Levels Of Antibiotic Resistance Research Articles

Genetic Relatedness of 5-Year Isolates of Clostridioides difficile Polymerase Chain Reaction Ribotype 017 Strains in a Hospital.

The objective of this study was to analyse the genetic relatedness of Clostridioides difficile polymerase chain reaction ribotype 017 (RT017) strains from patients with hospital-acquired C. difficile infection (HA-CDI) in a hospital with a high RT017 prevalence. From 2009 to 2013, 200 RT017 strains (26.8%) were collected from 745 HA-CDI patient isolates. They comprised 64 MLVA types, and 197 (98.5%) strains were genetically related to 5 clonal complexes (CCs). The largest cluster, CC-A, included 163 isolates of 40 MLVA types. CC-A accounted for 20% of RT017 strains in 2009 and sharply increased to 94.9% in 2010, 94% in 2011, 86.2% in 2012, and 73.5% in 2013. The other 4 CCs included 20 isolates with 7 MLVA types. The resistance rates of antimicrobials were as follows: clindamycin 100%, moxifloxacin 99%, rifaximin 88.5%, and vancomycin 1%. All isolates were susceptible to metronidazole and piperacillin/tazobactam. Comparing antibiotic resistance among CCs, the geometric mean of the minimum inhibitory concentrations of moxifloxacin, vancomycin, and piperacillin/tazobactam were significantly higher for CC-A isolates than for the other CCs. RT017 clones constantly evolved over the 5 years studied with regard to genetic relatedness. The levels of antibiotic resistance may contribute to the persistence of organisms in the institution.

Correlation Analysis among Environmental Antibiotic Resistance Genes Abundance, Antibiotics Concentrations, and Heavy Metals Concentrations Based on Web of Science Searches

Antibiotics and heavy metals are both important environmental pollutants and selective stressors for antibiotic resistance. However, the impact of their environmental concentrations on antibiotic resistance levels is still unclear. In this paper, research published before 2019 reporting the abundance of antibiotic resistance genes(ARGs), antibiotics concentrations, or heavy metal concentrations were extracted from the Web of Science database, and then statistical regression was used to investigate their correlative association. The results show that antibiotic selection pressure has a statistically significant effect on the increase in the abundance of ARGs in environmental media such as surface water, sediment, and soil, even at very low antibiotic concentrations(P<0.05). Different classes of antibiotics show different potential to select and enrich ARGs. Heavy metals and the interaction between antibiotics and heavy metals also have significant effects on ARG transmission(P<0.05). Multivariate statistical regression models can better explain the variance of ARG abundance, with R2 values for the water phase and solid phase environmental samples of 0.482 and 0.707 respectively, which are much higher than those achieved using univariate regression models. However, additional environmental factors not included may also affect ARG abundance. The results of this work provide a basis for the evaluation and control of environmental antibiotic resistance.

Upregulation of abeM, amvA, and qacEΔ1 efflux pump genes associated with resistance of Acinetobacter baumannii strains to disinfectants.

Background and aimsAcinetobacter baumannii is among the most concerning cause of nosocomial infections due to its high level of antibiotic resistance and high mortality. The aim of this study was to determine the role of efflux pumps in resistance of A. baumannii strains to three disinfectants, including MICROZED ID‐MAX, NANOSIL D2, and OPIDEX OPA.MethodsTwenty‐eight environmental and clinical isolates of A. baumannii were collected from selected hospitals of central Iran. The minimum inhibitory concentrations of the disinfectants were determined and real time reverse transcriptase‐PCR was performed to investigate the expression level of qacEΔ1, amvA, abeM, and adeB efflux pump genes.ResultsConsidering both clinical and environmental isolates, there was a significant difference in the mean expression level of qacEΔ1 gene between susceptible and resistant strains to MICROZED ID‐MAX disinfectant, of amvA and abeM genes between susceptible and resistant strains to NANOSIL D2 disinfectant and of abeM gene in susceptible and resistant strains to OPIDEX OPA disinfectant (all P ˂ .05). The expression levels of abeM and amvA genes were higher in the environmental isolates that were resistant to NANOSIL D2 disinfectant compared to those that were susceptible (P ˂ .05).ConclusionsThis study provided evidence for the role of abeM and amvA genes in the resistance of environmental isolates to disinfectants, particularly hydrogen peroxide derivatives.

Antimicrobial Resistance Situational Analysis 2019-2020: Design and Performance for Human Health Surveillance in Uganda.

Antibiotic resistance and its mechanisms have been known for over six decades, but global efforts to characterize its routine drivers have only gained momentum in the recent past. Drivers of clinical and community resistance go beyond just clinical practice, which is why one-health approaches offer the most realistic option for controlling antibiotic resistance. It is noteworthy that the emergence of resistance occurs naturally in the environment, but akin to climate change, the current accelerated emergence and spread bears hallmarks of anthropomorphic influence. If left unchecked, this can undo the medical and agricultural advancements of the last century. The WHO recommends that nations develop, adopt, and implement strategies that track the changing trends in antibiotic resistance levels to tackle this problem. This article examines efforts and progress in developing and implementing a human health antimicrobial resistance surveillance strategy in Uganda. We do so within the context of the National Action Plan for tackling antimicrobial resistance (AMR-NAP) launched in 2018. We discuss the technical milestones and progress in implementing surveillance of GLASS priority pathogens under this framework. The preliminary output of the framework examines the performance and compares AMR and AMU surveillance data to explain observed trends. We conclude that Uganda is making progress in developing and implementing a functional AMR surveillance strategy for human health.

Su Kaynaklarında Antibiyotik ve Ağır Metal Direncinin Küresel Sorunu, Gelevera Deresi’nin İncelemesi (Giresun, Türkiye)

In this study is to determine the current heavy metal and antibiotic resistance levels of isolates taken from the Gelevera Creek (Giresun). For this purpose, surface water and sediment were collected monthly from four different stations starting from April 2017 and ending in March 2018. After the Gr (-) and Gr (+) bacteria isolation in selective media, the 325 isolated were tested for their resistance against 4 different heavy metals. The resistance levels of these 325 bacteria against to cadmium, copper, lead and manganese heavy metals were detected respectively as 89.0%, 60.16%, 33.0%, 29.8% (Cd &gt; Cu &gt; Pb &gt; Mn). The 82 isolates with high resistance against heavy metals in each station were also tested for their resistance against antibiotics. The levels of resistance against antibiotics of these isolated strains were found respectively as follows: cefazolin: 69.6%, cefuroxime: 59.4%, nalidixic acid: 51.7%, ampicillin: 46.0%, cefotaxime: 39.1%, meropenem: 31.4%, amikacin: 21.7%, erythromycin: 13.0%, and chloramphenicol: 3.3%. In our study, two isolates with high antibiotic and heavy metal, using the Vitek-II Compact System were identified as Serratia marcenscens (99%) and Enterococcus avium (91%). Furthermore, the multiple antibiotic resistance levels (MAR) of all isolates are 80,5%. The results indicate that the isolates taken from the Gelevera Creek (Giresun) were found to be extremely resistant against commercially used antibiotics and heavy metals, and this shows that there is antibiotic and heavy metal contamination in drinking water reserves.

Multicomponent Peptide Hydrogels as an Innovative Platform for Cell-Based Tissue Engineering in the Dental Pulp.

In light of the increasing levels of antibiotic resistance, nanomaterials and novel biologics are urgently required to manage bacterial infections. To date, commercially available self-assembling peptide hydrogels have not been studied extensively for their ability to inhibit micro-organisms relevant to tissue engineering sites such as dental root canals. In this work, we assess the biocompatibility of dental pulp stem/stromal cells with commercially available multicomponent peptide hydrogels. We also determine the effects of dental pulp stem/stromal cell (DPSC) culture in hydrogels on growth factor/cytokine expression. Furthermore, to investigate novel aspects of self-assembling peptide hydrogels, we determine their antimicrobial activity against the oral pathogens Staphylococcus aureus, Enterococcus faecalis, and Fusobacterium nucleatum. We show that self-assembling peptide hydrogels and hydrogels functionalized with the adhesion motif Arg-Gly-Asp (RGD) are biocompatible with DPSCs, and that cells grown in 3D hydrogel cultures produce a discrete secretome compared with 2D-cultured cells. Furthermore, we show that soluble peptides and assembled hydrogels have antimicrobial effects against oral pathogens. Given their antibacterial activity against oral pathogens, biocompatibility with dental pulp stem/stromal cells and enhancement of an angiogenic secretome, multicomponent peptide hydrogels hold promise for translational use.

Staphylococcus aureus Toxins: An Update on Their Pathogenic Properties and Potential Treatments.

Staphylococcus aureus is a clinically important pathogen that causes a wide range of human infections, from minor skin infections to severe tissue infection and sepsis. S. aureus has a high level of antibiotic resistance and is a common cause of infections in hospitals and the community. The rising prevalence of community-acquired methicillin-resistant S. aureus (CA-MRSA), combined with the important severity of S. aureus infections in general, has resulted in the frequent use of anti-staphylococcal antibiotics, leading to increasing resistance rates. Antibiotic-resistant S. aureus continues to be a major health concern, necessitating the development of novel therapeutic strategies. S. aureus uses a wide range of virulence factors, such as toxins, to develop an infection in the host. Recently, anti-virulence treatments that directly or indirectly neutralize S. aureus toxins have showed promise. In this review, we provide an update on toxin pathogenic characteristics, as well as anti-toxin therapeutical strategies.

ANTIBIOTIC SENSITIVITY ISOLATION EVALUATION OF MAJOR MICROORGANISMS IN PERIODONTAL TISSUE PATHOLOGY

Relevance of research The loss of effectiveness and activity of antibiotics is caused by their irrational and inappropriate use (especially in self-medication). The risk of antibiotic-resistant mikrobiom potentially be associated not only with time proceeding systemic antibacterial component in the protocol complex treatment of periodontitis but with specific combinations of different used drugs duration, efficiency previously performed mechanical treatment by open or closed curettage, especially the dosing of selected antibiotics middlemen. In – depth study and development of or personalized approaches to treatment is relevant periodontitis by individualizing the choice of appropriate antibiotics for incorporation into the algorithm of complex therapy, or universal approaches, the possibility of implementation of which depends on arguing the effectiveness of a particular combination of antibacterial agents for the vast majority of patients according to studies with sufficient samples. Study Goal is to assess the levels of antibiotic resistance and antibiotic sensitivity of isolates of major microorganisms in periodontal tissue pathology. Materials and methods of research. The research was conducted on the basis of the University Dental Clinic and private dental clinics in Uzhhorod. Determination of levels antibiotic sensitivity was carried out using a disco-diffusion method with the advice and algorithm identified by order MOH Ukraine 05.04.2007 № 167 "On Approval of guidelines" Determination of the sensitivity of microorganisms to antibiotics and in accordance with the recommendations EUCAST (Eurepean Committee on Antimicrobial Susceptibility Testing). During the testing, standard sets of discs with antibiotics and appropriate test cultures were used, which were seeded with microorganisms obtained from patients with generalized periodontitis of varying severity. Research results and their discussion. During the microbiological analysis of smears obtained from periodontal pockets of whole patients study group, microorganisms were identified, which were characterized by relatively high levels of prevalence, among them: P. gingivalis, T. forsythia, F. nucleatum, P. intermedia, A. actinomycetemcomitans, K. pneumoniae, E. coli, E. cloaceae, S. aureus, S. haemolyticus, S. viridans, S. pyogenes. A detailed analysis of the distribution of mean levels of prevalence of antibiotic sensitivity and antibiotic resistance among the analyzed isolates was performed. The results of antibioticograms differ depending on the qualitative and quantitative composition of the isolated microorganisms, their levels of antibiotic sensitivity and antibiotic resistance. This distribution of results indicates the feasibility of a patient-centered approach to treatment, based on the preliminary identification of microorganisms isolated from periodontal pockets of patients, as well as determining the levels of their antibiotic sensitivity and antibiotic resistance. Conclusion. The application of the approach with preliminary determination of antibiotic sensitivity to microorganisms cultured from the oral cavity is characterized by the relevant biological principles of conducting. Prospects for further research. The analysis of the effectiveness of adjuvant antibiotic therapy in the process of complex treatment of periodontal patients and the development of personalized approaches to the treatment of periodontitis are promising.

Elevated levels of antibiotic resistance in groundwater during treated wastewater irrigation associated with infiltration and accumulation of antibiotic residues

Treated wastewater irrigation (TWW) releases antibiotics and antibiotic resistance genes (ARGs) into the environment and might thus promote the dissemination of antibiotic resistance in groundwater (GW). We hypothesized that TWW irrigation increases ARG abundance in GW through two potential mechanisms: the contamination of GW with resistant bacteria and the accumulation of antibiotics in GW. To test this, the GW below a real-scale TWW-irrigated field was sampled for six months. Sampling took place before, during and after high-intensity TWW irrigation. Samples were analysed with 16S rRNA amplicon sequencing, qPCR of six ARGs and the class 1 integron-integrase gene intI1, while liquid chromatography tandem mass spectrometry was performed to detect antibiotic and pharmaceutical residues. Absolute abundance of 16S rRNA in GW decreased rather than increased during long-term irrigation. Also, the relative abundance of TWW-related bacteria did not increase in GW during long-term irrigation. In contrast, long-term TWW irrigation increased the relative abundance of sul1 and intI1 in the GW microbiome. Furthermore, GW contained elevated concentrations of sulfonamide antibiotics, especially sulfamethoxazole, to which sul1 confers resistance. Total sulfonamide concentrations in GW correlated with sul1 relative abundance. Consequently, TWW irrigation promoted sul1 and intI1 dissemination in the GW microbiome, most likely due to the accumulation of drug residues.

Резистентність до протимікробних препаратів серед клінічних ізолятів, виділених при інфекції сечових шляхів у дітей

Актуальність. Інфекція сечових шляхів (ІСШ) — одна з основних причин госпіталізації дітей до стаціонару. Однією з основних причин неефективного лікування ІСШ у дітей є антибіотикорезистентність збудників ІСШ. Метою дослідження було визначення стану поширеності антибіотикорезистентності серед збудників інфекції сечових шляхів. Матеріали та методи. Дослідження антибіотикорезистентності проводилося на 61 клінічному ізоляті, що були виділені зі зразків сечі дітей, які були госпіталізовані з приводу захворювання на різні форми ІСШ. Визначення чутливості до 23 антимікробних препаратів здійснювалося за допомогою методу антимікробних дисків з подальшим визначенням зон затримок росту. Результати. Найбільшу ефективність щодо збудників інфекцій сечових шляхів мали представники групи аміноглікозидів (амікацин — до 91,9 % клінічних ізолятів, гентаміцин — до 82 %). Цефалоспорини ІІІ покоління мали різний рівень антибіотикорезистентності, що коливалася у межах від 11,8 % (цефтизоксим) до 42,5 % (цефподоксим). Зберігається високий рівень чутливості до синтетичних протимікробних препаратів: чутливість до фурагіну становила 89,8 %, до фосфоміцину — 86,5 %. Висновки. Рівень антибіотикорезистентності щодо збудників ІСШ значно варіює у різних антибактеріальних препаратів, а також залежно від форми ІСШ, тому проведення дослідження антибіотикорезистентності є важливим етапом в лікуванні хворих на ІСШ.

Co-infection of ST2IP carbapenem-resistant Acinetobacter baumannii with SARS-CoV-2 in the patients admitted to a Tehran tertiary referral hospital

BackgroundCarbapenem-resistant Acinetobacter baumannii (CRAB) is among the most concerning cause of healthcare-associated infections (HAI) due to its high level of antibiotic resistance and high mortality. In the era of the COVID-19 pandemic, the key priority of infection control committees is to contain the dissemination of antibiotic resistant Gram-negative bacteria. Here, we aimed to timely recognize the emergence of CRAB in COVID-19 cases admitted to the wards of a tertiary referral hospital and to identify the genetic relatedness of the isolates.MethodsFrom 30 March to 30 May 2020, a total of 242 clinical samples from COVID-19 cases were screened for CRAB isolates using standard microbiologic and antibiotic susceptibility tests. The PCRs targeting oxa23, oxa24, oxa58, blaTEM and blaNDM-1 genes were performed. Two multiplex PCRs for identifying the global clones (GC) of A. baumannii were also performed. The sequence type of CRABs was determined using Institut Pasteur (IP) multilocus sequence typing (MLST) scheme.ResultsEighteen CRAB isolates were recovered from COVID-19 patients with the mean age of 63.94 ± 13.8 years. All but 4 COVID-19 patients co-infected with CRAB were suffering from an underlying disease. Death was recorded as the outcome in ICUs for 9 (50%) COVID-19 patients co-infected with CRAB. The CRAB isolates belong to GC2 and ST2IP and carried the oxa23 carbapenem resistance gene.ConclusionThis study demonstrated the co-infection of CRAB isolates and SARS-CoV-2 in the patients admitted to different ICUs at a referral hospital in Tehran. The CRAB isolates were found to belong to ST2IP, share the oxa23 gene and to have caused several outbreaks in the wards admitting COVID-19 patients.

Antimicrobial Resistance and Comparative Genome Analysis of Klebsiella pneumoniae Strains Isolated in Egypt

Klebsiella pneumoniae is an important human pathogen in both developing and industrialised countries that can causes a variety of human infections, such as pneumonia, urinary tract infections and bacteremia. Like many Gram-negative bacteria, it is becoming resistant to many frontline antibiotics, such as carbapenem and cephalosporin antibiotics. In Egypt, K. pneumoniae is increasingly recognised as an emerging pathogen, with high levels of antibiotic resistance. However, few Egyptian K. pneumoniae strains have been sequenced and characterised. Hence, here, we present the genome sequence of a multidrug resistant K. pneumoniae strain, KPE16, which was isolated from a child in Assiut, Egypt. We report that it carries multiple antimicrobial resistance genes, including a blaNDM-1 carbapenemase and extended spectrum β-lactamase genes (i.e., blaSHV-40, blaTEM-1B, blaOXA-9 and blaCTX-M-15). By comparing this strain with other Egyptian isolates, we identified common plasmids, resistance genes and virulence determinants. Our analysis suggests that some of the resistance plasmids that we have identified are circulating in K. pneumoniae strains in Egypt, and are likely a source of antibiotic resistance throughout the world.

In Vitro and In Vivo Assessment of the Potential of Escherichia coli Phages to Treat Infections and Survive Gastric Conditions.

Enterotoxigenic Escherichia coli (ETEC) and Shigella ssp. infections are associated with high rates of mortality, especially in infants in developing countries. Due to increasing levels of global antibiotic resistance exhibited by many pathogenic organisms, alternative strategies to combat such infections are urgently required. In this study, we evaluated the stability of five coliphages (four Myoviridae and one Siphoviridae phage) over a range of pH conditions and in simulated gastric conditions. The Myoviridae phages were stable across the range of pH 2 to 7, while the Siphoviridae phage, JK16, exhibited higher sensitivity to low pH. A composite mixture of these five phages was tested in vivo in a Galleria mellonella model. The obtained data clearly shows potential in treating E. coli infections prophylactically.

Antibiotic resistance and biofilm formation of Acinetobacter baumannii isolated from high-risk effluent water in tertiary hospitals in South Africa

Discharge of drug-resistant, biofilm-forming pathogens from hospital effluent water into municipal wastewater treatment plants poses a public health concern. This study examined the relationship between antibiotic resistance levels and biofilm formation of Acinetobacter baumannii strains isolated from hospital effluents. Antibiotic susceptibility of 71 A. baumannii isolates was evaluated by the Kirby-Bauer disk diffusion method. Minimum inhibitory concentrations (MICs) were determined by the agar dilution method, while the minimum biofilm eradication concentration (MBEC) was determined by the broth dilution method. Genotyping was performed for plasmid DNA. Biofilm formation was evaluated by the microtitre plate method and was quantified using crystal violet. A P-value of <0.05 was regarded as statistically significant in all tests. Extensively drug-resistant (XDR) strains made up 58% of the isolates, while multidrug-resistant (MDR) and pandrug-resistant (PDR) strains made up 50% of the isolates from final effluent. The MBEC of ciprofloxacin increased by 255-fold, while that of ceftazidime was as high as 63-1310-fold compared with their respective MICs. Isolates were classified into four plasmid pattern groups with no association between biofilm formation and plasmid type (P=0.0921). The degree of biofilm formation was independent of the level of antibiotic resistance, although MDR, XDR and PDR isolates produced significant biofilm biomass (P=0.2580). These results suggest that hospital effluent is a potential source of MDR biofilm-forming A. baumannii strains. Appropriate treatment and disposal of effluents are essential to prevent the presence of drug-resistant pathogens in wastewater.

Antibiotic resistance of non-fermenting Gram-negative bacilli isolated at a large Infectious Diseases Hospital in North-Eastern Romania, during an 11-year period.

Increased antibiotic resistance of non-fermenting Gram-negative bacilli (NFGNB) associated with increased morbidity and mortality makes the infections they produce a major public health problem. This study aims to assess the evolution of antibiotic susceptibility and the level of NFGNB antibiotic resistance. We carried out a retrospective study on 994 NFGNB strains which had been isolated in the Clinical Laboratory of the "Sf. Parascheva" Clinical Hospital of Infectious Diseases, Iaşi, during a period of 11 years (2008-2018). Of the 994 NFGNB analyzed, 322 were Acinetobacter spp. and 672 Pseudomonas aeruginosa. Also, 882 NFGNB were isolated from non-sterile sites, in which there was a higher burden of P. aeruginosa strains (n=617). Acinetobacter spp. presented over 70% resistance to the majority of antibiotics. Three pandrug-resistant P. aeruginosa strains were identified. The rate of colistin resistance was 2.91% for P. aeruginosa and 3.33% for Acinetobacter spp. A comparative analysis of the antibiotic susceptibility of strains isolated from non-sterile sites versus sterile sites revealed statistically significant differences only for Acinetobacter spp. The percentage of resistant strains was significantly higher in tracheobronchial aspirate compared to sputum. The results show that Acinetobacter spp. is substantially more resistant to antibiotics compared to P. aeruginosa and that the use of medical devices can favor the occurrence of infections with multidrug-resistant strains.

Characterization of clinical Ralstonia strains and their taxonomic position

To improve understanding of the role of Ralstonia in cystic fibrosis (CF), whole genomes of 18 strains from clinical samples were sequenced using Illumina technology. Sequences were analysed by core genome Multi-Locus Sequence Typing, Average Nucleotide Identity based on BLAST (ANIb), RAST annotation, and by ResFinder. Phylogenetic analysis was performed for the 16S rRNA gene, and the OXA-22 and OXA-60 ß-lactamase families. The minimal inhibitory concentrations (MICs) were determined using broth microdilution. ANIb data for the 18 isolates and 54 strains from GenBank, supported by phylogenetic analysis, showed that 8 groups of clusters (A-H), as well as subgroups that should be considered as species or subspecies. Groups A-C contain strains previously identified as Ralstonia solanacearum and Ralstonia pseudosolanacearum. We propose that group A is a novel species. Group B and C are Ralstonia syzygii, Ralstonia solanacearum, respectively. Group D is composed of Ralstonia mannitolilytica and Group E of Ralstonia pickettii. Group F and G should be considered novel species. Group H strains belong to R. insidiosa. OXA-22 and OXA-60 family ß-lactamases were encoded by all strains. Co-trimoxazole generally showed high activity with low MICs (≤1 mg/l) as did ciprofloxacin (≤0.12 mg/l). MICs against the other antibiotics were more variable, but generally high. RAST annotation revealed limited differences between the strains, and virulence factors were not identified. The taxonomy of the genus Ralstonia is in need of revision, but sequencing additional isolates is needed. Antibiotic resistance levels are high. Annotation did not identify potential virulence factors.

An update on ampicillin resistance and β-lactamase genes of Bacteroides spp.

Introduction. There are several β-lactamase genes described for Bacteroides strains, of which cepA and cfiA are specific for Bacteroides fragilis and define two genetic divisions. The expression and phenotypic effects of these genes are usually regulated by insertional activation.Hypotheses/Gap Statement. Information is lacking about how cepA is regulated for most of the B. fragilis strains and whether there could be a genetic element for it.Aim. We aimed to investigate the molecular background of ampicillin (and other β-lactam) resistance among Bacteroides strains as mediated mainly by cepA and also to find a genetic element for it as known for cfiA.Methodology. Various PCR methods were used for β-lactamase-resistance gene and insertion sequence (IS) element detection in 42 Bacteroides strains. β-Lactamase activity measurements and antimicrobial-susceptibility testing using agar dilution were also applied. Further molecular experiments involved sequencing, gene targeting, Southern blotting and bioinformatic analyses.Results. We found that high antibiotic resistance and β-lactamase levels are brought about by insertional activation of the cepA gene or by similar or dissimilar activation of cfxA or cfiA, or by the newly described pbbA genes. Non-activated cepA genes produced low levels of specific β-lactamase activities that did not correlate with ampicillin resistance. We found a genetic element for cepA and another region close to it that are characteristic for division I B. fragilis strains, which are replaced by other sequences in division II B. fragilis strains.Conclusion. cepA usually is not activated by IS elements and usually produces low β-lactamase activities that do not correlate with the ampicillin MICs; therefore, it probably involves some non-β-lactamase-mediated resistance mechanism(s). pbpA is a newly described, effective β-lactamase gene that is located on a plasmid, and cepA resides on a well-defined chromosomal segment that is mutually replaced in division II B. fragilis strains. This latter finding demonstrates the genetic dichotomy of cepA-cfiA in B. fragilis and requires further investigation.

Association of some virulence genes in Methicillin resistant and Methicillin sensitive Staphylococcus aureus infections isolated in community with special emphasis on pvl/mecA genes profiles in Alexandria, Egypt

IntroductionThe uncontrolled use of disinfectants and antiseptics during the COVID-19 pandemic in 2020, in Egypt, poses the risk of dissemination of virulence and antibiotic resistance among community acquired Staphylococcus aureus. AimThe goal of this study, was to shed a light on the virulence profile of both MSSA and MRSA isolated in community. In addition, the present study aimed at evaluating the correlation between level of prevalence of certain virulence genes in Staphylococcus aureus (MSSA and MRSA) that are acquired in community settings and mecA/pvl profile. MethodologyA total of 75 Staphylococcus aureus isolates were obtained from different private laboratories, all over Alexandria, Egypt, in 2020. The isolates were identified phenotypically, tested for their antibiotic resistance profile with special emphasis on Methicillin resistance. The presence of seven virulence genes namely: mecA, mecC, Panton-Valentine leucocidin (pvl), Serine-aspartate repeat-containing protein E (sdrE), enterotoxigenic gene (sea), Exfoliative toxin (eta), toxic shock syndrome (tsst), using polymerase chain reaction, was tested. Prevalence of antigenic genes were correlated to four profiles of mecA, pvl existence. ResultsIt was shown that: both mecC and eta genes were absent in all tested isolates, 18 of 75 (24%) carried the five genes and only three isolates lacked all the tested genes. The study revealed high level of antibiotic resistance among the tested isolates, where the prevalence of methicillin resistance accounted for up to 76%. Different levels of association were detected between the different antigenic traits specially when isolates were divided into four profiles revealing a correlation between the absence of pvl and that of sea genes in addition to a correlation with gender, wound infections and sea genes. ConclusionAs far as we are concerned, correlation to both mecA and pvl profiles was not previously attempted. Slightly higher prevalence of pvl genes in MSSA isolates than MRSA isolates, correlated to an extent to the presence or absence of other antigenic traits revealing the entangled nature of genetic components shown to be affected by gender, wound infection and sea genes existence, such finding opens a door for the prediction of infectious agents' profiles along with targeted treatment options.: The absence of mecC, suggests low or still no prevalence in Staphylococcus aureus isolated in community in Alexandria, as geographical region normally impacts gene distribution.

Antibiotic Usage and Resistance in Food Animal Production: What Have We Learned from Bangladesh?

Irrational and inappropriate use of antibiotics in commercial chicken and aquaculture industries can accelerate the antibiotic resistance process in humans and animals. In Bangladesh, the growing commercial chicken and aquaculture industries are playing significantly important roles in the food value chain. It is necessary to know the antibiotic usage practices and antibiotic resistance in food animal production to design rational policies, guidelines, and interventions. We conducted a narrative review to understand the level of antibiotic usage and resistance in food animal production in Bangladesh. Information about antibiotic usage in different food animal production systems, including commercial chickens and aquaculture in Bangladesh is inadequate. Only a few small-scale studies reported that the majority (up to 100%) of the broiler and layer chicken farms used antibiotics for treating and preventing diseases. However, numerous studies reported antibiotic-resistant bacteria of public health importance in commercial chicken, fish, livestock, and animal origin food. The isolates from different pathogenic bacteria were found resistant against multiple antibiotics, including quinolones, the third or fourth generation of cephalosporins, and polymyxins. Veterinary practitioners empirically treat animals with antibiotics based on presumptive diagnosis due to inadequate microbial diagnostic facilities in Bangladesh. Intensive training is helpful to raise awareness among farmers, feed dealers, and drug sellers on good farming practices, standard biosecurity practices, personal hygiene, and the prudent use of antibiotics. Urgently, the Government of Bangladesh should develop and implement necessary guidelines to mitigate irrational use of antibiotics in food animals using a multi-sectoral One Health approach.

Role of antibiotic resistance in urinary tract infection management: a cost-effectiveness analysis

Urinary tract infections and recurrent urinary tract infections pose substantial burdens on patients and healthcare systems. Testing and treatment strategies are increasingly important in the age of antibiotic resistance and stewardship. This study aimed to evaluate the cost effectiveness of urinary tract infection testing and treatment strategies with a focus on antibiotic resistance. We designed a decision tree to model the following 4 strategies for managing urinary tract infections: (1) empirical antibiotics first, followed by culture-directed antibiotics if symptoms persist; (2) urine culture first, followed by culture-directed antibiotics; (3) urine culture at the same time as empirical antibiotics, followed by culture-directed antibiotics, if symptoms persist; and (4) symptomatic treatment first, followed by culture-directed antibiotics, if symptoms persist. To model both patient- and society-level concerns, we built 3 versions of this model with different outcome measures: quality-adjusted life-years, symptom-free days, and antibiotic courses given. Societal cost of antibiotic resistance was modeled for each course of antibiotics given. The probability of urinary tract infection and the level of antibiotic resistance were modeled from 0% to 100%. We also extended the model to account for patients requiring catheterization for urine specimen collection. In our model, the antibiotic resistance rate was based either on the local antibiotic resistance patterns for patients presenting with sporadic urinary tract infections or on rate of resistance from prior urine cultures for patients with recurrent urinary tract infections. With the base case assumption of 20% antibiotic resistance, urine culture at the same time as empirical antibiotics was the most cost-effective strategy and maximized symptom-free days. However, empirical antibiotics was the most cost-effective strategy when antibiotic resistance was below 6%, whereas symptomatic treatment was the most cost-effective strategy when antibiotic resistance was above 80%. To minimize antibiotic use, symptomatic treatment first was always the best strategy followed by urine culture first. Sensitivity analyses with other input parameters did not affect the cost-effectiveness results. When we extended the model to include an office visit for catheterized urine specimens, empirical antibiotics became the most cost-effective option. We developed models for urinary tract infection management strategies that can be interpreted for patients initially presenting with urinary tract infections or those with recurrent urinary tract infections. Our results suggest that, in most cases, urine culture at the same time as empirical antibiotics is the most cost-effective strategy and maximizes symptom-free days. Empirical antibiotics first should only be considered if the expected antibiotic resistance is very low. If antibiotic resistance is expected to be very high, symptomatic treatment is the best strategy and minimizes antibiotic use.