Multidrug-resistant Enterobacteriaceae Research Articles

Whole genome sequencing-based cataloguing of antibiotic resistant genes in piggery waste borne samples

The growing use of antibiotics in livestock is one of the main causes of the rapid global spread of antimicrobial resistance (AMR). However, extensive research on AMR in animals is currently absent. In this article, we provide the bacterial antibiotic resistance genes (ARGs) from piggery waste samples in West Bengal, India, based on whole genome sequencing (WGS). According to the study, there are alarmingly high levels of Enterobacteriaceae in piggery waste, especially slaughterhouse waste, that are resistant to beta-lactam, aminoglycoside, sulphonamide, and tetracycline. We found several plasmids carrying multidrug-resistant Enterobacteriaceae including resistant to last-resort medications like colistin and carbapenems. Our findings will serve as a guide for developing AMR management policies for livestock in India and aid in understanding the current AMR profiles of pigs. To grasp the actual situation with AMR in the pig sector, large scale sample screening must be done.

In vitro synergy screens of FDA-approved drugs reveal novel zidovudine- and azithromycin-based combinations with last-line antibiotics against Klebsiella pneumoniae

Treatment of infections caused by multi-drug resistant (MDR) enterobacteria remains challenging due to the limited therapeutic options available. Drug repurposing could accelerate the development of new urgently needed successful interventions. This work aimed to identify and characterise novel drug combinations against Klebsiella pneumoniae based on the concepts of synergy and drug repurposing. We first performed a semi-qualitative high-throughput synergy screen (sHTSS) with tigecycline, colistin and fosfomycin (last-line antibiotics against MDR Enterobacteriaceae) against a FDA-library containing 1430 clinically approved drugs; a total of 109 compounds potentiated any of the last-line antibiotics. Selected hits were further validated by secondary checkerboard (CBA) and time-kill (TKA) assays, obtaining 15.09% and 65.85% confirmation rates, respectively. Accordingly, TKA were used for synergy classification based on determination of bactericidal activities at 8, 24 and 48 h, selecting 27 combinations against K. pneumoniae. Among them, zidovudine or azithromycin combinations with last-line antibiotics were further evaluated by TKA against a panel of 12 MDR/XDR K. pneumoniae strains, and their activities confronted with those clinical combinations currently used for MDR enterobacteria treatment; these combinations showed better bactericidal activities than usual treatments without added cytotoxicity. Our studies show that sHTSS paired to TKA are powerful tools for the identification and characterisation of novel synergistic drug combinations against K. pneumoniae. Further pre-clinical studies might support the translational potential of zidovudine- and azithromycin-based combinations for the treatment of these infections.

Stability and genetic insights of the co-existence of blaCTX-M-65, blaOXA-1, and mcr-1.1 harboring conjugative IncI2 plasmid isolated from a clinical extensively-drug resistant Escherichia coli ST744 in Shanghai.

Co-existence of colistin, β-lactam and carbapenem in multidrug-resistant Enterobacteriaceae isolates poses a serious threat to public health. In this study, we investigated and characterized the co-occurrence of blaCTX-M-65, blaOXA-1, and mcr-1.1 strain isolated from a clinical extensively-drug-resistant Escherichia coli ST744 in Shanghai. Antimicrobial susceptibility test was carried out by agar dilution methods. Whole genome sequencing was conducted, and resistance genes, and sequence types of colistin in E. coli isolates were analyzed. Plasmid stability and amino acid mutations were assessed in E. coli isolates. A colistin resistant E. coli ST744, named ECPX221, was identified out of 145 fecal samples collected. The strain carries a 60,168 IncI2 plasmid with the mcr-1.1 gene. The strain also has blaCTX-M-65, blaOXA-1, dfrA14, qnrS1, cmlA5, arr2, ampC, aph(4)-Ia, sul1, and aadA5 resistance genes. The plasmid pECPX221 was capable of conjugation with an efficiency of 2.6 × 10-2. Notably, 45% of the transconjugants were determined as mcr-1.1-harboring in the colistin-free environment after 60 generation of passage. No mutations occurred in pmrB, mgrB, and phoPQ gene in the mcr-1.1-harboring transconjugants. Bioinformatic analysis indicated pECPX221 shared highly similar backbone with the previously reported mcr-1.1-harboring pAH62-1, pMFDS1339.1, pSCZE4, and p2018-10-2CC. Furthermore, sequencing and phylogenetic analyses revealed a similarity between other MCR-1-homolog proteins, indicating that ECPX221 was colistin resistant. The stable transferable mcr-1.1-harboring plasmid found in the E. coli ST744 strain indicated the high risk to disseminate the extensively-drug-resistance phenotype among Enterobacteriaceae.

Frequency and Distribution of Multidrug Resistance Enterobacteriaceae Isolated from Hospital and Community Acquired Urinary Tract Infection Patient Attended at a Tertiary Level Care Hospital in Dhaka City

Background: Urinary tract infection is caused by different bacteria of family enterobacteriaceae in the hospital and community acquired infection.
 Objective: The purpose of the present study was to find out the bacteria causing urinary tract infection, frequency as well as their antibiotic resistance pattern.
 Methodology: This cross-sectional study was conducted in the Department of Microbiology at National Institute of Neurosciences and Hospital, Dhaka, Bangladesh from June 2017 to November 2017 for a period of six months. Different urine samples of patient who were presented with infection in the urinary tract were included as study population. Using sterile container urine samples were taken from both IPD and OPD patients of National Institute of Neurosciences and Hospital, Dhaka, Bangladesh. The urine specimen was inoculated on blood and MacConkey agar plates and incubated at 37°C for 24 hours. Identification was based on standard microbiological methods The antibiogram testing was done by using modified Kirby-Bauer method. 
 Results: A total of 200 urine samples were included for study of which 118(59%) cases showed positive and 82(41.0%) cases showed negative growth. Among 118 samples Escherichia coli were in 56(47.5%) isolates followed by Klebsiella pneumoniae were in 22(18.6%); Citrobacter freundii were in 20(16.9%); Pseudomonas species were 12(10.2%) and Proteus mirabilis were 8(6.8%). Escherichia coli was most predominant urinary tract infection causing species (47.5%) and found most resistant against cefixime (96.4%), azithromycin (92.9%), ciprofloxacin (71.4%); Klebsiella pneumonia was most resistant to amikacin, azithromycin (81.82%), ciprofloxacin, tazobactum/piperacillin (72.7%) cefixime, meropenem (63.7%). Citrobacter freundii was resistance to ciprofloxacin, cefixime (80.0%).
 Conclusion: Escherichia coli infections are more common in urinary tract infection patients and predominant resistant against cefixime followed by Klebsiella pneumonia.
 Bangladesh Journal of Infectious Diseases, December 2022;9(2):47-52

Whole-genome sequence analysis of carbapenem-resistant Enterobacteriaceae recovered from hospitalized patients

Carbapenems are among the few effective antibiotics against multidrug-resistant Enterobacteriaceae. This study aimed at characterizing the plasmid content and resistome of clinical carbapenem-resistant Enterobacteriaceae (CRE) recovered between 2016-2019 from hospitalized patients in Lebanon. Plasmid typing and whole-genome sequencing were used to study the genomic characteristics of 65 clinical CREs including 27 Escherichia coli, 24 Klebsiella pneumoniae, one Klebsiella quasipneumoniae, three Morganella morganii, three Citrobacter freundii, five Enterobacter hormaechei, and two Serratia marcescens. blaOXA-48 (33.8%; n=22) and blaOXA-48-like genes were among the detected resistance determinants, with two isolates co-harboring blaNDM-5. Various blaNDM variants, blaNDM-1 (16.9%; n=11), blaNDM-5 (9.2%; n=6), blaNDM-7 (9.2%; n=6), and blaNDM-19 (4.6%; n=3), different ESBLs and AmpC β-lactamases were detected. Carbapenem resistance determinants were linked a variety of incompatibility groups with IncFIB(K) (43.1%; n=28) being the most prevalent, followed by IncFIA (40.0%), IncL (35.4%), IncX3 (32.3%), IncI1 (32.3%), and IncFIIK (29.2%). We analyzed the clonality and resistance determinants of 65 multi-drug resistant (MDR) Enterobacteriaceae recovered in the period between 2016-2019 from a large tertiary hospital in Lebanon. NDM variants, OXA-48 and OXA-181were the most prevalent detected carbapenemases and were mostly linked to the dissemination of IncL, IncX3, and IncF. This study reinforces the need to track the spread and dominance of clinically relevant carbapenemase-encoding plasmids in healthcare settings.

Rats as sources of multidrug-resistant Enterobacteriaceae in animal production environments.

Rattus norvegicus and Rattus rattus are commensal pest rodents, considered reservoirs and vectors of zoonotic pathogens. In livestock farms, the wide use of antimicrobials and their release into the environment lead to high long-term residual concentrations, which may in turn lead to the occurrence of antimicrobial resistance (AMR). Farm environments serve as AMR sources, resulting in the transmission of antimicrobial-resistant bacteria and their AMR genes of livestock origin into wildlife. This study aimed to analyse the profile of enterobacteria carrying AMR determinants in rats captured in livestock farms to determine their potential vectors as for the spread of AMR. To this end, 56 rats (52 R. norvegicus and 4 R. rattus) were live-trapped on 11 farms (pig, dairy, poultry and mixed farms) located in central Argentina, from spring 2016 to autumn 2017. From 50 of the R. norvegicus individuals and three of the R. rattus individuals found in 10 of the farms, we isolated 53 Escherichia coli and five Salmonella strains. Susceptibility to antimicrobials, genotypic profiles, minimal inhibitory concentration of colistin and the presence of mcr-1 and genes encoding extended-spectrum β-lactamase (ESBL) were determined. Of the 58 isolates not susceptible to different antimicrobial classes, 28 of the E. coli strains and two of the Salmonella strains were defined as multi-drug resistant (MDR). S. Westhampton and S. Newport recovered were not susceptible to ampicillin or all the cephems tested. One of the E. coli obtained showed resistance to colistin and harboured the mcr-1 gene, demonstrated by PCR and conjugation. In two ESBL-producing Salmonella isolated from rats, CTX-M-2 genes were responsible for the observed resistance to third-generation cephalosporins. The MDR E. coli isolates showed several different resistance patterns (23), although some of them were the same in different individuals and different farms, with six resistance patterns, evidencing the dispersion of strains. These findings suggest that rats play a role in the dissemination of AMR determinants between animal, humans and environmental reservoirs.

Microplastics accumulate priority antibiotic-resistant pathogens: Evidence from the riverine plastisphere

Microplastics (MPs) might accumulate and transport antibiotic-resistant bacteria (ARB) in aquatic systems. We determined the abundance and diversity of culturable ciprofloxacin- and cefotaxime-resistant bacteria in biofilms covering MPs placed in river water, and characterized priority pathogens from these biofilms. Our results showed that the abundance of ARB colonizing MPs tends to be higher compared to sand particles. Also, higher numbers were cultivated from a mixture of polypropylene (PP), polyethylene (PE) and polyethylene terephthalate (PET), compared to PP and PET alone. Aeromonas and Pseudomonas isolates were the most frequently retrieved from MPs placed before a WWTP discharge while Enterobacteriaceae dominated the culturable plastisphere 200 m after the WWTP discharge. Ciprofloxacin- and/or cefotaxime-resistant Enterobacteriaceae (n = 54 unique isolates) were identified as Escherichia coli (n = 37), Klebsiella pneumoniae (n = 3), Citrobacter spp. (n = 9), Enterobacter spp. (n = 4) and Shigella sp. (n = 1). All isolates presented at least one of the virulence features tested (i.e. biofilm formation, haemolytic activity and production of siderophores), 70% carried the intI1 gene and 85% exhibited a multi-drug resistance phenotype. Plasmid-mediated quinolone resistance genes were detected in ciprofloxacin-resistant Enterobacteriaceae [aacA4-cr (40% of the isolates), qnrS (30%), qnrB (25%), and qnrVC (8%)], along with mutations in gyrA (70%) and parC (72%). Cefotaxime-resistant strains (n = 23) harbored blaCTX-M (70%), blaTEM (61%) and blaSHV (39%). Among CTX-M producers, high-risk clones of E. coli (e.g. ST10 or ST131) and K. pneumoniae (ST17) were identified, most of which carrying blaCTX-M-15. Ten out of 16 CTX-M producers were able to transfer blaCTX-M to a recipient strain. Our results demonstrated the occurrence of multidrug resistant Enterobacteriaceae in the riverine plastisphere, harboring ARGs of clinical concern and exhibiting virulence traits, suggesting a contribution of MPs to the dissemination of antibiotic-resistant priority pathogens. The type of MPs and especially water contamination (e.g. by WWTPs discharges) seem to determine the resistome of the riverine plastisphere.

The Detection of Fosfomycin-Modifying Enzymes (fos) in Uropathogenic Enterobacterale, Azerbaijan, Iran.

Enterobacteriaceae is the most common agent of urinary tract infections (UTIs). Multidrug resistant (MDR) and XDR (extensively drug-resistant) Enterobacteriaceae in UTIs have increased in the world. The present study aimed to study the fosfomycin resistance frequency and the fosfomycin resistance genes among Enterobacteriaceae isolated from UTIs. The urine was collected and cultured in the standard protocol. To determine the susceptibility testing to fosfomycin in 211 isolates, agar dilution and disk agar diffusion methods were used. MDR was nonsusceptibility to at least one agent in three or more antimicrobial categories. The fosfomycin resistance genes were also evaluated by PCR. The frequency of resistance to fosfomycin was in 14 (6.6%) and 15 (7.1%) isolates by the disk agar diffusion and MIC assays, respectively. However, the MIC50 and MIC90 existed at 8 μg/mL and 16 μg/mL, respectively. The MDR was found in 80%. The frequencies of fosfomycin resistance genes were 5 (33.3%), 3 (20%), 2 (13.3%), 1 (6.6%), and 1 (6.6%) for fosC, fosX, fosA3, fosA, and fosB2, respectively. The fosB and fosC2 were not found. A low resistance rate to fosfomycin is observed. Fosfomycin is still one of the most effective and valuable alternative antibiotics against MDR Enterobacteriaceae isolated from UTIs in our region.

The Prevalence of Multidrug-Resistant Enterobacteriaceae among Neonates in Kuwait.

Increasing numbers of neonates with serious bacterial infections, due to resistant bacteria, are associated with considerable morbidity and mortality rates. The aim of this study was to evaluate the prevalence of drug-resistant Enterobacteriaceae in the neonatal population and their mothers in Farwaniya Hospital in Kuwait and to determine the basis of resistance. Rectal screening swabs were taken from 242 mothers and 242 neonates in labor rooms and wards. Identification and sensitivity testing were performed using the VITEK® 2 system. Each isolate flagged with any resistance was subjected to the E-test susceptibility method. The detection of resistance genes was performed by PCR, and the Sanger sequencing method was used to identify mutations. Among 168 samples tested by the E-test method, no MDR Enterobacteriaceae were detected among the neonates, while 12 (13.6%) isolates from the mothers' samples were MDR. ESBL, aminoglycosides, fluoroquinolones, and folate pathway inhibitor resistance genes were detected, while beta-lactam-beta-lactamase inhibitor combinations, carbapenems, and tigecycline resistance genes were not. Our results showed that the prevalence of antibiotic resistance in Enterobacteriaceae obtained from neonates in Kuwait is low, and this is encouraging. Furthermore, it is possible to conclude that neonates are acquiring resistance mostly from the environment and after birth but not from their mothers.

FOSFOMYCIN SUSCEPTIBILITY IN BACTERIAL ISOLATES FROM UROPATHOGENS WITH SPECIAL REFERENCE TO EXTENDED SPECTRUM B-LACTAMASE(ESBL) PRODUCERS AND MULTIDRUG RESISTANT(MDR) ORGANISMS

Introduction: Urinary tract infection (UTI) is one of the most common clinical entities encountered by physicians globally. Most of the uropathogens exhibit Multiple Drug Resistance(MDR) mechanisms especially in the members of Enterobacteriaceae. As there is increase in resistance rates, there is necessity in opting alternative treatment Strategies in cases of UTI like Fosfomycin which seems to be a good option attracting the clinicians interest globally. Objective: To evaluate the Fosfomycin susceptibility in bacterial isolates from uropathogens. Methodology: A total of 624 urine samples were included in the study, out of which 84 isolates satisfying Kass concept were processed and identified by standard protocol and all the isolates were tested for Fosfomycin susceptibility by using Kirby Bauer disc diffusion and E-test, interpreted as per Clinical Laboratory Standards Institute(CLSI) guidelines. Results:Among the isolates majority were Escherichia coli(60.71%) followed by Klebsiella species(26.19%), Enterococcus species(8.33%), Staphylococcus saprophyticus(2.38%) and Proteus species(2.38%) out of which 54.76% were Extended-spectrum-beta-lactamase-producing(ESBL) organisms, 40.47% were Multi Drug Resistant Enterobacteriaceae(MDRE) and 15.47% were Carbapenem Resistant Organisms(CRO). Fosfomycin susceptibility was observed highest in Staphylococcus saprophyticus(100%), Proteus species(100%) followed by E.coli(96.7%) Klebsiella species(95.45%) and Enterococcus species(85.71%). Conclusion: Our study mainly focussed on Fosfomycin susceptibility in various uropathogens where Fosfomycin was found to have a promising role in treating UTI with both Gram positive and Gram negative organisms and can be considered as a drug of choice for empirical oral treatment in cases of UTI.

Characterization of Carabapenem-resistant Enterobacteriaceae in Fresh vegetables

Carbapenem-resistant Enterobacteriacea (CRE) has become a growing food safety issue and an ongoing public-health problem of global dimensions. This research study determined the presence of CRE in fresh vegetables. Vegetables were purchased from the retailers and analyzed for Enterobacteriaceae in line with Standard guidelines. The antibiotic profile of the isolated Enterobacteriaceae was determined using Antibiotic Susceptibility Test (AST). The Modified Hodges test (MHT), Carbapenem inactivation method (CIM), Modified carbapenem inactivation (mCIM), and Ethylenediamine tetraacetic acid (EDTA) carbapenem inactivation (eCIM) were used screening for carbapenem resistance among Multidrug-resistant (MDR) Enterobacteriaceae. Forty-six Enterobacteriaceae were isolated in all. Among organisms isolated were Citrobacter freundi, Enterobacter cloacae, Salmonella typhi, Klebsiella sp, and Escherichia coli. AST of the isolates showed that two out of three third-generation antibiotics used had the highest resistance of 100%. Thirty-six (78.26%) were multidrug-resistant, eighteen were CRE using MHT but using CIM, and sixteen were CRE. Eighteen were CRE using the mCIM method, while 17 were using eCIM.
 Conclusion: This study shows that vegetables can be a source of carbapenem-resistant Enterobacteriaceae, and mCIM combined with eCIM is more sensitive in detecting CRE.
 Significance and Impact of Study: Ready-to-eat fresh Vegetables contain CRE.

Network of Interaction among Enterobacter Species and Klebsiella Pneumonia Clinical Isolates and the Antibiotic Resistance Pattern at Cape Coast

Introduction: Urgent surveillance is required to provide the needed information for the containment of multidrug-resistant (MDR) Enterobacteriaceae. The objective was to examine the antibiotic-resistant patterns among the clinically isolated Enterobacter species and Klebsiella pneumonia from the outpatient department of the University of Cape Coast from 2014 to 2020. Methodology: The cultured isolates were Gram-stained for morphological and biochemical tests. Antibiotic susceptibility tests for the K. pneumonia and Enterobacter spp were done using the modified Kirby-Bauer diffusion technique. A double-disk synergy antibiotic test using cefotaxime, amoxicillin/clavulanic acid and ceftazidime antibiotic test was used to identify extended-spectrum beta-lactase (ESBL) and MDR among the isolates. The network of interactions between bacteria isolates and resistant types and the pattern of interaction of K. pneumonia (in the resistant-10 group) and Enterobacter spp (resistant-12) and the various antibiotics tested was performed using Cytoscape version 3.8.2 software. The data are presented in percentage and statistical significance between MDR and extensively drug-resistant (XDR) compared with Chi-square test. Results: K. pneumonia formed a clustering network with other bacteria isolates around resistant type 10 (resistant-10) and Enterobacter spp around resistant type 12 (resistant-12). The interactions (edges) of bacteria isolates and resistant types (nodes) were unique for Staphylococcus saprophyticus with Proteus mirabilis which exhibited two patterns of interactions (resistant-10 and resistant-12), connecting the two resistant types among the bacteria isolates. The interactive network patterns of Enterobacter spp and the various antibiotics were different from the interaction patterns for K. pneumonia. The K. pneumonia isolates were highly resistant to cefuroxime 2/3 (66.67%) and ampicillin 2/3 (66.67%) in the year 2020. Enterobacter spp on the other hand were highly resistant to tetracycline 16/20 (80.00%) in 2014 and ceftriaxone 5/9 (55.56%), levofloxacin 5/9 (55.56%), ceftazidime 5/9 (55.56%) and gentamycin 5/9 (55.56%) in 2020. Chi-square analysis showed a highly significant difference of χ2 = 11.87, p=0.0006 and χ2 = 7.789, p=0.0053 between MDR and XDR Enterobacter spp isolates in 2014 and 2020, respectively. Conclusion: Early detection, constant monitoring and control practices and policies that prevent the misuse or overuse of these antibiotics are required to slow down the rapid development of resistance to Enterobacter spp and K. pneumonia in Cape Coast.

Clinical and microbiological patterns in critically ill patients with catheter-associated UTI: A report from Iran

Catheter-associated urinary tract infections (CAUTIs) are among the most common nosocomial infections with different clinical and microbiological characteristics. We studied these characteristics in critically ill patients. This research was a cross-sectional study conducted on intensive care unit (ICU) patients with CAUTI. Patients' demographic and clinical information and laboratory data, including causative microorganisms and antibiotic susceptibility tests, were recorded and analyzed. Finally, the differences between the patients who survived and died were compared. After reviewing 353 ICU cases, 80 patients with CAUTI were finally included in the study. The mean age was 55.9 ± 19.1 years, 43.7% were male and 56.3% were female. The mean length of infection development since hospitalisation and hospital stay were 14.7 (3-90) and 27.8 (5-98) days, respectively. The most common symptom was fever (80%). The microbiological identification showed that the most isolated microorganisms were Multidrug-resistant (MDR) Enterobacteriaceae (75%), Pseudomonas aeruginosa (8.8%), Gram-positive uropathogens (8.8%) and Acinetobacter baumannii (5%). Fifteen patients (18.8%) died among whom infections with A. baumannii (75%) and P. aeruginosa (57.1%) were associated with more death (p = 0.005). Although A. baumannii and P. aeruginosa can be the most important pathogens for death, MDR Enterobacteriaceae are still a serious concern as causes of CAUTIs.

Detection of Patients at Risk of Multidrug-Resistant Enterobacteriaceae Infection Using Graph Neural Networks: A Retrospective Study.

Background: While Enterobacteriaceae bacteria are commonly found in the healthy human gut, their colonization of other body parts can potentially evolve into serious infections and health threats. We investigate a graph-based machine learning model to predict risks of inpatient colonization by multidrug-resistant (MDR) Enterobacteriaceae. Methods: Colonization prediction was defined as a binary task, where the goal is to predict whether a patient is colonized by MDR Enterobacteriaceae in an undesirable body part during their hospital stay. To capture topological features, interactions among patients and healthcare workers were modeled using a graph structure, where patients are described by nodes and their interactions are described by edges. Then, a graph neural network (GNN) model was trained to learn colonization patterns from the patient network enriched with clinical and spatiotemporal features. Results: The GNN model achieves performance between 0.91 and 0.96 area under the receiver operating characteristic curve (AUROC) when trained in inductive and transductive settings, respectively, up to 8% above a logistic regression baseline (0.88). Comparing network topologies, the configuration considering ward-related edges (0.91 inductive, 0.96 transductive) outperforms the configurations considering caregiver-related edges (0.88, 0.89) and both types of edges (0.90, 0.94). For the top 3 most prevalent MDR Enterobacteriaceae, the AUROC varies from 0.94 for Citrobacter freundii up to 0.98 for Enterobacter cloacae using the best-performing GNN model. Conclusion: Topological features via graph modeling improve the performance of machine learning models for Enterobacteriaceae colonization prediction. GNNs could be used to support infection prevention and control programs to detect patients at risk of colonization by MDR Enterobacteriaceae and other bacteria families.

Antibiotic Resistance Pattern of Enterobacteriaceae Strains Isolated from Community Urinary Tract Infections in Algiers, Algeria

Abstract Urinary tract infections (UTIs) are currently one of the most important medical practice visits. The spread of antibiotic-resistant bacteria in the community complicates the therapeutic management. The aim of this study is to investigate the bacteria associated with community acquired urinary tract infections (CA-UTIs) and the antibiotic resistance pattern of bacterial isolates during 2021 in Algiers, northern Algeria. A total of 548 urine samples from patients with CA-UTIs symptoms were analyzed. Pure bacterial isolates were identified using morphological and biochemical characteristics, and subjected to antibiogram evaluation using the disk diffusion method. A total 133 out of 548 patients (24.27%) had positive CA-UTIs, mainly affecting women (84.21%). A percentage of 87.22% of isolates were identified as Enterobacteriaceae, which were represented mostly by Escherichia coli (76 isolates), Klebsiella pneumoniae (13 isolates), and Proteus mirabilis (13 isolates). A number of 125 isolates (93.98%) were resistant to at least one antibiotic tested. The results showed the highest antibiotic resistance to ampicillin (92.24%) and amoxicillinclavulanic acid (91.37%), and revealed the most sensitivity to cefotaxime and nitrofurantoin (95.69%) and colistin (93.11%). The results of this study revealed high concerns about CA-UTIs caused by multidrug-resistant Enterobacteriaceae.

Doxycycline for Multidrug-Resistant Gram-Negative Bacterial Infection Treatment: A Scoping Review.

Multidrug-resistant bacterial infections limit available therapeutic options. Doxycycline is an old antibiotic from the tetracycline class that exhibits a wide antibacterial action, including Gram-negative bacteria (GNB), and could be an alternative for the treatment of multidrug-resistant (MDR) Enterobacteriaceae. The study aimed to systematically identify, evaluate, and summarize the results of studies related to outcomes of treatments for MDR-GNB infections in patients treated with doxycycline. This review was conducted in four databases during weeks 41-52 of 2022: PubMed, Medline, Scopus, and Web of Science, from the earliest year available on each database to December 2022. Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines were followed in conducting this study, and PICO was used for the research question of this review. This scoping review found 8 retrospective studies that included 59 patients. Of these, 69% were treated for ventilator-associated pneumonia (VAP), 27% for urinary tract infections, 2% for bloodstream infections, and 2% for wound infections, both of which were associated with VAP. The usual dosage of doxycycline was 100 mg intravenously or orally. Clinical and microbiologic improvements were achieved in 81.3% and 87% of all patients, respectively. The mortality rate was 17.3% and was exclusively due to VAP. Doxycycline showed promising results in this review; however, randomized clinical trials or prospective cohorts are recommended to demonstrate the efficacy of doxycycline in the treatment of MDR infections with GNB.

Detection of β-lactamases among Multi-drug Resistant Enterobacteriaceae Colonising Gut of Normal Adults and Patient Population

Background and aims Antibiotic resistance is a growing threat in the medical field and the Enterobacteriaceae leading commensals in the gut are more likely to develop resistance. In this study we aimed to compare the anti-microbial resistance pattern with a special reference to beta-lactamase producers in Escherichia coli and Klebsiella pneumoniae as normal flora and pathogens.Methods A total of 120 bacterial strains of E. coli and Klebsiella were tested for antibiotic sensitivity by Kirby Bauer Disk diffusion method. Multi-drug resistant MDR bacteria were identified and phenotypically classified based on beta lactamase production into ESBL Extended Spectrum beta Lactamase AmpC beta Lactamase and MBL Metallo beta Lactamase respectively.Results Ampicillin resistance was the highest in both categories showing rates of 34 56 and 50 83.3 in normal and pathogenic strains respectively. Cefotaxime was a close second with resistance rates of 25 41.6 and 37 61.6. Imipenem showed the lowest resistance rates of 7 11.6 and 4 6.60 in normal and pathogenic strains. Pathogenic and normal strains showed an MDR rate of 51.6 and 40.5 respectively. ESBL production was observed in 1.6 P 41.6 N AmpC was 31.6 P 20 N and MBL was detected in 25 P 16.6 N.Conclusion The study revealed an alarming rate of beta lactamase-producing MDR commensals in the region. The narrow gap between the hospitalized and healthy individuals in resistance rates was a proof of rapid transmission of resistance genes signifying the need for screening even the normal population for antibiotic resistance patterns.

Invitro Activity of Tigecycline against Multidrug-Resistant Enterobacteriaceae from Blood Stream Infection at a Tertiary Care Hospital of Nepal

Invitro Activity of Tigecycline against Multidrug-Resistant Enterobacteriaceae from Blood Stream Infection at a Tertiary Care Hospital of Nepal

Aetiology, clinical features, diagnostic studies, and outcomes of community-acquired pneumonia in kidney transplant recipients admitted to hospital: a multicentre retrospective French cohort study

ObjectivesTo assess the aetiology, clinical features, diagnostic studies and outcomes of community-acquired pneumonia (CAP) in a French cohort of hospitalized kidney transplant recipients. MethodsWe performed a retrospective, multicentre study in kidney transplant recipients admitted to ten French centres for CAP from January 2016 to December 2018. CAP discharge diagnoses were clinically and radiologically validated. We assessed a descriptive analysis of all confirmed CAP including medical ward and intensive care unit admissions. ResultsOne hundred sixty-five CAP episodes in 132 patients were included. Median time from transplantation to admission was 6.4 (interquartile range, 1.6–12.3) years, with corticosteroid exposure in 112/165 (67.9%) cases. Sputum culture was performed in 47/165 (28.5%) cases including 7/47 (14.9%) positive samples. Bronchoscopy was performed in 87/165 (52.7%) cases with pathogens identified in 39/87 (44.8%) cases. Microbiological studies led to identifying a respiratory pathogen in 64/165 (38.8%) CAP episodes including 11/64 (17.2%) polymicrobial cases. Among these 64 episodes, 75 microorganisms were identified; 46/75 (61.3%) were core respiratory pathogens and 29/75 (38.7%) were opportunistic or drug-resistant organisms including Pneumocystis jirovecii 9/75 (12%), Pseudomonas aeruginosa 5/75 (6.7%), multidrug-resistant Enterobacteriaceae 4/75 (5.3%), and Aspergillus 4/75 (5.3%). Patients required intensive care unit admission in 26/165 (15.8%) episodes, invasive ventilation in 20/165 (12.1%) cases, and 22/165 (13.3%) needed in-hospital dialysis. DiscussionCAP episodes occurred in kidney transplant recipients with a long history of immunosuppressive drug exposure. Diagnostic studies identified a microorganism in more than one-third of CAP episodes, including drug-resistant and opportunistic pathogens.

Identification of multidrug-resistant enterobacteriaceae in fecal samples from infants residing in Talara, Piura, Peru.

La colonización fecal en lactantes por bacterias resistentes a los antimicrobianos es un potencial riesgo para futuras terapias antibióticas. Nuestro objetivo fue determinar la frecuencia y características sociodemográficas de lactantes portadores fecales de enterobacterias resistentes a ciprofloxacina (PFRC) y sus genes de resistencia asociados. Analizamos muestras fecales de 41 niños lactantes residentes en el distrito de Talara-Piura, Perú, en 2019. Evaluamos la presencia de 3 genes de resistencia a quinolonas: aac(6’)-Ib-cr, qnrB y oqxA y 2 de betalactamasas: blaCTX-M, blaPER-2.El 68% de lactantes fueron PFRC, Escherichia coli (83,3%) fue el más frecuente. El análisis genotípico detectó: oqxA (41,1%), qnrB (26,7%) y aac(6’)-Ib-cr (20%) y al gen blaCTX-M en el 93,3% de los aislados con betalactamasas. La elevada frecuencia de PFRC nos alertan sobre el potencial riesgo en la pérdida de utilidad de esta familia antibiótica en el área de estudio.