Isolation Of Multidrug Resistant Bacteria Research Articles

Isolation of Multidrug-Resistant Bacteria from Raw Hides, Salted Hides, and Tannery Wastewater and Their Heavy Metal (Cr) Tolerance

Numerous leather products are created from cattle hides and skins. However, the processing of these products can release toxic heavy metals, including chromium into the environment, leading to health hazards and environmental pollution. This study aims to isolate and identify multidrug-resistant bacteria from rawhide, salted hides, and tanneries in different areas of the Savar region in Dhaka City, Bangladesh. The secondary objective is to determine the heavy metal tolerance and Minimum Inhibitory Concentration (MIC) of Cr against all isolated bacteria. The study found 206 bacterial isolates from three areas: Polashbari Kathaltola, Polashbari Bazar, and Savar Hemaythpur. Rawhide yielded 100 (48.54%) bacterial isolates, salted hide yielded 80(38.83%) isolates, and tannery wastewater yielded only 26 (12.62%) isolates. Further, Bacillus spp. (60) was the most common isolated bacteria. The other identified bacteria were Pseudomonas spp. (46), Staphylococcus spp. (40), Proteus spp. (40), and Escherichia coli (20). The isolated strains showed multidrug resistance, with Staphylococcus spp. Being highly resistant to Erythromycin (100%), followed by Trimethoprim (95%) and Tetracycline (88%). Pseudomonas spp. Were highly resistant to Azithromycin (100%) and Gentamycin (100%). The MIC and the MIC breakpoint determined the screening and evaluation of Cr tolerance against bacteria, and among the isolated bacterial isolates, Bacillus spp. showed a MIC breakpoint of 600 ppm (11.52mM) for Cr tolerance. The isolated heavy metal-resistant bacteria are useful in the bioremediation process and can aid in recovering and removing heavy metals from environmental effluents, thus preventing adverse effects on humans and animals. The government and leather companies should take legal responsibility for proper leather processing to ensure a preventative approach for safe public health. Otherwise, carcinogenic heavy metals can cause cancer in humans.

Isolation of Multidrug-Resistant Bacteria as an Independent Mortality Factor in Patients with Suspected Sepsis at National Medical Center of the West

Introduction: In the changing epidemiological landscape sepsis corresponds to one of the main causes of in-hospital mortality, in third level care units the presence of multidrug resistant bacteria to antimicrobials correspond to a severe health problem, there are studies in intensive care units on mortality related to the appearance of multidrug resistant bacteria in cultures, however infection by multidrug resistant bacteria can appear at any instant of hospital stay which can become an independent risk factor for the appearance of mortality. Aims: To associate the isolation of multidrug-resistant bacteria as an independent mortality factor in patients with suspected sepsis at the Centro Médico Nacional De Occidente. Materials and methods: Place of study: Centro Médico Nacional De Occidente Guadalajara, Jalisco, Mexico. Type of study: Clinical, retrospective cohort type. The clinical records of patients admitted during the study period were searched. Patients with suspected sepsis according to the definition of the Third International Consensus were identified from continuous medical admission and followed up throughout their stay in the hospital. Patients with culture results were evaluated. Two follow-up cohorts were identified: those who presented isolation of multidrug-resistant bacteria at any time during hospitalization and the second cohort those who did not present isolation of multidrug-resistant bacteria; an initial determination of the variables was made and then the clinical records of the patients during their stay in the services were reviewed to search for in-hospital mortality. The association between the occurrence of multidrug-resistant bacteria and mortality was estimated by Hazard Ratio (with 95% confidence intervals). Results: A total of 94 patients were included with a minimum age of 16 years and a maximum age of 91 years with a mean of 48 years with a standard deviation of 20 years. A total of 93 cultures were included of which 21 (22.3%) were isolated with bacterial resistance. Of the positive cultures 42 % (9) were blood culture, 10 % (2) were surgical wound cultures, urine culture 23 % (5), bronchial aspirate 23 % (5). Regarding mortality, 57 % of the patients who presented bacterial resistance presented mortality, presenting a Hazard Ratio of 3.371 with 95% CI (1.125-10.100) p=0.02 Table 2 and 3. Regarding mortality with the different types of bacteria, it was 40 % in Gram negative bacteria with a Hazard Ratio of 1.875 (0.291-12.089), while it was 20 % in Gram positive bacteria, which was not statistically significant p=0.3. Conclusion: Isolation of multidrug-resistant bacteria is an independent mortality factor in patients with suspected sepsis at Centro Médico Nacional De Occidente. There is no relationship with the isolation of Gram-positive and Gram-negative bacteria type with respect to patient mortality.

Phytochemical investigation and antibacterial activity of Curcuma longa against multi-drug resistant bacteria

Emergence of antibiotic resistance in bacterial species is increasing at an alarming rate. This calls for an urge to search for new antimicrobial agents from natural sources. Curcuma longa rhizome is used in traditional medicine as a remedy for many infectious diseases. The rhizome extracted in different solvents is tested against hospital isolates of multidrug-resistant bacteria (Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa) using agar well diffusion and broth microdilution assays. Antioxidant activity was determined using DPPH radical scavenging and superoxide anion scavenging methods. GC–MS analysis was performed to identify biologically active compounds present in the plant. All the plant samples inhibited bacterial growth with varying degree of inhibition observed for different bacterial strains. In general MRSA was more sensitive to most of the extracts with larger zones of inhibition and high percentage inhibition while A. baumannii was the most resistant with smaller zones of inhibition and low percentage inhibition observed for different plant samples. n-Hexane fraction of C. longa was the most effective in inhibiting bacterial growth with lowest MIC values (2.5 mg/mL). Antioxidant activity assays indicated strong antioxidant potential of n-hexane fraction in DPPH assay and of methanol fraction in superoxide scavenging assay. GC–MS analysis indicated ar-turmerone as the most abundant component of the plant (34.63 %). The non-polar fractions of the plant were particularly more effective against multidrug-resistant bacteria. Further purification and characterization of bioactive compounds, from active fractions of this plant, for their applications as antibacterial leads in pharmaceutical industries is recommended.

Surgical site infection after 769 Tibial Plateau Leveling Osteotomies.

To report surgical site infections (SSI) after Tibial Plateau Leveling Osteotomy (TPLO), treatment course, associated risk factors, bacterial isolates and antimicrobial resistance. Retrospective clinical cohort study. Six hundred and twenty seven dogs and 769 TPLO procedures. Data from electronic medical records of dogs undergoing TPLO between 2005 and 2015 at a single institution have been retrospectively reviewed. A generalized mixed logistic regression was used to determine possible risk factors. The Chi-Square test of independence was used to examine the relationship between the isolation of multidrug-resistant (MDR) bacteria and the development of major infections undergoing additional surgical treatment. To assess the correlation between number of SSI and number MDR isolate per year, Pearson's correlation coefficient was calculated. The overall complication rate was 19.3% (n = 149). SSI was most frequent with 8.5% (n = 65). Major SSI occurred in 6.8% (n = 52) TPLO (80.0% SSI). Staphylococcus (S.) pseudintermedius (n = 37) and S. aureus (n = 10) were most frequently isolated. Multidrug-resistant bacteria were identified in 2.7% (n = 21) TPLO (32.3% SSI) but were not associated with major SSI (p = 0.426). There was a strong positive correlation between number of MDR isolates per year and number of SSI per year [r (9) = 0.79, p = 0.004]. Factors associated with SSI were previous TPLO in the contralateral stifle (p = 0.02, OR = 2.01, 95% CI = 1.11-3.64) and German Shepherd dogs (p = 0.035, OR = 4.41, 95% CI = 1.11-17.54). The use of non-locking implants was found to be protective (p = 0.02, OR = 0.179, 95% CI = 0.18-0.77). Infection with multidrug-resistant bacteria is an emerging problem in veterinary practice and treatment is challenging. The incidence of major SSI was found to be high but was not associated with the isolation of MDR bacteria.

Pseudomonas aeruginosa Bloodstream Infections in SARS-CoV-2 Infected Patients: A Systematic Review.

Bacterial co-infections increase the severity of respiratory viral infections and are frequent causes of mortality in COVID-19 infected subjects. During the COVID-19 period, especially at the beginning of the pandemic, an inappropriate use of broad-spectrum antibiotic treatments has been frequently described, mainly due to prolonged hospitalization, especially in intensive care unit departments, and the use of immune-suppressive treatments as steroids. This misuse has finally led to the occurrence of infections by multi-drug resistant (MDR) bacteria in hospitalized COVID-19 patients. Although different reports assessed the prevalence of Gram-negative infections in COVID-19 infected patients, scarce data are currently available on bloodstream infections caused by Pseudomonas aeruginosa in hospitalized COVID-19 patients. The aim of our systematic review is to describe data on this specific population and to discuss the possible implications that these co-infections could have in the management of COVID-19 pandemics in the future. We systematically analysed the current literature to find all the relevant articles that describe the occurrence of P. aeruginosa bloodstream infections in COVID-19 patients. We found 40 papers that described in detail P. aeruginosa HAIs-BSI in COVID-19 patients, including 756,067 patients overall. The occurrence of severe infections due to MDR bacteria had a significant impact in the management of hospitalized patients with COVID-19 infections, leading to a prolonged time of hospitalization and to a consequent increase in mortality. In the near future, the increased burden of MDR bacteria due to the COVID-19 pandemic might partially be reduced by maintaining the preventive measures of infection control implemented during the acute phase of the COVID-19 pandemic. Finally, we discuss how the COVID-19 pandemic changed the role of antimicrobial stewardship in healthcare settings, according to the isolation of MDR bacteria and how to restore on a large scale the optimization of antibiotic strategies in COVID-19 patients.

Elimination of pathogenic multidrug resistant isolates through different metal oxide nanoparticles synthesized from organic plant and microbial sources

Beta-hemolytic multidrug-resistant bacteria (MDR) are highly regarded as a major public health risk because they are resistant to at least 10 antibiotics in different groups with different mechanisms of action. The present study shows that among 98 bacterial isolates collected from laboratory fecal samples: 15 were beta-hemolytic and tested against 10 different antibiotics. 15 beta-hemolytic; 5 isolates exhibit strong multidrug resistance traits. Isolate 5 Escherichia coli (E. coli), Isolate 7 (E. coli), Isolate 21 (Enterococcus faecium), Isolate 27 (Staphylococcus sciuri), and isolate 36 (E. coli) are largely untested antibiotics. Substances (clear zone >10 mm) Its growth sensitivity to different types of nanoparticles was further evaluated by the agar well diffusion method. AgO, TiO2, ZnO, and Fe3O4 nanoparticles have been separately synthesized by microbial and plant-mediated biosynthesis. By evaluating the antibacterial activity of different nanoparticle types against selected MDR isolates, the results showed that global MDR bacterial growth was inhibited differently depending on the nanoparticle type. TiO2 was the most potent antibacterial nanoparticle type, followed by AgO, while Fe3O4 showed the least efficacy against selected isolates. The MICs of microbially synthesized AgO and TiO2 nanoparticles were 3 μg (67.2 μg/mL) and 9 μg (180 μg/mL) for isolates 5 and 27, respectively, indicating that biosynthetic nanoparticles via pomegranate of antibacterial activity at a higher MIC than microbial-mediated ones, it recorded (300 and 375 μg/ml, respectively) of AgO and TiO2 nanoparticles for isolates 5 and 27. Biosynthesized nanoparticles were examined by TEM, the average sizes of microbial AgO and TiO2 nanoparticles were 30 nm and 70 nm, respectively, and the average sizes of plant mediated AgO and TiO2 NPs were 52 nm and 82 nm respectively. Two most potent extensive MDR isolates (5 and 27) were identified as E. coli and Staphylococcus sciuri by 16s rDNA technology, and the sequencing results of the isolates were deposited with NCBI GenBank under accession numbers ON739202 and ON739204, respectively.

In vitro porphyrin-based photodynamic therapy against mono and polyculture of multidrug-resistant bacteria isolated from integumentary infections in animals

Multidrug-resistant (MDR) organisms have been frequently isolated from integumentary lesions of animals, and these lesions are usually infected by more than one pathogen. This study evaluated an in vitro antimicrobial photodynamic therapy (aPDT) using two water-soluble tetra-cationic porphyrins (3-H2TMeP and 4-H2TMeP) against mono and polyculture of MDR bacteria isolated from dogs, cats, and horses. Ten isolates of MDR bacteria (two of each species: Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Serratia marcescens, and Staphylococcus pseudointermedius) were used to evaluate aPDT against the monoculture using a non-cytotoxic concentration of 3-H2TMeP and 4-H2TMeP porphyrins (40 µM), with 30 min of light irradiation in Gram-positive and 90 min for Gram-negative bacteria. The aPDT using the 4-H2TMeP porphyrin was also tested against five different polycultures (Coagulase positive Staphylococcus (CPS) and Pseudomonas sp.; E. coli and Proteus sp.; Pseudomonas sp. and Proteus sp.; CPS and E. coli; and CPS and Proteus sp.) for 90 min. The efficacy of both treatments was evaluated by plating the solution exposed to light or kept in the dark and counting the colonies forming units after 24 h of incubation at 37 °C. Atomic force microscope analysis was used to map bacteria morphological changes and extract adhesion force parameters from the bacteria membranes. Only the 4-H2TMeP porphyrin had antibacterial activity against MDR bacteria in monoculture, especially S. pseudointermedius and P. aeruginosa. In polyculture, the 4-H2TMeP porphyrin reduced bacterial concentrations (p < 0.05) in the associations of E. coli and S. pseudointermedius, P. aeruginosa and S. pseudointermedius, and P. aeruginosa and P. mirabilis. These results showed that aPDT using 4-H2TMeP is a good option for future associations of aPDT and other therapies or in vivo research.

Multi-drug resistant bacteria isolates from lymphatic filariasis patients in the Ahanta West District, Ghana

BackgroundAntimicrobial resistance is associated with increased morbidity in secondary infections and is a global threat owning to the ubiquitous nature of resistance genes in the environment. Recent estimate put the deaths associated with bacterial antimicrobial resistance in 2019 at 4.95 million worldwide. Lymphatic filariasis (LF), a Neglected Tropical Disease (NTD), is associated with the poor living in the tropical regions of the world. LF patients are prone to developing acute dermatolymphangioadenitis (ADLA), a condition that puts them at risk of developing secondary bacterial infections due to skin peeling. ADLA particularly worsens the prognosis of patients leading to usage of antibiotics as a therapeutic intervention. This may result in inappropriate usage of antibiotics due to self-medication and non-compliance; exacerbating antimicrobial resistance in LF patients. In this perspective, we assessed the possibilities of antimicrobial resistance in LF patients. We focused on antibiotic usage, antibiotic resistance in Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa isolates and looked at genes (mecA and Extended-spectrum beta-lactamase [blaCTX-M, blaSHV and blaTEM]) coding for resistance in multi-drug resistant (MDR) bacterial isolates.ResultsOf the sixty (60) participants, fifty-four (n = 54, 90%) were within 31–60 years of age, twenty (n = 20, 33.33%) were unemployed and thirty-eight (n = 38, 50.67%) had wounds aged seven (7) months and above. Amoxicillin (54%) and chloramphenicol (22%) were the most frequently used antibiotics for self-medication. Staphylococcus aureus isolates (n = 26) were mostly resistant to penicillin (n = 23, 88.46%) and least resistant to erythromycin (n = 2, 7.69%). Escherichia coli isolates (n = 5) were resistant to tetracycline (n = 5, 100%) and ampicillin (n = 5, 100%) but were sensitive to meropenem (n = 5, 100%). Pseudomonas aeruginosa isolates (n = 8) were most resistant to meropenem (n = 3, 37.50%) and to a lesser extent ciprofloxacin (n = 2, 25%), gentamicin (n = 2, 25%) and ceftazidime (n = 2, 25%). Multi-drug resistant methicillin resistant Staphylococcus aureus (MRSA), cephalosporin resistant Escherichia coli and carbapenem resistant Pseudomonas aeruginosa were four (n = 4, 15.38%), two (n = 2, 40%) and two (n = 2, 25%) respectively. ESBL (blaCTX-M) and mecA genes were implicated in the resistance mechanism of Escherichia coli and MRSA, respectively.ConclusionThe findings show presence of MDR isolates from LF patients presenting with chronic wounds; thus, the need to prioritize resistance of MDR bacteria into treatment strategies optimizing morbidity management protocols. This could guide antibiotic selection for treating LF patients presenting with ADLA.

Biosynthesis of Silver Nanoparticles Using Seasonal Samples of Sonoran Desert Propolis: Evaluation of Its Antibacterial Activity against Clinical Isolates of Multi-Drug Resistant Bacteria.

Multi-drug resistant (MDR) bacteria have gained importance as a health problem worldwide, and novel antibacterial agents are needed to combat them. Silver nanoparticles (AgNPs) have been studied as a potent antimicrobial agent, capable of countering MDR bacteria; nevertheless, their conventional synthesis methods can produce cytotoxicity and environmental hazards. Biosynthesis of silver nanoparticles has emerged as an alternative to reduce the cytotoxic and environmental problems derived from their chemical synthesis, using natural products as a reducing and stabilizing agent. Sonoran Desert propolis (SP) is a poplar-type propolis rich in polyphenolic compounds with remarkable biological activities, such as being antioxidant, antiproliferative, and antimicrobial, and is a suitable candidate for synthesis of AgNPs. In this study, we synthesized AgNPs using SP methanolic extract (SP-AgNPs) and evaluated the reduction capacity of their seasonal samples and main chemical constituents. Their cytotoxicity against mammalian cell lines and antibacterial activity against multi-drug resistant bacteria were assessed. Quercetin and galangin showed the best-reduction capacity for synthesizing AgNPs, as well as the seasonal sample from winter (SPw-AgNPs). The SPw-AgNPs had a mean size of around 16.5 ± 5.3 nm, were stable in different culture media, and the presence of propolis constituents was confirmed by FT-IR and HPLC assays. The SPw-AgNPs were non-cytotoxic to ARPE-19 and HeLa cell lines and presented remarkable antibacterial and antibiofilm activity against multi-drug resistant clinical isolates, with E. coli 34 and ATCC 25922 being the most susceptible (MBC = 25 μg/mL), followed by E. coli 2, 29, 37 and PNG (MBC = 50 μg/mL), and finally E. coli 37 and S. aureus ATCC 25923 (MBC = 100 μg/mL). These results demonstrated the efficacy of SP as a reducing and stabilizing agent for synthesis of AgNPs and their capacity as an antibacterial agent.

Isolation of Multidrug Resistant Bacteria from the Lane College Soil

Antibiotics are substances that eliminate or slow down the growth of bacteria. Beta‐lactam antibiotics, such as penicillin, are antibiotics that contain a beta‐lactam ring that inhibits bacterial cell wall biosynthesis. Bacteria are becoming resistant to antibiotics being that antibiotics are highly prescribed when people seek health care. My goal for this project is to isolate and characterize soil bacteria that are resistant to beta‐lactams. I hypothesize that the bacteria present in the soil on Lane College campus is resistant to beta‐lactams. Furthermore, I hypothesize that these bacteria have a beta‐lactamase gene, which is an enzyme that inactivates the bacteria by cleaving the beta‐lactam ring. I collected soil samples from Lane College campus and cultured the bacteria on two nutrient agar plates with ampicillin and cultured over night at room temperature. For further characterization, I then chose 3 different colonies from the plates (S1A, S1B, and S2A) and streaked them on to new nutrient agar plates with ampicillin. The strains were tested for drug resistance using the Kirby‐Bauer method. They were incubated overnight at room temperature. I then streaked separate LB agar plates from all 3 colonies and added antibiotic disks to each plate (ampicillin, penicillin, amoxicillin, and streptomycin) with E. coli as a control group. Strains S1A, S1B, and S2A were resistant to ampicillin, penicillin, and amoxicillin, but were sensitive to streptomycin. We then further characterized by Gram staining and morphological observation. All samples were Gram negative, and the cells were a coccus shape. I am planning to use the 16S rDNA gene to identify the bacteria using Nanopore next generation sequencing, and to look for the presence of beta‐lactamase genes by PCR.

The Use of Long-Read Sequencing Technologies in Infection Control: Horizontal Transfer of a blaCTX-M-27 Containing lncFII Plasmid in a Patient Screening Sample.

Plasmid transfer is one important mechanism how antimicrobial resistance can spread between different species, contributing to the rise of multidrug resistant bacteria (MDRB) worldwide. Here were present whole genome sequencing (WGS) data of two MDRB isolates, an Escherichia coli and a Klebsiella quasipneumoniae, which were isolated from a single patient. Detailed analysis of long-read sequencing data identified an identical F2:A-:B- lncFII plasmid containing blaCTX-M-27 in both isolates, suggesting horizontal plasmid exchange between the two species. As the plasmid of the E. coli strain carried multiple copies of the resistance cassette, the genomic data correlated with the increased antimicrobial resistance (AMR) detected for this isolate. Our case report demonstrates how long-read sequencing data of MDRB can be used to investigate the role of plasmid mediate resistance in the healthcare setting and explain resistance phenotypes.

Bacterial profile of high-touch surfaces, leftover drugs and antiseptics together with their antimicrobial susceptibility patterns at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

BackgroundThe hospital environment serves as a source of nosocomial infections, which pose a major therapeutic challenge. Although many bacteria species are common in hospital environments, their distribution, frequency, and antimicrobial susceptibility pattern from high-touch surfaces, leftover drugs, and antiseptics in different wards remain largely unknown. Hence, the aim of this study was to assess the magnitude and frequency of bacterial contaminants and their antimicrobial susceptibility patterns.MethodsA total of 384 samples were collected from five selected wards and processed according to standard bacteriological procedures. Samples were collected from high-touch surface using swabs and inoculated on Blood agar, MacConkey agar, Chocolate agar and Mannitol salt agar plates, and incubated at 37 °C for 24 h. On the other hand, the leftover drugs and 80% ethanol samples were collected using sterile cotton swab immersed in sterile tryptone soy broth then inoculated on culture medias and incubated at 37 °C for 24 h. Identification of bacteria species was done using the morphological characteristics, Gram stain, and biochemical tests while antimicrobial susceptibility tests were done using modified Kirby-Bauer disk diffusion technique following the Clinical Laboratory Standards Institute 2021guidelines.ResultsAmong the 384 samples processed, 102 (26.6%) were culture positive and a total of 114 bacterial isolates were identified. Gram-positive bacterial isolates were predominant, 64.9%, while Gram-negatives were 35.1%. The most frequently isolated bacteria were coagulase negative Staphylococci (38.6%) followed by S. aureus (13.2%) and P. aeruginosa (11.4%). On the other hand, the proportion of bacteria isolated from surgical ward, post-natal ward, orthopedic ward, trauma ward, and neonatal intensive care unit ward were 24.6, 21, 20.2, 18.4,15.8%, respectively. Sinks were mainly contaminated with Klebsiella species (81.8%) and A. baumannii (55.6%), while A. baumannii (22.2%) was the most contaminant for 80% ethanol. Gram-positive bacteria had significantly high resistance levels to penicillin (67.6%), cotrimoxazole (67.8%), and cefepime (80%). On the other hand, Gram-negative bacteria revealed the highest resistance levels to tetracycline (82.4%), amoxicillin-clavulanic acid (76.5%), cefepime (66.7%), ceftazidime (67.5%), and piperacillin (92.3%). Moreover, the proportion of multidrug resistant bacteria isolates was 44.7%.ConclusionsData of the present study showed that coagulase negative Staphylococci was the dominant bacterial isolates followed by S. aureus and P. aeruginosa. The proportion of multi-drug resistant bacteria isolates was relatively high. Therefore, appropriate infection prevention and control measures should be implemented.

Antibiotic susceptibility pattern and risk factors associated with Acinetobacter and Pseudomonas infection at a tertiary care hospital

Background: Infection due to Acinetobacter spp. and Pseudomonas aeruginosa is a major worldwide concern these days. Antibiotic resistance and predisposing factors among the patients for acquiring such infection is a major challenge globally and in Nepal. Objectives: To determine antimicrobial susceptibility pattern of Acinetobacter spp. and Pseudomonas aeruginosa isolates along with predisposing factors. Methods: A total of 9,705 clinical samples were processed in this analytical cross-sectional study from December 2019 to November 2020. Antibiotic susceptibility pattern was determined following Clinical Laboratory Standard Institute guidelines. Patients’ information was obtained after informed consent. Results: Acinetobacter spp. and Pseudomonas aeruginosa isolates were 92 (0.95%). Fifty-three (57.61%) samples were respiratory samples. Thirteen (20%) Pseudomonas aeruginosa and 18 (66.67%) Acinetobacter spp. were multidrug-resistant (MDR). Eight (12.31%) Pseudomonas aeruginosa strains and 13 (48.15%) Acinetobacter spp. strains were sensitive only to Colistin. Twenty-two (95.65%) prolonged hospital stayers had MDR bacteria compared to only nine (13.04%) non-prolonged hospital stayers (p-value &lt;0.001). Sixteen (94.12%) of diabetic patients had MDR bacteria isolates in comparison to only 15 (20%) of non-diabetic patients (p-value &lt;0.001). Thirty-one (33.69%) were elderly patients (age ?65 years) and 61 (66.31%) were of age less than 65 years old. Seventeen (54.84%) of elderly patients had MDR isolates whereas only 14 (22.95%) of patients who are not elderly had MDR isolates (p-value =0.0047). Conclusion: Acinetobacter spp. and Pseudomonas aeruginosa strain were isolated from various samples. For effective treatment of infection by such organisms detailed microbiological diagnosis and drug susceptibility testing is needed along with identification of predisposing factors.

Antibiotic residues in the aquatic environment – current perspective and risk considerations

Antimicrobial resistance is a major concern for human and animal health, projected to deteriorate with time and given current trends of antimicrobial usage. Antimicrobial use, particularly in healthcare and agriculture, can result in the release of antimicrobials into surface waters, promoting the development of antibiotic resistance in the environment, and potentially leading to human health risks. This study reviews relevant literature, and investigates current European and Irish antimicrobial usage trends in humans and animals, as well as potential pathways that antibiotics can take into surface waters following use. Reported levels in the aquatic environment are summarized, with particular focus on Ireland. There are relatively few studies examining Irish water bodies or sewage effluent for antibiotic residues, however, five antibiotics, namely azithromycin, ciprofloxacin, clarithromycin, metronidazole, and trimethoprim, have been measured in Irish waters, in concentrations predicted to select for resistance. Numerous isolates of multi-drug resistant bacteria have also been found in water bodies throughout Ireland and Europe. The value of risk assessment methodologies in understanding risks posed by antibiotic residues is reviewed including the advantages and disadvantages of specific approaches. Hazard quotient and bespoke Monte Carlo approaches are predominant risk assessment tools used to examine antimicrobial release and their complex pathways. This study highlights the need for monitoring of antimicrobial releases and the potential for resistance development, persistence and transmission while highlighting the role of risk assessment methodologies in assessing potential human and environmental health impacts.

Pattern of antibiotics resistance and phenotypic characterization of Multidrug resistant bacteria isolates in four hospitals of Littoral region, Cameroon

Objective: To describe the pattern of antibiotics resistance and phenotypic characterization of Multidrug resistant bacteria isolates in four hospitals of Littoral region, Cameroon.&#x0D; Methods: We conducted a descriptive hospital based cross-sectional study from December 2018 to May 2019. A simple random sampling was used to swap 10 selected equipment and 10 materials in the mornings after disinfection but before the start of work in seven units. After inoculation in four agar media consecutively (Eosine Metyleine blue, Cled, Manitol salt agar and blood agar ) and incubated in appropriate conditions, the Kirby-Bauer disk-diffusion method was used for antimicrobial susceptibility test.&#x0D; Results: Among 50.4% (119/236) showed positive bacteria growth, a total of 89 (13 species), predominant bacteria and those more likely to cause nosocomial infections were selected and tested each one to 18 antibiotics. There was high level of resistance to Penicillin (amoxicillin (77.5%) and Oxacillin (76.4%)), followed by 3G Cephalosporine (Ceftazidime (74.2%)) and Monobactam (Aztreonam (70.8%)). Although the least level of resistance was observed in Carbapenem (imipenem (5.6%)). The overall prevalence of MDRB was 62.9% (56/89). MRSA were the mostly detected 57.5 % (30/89), followed by ESBL 10.1% (9/89). Military hospital of Douala and Emergency unit was the MDRBs dominantly contaminated area respectively 39.3% (22/56) and 17.9% (10/56).&#x0D; Conclusion: MDRB occurred to be a current public health problem as well as hospital surfaces are worrying reservoir that can be spread to patient, health professionals and visitors.&#x0D; Keywords: Antibiotic resistance, susceptibility test, multidrug-resistant bacteria, Hospital facilities, Units, Littoral Region-Cameroon

Microbiological profile and antibiotic susceptibility pattern in Blood stream infections in patients with Acute Cholangitis: A prospective observational study

Background: I analyzed the organisms isolated from the blood of patients with acute cholangitis and determined their antibiotic resistance characteristics. In addition, I evaluated risk factors associated with antibiotic-resistant bacteria and their impact on clinical outcomes.&#x0D; Methods: 113 consecutive cases of acute cholangitis who met the diagnostic criteria were included in the study. Acute cholangitis was defined by TG18 criteria. Blood culture was obtained from every patient. The microbiological results of blood cultures &amp; the antibiotic susceptibility pattern of the organisms were analyzed by SPSSv22.0. Multivariate analysis was performed to identify risk factors associated with antibiotic resistance &amp; mortality.&#x0D; Result: Among 113 patients, 71(62.8%) were male &amp; the median age was 51 years. Choledocholithiasis was the most common underlying biliary disease followed by malignant and benign strictures. Severe cholangitis occurred in 17(15%) cases. 32(28.3%) cases had nosocomial infection. Causative organisms were isolated from 55(48.7%) of 113 blood cultures. Escherichia coli was the most common bacterium isolated (36.36%) from blood, followed by Klebsiella pneumoniae (23.64%), Pseudomonas aeruginosa (7.27%) &amp; Enterococcus (7.27%). Anaerobic bacteria were isolated from 5(9.09%) specimens. Multiple organisms were isolated in 6(10.91%) specimens. Most organisms were susceptible to meropenem (86.7%), imipenem (83.1%), colistin (89.1%), amikacin (76.1%), piperacillin-tazobactam (79.6%) &amp; polymyxin-B (83.3%). Multidrug resistant bacteria comprised 30.91% of blood isolates. Risk factors associated with antibiotic resistance were presence of an indwelling biliary device (OR:7.7), prior biliary intervention (OR:6.167) and a nosocomial source of infection (OR:9.09). Thirteen (11.5%) patients died from acute cholangitis. Risk factors associated with mortality were severe cholangitis (OR:6.9), malignant biliary obstruction (OR:8.4), nosocomial infection (OR:7.5) and isolation of multidrug resistant organisms in blood (OR:6.9).&#x0D; Conclusion: E. coli was the most common organism isolated, followed by Klebsiella, Pseudomonas &amp; Enterococcus. Colistin, meropenem, polymyxin-B, imipenem, amikacin &amp; piperacillin-tazobactam were the most effective of all antibiotics. Risk factors associated with isolation of multidrug resistant bacteria from blood were presence of an indwelling biliary device, prior biliary intervention and a nosocomial source of infection. Risk factors associated with mortality were severe cholangitis, malignant biliary obstruction, nosocomial infection and isolation of multidrug resistant organisms in blood.&#x0D; Bangladesh Crit Care J September 2020; 8(2): 68-75

Ability of chlorhexidine, octenidine, polyhexanide and chloroxylenol to inhibit metabolism of biofilm-forming clinical multidrug-resistant organisms.

This in vitro study was designed to determine if standard antiseptics used for skin and environmental surface cleansing can disrupt the metabolic activity (as a measure of viability) of multidrug-resistant gram-negative bacteria, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus isolates within their native biofilms. Sixty clinical isolates of multidrug-resistant bacteria were selected for testing in different chlorhexidine gluconate, octenidine, polyhexanide and chloroxylenol concentrations. Metabolic inhibition of biofilm for each clinical isolate was analysed using a biofilm viability assay. Chlorhexidine gluconate (mean = 83.8% ± 9.8%) and octenidine (mean = 84.5% ± 6.8%) showed the greatest efficacy against biofilms of the tested microorganisms, with the greatest efficacies against MRSA. The antiseptics demonstrated the least efficacy against biofilms of Pseudomonas aeruginosa. Chlorhexidine gluconate and octenidine showed the greatest level of bacterial metabolic inhibition and were statistically equivalent. Polyhexanide was more effective than chloroxylenol, but both were inferior to chlorhexidine gluconate and octenidine against the tested organisms.

Multidrug-resistant bacteria in lung transplantation.

The review of infections in lung transplantation is beyond the scope of this article as it is a comprehensive topic, however we aim to focus on infections with multidrug-resistant (MDR) microorganisms in this patient population. New emerging clinical studies have provided data regarding outcomes in lung transplant recipients with MDR bacterial infections. Isolation of MDR bacteria from lung donors preoperatively has not been associated with worse outcomes in recipients. Patients with cystic fibrosis colonized with MDR bacteria do not have increased 1 year mortality rates compared to those without MDR bacteria.

Multi-drug resistant bacteria predict mortality in bloodstream infection in a tertiary setting in Tanzania.

Bloodstream infections (BSI) are serious and life-threatening, associated with high mortality and morbidity. In resource-limited settings, there is a paucity of data on predictors of outcome in patients with BSI. This study aimed at examining the predictors of mortality in patients with BSI as well as bacteria causing BSI. This was a cross-sectional study conducted at Muhimbili National Hospital between April and May 2018. Blood culture results from all inpatients at the clinical microbiology laboratory were recorded and clinical information was retrieved retrospectively from the files. Bacteria from positive blood culture were identified and antimicrobial susceptibility was performed. The overall prevalence of BSI was, 46/402 (11.4% 95% CI 8.6-15), with a case fatality rate of 37%. There was a significantly high rate of BSI in patients who had died (19.5%) compared to those who survived (9.2%) p = 0.008. Gram-negative bacteria (74%) were the common cause of BSI, with a predominance of Enterobacteriaceae (22), followed by Pseudomonas aeruginosa (11). The majority of bacteria (70.5%) isolated from patients with BSI were Multi-drug resistant (MDR). Forty-six percent of Pseudomonas aeruginosa were resistant to meropenem while 68% (15/22) of Enterobacteriaceae were extended-spectrum β lactamase producers. Carbapenemase production was detected in 27% (3/11) of Pseudomonas aeruginosa and one Proteus mirabilis. Forty percent of Staphylococcus aureus were methicillin-resistant Staphylococcus aureus. Positive blood culture (aOR 2.24, 95%CI 1.12-4.47, p 0.02) and admission to the intensive care unit (aOR 3.88, 95%CI 1.60-9.41, p = 0.003) were independent factors for mortality in suspected BSI. Isolation of MDR bacteria was an independent predictor for mortality in confirmed BSI (aOR 15.62, 95%CI 1.24-161.38, p = 0.02). The prevalence of BSI was 11.4%, with the majority of bacteria in BSI were MDR. Positive blood culture, admission to the ICU and MDR were predictors for mortality.

Multidrug-Resistant Bacteria Among Culture Isolates at University of Gondar, Specialized Referral Hospital, Northwest Ethiopia: a Five-Year Retrospective Study.

Updated information on multidrug-resistant bacteria is essential because multidrug-resistant bacteria are one of the most important current threats to public health and prevalence of multidrug-resistant bacteria varies from time to time. A large number of people die annually due to infections caused by multidrug-resistant pathogens, with millions more suffering from serious infectious complications. The aim of this study was to determine the rate of multidrug-resistant bacteria isolates among culture requested patients at University of Gondar Specialized Referral Hospital, Northwest Ethiopia. A hospital-based retrospective cross-sectional study was conducted on all culture-positive patients' results at University of Gondar Specialized Referral Hospital, Northwest Ethiopia. Of the 2,161 bacterial isolates, the overall prevalence of multidrug-resistant bacteria was 40.5% (876/ 2,161). The multidrug-resistance rate of Gram-negative bacteria was 52.4% (493/942) and Gram-positive bacteria was 31.4% (383/1,219). From all isolates, 22.3% (481/2,161) were from wound discharge followed by 19.57% (428/ 2,161) from blood and 18.14% (224/2,161) from urine. The predominant bacteria isolated were S. aureus (44.1% (952/2,161)) followed by E. coli (16.6% (359/2,161)), Klebsiella species (13.2% (179/2,161)), and Citrobacter (4% (86/2,161)). The isolates showed high levels of resistance to ampicillin (81.99% (692/844)), cotrimoxazole (66.62% (531/797)), and penicillin (62.66% (381/608)) and lower resistance to vancomycin (6.79% (46/677)), amikacin (20% (18/95)), and nitrofurantoin (20.90% (21/110)). Primary MDR isolates were Serratia species (83.3% (5/6)), Enterobacter species (66.7% (20/30)), Klebsiella pneumonia (65.3% (89/176)), and Enterococcus species (57.1% (8/14)). The majority of MDR isolates were from inpatients (58.6% (p-value < 0.0001)), males (53.77%), age group < 2 years (30.7%), and blood sample (25.22%). A higher level of resistance to ampicillin, cotrimoxazole, penicillin and lower level of resistance to vancomycin, amikacin, and tobramycin were detected. Slightly lower overall rates of multidrug-resistant bacteria are isolated and a higher resistance rate is observed on Serratia species, Enterobacter species, K. pneumonia, Enterococcus species, and E. coli. Hospital admission is highly associated with the isolation of multidrug-resistant bacteria. Hence patient hospital stay should be considered in the prevention of multidrug resistant bacterial infections.