Multi Drug Research Articles

Isolation and characterization of lytic bacteriophage from waste water to control clinical multidrug resistant Klebsiella pneumoniae

Klebsiella pneumoniae is an opportunistic bacterium which can cause nosocomial, community acquired, and respiratory infections. It also has the biofilm forming ability which is difficult to treat through antimicrobial drugs. Therefore, an alternative therapy to antibiotics, such as bacteriophages, are required to control this biofilm producing, multi-drug resistant bacterium. The aim of this study was to isolate and characterize a lytic bacteriophage to control the multi drug resistant K. pneumoniae-3206 planktonic cells and biofilm. Phage RAM-1 was isolated from wastewater. It was characterized through transmission electron microscopy and was classified to be a member of the Podoviridae family. SDS-PAGE analysis showed that the phage consisted of approximately eighteen different proteins (13–200 ​kDa). Its genome was found to be ds DNA of about of ≈36 ​kb. Phage RAM-1 displayed good heat (37–65 ​°C) and pH (5–11) stability. Phage RAM-1 showed promising activity against the 24-, 48-, and 72-h biofilms made (underneath static conditions along with media renewal) by K. pneumoniae-3206. After a 6-h phage treatment, about 2.5, 3.6 and 4-log reductions were observed respectively. Thus, we concluded from this study that RAM-1 has potential in eradicating both bacterial planktonic cells and biofilm. However, to achieve complete bacterial eradication, a phage cocktail (a combination of two or more phages) will be more promising.

Prevalence And Risk Factors Of Multi Drug Resistant Tuberculosis In Children.

To assess the prevalence of drug-resistant tuberculosis and to identify possible risk factors in children. The descriptive, interview-based study was conducted at the Pulmonology outdoor clinic of Jinnah Hospital, Lahore, Pakistan, from January to August 2019, and comprised children aged up to 14 years who were either contacts of a multi-drug resistant tuberculosis patients or non-contacts. Data related to their demography as well as clinical and social characteristics was collected using a questionnaire. Data was analysed using SPSS version 22. Of the 202 subjects, 115(56.9%) were girls and 87(43.1%) were boys. There were 70(34.7%) subjects aged >13 years, followed by 45(22.3%) aged 9-12 years, 44(21.8%) aged £4 years and 43(21.3%) aged 5-8 years. Overall, there were 26(12.9%) cases positive for multi-drug resistant tuberculosis; 16(61.5%) girls and 10(38.5%) boys. In terms of age, 17(65.4) cases were positive in those aged >13 years. Age, previous history of tuberculosis, co- infection with any immune-compromising disease and close contact with patients of multi-drug resistant tuberculosis were significant risk factors identified. The prevalence of multi-drug resistant tuberculosis was high in contacts of multi-drug resistant pulmonary tuberculosis patients, more prevalent in children aged 13-14 years.

Isolation and characterization of novel lytic bacteriophages that infect multi drug resistant clinical strains of Escherichia coli.

The pathogenic strains of Escherichia coli (E. coli) are frequent cause of urinary tract infections including catheter-associated, soft tissue infections and sepsis. The growing antibiotic resistance in E. coli is a major health concern. Bacteriophages are specific for their bacterial host, thus providing a novel and effective alternatives. This study focuses on isolation of bacteriophages from urban sewage treatment plants. Initially 50 different bacteriophages have been isolated against non-resistant reference E. coli strain and fifty multidrug resistant clinical isolates of extraintestinal infections. Out of which only thirty-one lytic phages which gave clear plaques were further analysed for different physico-chemical aspects such as thermal inactivation, pH, effect oforganic solvents and detergents. Two bacteriophages, ASEC2201 and ASEC2202, were selected for their ability to withstand temperature fluctuation from -20 to 62 °C and a pH range from 4 to 10. They also showed good survival (40-94%) in the presence of organic solvents like ethanol, acetone, DMSO and chloroform or ability to form plaques even after the treatment with detergents like SDS, CTAB and sarkosyl. Both efficiently killed reference strain and 40-44% of multidrug resistant clinical isolates of E. coli. Later ASEC2201 and ASEC2202 were subjected to morphological characterisation through transmission electron microscopy, which revealed them to be tailed phages. The genomic analysis confirmed them to be Escherichia phages which belonged to family Drexlerviridae of Caudovirales.

An automated drug dependence detection system based on EEG

ObjectiveSubstance abuse causes damage to the brain structure and function. This research aim is to design an automated drug dependence detection system based on EEG signals in a Multidrug (MD) abuser. MethodsEEG signals were recorded from participants categorized into MD-dependents (n = 10) and Healthy Control (HC) (n = 12). The Recurrence Plot investigates the dynamic characteristics of the EEG signal. The entropy index (ENTR) measured from the Recurrence Quantification Analysis was considered the complexity index of the delta, theta, alpha, beta, gamma, and all-band EEG signals. Statistical analysis was performed by t-test. The support vector machine technique was used for the data classification. ResultsThe results show decreased ENTR indices in the delta, alpha, beta, gamma, and all-band EEG signal and increased theta band in MD abusers compared to the HC group. That indicated the reduction of complexity in the delta, alpha, beta, gamma, and all-band EEG signals in the MD group. Additionally, the SVM classifier distinguished the MD group from the HC group with 90% accuracy, 89.36% sensitivity, 90.7% specificity, and 89.8% F1 score. Conclusions and significanceThe nonlinear analysis of brain data was used to build an automatic diagnostic aid system that could identify HC people apart from those who abuse MD.

Evaluation of Drug Abuse on Brain Function using Power Spectrum Analysis of Electroencephalogram Signals in Methamphetamine, Opioid, Cannabis, and Multi-Drug Abuser Groups

The effect of different types of substances on brain function is still challenging; however, many studies have shown the functional and structural damage to the brain under influence of substance abuse. This study aimed to quantitatively compare the effect of opioid (Op), methamphetamine (Meth), cannabis (Can), and simultaneous methamphetamine and opioid (Multi-Drug (MD)) abuse on brain function. Furthermore, the impacts of pure Op and Meth abuse were considered with simultaneous substance abuse. In this descriptive study, the electroencephalogram (EEG) signal was recorded from 52 participants in the Meth, Op, Can, and MD abusers, and the Healthy Control (HC) groups at rest state. EEG data were analyzed on the frequency domain with electrode-based, cortex-based, and hemisphere-based approaches. However, the power spectrum in the delta band in the Op group, the gamma band in the Can group, and the gamma and beta bands in the MD group more significantly increased compared to the HC group, the power spectrum values in the Meth group reduced in the alpha, beta, and gamma bands. Moreover, the power spectrum values in the MD group more significantly higher than the Meth and Op groups in the beta and gamma bands. Since substance abuse in different types caused various changes in frequency components, the different power spectrum bands analysis in abusers can be reasonable to apply as a biomarker to detect the drug types.

Multi Drug Resistance and Biofilm Production among Staphylococci Isolates from Clinical Samples at a Tertiary Care Hospital in Kathmandu, Nepal

Objectives: The purpose of the study was to determine multidrug resistance and biofilm production among Staphylococcus isolates from clinical samples at Nepal Armed Police Force Hospital, Kathmandu. Methods: A hospital based cross sectional prospective study was conducted at Department of Microbiology, Nepal Armed Police Force Hospital, Balambu, Kathmandu from February to July 2022. A total of 1813 clinical samples were collected and processed in microbiology laboratory. Through cultural and biochemical analysis, Staphylococcus spp. were isolated and identified, and the Kirby-Bauer disc diffusion method was used to determine multidrug resistant among isolates. While the Tissue Culture Plate method was employed to detect Staphylococcus spp. that produce biofilm. Results: Out of 1813 clinical samples, 304 (16.7%) exhibited bacterial growth; of these, 135 (44.4%) were Staphylococcus spp, among which 119 (88.1%) were S. aureus, 16 (11.8%) were coagulase negative Staphylococci (CONS) and 114 (84.4%) were MDR. Eighty-one (68.1%) of the 119 S. aureus isolates were methicillin resistant, and 11 (68.8%) of the 16 CONS were also resistant to the methicillin. Eighteen (13.3%) of the 135 Staphylococcus spp. were detected to be strong biofilm producers, 30 (22.2%) moderate, and 87 (64.4%) non or weak biofilm producers. Both biofilm producers and biofilm non-producers were found to be resistant against Ampicillin and Azithromycin. Conclusion: The study reveals higher percentage of MDR among Staphylococcus spp, indicating the need to discourage self-medication, insufficient or over – medication. Moreover, the high rates of biofilm development in MDR Staphylococcus spp and MRSA underscores the need for monitoring of biofilm producers.

Cefiderocol against Multi-Drug and Extensively Drug-Resistant Escherichia coli: An In Vitro Study in Poland.

Cefiderocol (CFDC) is a novel, broad-spectrum siderophore cephalosporin with potential activity against multi-drug (MDR) and extensively drug-resistant (XDR) Enterobacterales, including carbapenem-resistant strains. We assessed the in vitro susceptibility to CFDC of MDR, and XDR E. coli isolates derived from clinical samples of hospitalized patients. Disk diffusion (DD) and MIC (minimum inhibitory concentration) test strip (MTS) methods were used. The results were interpreted based on EUCAST (version 12.0 2022) recommendations. Among all E. coli isolates, 98 (94.2%) and 99 (95.2%) were susceptible to CFDC when the DD and MTS methods were used, respectively (MIC range: <0.016-4 µg/mL, MIC50: 0.19 µg/mL, MIC90: 0.75 µg/mL). With the DD and MTS methods, all (MIC range: 0.016-2 µg/mL, MIC50: 0.19 µg/mL, MIC90: 0.75 µg/mL) but three (96.6%) ESBL-positive isolates were susceptible to CFDC. Out of all the metallo-beta-lactamase-positive E. coli isolates (MIC range: 0.016-4 µg/mL, MIC50: 0.5 µg/mL, MIC90: 1.5 µg/mL), 16.7% were resistant to CFDC with the DD method, while 11.1% were resistant to CFDC when the MTS method was used. CFDC is a novel therapeutic option against MDR and XDR E. coli isolates and is promising in the treatment of carbapenem-resistant E. coli strains, also for those carrying Verona integron-encoded metallo-beta-lactamases, when new beta-lactam-beta-lactamase inhibitors cannot be used.

Optimal dosing interval of intravenous Colistin monotherapy versus combination therapy: A systematic review and meta-analysis

We aimed to maximize the clinical response and effectiveness of colistin antibiotics in patients with multi-drug (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria, there is an increasing interest in colistin combination therapy with other antibiotics and extended interval dosing regimens. This systematic review and meta-analysis aim is to evaluate if the combination therapy is superior to monotherapy with colistin regarding increased survival and also which dose interval is the most effective to utilize. English language, peer-reviewed journal publications from the first date available to 25 January 2022 were identified by searching the PubMed and Web of Science databases. Forest plots for overall and subgroups and funnel plots were graphed. 42 studies were included in the study. Among them, 38 studies were on combination therapy, and four on dose interval. The overall pooled odds ratio is 0.77 (CI: 0.62; 0.95) (p value < 0.017). The I^2 value was 43% (p value < 0.01). The Begg correlation test of funnel plot asymmetry showed no significant publication bias (0.064). The overall pooled odds ratio for Carbapenem is 0.74 (CI: 0.48; 1.13). A prospective randomized controlled trials (RCT) on 40 adults intensive care unit (ICU) patients with ventilator-associated pneumonia (VAP), comparing the mortality and ICU length of stay of 8- or 24- hour intervals regimens, showed that the ICU length of stay and ICU mortality were; 31.31, 35.3 days, and 32.06, 22.2% in groups 24-h interval and 8- hour interval (p value: 0.39, 0.87), respectively. It seems that combination therapy is associated with drug synergism and increased survival. The extended interval colistin administration may result in higher peak concentration and bacterial eradication. In both cases, we face a dearth of literature.

A multiplex pneumonia panel for diagnosis of hospital-acquired and ventilator-associated pneumonia in the era of emerging antimicrobial resistance.

BackgroundAntimicrobial resistance (AMR), including multidrug (MDR) and extensively drug-resistant (XDR) bacteria, is an essential consideration in the prevention and management of hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). In the AMR era, the clinical utility of the BioFire FilmArray Pneumonia Panel Plus (BFPP) to diagnose HAP/VAP has not been thoroughly evaluated.MethodsWe enrolled adult hospitalized patients with HAP or VAP at Siriraj Hospital and Saraburi Hospital from July 2019–October 2021. Respiratory samples were collected for standard microbiological assays, antimicrobial susceptibility testing (AST), and the BFPP analysis.ResultsOf 40 subjects, 21 were men. The median duration of HAP/VAP diagnoses was 10.5 (5, 21.5) days, and 36 endotracheal aspirate and 4 sputum samples were collected. Standard cultures isolated 54 organisms—A. baumannii (37.0%), P. aeruginosa (29.6%), and S. maltophilia (16.7%). 68.6% of Gram Negatives showed an MDR or XDR profile. BFPP detected 77 bacterial targets—A. baumannii 32.5%, P. aeruginosa 26.3%, and K. pneumoniae 17.5%. Of 28 detected AMR gene targets, CTX-M (42.5%), OXA-48-like (25%), and NDM (14.3%) were the most common. Compared with standard testing, the BFPP had an overall sensitivity of 98% (88-100%), specificity of 81% (74-87%), positive predictive value of 60% (47-71%), negative predictive value of 99% (96-100%), and kappa (κ) coefficient of 0.64 (0.53-0.75). The concordance between phenotypic AST and detected AMR genes in Enterobacterales was 0.57. There was no concordance among A. baumannii, P. aeruginosa, and S. aureus ConclusionsThe BFPP has excellent diagnostic sensitivity to detect HAP/VAP etiology. The absence of S. maltophilia and discordance of AMR gene results limit the test performance.

Novel D-form of hybrid peptide (D-AP19) rapidly kills Acinetobacter baumannii while tolerating proteolytic enzymes

Antimicrobial peptides (AMPs) are being developed as potent alternative treatments to conventional antibiotics which are unlikely to induce bacterial resistance. They can be designed and modified to possess several druggable properties. We report herein a novel hybrid peptide of modified aurein (A3) and cathelicidin (P7), or A3P7, by a flipping technique. It exhibited potent antibacterial activity against both Gram-negative and -positive pathogenic bacteria but had moderate hemolytic activity. To reduce the sequence length and toxicity, C-terminal truncation was serially performed and eight truncated derivatives (AP12–AP19) were obtained. They had significantly less hemolytic activity while preserving antibacterial activity. Secondary structures of the candidate peptides in environments simulating bacterial membranes (30 mM SDS and 50% TFE), determined by CD spectroscopy, showed α-helical structures consistent with predicted in silico 3D structural models. Among the peptides, AP19 demonstrated the best combination of broad-spectrum antibacterial activity (including toward Acinetobacter baumannii) and minimal hemolytic and cytotoxic activities. A D-form peptide (D-AP19), in which all L-enantiomers were substituted with the D-enantiomers, maintained antibacterial activity in the presence of pepsin, trypsin, proteinase K and human plasma. Both isomers exhibited potent antibacterial activity against multi-drug (MDR) and extensively-drug resistant (XDR) clinical isolates of A. baumannii comparable to the traditional antibiotic, meropenem. D-AP19 displayed rapid killing via membrane disruption and leakage of intracellular contents. Additionally, it showed a low tendency to induce bacterial resistance. Our work suggested that D-AP19 could be further optimized and developed as a novel compound potentially for fighting against MDR or XDR A. baumannii.

Streptomyces peucetius M1 and Streptomyces lavendulae M3 Soil Isolates as a Promising Source for Antimicrobials Discovery

The ever-increasing fatality due to the surge of drug resistance has demanded the development of therapeutic metabolites with novel modes of mechanism. Despite the discovery of new antimicrobials, antibiotic resistance is increasing at an alarming rate. The emergence of novel molecules is necessary for targeting the Multidrug (MDR) and Pan-Drug resistant (PDR) pathogens which are the principal cause of life-threatening infections. Streptomyces strains commonly found in the soil produce secondary metabolites which have outstanding potential for being an antifungal and antibacterial agent. This study aims to isolate, identify, and characterize Streptomyces strains isolated from soil and extract their crude metabolites to determine their hidden therapeutic property. Out of four isolates identified, Streptomyces peucetius and Streptomyces lavendulae have shown significant antimicrobial activity against test organisms. To further determine the activity of their extracts GC-MS analysis, and MIC, as well as radical scavenging activity, were determined. GC-MS analysis revealed the presence of compounds 2,3-butanediol, 1-methyl-2-pyrrolidone-4-carboxamide, and L-Lactic acid which are frequently associated with potent antimicrobial nature. The most vulnerable pathogen to M1 extract was Candida albicans with a MIC value of 7.8125 μg/mL while the susceptible bacteria to M3 extract included Staphylococcus aureus with a MIC value of 3.90 μg/mL. The data obtained for antioxidant activity in the case of metabolic extracts M1 and M3 had an IC50 value of 43.17 µg/mL and 22.65 µg/mL respectively. The above findings hint at the unrealized potential of Streptomyces strains.

Multi Bacterial Infection in Immunocompromised Patient

Infection is a major cause of morbidity and mortality in immunocompromised cancer patients due to chemotherapy, radiotherapy, or anti-inflammatory therapy. Approximately 0.9%-39% of cancer patients with febrile non neutropenia has bacteremia and about 7.3% of cancer patients hospitalized have positive bacterial blood cultures. Multi-bacterial infection with Multi Drug Resistant (MDR) in immunocompromised cancer patients complicates therapy and is often fatal. A 6 years old boy diagnosed with left orbital tumor intracranial infiltration. Physical examination: lump in the left eye ± 8 x 10 cm, solid, reddish in color, there was a wound on the left eye ± 12 x 10 cm; Temperature 390C. Hematology examination Hb 10.3 g / dL; PLT 156 x103 / uL; WBC 28.92 x103 / uL. Blood culture results: Methicillin Resistant Staphylococcus aureus (MRSA) resistant to Gentamicin, Amoxicillin Clavulanic Acid, Ampicillin, Penicillin G, Oxacillin and Enterococcus faecium resistant to Gentamicin, Ampicillin, Cotrimoxazole, Trimetoprim, Erythromycin, and Clindamycin. Results of pus culture from the left eye wound was Staphylococcus intermedius resistant to Gentamicin, Amoxicillin Clavulanic Acid, Ampicillin, Penicillin G, Oxacillin, Chloramphenicol, Ciprofloxacin. Based on the results of blood and pus culture, all bacterial isolates included multidrug-resistant organisms (MDRO). Multidrug resistant organisms are microorganisms, especially bacteria that are resistant to at least 1 antibiotic of three or more categories. Cancer patients are susceptible to infection with multi-drug resistant bacteria because of their decreased immune system, especially after undergoing chemotherapy. Appropriate antibiotic treatment determines patient morbidity and mortality. Infection due to multi-bacteria accompanied by multi-drug resistance in immunocompromised patients is a condition that has to be treated immediately since the onset of the disease to reduce morbidity and mortality.

Prevalence and Transmission of Multi Drug Resistance Gene in Staphylococcus aureus

Abstract: Antibiotics are antimicrobial substances that are commonly used to treat humans, ani-mals, and fish, as well as to research susceptibility patterns in a variety of bacteria. With the rising number of diseases and the emergence of new infections, many drugs for humans, animals, fish, and plants are being developed. However, with the development of pharmaceuticals came the advent of a phenomenon known as drug resistance, which has alarmed scientists and researchers all around the world. The building of resistance in genes that code for specific drugs, plasmids, or transposons, the action of multidrug efflux pumps, changes in chromosomal genes, or the Staphylococci cassette chromosome can all produce it. Staphylococcus aureus, the most common Gram-positive bacteria, has a multidrug-resistant phenotype that reveals its pathogenicity. Staphylococcus sp. possesses a variety of transmissible genes that cause them to be resistant to treatments such as antibiotics. The discovery of antibiotics by Alexander Fleming has long been a boon in the fight against bacterial illnesses. Drug-resistant bacteria have emerged as a result of antibiotic overuse and suboptimal us-age, attracting the attention of scientists throughout the world. Therefore, as a first step in combat-ing drug-resistant bacteria, it is obvious that widespread efforts to curb antibiotic abuse are required. This review focuses on and brings to society the prevalence of different multidrug resistant genes in Staphylococcus aureus and their transmission.

Molecular characterization of multi drug resistant Escherichia coli isolates at a tertiary hospital in Abuja, Nigeria

Infections caused by multi-drug resistant Escherichia coli cause significant morbidity and mortality especially in developing countries. In this study, we describe the molecular characteristics of E. coli isolated from clinical specimens and the patients’ outcomes. Phenotypic methods were used in the identification and antimicrobial susceptibility testing of E. coli from clinical specimens from a tertiary hospital in Abuja, Nigeria. Whole genome sequencing was used to describe the antimicrobial resistance genes, serotypes, sequence types/clonal complexes, and mobile genetic elements. The mean age of the patients was 20.3 years with 70.1% females and majority of isolates 75% from urine, 21% from blood cultures, and 3% each from cerebrospinal fluid and endo-cervical swabs. Of the 107 non-duplicate E. coli isolates, 101 (94.3%) were resistant to ampicillin, 95 (88.8%) to trimethoprim/sulfamethoxazole, 86 (80.4%) to ceftriaxone, 60 (56.1%) to gentamicin, and eight (7.5%) to meropenem. There were 102 (95.3%) isolates that were multi-drug resistant (MDR). Expression of Extended Spectrum Beta Lactamase (ESBL) phenotype was detected in 54 (50%) and blaCTX-M-15 genes detected in 75 (70.1%) isolates. The carbapenemase genes blaNDM-1 and blaNDM-5 were detected in six (5.6%), while the AmpC gene- blaCMY-2, was detected in seven (6.5%) isolates. Two (1.9%) isolates simultaneously harboured the blaOXA-1, blaCMY-2, blaCTX-M-15, and blaNDM-5 genes. In total, 35 sequence types (STs) were found with the majority being ST131 (n = 23; 21.5%). The most common serotype was O25:H4 associated with all 23 strains of ST131, followed by O1:H6/ST648 (n = 6). The ST410, ST671, and ST101 strains displayed phenotypic resistance to wide array of antibiotic classes and harbored high numbers of antibiotic resistance genes via in-silico analysis. The ST410 strain in particular harbored a higher number of antibiotic resistance genes and was phenotypically resistant to a wider array of antibiotics. Four pairs of isolates were closely related with three isolates (ST131, ST38, ST652) having a pairwise SNP difference of zero. 71/72 75/76 52/14. The MDR E. coli lineages circulating in this setting pose a clinical and public health threat as they can hinder effective prevention and management of infections. The genetic diversity and MDR E. coli with the emergence of ST410 and ST101 clones is concerning because of the potential for rapid dissemination in hospitals and communities- further increasing the problems of antibiotic resistance. Continuous routine surveillance of E. coli infections for AMR in hospitals becomes imperative, aimed at development of effective antimicrobial stewardship programs, facilitating prudent use of antimicrobial agents, and limiting dissemination of resistant strains.

Environmental Contamination with Multi-drug Resistant Organisms in a Nigerian Neonatal Intensive Care Unit. Impactful Infection Source

Background: Neonates admitted into neonatal intensive care unit (NICU) are at high risk of acquiring infections due to the immaturity of their immune systems and the barrage of intensive medical care. Multiple drug resistant organisms are mostly implicated in causing these infections, usually acquired through contaminated environment. This research was designed to assess the environmental contamination with multi-drug resistant organisms in neonatal intensive care unit.&#x0D; Methods: Environmental samples were collected from all the equipment in each of the 3 rooms in neonatal intensive care unit and cultured on 5% sheep blood agar, chocolate agar and MacConkey agar plates. The isolates were identified with standard biochemical tests. Antibiotic susceptibility profile was done using modified Kirby Bauer disc diffusion method and interpreted according to the guidelines by Clinical and Laboratory Standard Institute. Methicillin resistant Staphylococcus aureus was detected using cefoxitin disc while extended spectrum beta-lactamase (ESBL) producers were confirmed with ESBL chromogenic agar.&#x0D; Results: Out of 36 samples collected from different sites in the 3 rooms, 19(53%) yielded bacterial growth. A total of 28 (78%) bacterial isolates were detected, with majority 25(89%) isolated from room 1. Staphylococcus aureus 15(42%) was the predominant isolate followed by Klebsiella pneumoniae 5(14%) and non-Candida albicans spp 3(8%). Most of Staphylococcus aureus isolates were from samples collected from incubators. Out of 15 Staphylococcus aureus isolated, 11 (73%) were MRSA. Among the Gram negatives, all 5(100%) Klebsiella pneumonioae and 3(60) Acinetobacter species were positive for extended spectrum beta-lactamase production. All the isolates were resistant to 3 or more classes of antibiotics. Imipenem and linezolid were the most sensitive antibiotics to the isolated organisms.&#x0D; Conclusion: High degree of contamination of the environment in NICU with multi drug resistant bacteria is worrisome because of the serious threat it poses. This calls for immediate holistic interventional measures. Strict Compliance with infection prevention and control measures. Additionally, there should be regular antimicrobial resistance surveillance in NICU.

Causative agents of bloodstream infections in two Croatian hospitals and their resistance mechanisms

Blood samples were collected alongside with routine blood cultures (BC) from patients with suspected sepsis, to evaluate the prevalence of different causative agents in patients with bacteraemia. Among 667 blood samples, there were 122 positive BC (18%). Haemoglobin content, platelet number, and systolic blood pressure values were significantly lower in patients with positive BC, whereas serum lactate levels, CRP, creatinine and urea content were significantly higher in patients with positive BC. The rate of multidrug (MDR) or extensively drug resistant (XDR) bacteria was 24% (n = 29): Klebsiella pneumoniae (9), Pseudomonas aeruginosa (9), Acinetobacter baumannii (4), Escherichia coli (1), vancomycin resistant Enterococcus spp (VRE) (3), and methicillin-resistant Staphylococcus aureus MRSA (3). The dominant resistance mechanisms were the production of extended-spectrum β-lactamases, OXA-48 carbapenemase, and colistin resistance in K. pneumoniae, VIM metallo-β-lactamases in P. aeruginosa and OXA-23-like oxacillinases in A. baumannii. The study revealed high rate of MDR strains among positive BCs in Zagreb, Croatia.

A twenty years’ results of the antimicrobial resistance profile and multidrug resistance trend of invasive Streptococcus pneumoniae isolates recovered from adult patients in Turkey: A literature review

PurposeThe aim of this study is to analyze antimicrobial resistance and multidrug (MDR)/extensively (XDR) resistance trend among Streptococcus pneumoniae isolates causing invasive disease in adult patients. MethodsWe analyzed antimicrobial resistance and multidrug resistance trend among invasive S.pneumoniae isolates recovered from adult patients (≥18-years) in a tertiary University Hospital, Turkey between 1996 and 2018. The antibiotic susceptibility pattern was determined by using gradient-test for penicillin and cefotaxime and disk-diffusion method for other antibiotics. ResultsA total of 272 isolates (74.3% from the bloodstream) of S. pneumoniae were collected during the study period. The highest non-susceptibility rate was obtained for tetracycline (63.5%), followed by trimethoprim/sulfamethoxazole (48%), penicillin-oral (30.4%), erythromycin (21.7%), clindamycin (15.8%), ciprofloxacin/levofloxacin (5.9%), penicillin-parenteral (5.5%), cefotaxime (2.2%), and rifampisin (1.8%), respectively. No resistance was observed against vancomycin during the years studied. Over the study period, a significant increase in the rate of antimicrobial resistance among invasive pneumococcal isolates was detected with a peak at period 2014–2018. Although there was an increase in the rates of non-susceptibility to penicillin oral, parenteral penicillin, cefotaxime, erythromycin and clindamycin in adult patients, the results were not statistically significant except erythromycin. Prevalence of MDR and XDR S. pneumoniae were 29% and 9.2% respectively. When the serotypes of MDR isolates were examined, it was noted that serotype 19F (35%) and 14 (12.5%) were the most common. ConclusionsOur study showed an overall increase in non-susceptibility rates of penicillin and erythromycin in invasive S.pneumoniae isolates recovered from Turkish adult patients. Although the prevalence of MDR showed fluctuation between years, the incidence of MDR remained stable. These data indicate the necessity for continuous monitoring and assessment of serotypes and antimicrobial resistance trends in S.pneumoniae in different age groups at both the national and the regional levels as it can be affected by the serotypes dominant in that region, rational use of antibiotics and the vaccination programs.

Changing Trends Of Multidrug Resistant Bacteria: A Six Year Experience From A Tertiary Care Hospital.

There is a continuous increase in the number of bacteria showing resistance to various antibiotics, limiting the treatment options for infections. The objective of this study was to assess the trend in resistance pattern of multi drug resistant organisms over a period of 6 years. A retrospective study was conducted in Indus Hospital and Health Network, Karachi, Pakistan from January 2014 to December 2019. Multidrug resistant organisms were isolated from various samples and the data of corresponding patients were extracted from electronic medical record. The patients of all age groups and either gender was included. Specimens were inoculated on Sheep Blood Agar, chocolate agar and MacConkey agar. Organisms were identified and antibiotic susceptibility testing was performed according to Clinical Laboratory Standard Institute guidelines. In 34628 cases, 5159 (14.8%) were isolated as MDR organisms. Out of these 44.2% were Gram negative, while 55.7% were Gram-positive bacteria. The highest MDR trend was observed for A. baumannii (0-70%) followed by MRSA (0-64%) P. aeruginosa (0-16%) Enterococcus (0-10%) CRE (2.8-5.8%). The continuous rising trend of multidrug resistant organisms has been observed during the period of our study. Therefore, there is an imperative need of constant monitoring and firm adherences to infection control strategies to avoid spread of MDR organisms.

Review on Recent Advancement of Therapeutic Interventions in Combating Multidrug Resistant Bacteria

Antibiotics is a class of drug that plays an eminent role in combating the deadly infections caused by harmful pathogenic organisms. However, irrational use of these antibiotics leads to multidrug resistance in bacterial species which in turn contributes to the morbidity and mortality worldwide, due to which they are referred to as superbugs. Thus, multidrug resistance is known as the resistance of a microorganism to different initially sensitive antibiotics. Though research has led to the development of new antibiotics and its derivatives, the development of new antibiotics is challenged at every step due to the emergence of microbial resistance. The emergence of drug resistance resulted due to the presence of Drug Resistant Plasmid, transposon, antibiotic resistant cassette and further the resistant phenotype can be transferred from resistant to a sensitive microorganism making sensitive organism resistant. Some bacteria acquire the property of being Multi Drug Resistant due to the presence of efflux transporter proteins which can expel antibiotics in a nonspecific manner and overcoming such medical emergencies is the demand of the era. Thus, the lack of novel antibiotics has created the need for certain technological tools to combat this deadly phenomenon. Among them, anti-microbial peptide, anti-virulence compounds, phage therapy, nanotechnology and CRISPR-Cas system are the most commonly used techniques to combat multidrug resistance. The present review highlights different multidrug resistance tools such as the application of Phage therapy, use of nanotechnology, CRISPR-Cas system and antimicrobial peptides together, their working mechanism, utility, efficacy, credibility and relevance along with the modifications needed in the techniques for improvisation.

Escherichia coli ST1193: Following in the Footsteps of E. coli ST131.

Escherichia coli ST1193 is an emerging global multidrug (MDR) high-risk clone and an important cause of community-onset urinary and bloodstream infections. ST1193 is imitating E. coli ST131, the most successful MDR clone of all time. Both clones emerged in the early 1990s by acquiring quinolone resistance-determining region (QRDR) mutations, IncF plasmids, virulence factors, and type 1 pilus (fimH) recombination. They are the only MDR clones that are dominant among unselected E. coli populations. ST131 is the most frequent clone and ST1193 the second most frequent clone among fluoroquinolone/cephalosporin-resistant E. coli isolates. Both clones have played pivotal roles in the global spread of MDR E. coli. ST1193 originated from ST clonal complex 14 (STc14), is lactose nonfermenting, belongs to phylogenetic group B2, and contains the O type O75. Global ST1193 prevalence has been increasing since 2012, even replacing ST131 in certain regions. blaCTX-M genes are rapidly expanding among ST1193 isolates, a scenario that occurred with ST131 during the 2000s. A validated PCR will enable global surveys to determine the extent of ST1193 among One Health E. coli isolates. The rapid emergence of ST1193 is concerning and is adding to the public health burden of MDR E. coli clones. Basic mechanistic, evolutionary, surveillance, and clinical studies are urgently required to investigate the success of ST1193. Such information will aid with management and prevention strategies. The medical community can ill afford to ignore the spread of another global successful MDR high-risk E. coli clone, especially one that is following in the footsteps of E. coli ST131.