Monitoring Of Antibiotic Resistance Research Articles

Colistin-resistant <i>Escherichia coli</i> from hospital and community nexus: public and environmental health concern

Antimicrobial resistance (AMR) is one of the greatest encounters for human health globally, which is associated with elevated morbidity and increased economic burdens. Colistin represents an important resort in treating severe infections caused by multidrug-resistant difficult-to-treat Gram-negative bacteria, including Escherichia coli. The study aimed to investigate the prevalence of colistin-resistant E. coli (CREC) in community and hospital sources and their associated risk factors. Eighty-five samples from hospital and community sources were screened using cultural and biochemical techniques and confirmed via Analytical Profile Index 20E. The antimicrobial susceptibility profile was determined using disc diffusion procedure and the phenotypic virulence factors were determined using standard culture protocols. The occurrence of CREC based on sample types includes cow carcass (26.7%), abattoir effluents (20%) and hospital effluents (8.6%). Pumpkin leaf, carrots and smoked fish were negative for CREC. The percentage distribution of CREC positive samples based on sample sources were slaughterhouses (77%) and hospital environment (33%) with open markets showing no case of CREC. Overall, CREC positive samples were 9/85 (10.6%). CREC demonstrated 100% ampicillin and trimethoprim/sulfamethoxazole resistance. The multiple antibiotics resistance profile of the Escherichia coli in this study ranged from 0.83 – 0.46. The phenotypic virulence distribution of CREC were lipase activity (33.3%), β-hemolytic activity (22.2%) and gelatinase activity (22.2%).The detection of CREC in both community and hospital environment allays a notable threat to human and animal health. Public enlightenment campaign and proper education against indiscriminate antibiotics usage as animal feed and growth promoters coupled with routine antibiotic resistance monitoring is crucial to curtail the dissemination of superbugs

Practical Application of the AMRcloud Online Platform for Veterinary Monitoring of Antibiotic Resistance of Zoonotic Pathogens

Background. Veterinary monitoring of antibiotic resistance in pathogens of zoonotic diseases is necessary for the rational use of antibiotics. Integration and use of the AMRcloud online platform in veterinary institutions will significantly simplify data processing, increase the speed of data analysis of monitoring results, and help overcome the interagency barrier in the exchange of information between human medicine and veterinary medicine.The aim of the study is the practical ap- plication of the AMRcloud online platform for veterinary monitoring of antibiotic resistance in pathogens of zoonotic origin.Material and methods. In the course of veterinary monitoring, the susceptibility of 275 isolates (16 species of bacteria) to 13 antimicrobial drugs most commonly used in animal husbandry was determined. Among the antimicrobial drugs were: amoxiclav, ampicillin, benzylpenicillin, gentamicin, clindamycin, streptomycin, tetracycline, tobramycin, cephalexin cefotaxime, ceftriaxone, erythromycin, and colistin. The data obtained were combined into a single system using the AMRcloud online platform.Results. The most common causative agents of mastitis were identified: Streptococcus agalactiae (n=96), Escherichia coli (n=55), Staphylococcus aureus (n=33) and Enterococcus faecalis (n=31). ESBL production have been detected in 13 (19.7%) of 66 isolates of the order Enterobacterales, isolated from clinical material of cattle and small ruminants, which limits the use of beta-lactam antibiotics for the treatment of mastitis.Conclusion. The use of the AMRcloud online platform in veterinary laboratories greatly simplifies data processing, increases the result analysis speed, and provides an opportunity to exchange information on antibiotic resistance between laboratories.

Candidate biomarkers of antibiotic resistance for the monitoring of wastewater and the downstream environment

Urban wastewater treatment plants (UWTPs) are essential for reducing the pollutants load and protecting water bodies. However, wastewater catchment areas and UWTPs emit continuously antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs), with recognized impacts on the downstream environments. Recently, the European Commission recommended to monitor antibiotic resistance in UWTPs serving more than 100 000 population equivalents. Antibiotic resistance monitoring in environmental samples can be challenging. The expected complexity of these systems can jeopardize the interpretation capacity regarding, for instance, wastewater treatment efficiency, impacts of environmental contamination, or risks due to human exposure. Simplified monitoring frameworks will be essential for the successful implementation of analytical procedures, data analysis, and data sharing. This study aimed to test a set of biomarkers representative of ARG contamination, selected based on their frequent human association and, simultaneously, rare presence in pristine environments. In addition to the 16S rRNA gene, ten potential biomarkers (intI1, sul1, ermB, ermF, aph(3′’)-Ib, qacEΔ1, uidA, mefC, tetX, and crAssphage) were monitored in DNA extracts (n = 116) from raw wastewater, activated sludge, treated wastewater, and surface water (upstream and downstream of UWTPs) samples collected in the Czech Republic, Denmark, Israel, the Netherlands, and Portugal. Each biomarker was sensitive enough to measure decreases (on average by up to 2.5 log-units gene copy/mL) from raw wastewater to surface water, with variations in the same order of magnitude as for the 16S rRNA gene. The use of the 10 biomarkers allowed the typing of water samples whose origin or quality could be predicted in a blind test. The results show that, based on appropriate biomarkers, qPCR can be used for a cost-effective and technically accessible approach to monitoring wastewater and the downstream environment.

Veterinary monitoring of antibiotic resistance as a tool of infectious safety

Veterinary antibiotic resistance monitoring is a systematic, ongoing process of collecting, analyzing and reporting data on antimicrobial resistance. The information received within the framework of monitoring has practical application points, including the organization of therapeutic and preventive measures.For veterinary monitoring, it is fundamentally important to separate all isolated microorganisms into clinical and colonization isolates.Clinically significant isolates, i.e. isolates that are the cause of the infectious process, specific localization.Colonizing bacteria that are not the cause of infection at a specific location. It should be noted that under certain conditions (entrance gates of infection, weakened immune status, etc.), a colonizing isolate can cause an infectious process, i.e. become clinically significant.For the preparation of local protocols for antimicrobial therapy of animals and birds, clinically significant isolates are of the greatest value.It is necessary to develop methodological recommendations for laboratory control of antibiotic resistance of pathogens of bacterial diseases of different species of animals, birds, fish, bees and introduce them into the practice of veterinary laboratories.

Streptococcus pyogenes: Pathogenesis and the Current Status of Vaccines.

Streptococcus pyogenes (group A Streptococcus; GAS), a Gram-positive coccal bacterium, poses a significant global disease burden, especially in low- and middle-income countries. Its manifestations can range from pharyngitis and skin infection to severe and aggressive diseases, such as necrotizing fasciitis and streptococcal toxic shock syndrome. At present, although GAS is still sensitive to penicillin, there are cases of treatment failure for GAS pharyngitis, and antibiotic therapy does not universally prevent subsequent disease. In addition to strengthening global molecular epidemiological surveillance and monitoring of antibiotic resistance, developing a safe and effective licensed vaccine against GAS would be the most effective way to broadly address GAS-related diseases. Over the past decades, the development of GAS vaccines has been stalled, mainly because of the wide genetic heterogeneity of GAS and the diverse autoimmune responses to GAS. With outbreaks of scarlet fever in various countries in recent years, accelerating the development of a safe and effective vaccine remains a high priority. When developing a GAS vaccine, many factors need to be considered, including the selection of antigen epitopes, avoidance of self-response, and vaccine coverage. Given the challenges in GAS vaccine development, this review describes the important virulence factors that induce disease by GAS infection and how this has influenced the progression of vaccine development efforts, focusing on several candidate vaccines that are further along in development.

ARGem: a new metagenomics pipeline for antibiotic resistance genes: metadata, analysis, and visualization.

Antibiotic resistance is of crucial interest to both human and animal medicine. It has been recognized that increased environmental monitoring of antibiotic resistance is needed. Metagenomic DNA sequencing is becoming an attractive method to profile antibiotic resistance genes (ARGs), including a special focus on pathogens. A number of computational pipelines are available and under development to support environmental ARG monitoring; the pipeline we present here is promising for general adoption for the purpose of harmonized global monitoring. Specifically, ARGem is a user-friendly pipeline that provides full-service analysis, from the initial DNA short reads to the final visualization of results. The capture of extensive metadata is also facilitated to support comparability across projects and broader monitoring goals. The ARGem pipeline offers efficient analysis of a modest number of samples along with affordable computational components, though the throughput could be increased through cloud resources, based on the user's configuration. The pipeline components were carefully assessed and selected to satisfy tradeoffs, balancing efficiency and flexibility. It was essential to provide a step to perform short read assembly in a reasonable time frame to ensure accurate annotation of identified ARGs. Comprehensive ARG and mobile genetic element databases are included in ARGem for annotation support. ARGem further includes an expandable set of analysis tools that include statistical and network analysis and supports various useful visualization techniques, including Cytoscape visualization of co-occurrence and correlation networks. The performance and flexibility of the ARGem pipeline is demonstrated with analysis of aquatic metagenomes. The pipeline is freely available at https://github.com/xlxlxlx/ARGem.

Роль условно-патогенных микроорганизмов в этиологии инфекций центральной нервной системы и мониторинг антибиотикорезистентности их возбудителей

Введение. Бактериальные поражения центральной нервной системы являются одной из актуальных проблем современной медицины, которые обусловливают необходимость оказания неотложной помощи, интенсивного, в том числе реанимационного, лечения, а также нередко и специализированного хирургического лечения пациентов. Цель. Выявление доминирующих популяций микроорганизмов в этиологической структуре инфекций ЦНС и детекция их антибиотикорезистентных штаммов. Материалы и методы. Исследования проводились в 2019–2022 гг. на кафедре медицинской микробиологии и иммунологии Азербайджанского медицинского университета, откуда и были предоставлены для исследования микроорганизмы, изолированные из патологического материала (ликвор, кровь, выделения из ушных и носовых полостей), взятого от пациентов с подозрением на менингит. Результаты. Наиболее высокую активность против E.coli обнаруживали у гентамицина (70,3; 64,5; 68,2; 69,2% соответственно по годам), нитрофурантоина (60,0; 75,5; 70,1; 70,0% соответственно), а меропенем в 100% случаев во все года исследований показал высокую активность против кишечной палочки. Заключение. Препаратами выбора при лечении инфекций ЦНС, обусловленных E.coli, являются гентамицин, нитрофурантоин, меропенем. При назначении тех или иных химиотерапевтических препаратов рекомендуется проводить постоянный микробиологический мониторинг в клиниках и лабораториях с учетом частоты выявления резистентных штаммов. Introduction. Bacterial lesions of the central nervous system are one of the urgent problems of modern medicine, which is due to the need to provide emergency care, intensive treatment, including resuscitation, and often also specialized surgical treatment of patients. Purpose. Identification of the dominant populations of microorganisms in the etiological structure of CNS infections and detection of their antibiotic-resistant strains. Materials and methods. The studies were carried out in 2019–2022 at the Department of Medical Microbiology and Immunology of the Azerbaijan Medical University, from which microorganisms isolated from pathological material (cerebrospinal fluid, blood, discharge from the ear and nasal cavities) taken from a patient with suspected meningitis were provided for research. Results. The highest activity against E. coli was found in gentamicin (70.3; 64.5; 68.2; 69.2%, respectively by years), nitrofurantoin (60.0; 75.5; 70.1; 70.0% respectively); and meropenem in 100% of cases in all years of research showed high activity against Escherichia coli. Conclusions. The drugs of choice in the treatment of CNS infections caused by E.coli are gentamicin, nitrofurantoin, meropenem. When prescribing certain chemotherapeutic drugs, it is recommended to conduct constant microbiological monitoring in clinics and laboratories, taking into account the frequency of detection of resistant strains.

Antibiotic resistance of bacterial pathogens isolated from the conjunctiva in the Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) surveillance study (2009–2021)

Antibiotic resistance in bacterial ocular infections is of significant clinical concern and may affect treatment outcomes. We report on in vitro antibiotic susceptibility rates and trends among conjunctival-sourced isolates collected in the Antibiotic Resistance Monitoring in Ocular micRoorganisms (ARMOR) surveillance study. A total of 2214 conjunctival isolates (918 Staphylococcus aureus, 589 coagulase-negative staphylococci [CoNS], 194 Streptococcus pneumoniae, 171 Pseudomonas aeruginosa, and 342 Haemophilus influenzae) obtained between 2009–2021 were analyzed. Staphylococci were commonly resistant to azithromycin (≥54.8%) and oxacillin (≥29.3%). Resistance among S. pneumoniae isolates was notable for azithromycin (34.0%) and penicillin (28.9%), while P. aeruginosa and H. influenzae isolates were highly susceptible to most tested antibiotics. Methicillin-resistant staphylococci demonstrated greater concurrent resistance to other antibiotics than methicillin-susceptible isolates and exhibited high rates of multidrug resistance (≥74.0%). Among staphylococci, antibiotic resistance increased with patient age, and there were small decreases in resistance to several drugs over the 13-year period. These findings indicate that resistance to antibiotics routinely used in ophthalmic practice remains high among conjunctival isolates.

Multidrug Resistance Profiles and Resistance Mechanisms to β-Lactams and Fluoroquinolones in Bacterial Isolates from Hospital Wastewater in Bangladesh.

Multidrug resistance (MDR) is one of the deadliest public health concerns of the 21st century, rendering many powerful antibiotics ineffective. The current study provides important insights into the prevalence and mechanisms of antibiotic resistance in hospital wastewater isolates. In this study, we determined the MDR profile of 68 bacterial isolates collected from five different hospitals in Dhaka, Bangladesh. Of them, 48 bacterial isolates were identified as Enterobacteriaceae. Additionally, we investigated the prevalence and distribution of five beta-lactam resistance genes, as well as quinolone resistance mechanisms among the isolates. The results of this study showed that 87% of the wastewater isolates were resistant to at least three different antibiotic classes, as revealed using the disc diffusion method. Resistance to β-lactams was the most common, with 88.24% of the isolates being resistant, closely followed by macrolides (80.88% resistant). Polymyxin was found to be the most effective against wastewater isolates, with 29.41% resistant isolates. The most common β-lactam resistance genes found in wastewater isolates were blaTEM (76.09%), blaCTX-M1 (71.74%), and blaNDM (67.39%). Two missense mutations in the quinolone resistance-determining region (QRDR) of gyrA (S83L and D87N) and one in both parC (S80I) and parE (S458A) were identified in all isolates, and one in parE (I529L), which had not previously been identified in Bangladesh. These findings suggest that hospital wastewater acts as an important reservoir of antibiotic-resistant bacteria wherein resistance mechanisms to β-lactams and fluoroquinolones are obvious. Our data also emphasize the need for establishing a nationwide surveillance system for antibiotic resistance monitoring to ensure that hospitals sanitize their wastewater before disposal, and regulation to ensure hospital wastewater is kept away from community settings.

Comparison of Cefotaxime-Resistant Escherichia coli and sul1 and intI1 by qPCR for Monitoring of Antibiotic Resistance of Wastewater, Surface Water, and Recycled Water.

Awareness of the need for surveillance of antimicrobial resistance (AMR) in water environments is growing, but there is uncertainty regarding appropriate monitoring targets. Adapting culture-based fecal indicator monitoring to include antibiotics in the media provides a potentially low-tech and accessible option, while quantitative polymerase chain reaction (qPCR) targeting key genes of interest provides a broad, quantitative measure across the microbial community. The purpose of this study was to compare findings obtained from the culture of cefotaxime-resistant (cefR) Escherichia coli with two qPCR methods for quantification of antibiotic resistance genes across wastewater, recycled water, and surface waters. The culture method was a modification of US EPA Method 1603 for E. coli, in which cefotaxime is included in the medium to capture cefR strains, while qPCR methods quantified sul1 and intI1. A common standard operating procedure for each target was applied to samples collected by six water utilities across the United States and processed by two laboratories. The methods performed consistently, and all three measures reflected the same overarching trends across water types. The qPCR detection of sul1 yielded the widest dynamic range of measurement as an AMR indicator (7-log versus 3.5-log for cefR E. coli), while intI1 was the most frequently detected target (99% versus 96.5% and 50.8% for sul1 and cefR E. coli, respectively). All methods produced comparable measurements between labs (p < 0.05, Kruskal-Wallis). Further study is needed to consider how relevant each measure is to capturing hot spots for the evolution and dissemination of AMR in the environment and as indicators of AMR-associated human health risk.

Tracking spatio-temporal distribution and transmission of antibiotic resistance in aquatic environments by using ESBL-producing Escherichia coli as an indicator

Wastewater treatment plants (WWTPs) play an important role in the production, and transmission of antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) as a convergence for human, animal, and environmental wastewater. The aim of this study was to investigate the spatio-temporal variation and influencing factors of ARB in different functional areas of the urban WWTP and the connecting rivers for 1-year monitoring using extended-spectrum β-lactamase-producing Escherichia coli (ESBL-Ec) as an indicator bacteria, and to study the transmission patterns of ARB in the aquatic environment. The results showed that ESBL-Ec isolates were identified from the WWTP (n = 219), including influent (n = 53), anaerobiotic tank (n = 40), aerobiotic tank (n = 36), activated sludge tank (n = 31), sludge thickner tank (n = 30), effluent (n = 16), and mudcake storage area (n = 13). The dehydration process can significantly remove the ESBL-Ec isolates; however, ESBL-Ec was still detected in samples collected from the effluent of the WWTP (37.0%). The detection rate of ESBL-Ec was significantly different across seasons (P < 0.05), and ambient temperature was negatively correlated with the detection rate of ESBL-Ec (P < 0.05). Furthermore, a high prevalence of ESBL-Ec isolates (29/187, 15.5%) was detected in samples collected from the river system. These findings emphasize that the high majority of ESBL-Ec in aquatic environments is alarming because it poses a significant threat to public health. Clonal transmission of ESBL-Ec isolates between the WWTP and rivers based on the spatio-temporal scale was observed by pulsed-field gel electrophoresis analysis, ST38 and ST69 ESBL-Ec clone were selected as prioritized isolates for antibiotic resistance monitoring in the aquatic environment. Further phylogenetic analysis showed human-associated (feces, blood) E. coli was the main source contributing to the presence of antibiotic resistance in aquatic environments. Longitudinal and targeted monitoring of ESBL-Ec in WWTPs and the development of effective wastewater disinfection strategies before effluent discharge from WWTPs are urgently required, to prevent and control the spread of antibiotic resistance in the environment.

Molecular detection of Helicobacter pylori and its genotypic antimicrobial resistance patterns in dyspeptic Mozambican patients

AbstractBackgroundHelicobacter pylori strains show a high level of genotypic diversity and express several genes that contribute to their pathogenicity and resistance. In Mozambique, there is lack of information regarding its resistance pattern to antibiotics. In this study, we aimed to investigate the prevalence of H. pylori and its genotypic resistance to clarithromycin, metronidazole, and fluoroquinolones in Mozambican dyspeptic patients. Since appropriate eradication should be based on the local resistance rate, our data will guide clinicians in choosing the best drugs for the effective treatment of H. pylori‐infected patients.MethodsThis is a cross‐sectional descriptive study conducted between June 2017 and June 2020, in which 171 dyspeptic patients were recruited, and through upper gastrointestinal endoscopy, gastric biopsies were collected from those patients. Polymerase chain reaction was performed for the detection of H. pylori and its resistance mechanisms to clarithromycin (23S rRNA), metronidazole (rdxA), and fluoroquinolones (gyrA); mutations conferring resistance to these antibiotics were investigated by sequencing 23S rRNA, rdxA, and gyrA genes.ResultsOf the 171 samples tested, H. pylori was detected in 56.1% (96/171). The clarithromycin resistance rate was 10.4% (the responsible mutations were A2142G and A2143G), the metronidazole resistance rate was 55.2% (4 types of mutations responsible for metronidazole resistance were identified which include, D59N, R90K, H97T, and A118T. However, in many cases, they appeared in combination, with D59N + R90K + A118T being the most frequent combination), and the fluoroquinolones resistance rate was 20% (the responsible mutations were N87I and D91G).ConclusionH. pylori infection remains common in dyspeptic Mozambican patients. High resistance to metronidazole and fluoroquinolones requires continuous monitoring of antibiotic resistance and adaptation of therapy to eradicate this infection.

Microbiological monitoring of antibiotic resistance of strains of Streptococcus agalactiae among pregnant women

Group B Streptococcus (GBS) is the causative agent in 2–7% of all urinary tract infections (UTI), including asymptomatic bacteriuria (AB), cystitis, and pyelonephritis. We used the bacteriological quantitative method of sowing urine samples of pregnant women on Columbia agar with 5% lamb blood), Strepto B chromogenic agar and Todd Hewitt broth, identification of GBS strains with determination of sensitivity to bacitracin, hippurate hydrolysis test and CAMP test. Susceptibility to antimicrobial drugs was determined by the disk-diffusion method according to recommendations of the European Committee on Antimicrobial Susceptibility Testing. For the period of 2021, out of 3,356 urine samples of pregnant women, there were 149 samples of the investigated biomaterial with a positive result for GBS (resultancy – 4.4%). It was established that among the studied contingent, 41 strains of GBS were isolated in the first trimester of pregnancy (27.5%), in the second trimester – 59 strains (39.5%), in the third trimester – 49 strains (33.0%). It is established that out of the 149 strains of GBS, 38 strains (25.0%) were resistant to norfloxacin, 45 strains (30.0%) to erythromycin, 41 strains (28.0%) to clindamycin,125 strains (84.0%) to tetracycline, 20 strains (13.0%) to levofloxacin, 3 strains (2.0%) to nitrofurantoin. All strains of Streptococcus agalactiae were found to be sensitive to benzylpenicillin. The number of resistant strains of SGB identified from the urine of pregnant women was 47 strains. All resistant strains were resistant to at least three groups of antibacterial drugs, except beta-lactams. The results of the scientific research will allow us to obtain dynamic data on the antibiotic resistance of GBS strains in order to study the rate of development of antibiotic sensitivity of this microorganism. In the future, the research data can be used by scientists when reviewing protocols for the treatment of urinary tract infections in pregnant women.

Assessment and Management of Hospital Acquired Infections in a Tertiary Care Hospital

Abstract: Aim: To assess hospital acquired infections and its management in a tertiary care hospital. Materials and Methods: A cross-sectional study of six months was carried out. Utilizing SPSS Version 25 and Microsoft Office Excel, statistical analysis was carried out, after the collected data were imported into Excel. Results: In our investigation, the prevalence of hospital acquired infections was discovered to be 6.1%. Male patients made up 70% of study’s total participants while female made up 30%. The highest distribution of Hospital Acquired Infections (HAI) was found to be Bloodstream Infection (BSI) (41.80%), followed by Hospital-Acquired Pneumonia (HAP) (17.20%), Respiratory tract infections (RTI) (13.90%) and other HAI. (Hospital Aquired Infections). Most common causative organism was found to be as Klebsiella pneumoniae (15.46%). According to lab investigations, Leukocytosis (61.47%), Neutrophilia (59.83%), Lymphopenia (78.68%), Hyperglycaemia (53.3%) and elevated level of CRP (81.13%) was found in majority patients. Most of the patients were treated with Meropenem (17.55%), Linezolid (15.98%) and others. Conclusion: Hospital acquired infections are a significant risk to medical facilities and one of the most often avoidable negative patient outcomes. They make a major contribution to hospital expenses and mortality rates. The basis of effective infection control programmes in hospitals can be the monitoring of antibiotic resistance in conjunction with tracking physician prescribing patterns. Keywords: Hospital Acquired Infections (HAI), Nosocomial infections, Causative organism, Prevalence.

Prevalence and Abundance of Beta-Lactam Resistance Genes in Hospital Wastewater and Enterobacterales Wastewater Isolates

Antimicrobial resistance may develop in nature including in hospital wastewater through horizontal genetic transfer. Few studies were conducted on the antimicrobial resistance genes in hospital wastewater and wastewater isolates in Indonesia. The prevalence and abundance of beta-lactam resistance genes in hospital wastewater and Enterobacterales wastewater isolates were investigated. Twelve wastewater samples were collected from an influent wastewater treatment plant. Escherichia coli and Klebsiella pneumoniae were isolated from the wastewater samples by culture-based methods. DNA was extracted from wastewater samples and the isolates. Nineteen beta-lactam resistance genes were tested by a high throughput qRT-PCR method. blaGES and blaTEM were the most abundant genes detected in hospital wastewater and Escherichia coli, respectively (p < 0.001). The relative abundance of blaCMY_2, blaCTX-M5, blaCTX-M8, blaGES, blaNDM, and blaSHV11 in Klebsiella pneumoniae was higher than in the wastewater and Escherichia coli (p < 0.001; p = 0.006; p = 0.012; p < 0.001; p = 0.005; p < 0.001). Klebsiella pneumoniae might be associated with resistance to piperacillin/tazobactam, ceftriaxone, and cefepime (p < 0.001; p = 0.001; p < 0.001). In conclusion, ESBL genes showed higher abundance than carbapenemase genes in hospital wastewater samples. The ESBL-producing bacteria that were predominantly found in hospital wastewater may originate from clinical specimens. The culture-independent antibiotic resistance monitoring system might be developed as an early warning system for the increasing beta-lactam resistance level in clinical settings.

Genetic Determinants of Macrolide and Fluoroquinolone Resistance in Mycoplasma genitalium and Their Prevalence in Moscow, Russia

Macrolide (MLR) and fluoroquinolone (FQR) resistance in Mycoplasma genitalium (MG) has recently become a major problem worldwide. The available data on the prevalence of MLR and FQR in MG in Russia are limited. In this study, we aimed to evaluate the prevalence and pattern of mutations in 213 MG-positive urogenital swabs from patients in Moscow between March 2021 and March 2022. MLR- and FQR-associated mutations were searched in 23S rRNA as well as in the parC and gyrA genes using Sanger sequencing. The prevalence of MLR was 55/213 (26%), with A2059G and A2058G substitutions being the two most common variants (36/55, 65%, and 19/55, 35%, respectively). FQR detection showed 17% (37/213); two major variants were D84N (20/37, 54%) and S80I (12/37, 32.4%) and three minor variants were S80N (3/37, 8.1%), D84G (1/37, 2.7%), and D84Y (1/37, 2.7%). Fifteen of the fifty-five MLR cases (27%) simultaneously harbored FQR. This study revealed the high frequency of MLR and FQR. We conclude that the improvement of patient examination algorithms and therapeutic approaches should be combined with the routine monitoring of antibiotic resistance based on the sensitivity profiles presented. Such a complex approach will be essential for restraining the development of treatment resistance in MG.

Sampling Considerations for Wastewater Surveillance of Antibiotic Resistance in Fecal Bacteria

Wastewaters can be analyzed to generate population-level data for public health surveillance, such as antibiotic resistance monitoring. To provide representative data for the contributing population, bacterial isolates collected from wastewater should originate from different individuals and not be distorted by a selection pressure in the wastewater. Here we use Escherichia coli diversity as a proxy for representativeness when comparing grab and composite sampling at a major municipal wastewater treatment plant influent and an untreated hospital effluent in Gothenburg, Sweden. All municipal samples showed high E. coli diversity irrespective of the sampling method. In contrast, a marked increase in diversity was seen for composite compared to grab samples from the hospital effluent. Virtual resampling also showed the value of collecting fewer isolates on multiple occasions rather than many isolates from a single sample. Time-kill tests where individual E. coli strains were exposed to sterile-filtered hospital wastewater showed rapid killing of antibiotic-susceptible strains and significant selection of multi-resistant strains when incubated at 20 °C, an effect which could be avoided at 4 °C. In conclusion, depending on the wastewater collection site, both sampling method and collection/storage temperature could significantly impact the representativeness of the wastewater sample.

Character of wound microflora and resistance to antibiotics: monitoring results 2012–2020

The aim of the study was to improve the microbiological diagnosis of surgical infections, collect and analyze the data on the spectrum of surgical microflora and monitoring of antibiotic resistance in the period from 2012 to 2020.The research material was the separation of surgical wounds of patients, cultures of gram-negative and gram-positive bacteria isolated from the biological material of patients by the bacteriological method, the results of testing the sensitivity of bacterial cultures to antibiotics by diffusion into agar and using semi-automatic analyzers VITEK-2.A 9-year multicenter monitoring of the species composition of bacteria associated with wound infections revealed a high frequency of isolation of a number of conditionally pathogenic microorganisms – Escherichia spp., Klebsiella spp., Pseudomonas spp., Acinetobacter spp., Enterococcus spp., Streptococcus spp., Staphylococcus spp., Citrobacter spp., Proteus spp. In the period from 2012 to 2020, the amount of information entered into the computer database about these bacterial strains increased 1.4–2.0 times. Monitoring of bacterial resistance to antibiotics during this period showed a high level and dynamics to 3rd generation cephalosporins, carbapenems, and other classes. The lowest levels of resistance were found among the strains of Escherichia and the highest – Klebsiella, Pseudomonas and Acinetobacter. Staphylococci are characterized by high percentage of methicillin-resistant strains.Gram-negative (Escherichia, Klebsiella, Pseudomonas, Acinetobacter) and gram-positive (Enterococci, Streptococci, Staphylococci) are detected in the surgical patients with UTI with a high frequency. Surgical pathogens are characterized by a high level of resistance to 3rd generation cephalosporin, carbapenems, and other antibiotics. Long-term monitoring of bacterial resistance to antibiotics makes it possible to increase the effectiveness of laboratory diagnostics of surgical infections, to assess a resistance level of pathogens, an antibacterial therapy strategy and a medical aid quality.

Wastewater Surveillance for Communicable Diseases

&#x0D; This Horizon Scan summarizes the available information regarding wastewater epidemiology, or wastewater surveillance, for the detection of pathogens that cause communicable diseases.&#x0D; Wastewater surveillance can detect the presence of pathogens or chemical substances within the wastewater system and allows for the monitoring of a broad population with a single sample.&#x0D; Wastewater surveillance has been used for decades but has become more common since it was implemented around the world for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. In Canada, wastewater surveillance is currently used for the detection of SARS-CoV-2, influenza, and respiratory syncytial virus.&#x0D; Studies conducted in Canada and internationally indicate that wastewater surveillance can be used as a reliable method for detecting pathogens at the population level.&#x0D; Future uses of wastewater surveillance may include monitoring of antibiotic use and antibiotic resistance, detection of cancers in the population, or assessing the prevalence of other infections within communities.&#x0D;

A Clinical-Based Study to Evaluate the Extent of Microbial Sensitivity Tests Performed Among ICU Patients Prescribed with Antibiotics in a Tertiary Care Hospital

Antibiotic resistance is recognized as a global threat to human health. ICUs are generally considered as the main source of outbreaks of multi-drug resistant bacteria. Infectious complications are one of the dominant causes of morbidity and mortality among elderly and geriatric patients, especially in the ICU. The impact of microbial resistance on them is more due to immune senescence. This can be overcome by strengthening antibiotic resistance monitoring and surveillance systems. Antibacterial sensitivity analysis prior to antibiotic therapy is one of the tools in practicing rationality of antibiotic use as it helps to choose the most effective antibiotic. This study evaluates the extent of microbial sensitivity tests performed among ICU patients prescribed with antibiotics. A prospective observational study was conducted on a total of 60 ICU patients at Srinivas Institute of Medical Science and Research Centre, Mangalore, for a period of six months. ICU patients diagnosed with infectious diseases and prescribed with antibiotics are included in the study. Data were collected using an antimicrobial stewardship form and were analyzed using MS Excel 2016. Majority of the 60 people involved in the study were adults (36-65 yrs old) and geriatrics (65 yrs and older). Sensitivity test of pathogen toward various antibiotics were performed among 68.33% (N=41) of the patients, where most of the patients were Geriatrics(25%) and Adults(38.3%). Although the sensitivity test was performed on the majority of the patients in the study, it is critical to follow this test with antimicrobial therapy in each patient. It is important to evaluate the sensitivity of pathogen before therapy and at ongoing times of therapy which avoids complications due to resistance issues by enabling the selection of appropriate antimicrobial treatment and helps in overall clinical management. Keywords: Resistance, Sensitivity, Antibiotic, Geriatrics, ICU.