Multidrug Resistance Pattern Research Articles

Prevalence and Multidrug Resistance Pattern of E. Coli among Urinary Tract Infection Patients in Tertiary Care Hospital of Multan

Urinary Tract Infection is alarming problem worldwide due to the intensity of antimicrobial resistance. Escherichia coli is the most predominant organism in UTI. This study was planned to evaluate demographic parameters, the prevalence of E. coli, and antimicrobial resistance patterns among E. coli isolates from UTI patients in Nishtar Hospital of Multan from January to June 2018. A total of 350 mid-stream urine samples were collected from different patients having age group from 25 to 60 years and processed by standard laboratory procedures. Out of 350 samples, 100 samples were observed as critical bacteremia. Escherichia coli and Klebsiella pneumonia were the most persistent (47 % and 19 % individually) among the Gram-negative pathogens followed by S. aureus (14 %), Enterobacter spp. (11 %) and Candida (9 %) respectively. The incidence of UTI was found higher in 25-35 age groups. The prevalence of UTI with E. coli as an infectious agent was 72 % in females, and 28 % in males. The prevalence of E. coli was more in rural areas (70 %) than in urban areas (26 %). The antimicrobial testing against E. coli showed the highest resistance to amoxicillin (65.9 %) and ciprofloxacin (38.2 %), whereas highly sensitive rate observed against Fosfomycin (FOS) (95.7 %), Gentamicin (GEN) (89.3 %), and Nitrofurantoin (NIT) (85 %) respectively. The increased resistance against ampicillin and ciprofloxacin was observed in Multan have a great emerging problem so there is a need for effective prevention strategies for the E. coli drug resistance and successful surveillance required to be improved.

Emergence of bla TEM, bla CTX-M, bla SHV and bla OXA genes in multidrug-resistant Enterobacteriaceae and Acinetobacter baumannii in Saudi Arabia.

Multidrug-resistant (MDR) patterns due to extended-spectrum β-lactamase (ESBL) production in pathogenic bacteria are now becoming prevalent in hospitals worldwide, posing a public health challenge. The aim of the present study was to determine the antibiotic susceptibility patterns and distribution of the blaTEM, blaCTX-M, blaSHV and blaOXA ESBL resistance genes in MDREnterobacteriaceae and Acinetobacter baumannii (A. baumannii). A cross-sectional study was conducted between September 2017 and August 2018 in the King Abdullah Hospital (Bisha, Saudi Arabia). Bacterial isolates were collected from the clinical samples of patients; these were identified and screened for ESBL production and their antibiotic susceptibility was examined using standard microbiology methods. Multiplex-PCR runs were performed to identify genes encoding ESBL producers. DNA sequencing analysis was used to identify the specific gene variants. Of the 274 isolates, 173 (63.1%) exhibited MDR patterns to different antibiotics. A. baumannii revealed the highest resistance rates for cefuroxime (100%), gentamicin (88%) and amikacin (86%). Klebsiella pneumoniae (K. pneumoniae) isolates had the highest resistance rates for cefuroxime (98%), aztreonam and trimethoprim/sulfamethoxazole (87% for each). Escherichia coli (E. coli) exhibited high resistance rates for trimethoprim/sulfamethoxazole (92%) and cefuroxime (87%). Of the 173 MDR isolates, 78 (45.1%) exhibited ESBL production. Of these, 88.9% (72/78) carried ESBL genes. The most prevalent gene-encoding isolates were blaTEM (84.7%), followed by blaCTX-M (33.3%), blaSHV (2.7%) and blaOXA-1 (1.4%). A single blaTEM gene was predominantly produced by K. pneumoniae (60.7%), A. baumannii (78.9%) and Proteus mirabilis (80%), whereas blaCTX-M was harbored by E. coli (33.3%). The co-existence of two different genes in a single bacterium was revealed in 22.2% of isolates, commonly between blaTEM and blaCTX-M (19.4%). Sequencing analysis revealed that blaCTX-M-15 and blaTEM-1 were predominant variants of the blaCTX-M and blaTEM genes, respectively. The present study revealed a diversity of ESBL genes in Gram-negative bacterial isolates, with blaTEM being the most prevalent type. The emergence of various ESBL genes with several co-existing genotypes is alarming, rendering extensive surveillance studies necessary to understand the transmission and epidemiology of such resistant gene-carrying isolates.

Multidrug resistance in Shiga toxin-producing Escherichia coli (STEC) isolated from broiler chickens at slaughter

Broiler chickens and derived products are a key source of Shiga toxin-producing Escherichia coli (STEC) in humans. This pathotype is responsible for causing severe episodes of diarrhea, which can progress to systemic complications. A rapid and accurate diagnosis of the disease, and early treatment of the infection with antimicrobials, can prevent it worsening. However, multidrug-resistant strains have potentially negative implications for treatment success. In this context, the aim of the present study was to isolate and identify multidrug-resistant STEC strains from broiler chickens and carcasses. Of 171 E. coli strains, isolated by conventional microbiological techniques and submitted to Polymerase Chain Reaction (PCR), for detection of stx1 and stx2 genes, 21.05% (36/171) were STEC pathotype, and most of them (66.67% - 24/36) carried both stx1 and eae genes. The multidrug resistance pattern was observed in 75% (27/36) of STEC strains. The presence of STEC in broiler chickens and carcasses reinforces that these sources may act as reservoirs for this pathotype. Multidrug-resistant bacteria contaminating animal products represent a public health issue because of the possibility of spread of multidrug-resistant determinants in the food chain and a higher risk of failure in human treatment when antimicrobials are needed.

Comparison between Phenotypic and Genotypic Detection of Metallo Beta Lactamase Enzyme among Gram Negative Bacteria Isolated from Burn Patient

Background: -lactamases (MBLs) are emerging worldwide as powerful resistance determinants in Gram negative bacteria Rapid dissemination and spread between different bacterial species by large gene transfer favor by globalization and travel represent a high risk of worldwide pandemic among Enterobacteriaceae Objective:This study design to screen for phenotypic detection of MBL and genes coding for metallo - lactamase(MBL) such as, blaVIM, blaIMP and bla NDM among infected burn wound patients in Sulaimani city /Iraq. Materials and Methods: Out of 230 burn wound samples, 201 wound swabs and 29 tissue biopsy were collected from hospitalized burn patients with second and third degrees burnfrom Burn and Plastic Surgery Hospital in Sulaimani city from the period of April to October 2011. According to direct gram stain , bacterial cultural , biochemical tests, analytic profile identification(API) system and vitek 2 Compact system , antimicrobial susceptibility Testing by using Kirby-Bauer disk diffusion method and vitek compact system, -lactamase by Double disk synergy test and Combined EDTA disk test and Modified Hodge test and -lactamase enzyme by using polymerase chain reaction. Results: Out of 230 burn wound samples177 samples gram negative bacteria were isolated; inflammatory cells showed significantly associated with positive bacterial culture. The most frequent bacteria isolated were Pseudomonas species 48(27.12%), in which Pseudomonas aeruginosa account for a higher percentage 46(25.98%) and one species (0.56%) of each P. stutzeri and P.florescence wasisolated followed by Acinetobacterspecies 44 (24.86%) in which Acinetobacterbaumanniiwas the commonest and accounts for a higher percentage 41 (23.16%) and one species(0.56%) of each of A. ursingi, A. hemolyticasandA.complexwere identified. On the other hand in the family of Enterobacteriaceae,the most common bacteria were Klebsiellapneumoniae44(24.86%), Enterobacter cloacae 18 (10.17%) and Escherichia species 11(6.21%). The susceptibility of bacterial isolates against 18 antibiotics from different classes of antibiotics was tested and it was found that most of the isolated species of non fermenter bacteria such as Acinetobacterand Pseudomonas species show multidrug resistant pattern and high resistance against most of the antibiotics commonly used. The most resistant antibiotics against non fermenter bacteria were Ticarcillin (81.82%) against Pseudomonas species and Ticarcillin, Tazobactam- Pipracillin and Cefoxitin (93.18%) against Acinetobacterspecies .The most resistant antibiotic against K. pneumonia andE.cloacaewere Cefoxitin(84.9%)and Amoxicillin Clavulanic acid (84.9%).The most resistant antibiotics against Escherichia specieswere Cefotaxime, Trimethoprim and Cefipime (90.91%) but the most effective antibiotic with a highsensitivity rate was Imipenem (90.91).Phenotypic tests were carried out for the detection of MBL enzyme for all studied isolates and it was found that Combined disk test was the most sensitive test giving the highest percentage (31.07%) followed by Double disk synergy test(28.8%), Modified Hodge test (20.9%) .Polymerase chain reaction assay was used for genotypic detection of MBL genes (blaIMP,blaVIM, ,blaNDM ) in all isolates and the results revealed that the gene blaIMPwas locatedin 33(18.64%),blaVIM,in19 (10.73%), 2(1.12%)forblaNDM Also these genes were detected in 25 stock cultures of Gram negative bacteria preserved in 25 °C since 2008 to 2010. blaIMP gene was detected in11(44%) , blaVIM in 12(48%) and 2(8%) for blaNDM, all these genes were detected in K. pneumonae,P. aeruginosa and A. baumanniiwith length amplified genes (230) bp for IMP and (390)bp for VIM and( 621)bp for NDM. Conclusions:These results indicate that most of the Meropenem resistant strains from infected burn wound strains in this study were producing MBL enzymes The presence of MBL genes among Meropenem sensitive strains indicates that there might be a hidden MBL gene among isolated strains which cannot be diagnosed by phenotypic tests leading to the dissemination of these genes in the hospital silently among patients even within normal health workers who act as carriers for MBL genes in future

Antimicrobial resistance of Haemophilus influenzae isolates from pediatric hospitals in Mainland China: Report from the ISPED program, 2017–2019

PurposeThis study set out to determine the antimicrobial resistance trends of Haemophilus influenzae isolates from pediatric hospitals in Mainland China, which would provide basis for clinical treatment. MethodsThe Infectious Disease Surveillance of Pediatrics (ISPED) collaboration group conducted this study. H. influenzae strains isolated from nine pediatric hospitals in Mainland China were included. Disk diffusion method was used for antimicrobial susceptibility test. Cefinase disc was used for detection of β-lactamase. ResultsIn total, 13810 H. influenzae isolates were included during 2017–2019: 93.17% of which were from respiratory tract specimens, 4.63% from vaginal swabs, 1.10% from secretion, and 1.10% from others. Of all strains, 63.32% isolates produced β-lactamase; 8.22% isolates were β-lactamase-negative and ampicillin-resistant (BLNAR). The resistance to sulfamethoxazole-trimethoprim was 70.98%, followed by resistance to ampicillin (69.37%), cefuroxime (51.35%), ampicillin-sulbactam (38.82%), azithromycin (38.21%), amoxicillin-clavulanate (35.28%). More than 90% of H. influenzae isolates were susceptible to ceftriaxone, cefotaxime, meropenem, levofloxacin and chloramphenicol. The resistance rate of ampicillin and azithromycin in H. influenzae showed an increasing trend through the years. Statistically significant differences in antibiotic-resistance rates of all the antibiotics except chloramphenicol were found in different regions. The major Multi-Drug Resistance pattern was resistant to β-lactams, macrolides, and sulfonamides. ConclusionsThere is a rising trend of resistance rate of ampicillin and azithromycin in H. influenzae. Antimicrobial resistance of H. influenzae deserves our ongoing attention. Third-generation cephalosporin could be the preferred treatment option of infections caused by ampicillin-resistant H. influenzae.

Salmonella Typhimurium ST34 Isolate Was More Resistant than the ST19 Isolate in China, 2007 - 2019.

To disclose the antimicrobial susceptibility and wide adaptability of commonly occurring genotypes of Salmonella enterica serovar Typhimurium, the antimicrobial resistance and multilocus sequence typing (MLST) profiles of 196 Salmonella Typhimurium isolates (136 from food-producing animals, 19 from environments, 15 from markets, and 26 from humans) in China between 2007 and 2019 were analyzed. Tests of susceptibility to 19 antimicrobial agents using the broth microdilution method showed that 84.7% of the isolates were resistant to at least one antimicrobial. Antimicrobial susceptibility analysis demonstrated that 66.8% of the isolates were multidrug-resistant (MDR) strains, with resistance to three or more antimicrobials. The highest antidrug resistance was to ampicillin, amoxicillin/clavulanic acid, and tetracycline. Three MLST types were detected, and sequence type (ST) 19 was the most common ST. However, ST34 was associated with a higher MDR rate and more complex MDR patterns, than ST19 and ST99, although the exact mechanism has not been reported. Our study highlights the variation of drug resistance and STs from different sources and the association between STs and drug resistance, providing useful information for epidemiological research and developing a public health strategy.

Multidrug resistance analysis method for pathogens of cow mastitis based on weighted-association rule mining and similarity comparison

Mastitis is one of the most common diseases and causes the greatest economic loss in dairy farming. Antibiotics are the most effective drugs to prevent and treat bacterial infection of mastitis. However, yet the growing problem of drug resistance, especially multidrug resistance (MDR), poses a great threat to disease control. To understand the MDR rules in bacteria of cow mastitis from national level, the main bacteria from cows with mastitis in large-scale farms were isolated and identified in China, and then drug sensitivity tests were conducted to establish a drug resistance data set. Aiming at the problem of numerous and disordered drug resistance data and lack of extensive correlations, a weighted Apriori association rule mining algorithm in conjunction with the bacterial drug resistance prevalence is proposed. We analyzed the associations between different antibiotics of key bacteria, extracted and visualized the key trends of high resistance prevalence and frequent occurrence, and discovered MDR patterns. Finally, a similarity comparison method based on Euclidean measurement was proposed to compare the relative MDR rules of different bacteria from the overall level with support, confidence, and promotion as characteristic parameters. The drug resistance data set showed that staphylococcus were the main bacteria isolated from dairy cow mastitis in China. Then based on the association rule algorithm, the important rules between different antibiotics resistance in this dataset were identified. In addition, the MDR patterns of different bacteria were visualized and analyzed by using the chord diagram. The results showed the bacteria are highly resistant to penicillin, gentamicin, and ampicillin, and most other antibiotics were linked with these three antibiotics. Finally, the high correlations and main rules in different bacteria were confirmed by a similarity comparison method. The assessment model and conclusions of this study are potentially valuable for assessing the evolution of MDR patterns, providing a scientific basis for relevant authorities to guide the rational use of antibiotics in the farming industry.

Understanding patterns of HIV multi-drug resistance through models of temporal and spatial drug heterogeneity.

Triple-drug therapies have transformed HIV from a fatal condition to a chronic one. These therapies should prevent HIV drug resistance evolution, because one or more drugs suppress any partially resistant viruses. In practice, such therapies drastically reduced, but did not eliminate, resistance evolution. In this article, we reanalyze published data from an evolutionary perspective and demonstrate several intriguing patterns about HIV resistance evolution - resistance evolves (1) even after years on successful therapy, (2) sequentially, often via one mutation at a time and (3) in a partially predictable order. We describe how these observations might emerge under two models of HIV drugs varying in space or time. Despite decades of work in this area, much opportunity remains to create models with realistic parameters for three drugs, and to match model outcomes to resistance rates and genetic patterns from individuals on triple-drug therapy. Further, lessons from HIV may inform other systems.

Occurrence, distribution and pattern analysis of methicillin resistant (MRSA) and methicillin sensitive (MSSA) Staphylococcus aureus on fomites in public facilities

ABSTRACT Methicillin-resistant Staphylococcus aureus (MRSA) is a human pathogen incriminated as a causative agent of hospital nosocomial infections as well as a wide range of diseases in communities. This study was conducted to assess the occurrence and distribution of MRSA and methicillin-sensitive (MSSA) on different fomites in public facilities in northern Jordan and to determine their antibiograms, toxin genes profiles, as well as identify their genetic relatedness. A total of 2600 swabs were collected from 14 fomite surfaces in a variety of public facilities including hospitals, universities, schools, transportation sites, and market places. The identity of the 380 S. aureus isolates was confirmed. Among them, 158 (41.6%) were MRSA while the rest of the isolates, 222 (58.4%) were MSSA. MRSA isolates were recovered from all fomites sites. However, among the total collected samples, the percentages of MRSA in public facilities were significantly higher in hospitals and transportation fomites, while percentages of MRSA among fomites sites were higher in public reception sites, chairs, and toilet seats. Antibiotic resistance profiles indicated that 24.5% of the isolates were resistant to cefoxitin, oxacillin, and oxytetracycline. In contrast, only 3.95% were resistant to trimethoprim-sulfamethoxazole, and 15.3% were resistant to ciprofloxacin. Multidrug-resistant patterns were higher in MRSA than in MSSA isolates. There was no apparent difference in toxin gene profiles between MRSA and MSSA. Molecular analysis revealed 85 patterns and 16 clusters at a 9% mean similarity level. In conclusion, this study provides evidence for the potential of MRSA transmission via inanimate surfaces.

Gram-Negative Bacteria Bloodstream Infections in Patients with Hematological Malignancies - The Impact of Pathogen Type and Patterns of Antibiotic Resistance: A Retrospective Cohort Study.

BackgroundEnterobacteriaceae (EB) and non-fermentative bacteria (NFB) are the main pathogens responsible for gram-negative bloodstream infections (GN-BSI) in patients with hematological malignancies (HMs). These two pathogen types have heterogeneous resistance mechanisms to antibiotics. However, the impact of pathogen species and pattern of antibiotic resistance on the outcomes of patients with HMs remains unclear.MethodsWe retrospectively collected clinical data of patients with HMs at three comprehensive hospitals in Hunan Province, China, between January 2010 and May 2018. The data analyzed the impact that different species and patterns of antibiotic resistance had on the outcome of patients with HMs.ResultsThe majority of the 835 monomicrobial isolates collected from patients with HMs and GN-BSIs were Enterobacteriaceae (75.7%). While detections of MDR pathogens in BSIs as a whole are decreasing, sub-analysis shows that detections of extended spectrum β-lactamase-producing (ESBL) Enterobacteriaceae and carbapenem-resistant pathogens in BISs are rising. Comparing different species, the early mortality rate associated with infections caused by NFB was significantly higher than infections caused by Enterobacteriaceae (22.6% vs 9.7%, p < 0.001). Across different multidrug-resistant (MDR) patterns, ESBL bacteria did not have a significant impact on health outcomes. Carbapenem-resistant bacteria, on the other hand, were observed to significantly affect early mortality rate, such as carbapenem-resistant Klebsiella pneumoniae (36.0% vs 7.6%, P < 0.001) and carbapenem-resistant non-fermentative bacteria (44.7% vs 16.5%, P < 0.001).ConclusionOur findings suggest that both species and patterns of antibiotic resistance can affect the early mortality of patients with HMs during BSI.

Comparative Analysis of Chloramphenicol-Resistant Enterococcus faecalis Isolated from Dairy Companies in Korea.

Although chloramphenicol is currently banned from use in livestock, other phenicols, such as florfenicol and thiamphenicol, have been used for the treatment of bacterial infections in domestic cattle in Korea. This study compares the characteristics of chloramphenicol-resistant Enterococcus faecalis isolated from the bulk tank milk of four major dairy companies in Korea. Although the distribution of multidrug resistance patterns showed no significant differences between the four companies, 85 chloramphenicol-resistant Enterococcus faecalis isolates showed a significantly high number of resistances against five or six antimicrobial classes (37.6%, respectively) (p < 0.05). When analyzing the distribution of phenicol resistance genes, 31 (36.5%) isolates only carried the catA gene, and two (6.3%) isolates from company A only carried the cfr gene. No isolates carried the catB or fexA genes. Regarding the distribution of other resistance genes, both the tetL and tetM (45.9%), ermB (82.4%), and both aac(6″)-Ie-aph(2″)-la and ant(6′)-Ia genes (30.6%) showed a high prevalence, and the optrA and poxtA genes were observed separately, each in only two (2.4%) isolates. Our results confirm that the dissemination of chloramphenicol-resistant Enterococcus faecalis and some antimicrobial resistance genes show significant differences between dairy companies. Therefore, our results support that each dairy company should undertake effective surveillance programs to better understand and minimize the emergence of resistance on a multidisciplinary level.

​Multidrug-resistance Pattern of Antibiogram of Escherichia coli and Staphylococcus aureus Isolated from Mastitis Affected Buffaloes in Eastern Uttar Pradesh

Background: Mastitis is a problem of dairy animals including buffaloes. Treatment failure has become a common problem and the most cited reason is antibiotic resistance. The paper presents the scenario of antibiotic resistance with special reference to multi drug resistance pattern. Methods: Microbiological assay of mastitis affected 48 milk samples was carried out using standard protocols to establish the prevalence of mastitis caused by E. coli and S. aureus. Antibiotic sensitivity test was carried out against these organisms and the whole milk culture for commonly used antibiotics. The drug resistance pattern was established. Result: The overall prevalence of mastitis was 20%. The prevalence of E. coli and S. aureus was 29.17% and 54.17% respectively. The antibiotic sensitivity revealed that E.coli isolates were 100% susceptible to tetracycline, gentamicin, enrofloxacin and streptopenicillin followed by Ceftriaxone and sulbactum combination and streptomycin (92.86%) and ceftriaxone and methicillin (85.71%). The isolates of S. aureus were 100% sensitive to only two antibiotics gentamicin and streptopenicillin. The antibiogram of whole milk culture revealed maximum susceptibility to enrofloxacin, gentamicin and streptopeniciliin (95.83% each). Multiple drug resistance has been observed in this study.

Multidrug-resistant Bacterial Profile and Patterns for Wound Infections in Nongovernmental Hospitals of Jordan

Globally, multidrug-resistant bacteria affects wound infections, both hospital-acquired infections and community-acquired infections. The main isolates cultured from 607 subjects with wound infections were methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter spp. [multidrug resistant (MDR)]. Gram-negative bacteria caused most of the infections (67%) compared with gram-positive bacteria. Diabetic patients tend to have wound infections with mixed causative agents compared with non-diabetic patients.

Molecular Characterization and Antimicrobial Susceptibility of Methicillin-Resistant Staphylococcus Aureus Isolates from Clinical Samples and Asymptomatic Nasal Carriers in Istanbul (Turkey)

Methicillin-resistant Staphylococcus aureus (MRSA) has been a widespread problem in Turkish hospitals. The aim of this study was to investigate the staphylococcal toxin genes of the clinical and nasal MRSA isolates, and their antibiotic resistance profiles. Isolation of nasal and clinical bacteria was done following standard microbiological methods. The presence of antimicrobial resistance genes (mec A, pvl, tsst-1, and SEs genes) was determined using the real-time polymerase chain reaction (PCR) assay. Among nasal MRSA isolates, 66.7% were toxigenic. The distribution of genes was as follows: pvl 26.7%, tsst-1 3.3%, and SEs 36.7%. Therefore, the nasal MRSA isolates had a rate of 23.3% multidrug resistance (MDR) pattern to the non-beta-lactams antibiotics. All (100%) clinical MRSA isolates were found to be toxigenic. The distribution of genes was as follows; pvl 10%, tsst-1 6.7%, and SEs 100%. The clinical MRSA isolates had a rate of 60% MDR. Following detection of pvl, tsst-1, and SEs among nasal and clinical MRSA isolates, and the presence of high antimicrobial resistance, the spread of these strains may be an additional factor contributing to the emergence of community-acquired (CA)-MRSA and hospital-acquired (HA)-MRSA. This study is the first to determine the resistance to linezolid and tigecycline in both nasal and clinical MRSA isolates, for the first time in Turkey. All nasal and clinical MRSA isolates were uniformly susceptible to vancomycin and quinupristin-dalfopristin. Our findings show that MRSA infections in Turkey can be empirically treated with vancomycin and quinupristin-dalfopristin based on the lack of demonstrable resistance to these drugs.

Characterization and antibiotic resistance of staphylococci strains isolated from brack hospital in the Southern Region of Libya

Abstract Background: Staphylococcus species are one of the most important healthcare-associated pathogens able to acquire and spread multidrug-resistant determinants. Objectives: The present study investigated and analyzed 110 potential Staphylococcus species isolated from various clinical and nonclinical samples at Brack hospital. Materials and Methods: A nonselective laboratory approach was applied, using cultural characteristics, Gram stain, and catalase reactivity followed by confirmation at the species levels and determination the susceptibility against antimicrobial agents using the Phoenix automated microbiological system. Results: In total, 57.5% were confirmed as species and subspecies of Staphylococcus represented by ten different species: nine subspecies of coagulase-negative staphylococci (CoNS) (76.2%) and one coagulase-positive staphylococci (CoNS) subspecies (23.8%). Of these strains, 16.6% were identified as methicillin-resistant staphylococci (MRS) mostly of the CoNS group expressing significant resistance to important antimicrobial classes. Conclusion: This study reports a high prevalence of various staphylococci species, particularly of CoNS group expressing multidrug resistance patterns of public health concern, from a healthcare setting in the south region of Libya. The identification of higher rate of MRCoNS underlines the importance of monitoring all multidrug-resistant staphylococci species requiring further epidemiological investigations.

Changing Antimicrobial Susceptibility and Resistance Pattern of Acinetobacter Species over the Last Eight Years in a Tertiary Care Hospital in Lahore, Pakistan

Background: Acinetobacter spp. is a highly resistant nosocomial pathogen that leads to a broad range of human infections resulting in high morbidity and mortality. Due to unpredictable MDR patterns of Acinetobacter spp., it is imperative to know the institutional prevalent susceptibility profiles of these residing pathogens. The objective of this study was to determine the antimicrobial susceptibility pattern of Acinetobacter species over the last 8 years in a tertiary care hospital in Lahore, Pakistan.Material and Methods: A retrospective study was carried out in Lahore General Hospital, a tertiary care hospital in Lahore, Pakistan. Eight-year data was gathered from January 2012 to December 2019. All specimens were handled according to standard operating procedures in the microbiology laboratory of the Pathology department of Lahore General Hospital. The Acinetobacter spp. were identified in the laboratory by Gram staining, oxidase test, catalase test and Triple sugar iron fermentation and their antibiotic sensitivity pattern was noted.Results: The highest yield of Acinetobacter spp. from the clinical specimen was isolated from pus followed by tracheal secretion, blood, and urine in the last three years (from 2017 to 2019). Most of the isolates were multi-drug resistant (MDR). There was a progressive increase in resistance of Acinetobacter spp. The highest progression in resistance was observed among the cephalosporin and quinolone group of antibiotics.Conclusions: Increased resistance to commonly used antimicrobials against Acinetobacter species has been observed with the highest resistance to quinolones and cephalosporins.

Antibiotic Resistance Profile of Salmonella enterica Isolated from Exotic and Indigenous Leafy Green Vegetables in Accra, Ghana

Fresh produce-borne enteric bacterial pathogens that are resistant to antibiotics have posed serious challenges to food safety and public health worldwide. This study was conducted to evaluate the antibiotic resistance profiles of Salmonella enterica isolates (n = 33) recovered from exotic and indigenous leafy green vegetable samples (n = 328) collected from 50 vegetable farms in 12 farming areas and 37 vegetable sellers in four market centers in Accra, Ghana, from March 2016 to March 2017 and to determine the distribution of integrons among antibiotic-resistant isolates. The susceptibility of the Salmonella isolates to 12 antibiotics was assayed with the standard disk diffusion assay. The MICs of the five most resisted antibiotics were determined with a twofold macrodilution method. A PCR assay was used to detect the presence of integrons in Salmonella isolates, and PCR products with the amplified integron gene cassette were purified and sequenced with the Sanger sequencing technology. The Salmonella isolates used in the study were resistant to at least one tested antibiotic, and 30.3% (10 of 33) of the isolates were multidrug resistant. Most isolates (81.8%) were resistant to sulfisoxazole. The MICs of tetracycline, cefoxitin, streptomycin, ampicillin, and sulfisoxazole were 16, 32, 64, 64, and >1,024 μg/mL, respectively. Five patterns of multidrug resistance were observed among the Salmonella isolates, and the most common patterns were AAuFox (30.3%) and AAuFoxSSu (18.1%). One (3.0%) of the 33 Salmonella isolates tested positive for the class 1 integron, with a gene cassette of about 800 bp. Nucleotide sequencing revealed that this class 1 integron carried a single gene, dfrA7. Further studies are needed to determine whether the consumption of contaminated leafy green vegetables is a route for acquiring antibiotic-resistant Salmonella in Accra, Ghana.

Isolation Frequency of Uropathogenic Strains and Search for ESBL Producing Enterobacteriaceae Isolated from Patients with UTI in Bechar (Algeria)

Background: The emergence of multidrug-resistant uropathogenic strains, mainly the global spread of extended-spectrum beta-lactamase (ESBL) genes accompanied both by the uncontrolled use of antibacterial agents and a considerable decrease in their activities, makes the monitoring of the resistance pattern one of the necessary means that could help the medical practitioners to choose the best treatment. For this purpose and during four months from March 1 to June 30 (2019), an experimental study has been carried out on urine specimens of 123 inpatients (IP) and outpatients (OP) at infectious disease service Boudjemaa TOURABI Public Hospital of Bechar (Algeria), aiming the detection of ESBL-producing Enterobacteriaceae uropathogenic strains. Methods: Firstly, the antibiotic susceptibility testing has been carried out by using the disk diffusion method to determine not only the multidrug resistance patterns, but also the multiple antibiotic resistance MAR indexes of uropathogenic strains that were isolated from clinical IP and OP samples. Secondly, the ESBL detection was done using the following methods: synergy tests based on the synergy between a third-generation cephalosporin and clavulanate, double-disc synergy test (DDST) and phenotypic tests on a cloxacillin-containing agar. Results: As a result, 56 patients had a urinary tract infection (UTI) in overall 123 patients; thus, a frequency of 45,52%. Through a UTI’s frequency of 64,7%, the female gender was the most affected. All age groups were affected by UTI, with a mean age of 38,47±19,97 years old. Knowing that UTIs’ patients aging from 16 to 49 years old were the most affected compared to other ages’ groups, with a frequency of 66,6 and 50% for female and male gender, respectively. The microbial strains represented by the bacteria group were predominant, i.e. (98,22%) followed by yeasts (1,78%), where Gramnegative bacilli showed (96,36%) of the uropathogenic agents, so (3,64%) were Gram-positive bacteria. The antibiotic resistance profile of isolated Enterobacteriaceae showed very high resistance rates for the species of Escherichia coli, Klebsiella spp, and Proteus spp to aminopenicillins, cephalosporins, and less against carbapenems and other drug groups. E. coli had presented the highest multidrug resistance followed by Klebsiella spp with a MAR index ranged from 0,53 to 0,82. Within this range, a total of 28 isolate (25 E. coli, 2 Klebsiella spp, and 1 Proteus mirabilis) had shown resistance against 9 to 14 out of the 17 tested antibiotics. The rate of ESBL-producing Enterobacteriaceae strains was 23,07 and 55,26% for inpatients and outpatients, respectively, where E. coli was the most important ESBL producers out of all isolated strains. Conclusion: An alarming ESBLs rate for outpatients is usually higher among inpatients with UTI, who receive several classes of antibiotics. Such conditions should be considered as a major public health concern, and measures must be taken to establish the sources and drivers of this issue. Thus, the findings of this research push the health sector stakeholders as well as the scientific communities to act on reducing the transmission of the multidrug-resistant strains that threaten several classes of life-saving antibiotics.

The Antibiogram Profile of Commensal Escherichia coli of the Gastrointestinal Tract of Apparently Healthy Ostriches and Diseased Chickens with Colibacillosis

The present study aimed to assess the antibiotic resistance of commensal Escherichia coli (E. coli) of the healthy ostriches (Eho) and the diseased chickens with colibacillosis (Epc) and to determine if the odds that Eho (test group) shows antimicrobial resistance different from the Epc (reference group). In this descriptive cross-sectional study, we calculated the odd ratio (OR) after determination of the resistance and multidrug resistance (MDR) rates, MDR pattern, and the antibiotype of Eho (n= 49) and Epc (n= 39) against ampicillin, amoxicillin, gentamicin, amikacin, oxytetracycline, sultrim, lincospectin, and chloramphenicol. All of the Eho (100%) were resistant to ampicillin, gentamicin, and amoxicillin (P 0.05) antibiotypes, respectively. The odds of Eho being resistant to ampicillin, amoxicillin, and gentamicin (P > 0.05) and P1 MDR pattern (P 0.05) and one (P < 0.05) antibiotypes were higher in Eho compared to those in Epc. Our findings emphasized the development of antibiotic resistance in commensal E. coli and indicated that not only one antibiotic may not treat the disease in chickens, but antibiotic susceptibility testing is also of great necessity for veterinary health. The possible contamination of meat, carcasses, and eggs of apparently healthy ostriches by their fecal MDR E. coli threatens human health.

Understanding the evolution of multiple drug resistance in structured populations.

The evolution of multidrug resistance (MDR) is a pressing public health concern. Yet many aspects, such as the role played by population structure, remain poorly understood. Here, we argue that studying MDR evolution by focusing upon the dynamical equations for linkage disequilibrium (LD) can greatly simplify the calculations, generate more insight, and provide a unified framework for understanding the role of population structure. We demonstrate how a general epidemiological model of MDR evolution can be recast in terms of the LD equations. These equations reveal how the different forces generating and propagating LD operate in a dynamical setting at both the population and metapopulation levels. We then apply these insights to show how the LD perspective: (i) explains equilibrium patterns of MDR, (ii) provides a simple interpretative framework for transient evolutionary dynamics, and (iii) can be used to assess the consequences of different drug prescription strategies for MDR evolution.