Local Antimicrobial Resistance Patterns Research Articles

Antimicrobial Resistance Trends in Hidradenitis Suppurativa Lesions.

Background/Objectives: Antibiotic (AB) therapy is the first step in managing hidradenitis suppurativa (HS). Knowledge of the local patterns of antimicrobial resistance is paramount for the appropriate selection of antimicrobials. This study aimed to assess the occurrence of antibiotic resistance in patients with HS. Methods: A cross-sectional study was conducted on 103 patients with HS seen at the Dermatology Department at the University Hospital of Heraklion, Heraklion, Crete, Greece, from January 2019 to December 2023, who were not on any antibiotics in the last three months. Results: A total of 103 patients with HS participated in this study. Purulent material from 139 skin lesions of these patients was swabbed, and 79.86% (111/139) tested positive for bacteria. Gram-positive isolates accounted for 73%, whereas Gram-negative isolates comprised 27%. Among the isolates, 85.1% were aerobes, and 14.9% were anaerobic. The most common bacterial families isolated were Staphylococcaceae (48.27%), Enterobacteriaceae (14.94%), and Streptococcaceae (6.89%). The antibiogram profiles of bacterial cultures revealed a 57.1% resistance to levofloxacin and a 53.3% resistance to penicillin in Staphylococcus lugdunensis, whereas Staphylococcus aureus showed a 76.9% resistance to penicillin and a 58.3% resistance to fusidic acid. High resistance rates of 63.5% for tigecycline, 63.3% for ampicillin, and 40.5% for colistin were observed for Gram-negative isolates. Resistances of 62.5%, 61.5%, and 53.8% to erythromycin, clindamycin, and penicillin, respectively, were observed in the anaerobes. Conclusions: Patients with HS displayed considerable resistance to bacterial proliferation. The revised therapeutic guidelines for HS should incorporate the latest insights into bacterial antibiotic resistance.

Antibiotic stewardship in the emergency department setting: Focus on oral antibiotic selection for adults with skin and soft tissue infections.

An advisory panel of experts was convened by the ASHP Foundation as a part of its Medication-Use Evaluation Resources initiative to provide commentary on an approach to antibiotic stewardship in the treatment of skin and soft tissue infections (SSTIs), with a focus on oral antibiotics in the emergency department (ED) setting for patients who will be treated as outpatients. Considerations include a need to update existing guidelines to reflect new antibiotics and susceptibility patterns, patient-specific criteria impacting antibiotic selection, and logistics unique to the ED setting. While national guidelines serve as the gold standard on which to base SSTI treatment decisions, our advisory panel stressed that institutional guidelines must be regularly updated and grounded in local antimicrobial resistance patterns, patient-specific factors, and logistical considerations. Convening a team of experts locally to establish institution-specific guidelines as part of a comprehensive antibiotic stewardship program can ensure patients receive the most appropriate oral therapy for the outpatient treatment of SSTIs in patients visiting the ED. SSTI treatment considerations for antibiotic selection in the ED supported by current, evidence-based guidelines, including guidance on optimal oral antibiotic selection for patients discharged for outpatient treatment, are a useful tool to improve the quality and efficiency of care, enhance patient-centric outcomes and satisfaction, decrease healthcare costs, and reduce overuse of antibiotics.

Antimicrobial resistance trends in clinical Escherichia coli and Klebsiella pneumoniae in Ethiopia.

Clinicians rely on local antimicrobial resistance pattern data to guide empiric treatment for seriously ill patients when culture and antimicrobial susceptibility testing results are not immediately available. This study aimed to analyse 5-year trends in antimicrobial resistance profiles of Escherichia coli and Klebsiella pneumoniae isolates. Bacteriology reports from 2017 to 2021 at the Ethiopian Public Health Institute were analysed retrospectively. Isolates were identified using either the VITEK 2 Compact system, the BD Phoenix M50 instrument, or conventional biochemical tests. Antimicrobial susceptibility testing was conducted using either the Kirby-Bauer disk diffusion method or the VITEK 2 Compact system and BD Phoenix M50 systems available at the time of testing. The Cochran Armitage trend test was employed to test the significance of antimicrobial resistance trends over time. P-values less than 0.05 were considered statistically significant. Of the 5382 bacteriology reports examined, 458 (9%) were on E. coli and 266 (5%) were on K. pneumoniae. Both K. pneumoniae (88%) and E. coli (65%) demonstrated high resistance to extended-spectrum cephalosporins. However, both K. pneumoniae (14%) and E. coli (5%) showed lower rates of resistance to carbapenems compared to other antimicrobials. In K. pneumoniae, resistance to carbapenems (from 0% to 38%; p < 0.001) and ciprofloxacin (from 41% to 90%; p < 0.001) increased significantly between 2017 and 2021. Both organisms showed very high resistance to broad-spectrum antibiotics. Additionally, K. pneumoniae demonstrated a statistically significant rise in ciprofloxacin and carbapenem resistance. This study emphasises the significance of regular reporting of local antimicrobial resistance patterns as this information can guide appropriate empiric therapy and efforts to address antimicrobial resistance issues.

Microbial Spectrum of Keratitis at a Rural Tertiary Care Teaching Hospital.

Microbial keratitis poses a significant threat to vision and is a common ocular infection. Its causative agents encompass a wide spectrum, including bacteria, fungi, viruses, and parasites. The microbiological profile of microbial keratitis is influenced by factors such as patient demographics, geographical location, climate, and occupational hazardsand evolves over time. Corneal scrapings were collected from 75 patients with a provisional diagnosis of microbial keratitis.The samples were processed in the microbiology laboratory, and the bacterial and fungal growth isolated in the study were identified according to standard procedures. Among the 75 patients, 48 (64%) were maleand 27 (36%) were female.Corneal ulceration was found in individuals of all age groups, with the highest prevalence of 77.33% (58/75) observed in the 21-60 age range. Farmers exhibited a higher susceptibility, constituting 66.67% (50/75) of the cases.The study noted a higher occurrence of keratitis from November to February, accounting for 69.33% (52/75). Microbial etiology was identified in 25.33% (19/75) of scrapings, with fungi accounting for 68.42% (13/19) and bacteria for 31.57% (6/19). The prevalent fungal species included Fusarium (7/13, 53.84%),Aspergillus(3/13, 23.07%),Colletotrichum(2/13, 15.38%), andCurvularia​​​​​​​(1/13, 7.69%). Bacterial isolates featuredStreptococcus pneumoniae(5/6, 83.33%) and Klebsiella pneumoniae (1/6, 16.66%). This study underscores the importance of regularly updating local microbial profiles and understanding antimicrobial resistance patterns. Such updates are critical for informed decision-making in selecting optimal topical treatments for microbial keratitis.

Bloodstream infections after solid organ transplantation: clinical epidemiology and antimicrobial resistance (2016-21).

Solid organ transplant (SOT) recipients are at risk of bloodstream infections (BSIs) with MDR organisms (MDROs). To describe the epidemiology of BSI in the year after several types of SOT, as well as the prevalence of MDRO infections in this population. We conducted a single-centre, retrospective study of kidney, liver, heart, and multi-organ transplantation patients. We examined BSIs ≤1 year from SOT and classified MDRO phenotypes for Staphylococcus aureus, enterococci, Enterobacterales, Pseudomonas aeruginosa and Candida spp. We compared BSI characteristics between SOT types and determined risk factors for 90 day mortality. We included 2293 patients [1251 (54.6%) kidney, 663 (28.9%) liver, 219 (9.6%) heart and 160 (7.0%) multi-organ transplant]. Overall, 8.5% of patients developed a BSI. BSIs were most common after multi-organ (23.1%) and liver (11.3%) transplantation (P < 0.001). Among 196 patients with BSI, 323 unique isolates were recovered, 147 (45.5%) of which were MDROs. MDROs were most common after liver transplant (53.4%). The most frequent MDROs were VRE (69.8% of enterococci) and ESBL-producing and carbapenem-resistant Enterobacterales (29.2% and 27.2% of Enterobacterales, respectively). Mortality after BSI was 9.7%; VRE was independently associated with mortality (adjusted OR 6.0, 95% CI 1.7-21.3). BSI incidence after SOT was 8.5%, with a high proportion of MDROs (45.5%), especially after liver transplantation. These data, in conjunction with local antimicrobial resistance patterns and prescribing practices, may help guide empirical antimicrobial selection and stewardship practices after SOT.

Fluoroquinolone prophylaxis in patients with neutropenia at high risk of serious infections: Exploring pros and cons.

The use of fluoroquinolones to prevent infections in neutropenic patients with cancer or undergoing hematopoietic stem cell transplantation (HSCT) is a controversial issue, with international guidelines providing conflicting recommendations. Although potential benefits are clear, concerns revolve around efficacy, potential harms, and antimicrobial resistance (AMR) implications. Fluoroquinolone prophylaxis reduces neutropenic fever (NF) bloodstream infections and other serious bacterial infections, based on evidence from systematic reviews, randomized controlled trials, and observational studies in adults and children. Fluoroquinolone prophylaxis may also reduce infection-related morbidity and healthcare costs; however, evidence is conflicting. Adverse effects of fluoroquinolones are well recognized in the general population; however, studies in the cancer cohort where it is used for a defined period of neutropenia have not reflected this. The largest concern for routine use of fluoroquinolone prophylaxis remains AMR, as many, but not all, observational studies have found that fluoroquinolone prophylaxis might increase the risk of AMR, and some studies have suggested negative impacts on patient outcomes as a result. The debate surrounding fluoroquinolone prophylaxis calls for individualized risk assessment based on patient characteristics and local AMR patterns, and prophylaxis should be restricted to patients at the highest risk of serious infection during the highest risk periods to ensure that the risk-benefit analysis is in favor of individual and community benefit. More research is needed to address important unanswered questions about fluoroquinolone prophylaxis in neutropenic patients with cancer or receiving HSCT.

Prevalence and antimicrobial susceptibility pattern of bacterial uropathogens among adult patients in Madinah, Saudi Arabia

BackgroundUrinary tract infection (UTI) is considered one of the most prevalent infections that may lead to many renal complications. They account for almost 10% of all infections in Saudi Arabia, making them the second most common cause of emergency department admissions. Bacterial pathogens, primarily Escherichia coli, Klebsiella spp., Enterococcus spp., Proteus spp., and Staphylococcus spp. are the most causative agents of UTI. This study aims to evaluate the prevalence and antimicrobial susceptibility patterns of uropathogens in adult patients from Madinah, Saudi Arabia.MethodsA retrospective cross-sectional study was performed using data collected from patients who visited King Fahad General Hospital in Madinah, Saudi Arabia. Data included 16,803 urine bacterial cultures and their antimicrobial susceptibility profiles collected between January 2019 and October 2021.ResultsAmong the 16,803 tested samples, 3937 (23.4%) showed positive results for urine bacterial cultures. UTI prevalence was slightly higher in women (52.1%) than men (47.9%). Escherichia coli (29.8%) was the most prevalent, followed by Klebsiella spp. (23.2%) and Pseudomonas spp. (8.4%). As for Gram-positive bacteria, Enterococcus spp. (10.8%) were most common, followed by Streptococcus spp. (8%) and Staphylococcus spp. (3.3%). Gram-negative bacteria exhibited high resistance rates toward aztreonam (> 83.3%), ampicillin (78.8%), and cephalexin (68.5%). Enterococcus spp. displayed elevated resistance rates (> 62.3%) against ciprofloxacin, gentamicin, and tetracycline. Conversely, Streptococcus spp. showed substantial resistance rates (> 76.6%) toward colistin and trimethoprim/sulfamethoxazole.ConclusionTo optimize therapy and minimize the risk of multidrug-resistant uropathogenic infections, physicians should consider the local epidemiological trends and antimicrobial resistance patterns of prevalent uropathogens prior to initiating any empirical antibacterial therapy.

Exploring the Etiological Profile and Sensitivity Pattern of Bacterial Pathogens Isolated from Cerebrospinal Fluid in Meningitis Patients: A Tertiary Care Center Study

Objective: To explore the etiological profile and sensitivity pattern of bacterial pathogens isolated from cerebrospinal fluid (CSF) in meningitis patients at a tertiary care center. Study Design: Cross sectional study.Place and Duration of Study: The study was conducted at a tertiary care center, Lahore, Pakistan, from Jun 2021 to May 2022.Methodology: CSF samples obtained from hospitalized patients were processed according to standard microbiological protocols. Preliminary identification of pathogens was based on colony morphology, Gram staining, and biochemical testing. Gram-negative organisms were confirmed using API 10s. Antimicrobial susceptibility testing was performed using the standard Kirby Bauer disc diffusion method and interpretation was done according to CLSI guidelines (2023). E- Test method was used to determine the minimum inhibitory concentrations (MICs) of Penicillin and Vancomycin. Results: Out of 460 suspected cases, 94 (20.43%) were confirmed positive for meningitis. Streptococcal species were predominant among gram-positive organisms, while lactose fermenters, including E-coli dominated among gram-negative organisms. Lactose fermenters depicted poor sensitivity towards beta-lactams, extended generation cephalosporins and quinolones. Most of the non-lactose fermenters were sensitive to colistin.Conclusion: The study identified high prevalence rates of both gram-positive and gram-negative bacteria in CSF samples from bacterial meningitis. Additionally, low susceptibility to various tested drugs was observed. These findings emphasize the importance of accurate diagnosis and appropriate antibiotic management based on local antimicrobial resistance patterns, guiding antimicrobial stewardship and infection control practices.

Editorial: The Value of Monitoring Local Antimicrobial Resistance Patterns in Enteric Fever

Editorial: The Value of Monitoring Local Antimicrobial Resistance Patterns in Enteric Fever

Bacterial etiology of urinary tract infections in patients treated at Kenyan health facilities and their resistance towards commonly used antibiotics.

Evidence-based empirical antibiotic prescribing requires knowledge of local antimicrobial resistance patterns. The spectrum of pathogens and their susceptibility strongly influences guidelines for empirical therapies for urinary tract infections (UTI) management. This study aimed to determine the prevalence of UTI causative bacteria and their corresponding antibiotic resistance profiles in three counties of Kenya. Such data could be used to determine the optimal empirical therapy. In this cross-sectional study, urine samples were collected from patients who presented with symptoms suggestive of UTI in the following healthcare facilities; Kenyatta National Hospital, Kiambu Hospital, Mbagathi, Makueni, Nanyuki, Centre for Microbiology Research, and Mukuru Health Centres. Urine cultures were done on Cystine Lactose Electrolyte Deficient (CLED) to isolate UTI bacterial etiologies, while antibiotic sensitivity testing was done using the Kirby-Bauer disk diffusion using CLSI guidelines and interpretive criteria. A total of 1,027(54%) uropathogens were isolated from the urine samples of 1898 participants. Staphylococcus spp. and Escherichia coli were the main uropathogens at 37.6% and 30.9%, respectively. The percentage resistance to commonly used drugs for the treatment of UTI were as follows: trimethoprim (64%), sulfamethoxazole (57%), nalidixic acid(57%), ciprofloxacin (27%), amoxicillin-clavulanic acid (5%), and nitrofurantoin (9%) and cefixime (9%). Resistance rates to broad-spectrum antimicrobials, such as ceftazidime, gentamicin, and ceftriaxone, were 15%, 14%, and 11%, respectively. Additionally, the proportion of Multidrug-resistant (MDR) bacteria was 66%. High resistance rates toward fluoroquinolones, sulfamethoxazole, and trimethoprim were reported. These antibiotics are commonly used drugs as they are inexpensive and readily available. Based on these findings, more robust standardised surveillance is needed to confirm the patterns observed while recognising the potential impact of sampling biases on observed resistance rates.

Prevalence and antimicrobial resistance patterns of microbes isolated from individuals attending private diagnostic centre in Cape Coast Metropolis of Ghana

The evidence of rising numbers of multidrug-resistant organisms requires the implementation of effective stewardship programs. However, this should be informed by evidence-based knowledge of local antimicrobial resistance patterns. The current study aims to establish the prevalence of common pathogenic microbes including their antimicrobial susceptibility patterns and distribution in the Cape Coast Metropolis. This was a retrospective study where microbial culture and antimicrobial susceptibility records for 331 patients were reviewed from January to December 2019, at a private health centre. All data were analysed using Excel (Microsoft Office, USA), SPSS and GraphPad Prism 8 software programs. Among the samples tested, 125 (37.76%) were positive for microbes with high vaginal swab (HVS) samples recording the highest number of pathogens (44%), followed by urine (40%) and both pleural and semen samples having the least (0.3% each). Again, gram-negative isolates were more prevalent than the gram-positive isolates. The prevalence of antimicrobial resistance was very significant with isolates resistant to more than one antibiotic (P < 0.05). Escherichia coli showed the highest level of resistance, followed by Citrobacter spp. These were followed by Klebsiella spp., Staphylococcus spp., Coliforms, Pseudomonas spp., Commensals and Candida spp. The high resistance pattern suggests an inevitable catastrophe requiring continuous monitoring and implementation of effective antibiotic stewardship.

Increasing rates of extended-spectrum B-lactamase-producing Escherichia coli and Klebsiella pneumoniae in uncomplicated and complicated acute pyelonephritis and evaluation of empirical treatments based on culture results.

Increasing rates of extended-spectrum beta-lactamase (ESBL) producing E. coli and K. pneumoniae over time made empirical treatment complicated. Knowing local antimicrobial resistance patterns of common pathogens can make it easier to decide on empirical antibiotics. We aimed to investigate the prevalence and risk factors of ESBL positivity of E. coli and K. pneumoniae strains in uncomplicated and complicated pyelonephritis acquired in community and healthcare associations and to evaluate the appropriateness of empirical treatment. Adult patients hospitalized with diagnosis of community-acquired or healthcare-associated uncomplicated/complicated pyelonephritis initiated empirical antimicrobial therapy were included in the study. Appropriateness of empirical treatment at 48-72h based on culture resultsand treatment modifications were evaluated. A total of 369 uncomplicated (94) and complicated (275) episodes of pyelonephritis were evaluated. The most common agents wereE. coli(71.0%) andK. pneumoniae(17.7%),and the ESBL-production rate was 64.4%, and higher in healthcare-associated pyelonephritis (P 0.013). Being of healthcare-associated infection, previous antibiotic use, and presence of urinary catheters were independent risk factors for ESBL-producing E. coli and K. pneumoniae (P 0.009, < 0.001, and 0.024, respectively). The treatment inappropriateness was mostly associated with use of ceftriaxone (56.3%) (P < 0.001). Treatment has escalated in 41.5% of ceftriaxone-initiated patients, in only 8.8% and 9.5% ertapenem and piperacillin-tazobactam-initiated patients, respectively. ESBL-production rates are quite high even in community-acquired infections. The use of broad-spectrum antibiotics covering ESBL-producing pathogens to increase the appropriateness of empirical treatment and then narrowing treatment based on culture results appears a better and life-saving choice.

A Risk-Based Clinical Decision Support System for Patient-Specific Antimicrobial Therapy (iBiogram): Design and Retrospective Analysis.

BackgroundThere is a pressing need for digital tools that can leverage big data to help clinicians select effective antibiotic treatments in the absence of timely susceptibility data. Clinical presentation and local epidemiology can inform therapy selection to balance the risk of antimicrobial resistance and patient risk. However, data and clinical expertise must be appropriately integrated into clinical workflows.ObjectiveThe aim of this study is to leverage available data in electronic health records, to develop a data-driven, user-centered, clinical decision support system to navigate patient safety and population health.MethodsWe analyzed 5 years of susceptibility testing (1,078,510 isolates) and patient data (30,761 patients) across a large academic medical center. After curating the data according to the Clinical and Laboratory Standards Institute guidelines, we analyzed and visualized the impact of risk factors on clinical outcomes. On the basis of this data-driven understanding, we developed a probabilistic algorithm that maps these data to individual cases and implemented iBiogram, a prototype digital empiric antimicrobial clinical decision support system, which we evaluated against actual prescribing outcomes.ResultsWe determined patient-specific factors across syndromes and contexts and identified relevant local patterns of antimicrobial resistance by clinical syndrome. Mortality and length of stay differed significantly depending on these factors and could be used to generate heuristic targets for an acceptable risk of underprescription. Combined with the developed remaining risk algorithm, these factors can be used to inform clinicians’ reasoning. A retrospective comparison of the iBiogram-suggested therapies versus the actual prescription by physicians showed similar performance for low-risk diseases such as urinary tract infections, whereas iBiogram recognized risk and recommended more appropriate coverage in high mortality conditions such as sepsis.ConclusionsThe application of such data-driven, patient-centered tools may guide empirical prescription for clinicians to balance morbidity and mortality with antimicrobial stewardship.

Antibiotic sensitivity/resistance pattern of hospital acquired blood stream infection in children cancer patients: A retrospective study.

The literature shows a growing emphasis on understanding the local patterns of antimicrobial resistance (AMR). We aimed to evaluate the spectrum of local microorganisms that cause bloodstream infections (BSI) and their AMR patterns in an Egyptian institution treating children with cancer. We conducted a single-centre, retrospective, study on children with confirmed primary, hospital-acquired, BSIs over one year. The microbiological examination of blood samples was done according to the Clinical and Laboratory Standards Institute. The antibiotic sensitivity test was done using VITEK® 2 system. We retrieved the data of 607 children with a median age of 5 (0.25-18) years old. The most encountered diagnosis was acute lymphoblastic leukaemia (40%). Most identified microorganisms were gram-negative bacilli, mainly Escherichia coli (27.8%), followed by Klebsiella pneumoniae (12.2%). Gram-negative bacilli showed high resistance to piperacillin/tazobactam, levofloxacin, and meropenem. The lowest resistance rates for Gram-negative bacilli isolates were noted for colistin and tigecycline. Similarly, the gram-positive cocci showed high resistance to ampicillin/sulbactam, cefoxitin, and clindamycin; and low resistance regarding vancomycin and linezolid. Resistance proportions (pattern) were similar to those reported in other countries with a higher distribution of E coliand a growing resistance to levofloxacin. Further investigation of the predisposing factors and the development of more effective strategies for the prevention of BSI should be a significant public health priority.

Acute Diarrhea in Children Less than Five Years of Age: Epidemiology of Bacterial Pathogens

Objectives: Acute diarrhea is among the leading causes of mortality and morbidity worldwide. Bacteria tend to cause more fatal illnesses and complications such as septicemia and persistent diarrhea. This study aimed to determine the causes of acute diarrhea, laboratory and clinical predictors of bacterial causes, and antimicrobial resistance pattern among the isolates among children in Dar es salaam, Tanzania. Methods: A cross-sectional hospital-based study was conducted in Dar es salaam Hospitals from April 2015 to March 2016 among children below five years of age who presented with acute diarrhea. Demographic characteristics and results from stool specimen analysis, complete blood count, C- reactive protein and antimicrobial resistance results were recorded using a pre-structured clinical research form. Results: Among 200 children enrolled, viruses were identified in 149 (74.5%) of the cases. Bacterial pathogens were found in 15 (7.5%) cases only. Elevated stool red blood cell count, stool white blood cell count, and fever were highly associated with enteric bacterial pathogens (p<0.001, p=0.002 and p=0.04 respectively). Most of the bacterial isolates were resistant to Cotrimoxazole and erythromycin but highly sensitive to ciprofloxacin and Ceftriaxone. Conclusion: Fever, elevated stool leukocyte and elevated stool red blood cells are significant predictors of bacterial enteric pathogens in children with acute diarrhea. These parameters may guide clinicians in resource-limited settings in the diagnosis and management of acute diarrhea. Further studies should be conducted to determine local antimicrobial resistance patterns. J Microbiol Infect Dis 2020; 10(3): 208-214.

Steroid Use, Advanced Stage Disease and ≥3 Lines of Prior Chemotherapy Are Associated with a Higher Risk of Infection Following CD19 CAR T-Cell Therapy for B-NHL: Real World Data from a Large UK Center

Steroid Use, Advanced Stage Disease and ≥3 Lines of Prior Chemotherapy Are Associated with a Higher Risk of Infection Following CD19 CAR T-Cell Therapy for B-NHL: Real World Data from a Large UK Center

Epidemiology of antibiotic treatment for uncomplicated cystitis in adults in Japan

IntroductionA large number of antibiotics are used for the treatment of uncomplicated cystitis owing to its high morbidity. As the administration of antibiotics for uncomplicated cystitis may be considered an example of inappropriate use, outpatient antimicrobial stewardship for this condition is important. We evaluated the current pharmacoepidemiology trends for the treatment of uncomplicated cystitis in Japan to predict stewardship strategies. MethodsThis descriptive observational study analyzed data from an anonymized claims database of employees and their family members covered by the employer’s health insurance. We identified female outpatients diagnosed with acute cystitis (ICD-10 code N300) aged ≥15 years and extracted oral antibiotic prescription records between 2013 and 2016. We excluded prescriptions for >7 days. ResultsThe most prescribed antibiotic category was fluoroquinolones (52.67%), followed by cephalosporins and penems (40.63%). Third-generation cephalosporins accounted for 90.91% of cephalosporin and penem prescriptions. The most common duration of antibiotic prescription was 5 days, except for first-generation cephalosporins, penem (7 days) and sulfamethoxazole and trimethoprim (3 days). ConclusionFluoroquinolones and third-generation cephalosporins were prescribed to most uncomplicated cystitis cases in Japan. Although the lack of alternatives to quinolones and beta-lactams in Japan is an obstacle for antimicrobial stewardship for uncomplicated cystitis, promoting accurate diagnoses and establishing alternatives available in the Japanese market are important. Shortening the treatment duration is also an important strategy. Further research is needed on local antimicrobial resistance patterns to determine a fixed treatment strategy for uncomplicated cystitis.

Antimicrobial resistance in N’Djamena (Chad): Four-year experience of the French Forward Medical and Surgical Team engaged in the “Barkhane Operation”

ObjectivesKnowledge of local antimicrobial resistance (AMR) patterns is required for effective empirical treatment of bacterial diseases. Very little is known about current resistance patterns of common pathogenic bacteria in the African region and particularly in the Sahel region. We aimed to describe the local bacterial epidemiology and to determine whether French recommendations for empirical treatment could be implemented. Patients and methodsWe performed a single-center observational study. Data was collected retrospectively from the Forward Medical and Surgical Center (FFMSC) bacterial database from January 2015 to December 2018. All bacteriological analyses, negative or positive, were included. ResultsA total of 2194 samples were analyzed. Infectious diseases were urinary tract infections (20.8%), bone and joint infections (20.4%), skin infections of chronic wounds (13.4%), soft tissue abscesses (13%), and gastroenteritis (10.8%). The most frequent infections were enterobacterial infections (43.6%) and staphylococcal infections (31.1%). The prevalence of AMR was 32.1%. Significantly more ESBL-producing bacteria (41.3%) were observed in the Chadian population than in the French population in N’djamena (6.3%) (P<0.001). ConclusionsWe reported a high rate of ESBL-producing bacteria in N’Djamena. The use of empirical antibiotic therapies in the FFMSC may thus be questioned: French recommendations cannot be implemented in such setting and the use of carbapenems or new anti-ESBL antibiotics should be considered. Prospective studies are required to conclude.

Bacteriological profile and antimicrobial sensitivity pattern of endotracheal tube aspirates of patients admitted in ICU

Background: Ventilator-associated pneumonia (VAP) in critically ill patients are associated with high morbidity and mortality as they are at a high risk of acquiring respiratory infections, due to complex interplay between the endotracheal tube, host immunity and virulence of invading bacteria. Several studies reported multidrug-resistant bacteria like Acinetobacter spp., Pseudomonas spp., Gram-positive bacteria like S. aureus. For prompt initiation of empirical antimicrobial treatment, knowledge of local antimicrobial resistance patterns is essential. Aims: To study antimicrobial sensitivity among organisms isolated from endotracheal aspirates of patients with VAP and examine their various resistance pattern and look for biofilm production. Materials and Methods: ET aspirates were taken from 140 patients who were mechanically ventilated for various reasons in ICU of our hospital and were subjected to Gram stain and semiquantitative cultures. Organism identification and antimicrobial susceptibility testing were performed according to standard guidelines. Various resistance patterns and biofilm production on Congo Red Agar were observed. Results: Out of 140 ET aspirates processed, 120 samples (85.7%) were culture positive; most common isolate being Acinetobacter spp. (45.8%), followed by Pseudomonas spp. and Klebsiella spp. (16.6% each), and Gram-positive isolate Staphylococcus aureus (12.5%). All Staphylococcus aureus were sensitive to linezolid and resistant to cefoxitin (MRSA). Most of the Gram-negative isolates were sensitive to imipenem. ESBL resistance was seen in 25% of Klebsiella spp. and Amp C resistance was seen in 27% of Acinetobacter spp. Biofilm was produced in 62.5% of the isolates. Mortality was maximum in patients whose ET aspirates showed biofilm production. Conclusion: A local antibiogram pattern for each hospital, based on bacteriological profile and susceptibilities, is essential, to initiate empiric therapy and help in framing the appropriate institutional antibiotic policy.

Multiple Drug Resistance Pattern in Urinary Tract Infection Patients in Saudi Arabia

Background: Urinary tract infection (UTI) is the most common problem in hospitalized and outdoor patients. It is mainly found in females because of the shortness of the urethra and closeness to anus, which facilitate entrance of fecal micro–flora to urinary tract. Knowledge of local antimicrobial resistance patterns is essential for evidence- based empirical antibiotic prescribing.&#x0D; Objective: The main aim of this study was to analyze the drug resistance pattern of bacterial isolates from suspected urinary tract infection (UTI) patients in Al-Kharj, Saudi Arabia.&#x0D; Methodology: This cross- sectional study was carried out in Al-Kharj region of Saudi Arabia from 1st. September, 2016 to 28th. February, 2017. Midstream urine specimens were collected from patients at a general hospital. The specimens were cultured and the isolates were identified using standard microbiological techniques. The antibiotic susceptibilities of the isolates were also determined.&#x0D; Results: The number of patients with urinary tract infection who yielded positive cultures from their mid stream urine specimens was 249(12.0%) out of 2064 specimens. The commonest isolates were Escherichia coli (53.4%) and Klebsiella pneumoniae (28.5%). Other bacterial pathogens were Proteus mirabilis (5.2%), Pseudomonas aeruginosa (4.4%), Streptococcus agalactiae (6.0%) and Enterococcus faecalis. (2.5%).&#x0D; Conclusions: E. coli is the most common causative agent of urinary tract infection followed by Klebsiella pneumoniae. Ampicillin, Augmentin, Cotrimoxazole, Norfloxacin and Nalidixic acid have the highest resistance rates against both these pathogens. No isolate is found to be resistant to imipenem.&#x0D; Bangladesh Journal of Infectious Diseases 2019;6(1):3-7