 73.3% and 77.8% against E. coli and Salmonella Derby, respectively, while towards M. lentus the reduction was 50%. Our data confirm the antimicrobial activity of TEO and suggest its possible application for the treatment of poultry litter as an effective and natural approach for the prevention of diseases caused by the most common bacteria that colonize poultry farms, counteracting the onset of antibiotic resistance.

Multisite validation of a host response signature for predicting likelihood of bacterial and viral infections in patients with suspected influenza.

Indiscriminate use of antimicrobials and antimicrobial resistance is a public health threat. IMX-BVN-1, a 29-host mRNA classifier, provides two separate scores that predict likelihoods of bacterial and viral infections in patients with suspected acute infections. We validated the performance of IMX-BVN-1 in adults attending acute health care settings with suspected influenza. We amplified 29-host response genes in RNA extracted from blood by NanoString nCounter. IMX-BVN-1 calculated two scores to predict probabilities of bacterial and viral infections. Results were compared against the infection status (no infection; highly probable/possible infection; confirmed infection) determined by clinical adjudication. Amongst 602 adult patients (74.9% ED, 16.9% ICU, 8.1% outpatients), 7.6% showed in-hospital mortality and 15.5% immunosuppression. Median IMX-BVN-1 bacterial and viral scores were higher in patients with confirmed bacterial (0.27) and viral (0.62) infections than in those without bacterial (0.08) or viral (0.21) infection, respectively. The AUROC distinguishing bacterial from nonbacterial illness was 0.81 and 0.87 when distinguishing viral from nonviral illness. The bacterial top quartile's positive likelihood ratio (LR) was 4.38 with a rule-in specificity of 88%; the bacterial bottom quartile's negative LR was 0.13 with a rule-out sensitivity of 96%. Similarly, the viral top quartile showed an infinite LR with rule-in specificity of 100%; the viral bottom quartile had a LR of 0.22 and a rule-out sensitivity of 85%. IMX-BVN-1 showed high accuracy for differentiating bacterial and viral infections from noninfectious illness in patients with suspected influenza. Clinical utility of IMX-BVN will be validated following integration into a point of care system.

The emergence and molecular epidemiological characteristics of foodborne superbacteria resistant to next-generation antimicrobials

Superbacteria are antimicrobial resistant bacteria, and their emergence and widespread became great threats to humanity. Next-generation antimicrobials were developed to deal with existing antimicrobial resistance, but resistant bacteria emerged and spread immediately due to indiscriminate use of antimicrobials. In particular, the foodborne superbacteria are highly serious problem because they are closely related to the overall human life. In this article, we explored the distribution and resistance level of foodborne colistin-resistant Salmonella and linezolid-resistant Enterococcus among through the latest research papers about their resistance and molecular epidemiological transmission route. The transmission of resistance factors between food-derived superbacteria and other environment was also confirmed for the case of next-generation antimicrobials. Therefore, it is increasingly important to develop national and global resistance monitoring projects with One-health scheme.

Increasing Consumption of Antibiotics during the COVID-19 Pandemic: Implications for Patient Health and Emerging Anti-Microbial Resistance.

The emergence of COVID-19 infection led to the indiscriminate use of antimicrobials without knowing their efficacy in treating the disease. The gratuitous use of antibiotics for COVID-19 treatment raises concerns about the emergence of antimicrobial resistance (AMR). In this systematic review, we performed a thorough systematic search using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of scientific databases (Scopus, Web of Science, and PubMed) to identify studies where antibiotics were prescribed to treat COVID-19 (December 2019 to December 2021). Of 970 identified studies, 130 were included in our analyses. Almost 78% of COVID-19 patients have been prescribed an antibiotic. Cephalosporins were the most prescribed (30.1% of patients) antibiotics, followed by azithromycin (26% of patients). Antibiotics were prescribed for COVID-19 patients regardless of reported severity; the overall rate of antibiotic use was similar when comparing patients with a severe or critical illness (77.4%) and patients with mild or moderate illness (76.8%). Secondary infections were mentioned in only 11 studies. We conclude that concerns related to COVID-19 and the lack of treatment strategy led to the overuse of antibiotics without proper clinical rationale. Based on our findings, we propose that antimicrobial stewardship should be retained as a priority while treating viral pandemics.

Evaluation of pharmacist’s practices regarding the antimicrobials dispensing: a simulated patient study

BackgroundThe indiscriminate use of antimicrobials is considered a major contributing factor to the increase in antimicrobial resistance. Community pharmacies are the main source of access to antimicrobials, and pharmacists are in a strategic position to promote rational use of these medicines. Therefore, it is important to know dispensing service quality.ObjectiveTo evaluate the behavior of pharmacists in dispensing antimicrobials in community pharmacies in northeast Brazil.MethodsThis cross-sectional pilot study was conducted from August to October 2021 in a private community pharmacy chain in Sergipe. Dispensing was evaluated using the simulated patient (SP) technique. Two SP asked the pharmacists for the antimicrobials (case clinic 1: upper respiratory infection; case clinic 2: urinary tract infection) and recorded the service through audio. Dispensing practices were independently analyzed by two researchers based on the tools available in the literature. Data were presented using descriptive statistics.ResultsA total of 54 simulated patient visits were conducted. Based on the 12 steps recommended by the research team for good dispensing, pharmacists asked an average of 1 (±1.17) question for upper respiratory infections and 0.3 (±0.54) for urinary tract infections, as well as provided counseling (mean number of recommendations, 2.6 (±1.44) and 4.5 (±2.35), respectively). As for communication skills, pharmacists had a regular score (3.07 ± 0.34). Furthermore, there was no significant difference in the number of steps and counseling recommendations by pharmacists in dispensing clinical cases 1 and 2 (p = 0.0674).ConclusionThe quality of antimicrobial dispensing was evaluated as suboptimal, requiring improvements in practice and multifaceted strategies to promote continuing education of these professionals. In addition, awareness actions for the population must be implemented to promote the rational use of antimicrobials and reduce microbial resistance.

A Glimpse into the Resistant Pattern of Uropathogens: An Overview

Urinary tract infection (UTI) poses a serious health issue for all age groups from neonates to geriatric age groups. Majority of the women experience urinary tract infections once in their lifetime. Escherichia coli (E.coli) is the most common uropathogen causing UTI which is followed by Klebsiella and Enterococci. Amoxicillin is the most resistant antibiotic against both E.coli and Klebsiella pneumonia whereas Gentamycin and Nitrofurantoin have been sensitive to both E.coli and Klebsiella pneumonia. Gram-negative bacteria such as E. coli, Klebsiella species, Proteus species, Acinetobacter species, Enterobacter species, Pseudomonas aeruginosa, and Citrobacter species are the most common causes of UTI. Enterococcus species, Staphylococcus saprophyticus, and Coagulase-negative bacteria are among Gram-positive bacteria. Staphylococcus aureus is a coagulase-positive gram-positive bacteria that cause urinary tract infections (UTIs). Hence, we come to the serious conclusion that Uropathogens are becoming increasingly resistant to a different group of antibiotics. The misuse and indiscriminate use of antimicrobials have led to the emergence of antibiotic resistance in bacteria all over the world, posing a threat to the public. Estimating the local etiology and sensitivity pattern could help in successful treatment. Inquiring into UTI epidemiology, such as risk factors, bacterial strains, and antimicrobial susceptibility, could help healthcare planners determine the best course of action.

Single-capsule bismuth-based quadruple therapy as a rescue therapy for Helicobacter pylori eradication

Introduction Helicobacter pylori (H. pylori) infection is highly prevalent in Portugal and its eradication is formally recommended. However, the indiscriminate use of antimicrobials has led to a drastic rise in antibiotic resistance, with the failure of traditional eradication schemes. A single-capsule bismuth-based quadruple therapy became recently available in Portugal. This study aims to evaluate the efficacy and safety of a bismuth-based quadruple therapy as a second-line or rescue therapy. Patients and methods This was a multicentric study. All consecutive patients that were treated with bismuth-based quadruple therapy, as second-line or salvage treatment between July 2017 and April 2019 were enrolled. Their medical records were reviewed and clinical and laboratorial parameters, as well as data on treatment efficacy and adverse events were retrieved. Patients were also contacted by phone after treatment to confirm compliance, adverse events, and global satisfaction with this specific therapy. Results A total of 151 subjects were included (female—68.9%; mean age—56 ± 13.5 years). Patients were previously submitted to 212 eradication schemes (Median-1; 1–5; IQR:4): 33.5% triple clarithromycin-based, 25% sequential, 7.5% concomitant, 5.2% others, and in 28.8% it was not possible to know the previous eradication scheme(s) followed by the patient. The PPI of choice was esomeprazole (39.7%), followed by omeprazole (27.8%). Compliance was achieved in 93.4% and the overall eradication rate was 90.1% (95% CI: 84.6–94.2). Treatment-related adverse effects were experienced by 63 patients (41.7%; 95% CI: 34–49.7), being mild in 29, moderate in 19, and severe in 15. The main drawbacks of the treatment, from the patient’s perspective, were the high price (47%) and the adverse effects (16.6%). Failure to eradicate H. pylori was correlated with the following: previous rifabutin-based scheme (0 vs. 100%; p = 0.010) and a higher number of previous treatment schemes (1.5 ± 0.7 vs. 2.3 ± 1.2; p < 0.001). Conclusion In this South-European country a single-capsule bismuth-based quadruple therapy is an excellent option as a second-line or rescue therapy, with acceptable compliance and side effects.

Occurrence, Phenotypic and Molecular Characteristics of Extended-Spectrum Beta-Lactamase-Producing Escherichia coli in Healthy Turkeys in Northern Egypt.

Poultry is one of the most important reservoirs for zoonotic multidrug-resistant pathogens. The indiscriminate use of antimicrobials in poultry production is a leading factor for development and dissemination of antimicrobial resistance. This study aimed to describe the prevalence and antimicrobial resistance of E. coli isolated from healthy turkey flocks of different ages in Nile delta region, Egypt. In the current investigation, 250 cloacal swabs were collected from 12 turkey farms in five governorates in the northern Egypt. Collected samples were cultivated on BrillianceTM ESBL agar media supplemented with cefotaxime (100 mg/L). The E. coli isolates were identified using MALDI-TOF-MS and confirmed by a conventional PCR assay targeting 16S rRNA-DNA. The phenotypic antibiogram against 14 antimicrobial agents was determined using the broth micro-dilution method. DNA-microarray-based assay was applied for genotyping and determination of both, virulence and resistance-associated gene markers. Multiplex real-time PCR was additionally applied for all isolates for detection of the actual most relevant Carbapenemase genes. The phenotypic identification of colistin resistance was carried out using E-test. A total of 26 E. coli isolates were recovered from the cloacal samples. All isolates were defined as multidrug-resistant. Interestingly, two different E. coli strains were isolated from one sample. Both strains had different phenotypic and genotypic profiles. All isolates were phenotypically susceptible to imipenem, while resistant to penicillin, rifampicin, streptomycin, and erythromycin. None of the examined carbapenem resistance genes was detected among isolates. At least one beta-lactamase gene was identified in most of isolates, where blaTEM was the most commonly identified determinant (80.8%), in addition to blaCTX-M9 (23.1%), blaSHV (19.2%) and blaOXA-10 (15.4%). Genes associated with chloramphenicol resistance were floR (65.4%) and cmlA1 (46.2%). Tetracycline- and quinolone-resistance-associated genes tetA and qnrS were detected in (57.7%) and (50.0%) of isolates, respectively. The aminoglycoside resistance associated genes aadA1 (65.4%), aadA2 (53.8%), aphA (50.0%), strA (69.2%), and strB (65.4%), were detected among isolates. Macrolide resistance associated genes mph and mrx were also detected in (53.8%) and (34.6%). Moreover, colistin resistance associated gene mcr-9 was identified in one isolate (3.8%). The class 1 integron integrase intI1 (84.6%), transposase for the transposon tnpISEcp1 (34.6%) and OqxB -integral membrane and component of RND-type multidrug efflux pump oqxB (7.7%) were identified among the isolates. The existing high incidence of ESBL/colistin-producing E. coli identified in healthy turkeys is a major concern that demands prompt control; otherwise, such strains and their resistance determinants could be transmitted to other bacteria and, eventually, to people via the food chain.

Temporal Trends in Antimicrobial Prescribing During Hospitalization for Potential Infection and Sepsis

Some experts have cautioned that national and health system emphasis on rapid administration of antimicrobials for sepsis may increase overall antimicrobial use even among patients without sepsis. To assess whether temporal changes in antimicrobial timing for sepsis are associated with increasing antimicrobial use, days of therapy, or broadness of antimicrobial coverage among all hospitalized patients at risk for sepsis. This is an observational cohort study of hospitalized patients at 152 hospitals in 2 health care systems during 2013 to 2018, admitted via the emergency department with 2 or more systemic inflammatory response syndrome (SIRS) criteria. Data analysis was performed from June 10, 2021, to March 22, 2022. Hospital-level temporal trends in time to first antimicrobial administration. Antimicrobial outcomes included antimicrobial use, days of therapy, and broadness of antibacterial coverage. Clinical outcomes included in-hospital mortality, 30-day mortality, length of hospitalization, and new multidrug-resistant (MDR) organism culture positivity. Among 1 559 523 patients admitted to the hospital via the emergency department with 2 or more SIRS criteria (1 269 998 male patients [81.4%]; median [IQR] age, 67 [59-77] years), 273 255 (17.5%) met objective criteria for sepsis. In multivariable models adjusted for patient characteristics, the adjusted median (IQR) time to first antimicrobial administration to patients with sepsis decreased by 37 minutes, from 4.7 (4.1-5.3) hours in 2013 to 3.9 (3.6-4.4) hours in 2018, although the slope of decrease varied across hospitals. During the same period, antimicrobial use within 48 hours, days of antimicrobial therapy, and receipt of broad-spectrum coverage decreased among the broader cohort of patients with SIRS. In-hospital mortality, 30-day mortality, length of hospitalization, new MDR culture positivity, and new MDR blood culture positivity decreased over the study period among both patients with sepsis and those with SIRS. When examining hospital-specific trends, decreases in antimicrobial use, days of therapy, and broadness of antibacterial coverage for patients with SIRS did not differ by hospital antimicrobial timing trend for sepsis. Overall, there was no evidence that accelerating antimicrobial timing for sepsis was associated with increasing antimicrobial use or impaired antimicrobial stewardship. In this multihospital cohort study, the time to first antimicrobial for sepsis decreased over time, but this trend was not associated with increasing antimicrobial use, days of therapy, or broadness of antimicrobial coverage among the broader population at-risk for sepsis, which suggests that shortening the time to antibiotics for sepsis is feasible without leading to indiscriminate antimicrobial use.

Management of Multidrug-Resistant Infections in Cirrhosis.

The World Health Organization describes antimicrobial resistance as one of the biggest threats to global health, food security, and development with indiscriminate use of antimicrobials globally driving the emergence of multidrug-resistant bacteria, resistant to 60% of antimicrobials in some countries. Infections with multidrug-resistant organisms (MDROs) have increased in recent decades in patients with cirrhosis, who are frequently prescribed antibiotics, regularly undergo invasive procedures such as large volume paracentesis, and have recurrent hospitalizations, posing a particular risk in this already immunocompromised cohort of patients. In this review, we explore mechanisms underlying this vulnerability to MDRO infection; the effect of bacterial infections on disease course in cirrhosis; prevalence of MDROs in patients with cirrhosis; outcomes following MDRO infection; fungal infections; antibiotics and their efficacy; and management of MDRO infections in terms of detection, antimicrobial and nonantimicrobial treatments, prophylaxis, antibiotic stewardship, the gut microbiome, and technological interventions.

Residuos de antimicrobianos encontrados en aves de corral comercializadas en tiendas minoristas de la zona Metropolitana de Guadalajara, Jalisco

The increased demand to produce large quantities of meat and animal products for human consumption has promoted the indiscriminate use of antimicrobials. The increased use of these substances in the production of poultry, has negative consequences on Public Health due to the fact that the accumulation of antimicrobial residues in the organs and tissues of poultry might reach the consumer. The presence of antimicrobial residues can cause problems of hypersensitivity in humans, or the emergence of antimicrobial resistant pathogens. The purpose of this work was to assess the presence of antimicrobial residues in kidney and muscle tissue of poultry, commercialized in four municipalities of the Metropolitan Area of Guadalajara, Jalisco. The results show that kidney samples had a higher number of positive results compared to muscle tissue. Inhibitors of the folate pathway (sulfamethazine) were the antimicrobials with the highest number of positive results in kidney samples. In contrast, in muscle tissue, β-Lactam (penicillin) were the antimicrobials with the highest number of positive samples. Regarding the analysis of the results by municipalities, it was observed that one of them showed a greater number of positive samples for all the classes of antimicrobials evaluated. This work shows the presence of antimicrobial residues in kidney and muscle tissues of poultry, commercialized in retail sites. Therefore, it is necessary to increase efforts to monitor and control the use of antimicrobial in poultry farms.