Multiple Drug Resistant Organisms Research Articles

Effect of the Step-Jump Approach in Infected Pancreatic Necrosis: A Propensity Score-Matched Study.

The effects of the step-jump approach on the survival and prognosis of infected pancreatic necrosis (IPN) patients have not yet been determined. Between November 2018 and June 2023, 188 patients were included in this study. There were 144 patients in the step-up group (the SU group) and 44 in the step-jump group (the SJ group). In the SU group, patients successfully treated with percutaneous catheter drainage (PCD) alone were classified into the SU-1 group (n=101), while those requiring additional surgery after PCD were categorized into the SU-2 group (n=43). In the SJ group, patients who underwent minimally invasive necrosectomy (MIN) without PCD were assigned to the SJ-1 group (n=34), whereas those who initially underwent PCD followed by immediate open surgery were placed in the SJ-2 group (n=10). Propensity score matching (PSM) was used to mitigate bias. After PSM, a total of 34 pairs were successfully matched. A comparison of the SU group with the SJ-1 group (upfront MIN without PCD) revealed similar mortality rates (P=0.239); however, the incidences of multiple drug-resistant organisms (MDROs) (P=0.029) and surgical complications (P<0.001) were significantly lower in the SJ-1 group. After comparing the SU-2 and SJ-2 groups (patients who underwent direct open necrosectomy without MIN after PCD failure), the incidences of surgical complications and MDRO in the SJ-2 group were significantly lower (P<0.05). Compared with the step-up approach, the step-jump approach is safer and more effective and can significantly reduce the incidence of MDRO and surgical complications.

A retrospective study of uropathogen and its antibiotic resistance among children with urinary tract infection from a single center in China

Urinary tract infection (UTI) is a well-known bacterial infection posing serious health problem in children. A retrospective study was conducted to explore the uropathogen and its antibiotic resistance in children with UTI. Data of urine culture and antimicrobial susceptibility test was collected. Consequently, 840 children were included. The overall culture-positive UTI was 458 (54.52 %) with Escherichia coli 166 (36.24 %), followed by Enterococcus faecalis 59 (12.88 %), Enterococcus faecium 70 (15.28 %) and others. They were highly resistant to the most commonly used antibiotics. In 694 children with complicated UTI, there were 8 children with fungal infection. Multiple drug resistance (MDR) was recorded in 315 (80.98 %). The overall proportion of Extended Spectrum β-Lactamase (ESβL) production was 25 (6.43 %). In 146 children with simple UTI, MDR were also detected in 47 (77.05 %). There were 6 (9.84 %) positive for ESβL production. Our study found that complicated UTI was relatively common. Escherichia coli was the most prevalent isolate, followed by Enterococcus faecium and Enterococcus faecalis. These organisms were highly resistant to the most commonly used antibiotics. Relatively high prevalence of MDR and low ESβL-producing organisms were observed.

Increasing Infection Prevention Practices in a Trauma/Burn ICU with Heightened Awareness of Multiple Drug-resistant Organisms

Increasing Infection Prevention Practices in a Trauma/Burn ICU with Heightened Awareness of Multiple Drug-resistant Organisms

Antibiotics Stewardship During the Ongoing COVID-19 Pandemic

&lt;p&gt;自2019年底，全球遭逢了COVID-19疫情，除了造成全球大量的感染及死亡，醫療機構也面臨重大的考驗。在病人處置中，傳統上於流感之後常見的次發感染為革蘭氏陽性菌，例如：肺炎鏈球菌感染。而在 COVID-19疫情中，自文獻發現有相當多的患者接受了經驗性抗生素療法，但實際上續發或共同感染的比率 並沒有比在流感疫情中來得高。所以在疫情中，立即可見的問題是經驗性抗生素的使用增加，可能的影響 是多重抗藥性菌株隨之增加，而背後的結構性問題是院內抗生素管理系統(antimicrobial stewardship program, AMS)運作的困難，如：AMS的人力挪為防疫人員，無法維繫多團隊溝通，或是基本的院內感染與多重感染 性菌株監測無法進行。因此如何面對現在COVID-19對抗生素管理的影響，為未來可能的新興疫情做準備， 是一個重要的議題。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;The COVID-19 pandemic has affected the globe since the late 2019 and caused immense infections and deaths worldwide, thereby posing severe challenges to medical institutions. Regarding patient treatments, a common secondary infection following influenza is associated with symptoms induced by gram-positive bacteria such as streptococcus pneumoniae. A review of relevant literature suggests that the during the COVID-19 pandemic, numerous patients have received empiric antimicrobial therapy. However, the incident rates of secondary diseases or coinfection during the COVID-19 pandemic are not higher than those during influenza epidemics. Consequently, an immediate problem emerges regarding the increased use of empiric antibiotics during the current pandemic, which may lead to the increase of multiple drug resistant organisms. A structural problem underlying this situation is incurred by difficulty associated with the operation of the antimicrobial stewardship program (AMS) in hospitals. For example, AMS personnel have been reassigned to pandemic prevention units, preventing them from maintaining communications with multiple teams. In addition, the pandemic has impeded the basic monitoring of nosocomial infections or multiple drug resistant organisms. Therefore, approaches to addressing the effect of the COVID-19 pandemic on antimicrobial stewardship and preparing for emerging pandemics in the future are critical topics that merit further exploration.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Evaluation of In vitro Activity of Tigecycline against Multidrug-Resistant Clinical Isolates

Introduction: Multiple drug resistance (MDR) of the bacteria is an issue across any health-care setting worldwide. This leads to prolonged hospital stay and high cost of treatment. One must be cautious to use reserve drugs such as imipenem, meropenem, colistin, polymyxin, and tigecycline. Tigecycline is a mainstay to treat emerging single or MDR pathogens. The study was conducted to assess the in vitro sensitivity of tigecycline to MDR isolates and to compare the sensitivity of Kirby–Bauer (KB) disc-diffusion method with the Epsilometer (E-test) against various MDR clinical isolates. Materials and Methods: This prospective study was done from January 2019 to 2020 on MDR isolates from clinical specimens. The isolates were tested for their antibiotic sensitivity to tigecycline by KB and E-test method to know the minimum inhibitory concentration (MIC) of tigecycline. Statistical data were analyzed by the percentage method. Results: Tigecycline showed a higher in vitro sensitivity against multidrug-resistant isolates in our study. Among the 89 MDR isolates obtained, 38 (42.7) were found to be sensitive to tigecycline by the KB diffusion and 67 (75.3) were sensitive by the E-test method. Conclusions: Tigecycline is a reserve antibiotic against MDR organisms, especially useful to treat coinfections of Gram-positive and Gram-negative superbugs. The E-test was found to be far superior to the KB method to detect in vitro activity and the results of this test will guide the clinician to judiciously use this antibiotic in their day-to-day practice.

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.

In Vitro-In Vivo Correlation for the Antibacterial Effect of Lactiplantibacillus plantarum as a Topical Healer for Infected Burn Wound.

Difficulties in delivering antimicrobial agents to wound areas and emersion of multiple drug resistant organisms (MDROs) have converted managing burn infections into a complicated task in medicine. Probiotics emerged not only as a probable solution for burn infections but also as an accelerator in the healing process. The probability of in vitro-in vivo correlation (IVIVC) in probiotic activity leads to lower costs in finding new therapeutic options. Simulated wound fluid (SWF) was used to evaluate the antibacterial function of Lactiplantibacillus plantarum in wounds. The growth parameters in SWF were evaluated using a logistic model to predict growth behavior in the wound area. In addition, probiotic antimicrobial activity and secretion of antibacterial substances in SWF were also studied. Data were used to select the initial dose and apply frequency for in vivo study. The wound models were infected by two main pathogens (Pseudomonas aeruginosa or Staphylococcus aureus). In vitro results showed less lag time associated with considerable acid production in SWF. In the following, secretion of antimicrobial substances and co-aggregation with pathogens became more important. The susceptibility of pathogens to these factors was different, and culture medium affected the yield of each factor involved in eliminating pathogens. Histological analysis and macroscopic examination of wounds revealed probiotics as effective as positive control or more. There were some differences in the antibacterial functions of probiotics in simulated and real wound environments. The in vitro effect of probiotics on removal of pathogens was not the same as the trend seen in vivo.

Analysis of Antibiotic Usage in Critical COVID-19 Patients with Secondary Infections

Background: Infrequent data exist on the frequency of bacterial co-infections and secondary infection among COVID-19-infected patients admitted to intensive care units (ICU). Objective: To describe the quantity and the quality of antimicrobial usage in COVID-19 with secondary infection, multiple drug resistance organisms and the outcome of antimicrobial treatment. Methods: This study applies observational design with a cross sectional approach. All the patients with laboratory-confirmed severe COVID-19 pneumonia who were discharged from the Intensive Care Unit (ICU) Dr. Ramelan Navy Hospital from February 1st to June 30th 2022 included. The quantity of antibiotics usage was assessed by counting the Defined Daily Dose (DDD). Result: During the study period, 126 patients were referred to the ICU for COVID-19 with severe pneumonia. There were 70.6% (89 patients) treated with antibiotics and 29.4% (37 patients) untreated with antibiotics. Quantitative analysis of 89 patients revealed that levofloxacin was the most common antibiotic prescribed with 43 DDD, followed by Meropenem and Cefoperazone-Sulbactam, which were 17.76 DDD and 16.87 DDD, respectively. Meanwhile, qualitative analysis resulted in 81 antibiotics (43.55%) being used appropriately. No indications of the use of antibiotics were found in 53 antibiotics (28.49%). Klebsiella pneumonia was the main pathogen identified in the blood, sputum. While E. Coli was found to be the main pathogen in urine. Conclusion: A high death rate in patients treated with antibiotics compared to patients not treated with antibiotics.

Microbiological Profile and Antimicrobial Resistance in Burn Unit of Ramathibodi Hospital

Background: Infection of burn patients remains a major challenge due to an immunocompromised state and prolonged hospitalization. Knowing bacteriology and antibiotic susceptibility would therefore facilitate tailored management of infection in the Burn Unit. Objective: To investigate microbiological profile and antimicrobial resistance in the Burn Unit, Ramathibodi Hospital. Materials and Methods: A retrospective review of patients admitted to the Burn Unit was conducted during a two-year period (June 2019 to May 2021). Demographic data of infected and non-infected patients were collected including percentage of total body surface area (%TBSA), number of operations, length of hospital stay, and mortality. Bacterial isolates were cultured from burn wounds and blood. Antibiotic resistant profile of all common pathogens was analyzed. Results: A total of 49 burn patients were included. There were 33 patients (67.3%) in the infected group and 16 patients (32.7%) in the non-infected group. Infected patients had larger burn sizes (25.5 vs. 4.0 %TBSA, p=0.001) and required more operations (4 vs. 0.5, p=0.008) and longer hospitalization (36 vs. 11.5 days, p&lt;0.001). Nevertheless, mortality of both groups was not significantly different (9.1% vs. 0%, p=0.213). Of all 212 bacterial isolates, the common organisms from the wounds were Pseudomonas aeruginosa (25.0%), Klebsiella pneumoniae (20.8%), and Enterococcus faecalis (16.5%). The common pathogens from 16 isolates of hemocultures were coagulase-negative staphylococcus (12.5%), Klebsiella pneumoniae (12.5%), and Proteus mirabilis (12.5%). Acinetobacter baumannii and Pseudomonas aeruginosa were two majority of multiple-drug resistant organisms (MDROs). These two strains were resistant to most antibiotics. However, colistin was still effective against the MDROs. Conclusion: The present study reviewed the prevalence of bacterial infection obtained from burn wounds and hemocultures to determine the bacteriological profile and antibiotic resistant patterns. This knowledge help improve decision making for appropriate antibiotic prescription in the Burn Unit. Keywords: Wound infection; Sepsis; Bacteriological profile; Antibiotic resistance; Multiple-drug resistance

Detection of CTX-M Gene in Escherichia coli Producing Extended Spectrum Beta Lactamase (ESBL) Isolated from Patients with Urinary Tract Infection

Escherichia coli is a Gram-negative bacterium from Enterobacteriaceae family causes urinary tract infections (UTI). A major problem encountered in antibiotics therapy is Multiple Drug Resistant Organisms (MDROs). MDROs occur because of the presence of resistance coding genes such as CTX-M which causes bacteria to produce the Extended Spectrum Beta-Lactamase (ESBL) enzyme. This study aims to detect the presence of the CTX-M gene in Extended-Spectrum Beta Lactamase (ESBL) Escherichia coli isolated from UTI patients. The study was conducted at the Institute of Tropical Disease (ITD) Airlangga University, Jl. Mulyorejo Campus C Surabaya, Indonesia for polymerase chain reaction (PCR) examination. The isolation and identification of Escherichia coli bacteria were carried out at the Microbiology Laboratory Department in Poltekkes Kemenkes Surabaya, Jl. Karangmenjangan 18A, Surabaya, Indonesia. Conventional identification of Escherichia coli and the presence of the CTX-M gene were observed using the PCR method. The results showed that 18 of 30 samples (60%) were caused by Escherichia coli. Escherichia coli producing ESBL was found in 15 samples (83%), of which 12 samples (80%) showed the presence of the CTX-M gene.&#x0D; Keywords : CTX-M gene, Extended-Spectrum Beta Lactamase (ESBL), Escherichia coli

Synergistic Interactions of Antimicrobials to Counteract the Drug-Resistant Microorganisms

The development of multiple drug resistance organisms (MDR) is a major threat, and due to this emergence, it is found that it is difficult to treat many infectious diseases. Synergistic interaction means combining existing antimicrobials with any component that says it can be a herbal compound, phytochemicals, essential oils, antibiotics, antimicrobial peptides, and even any other antimicrobial. With the help of antimicrobial and phytochemical blending, this effective resistance conversion will neutralize the resistance mechanism, which makes the drug effective in resistant organisms. Microbes have developed several strategies, such as efflux pump inhibitors or inhibition of drug degrading enzymes. This combination interaction has shown promising abatement in minimum inhibitory concentrations and upturn of susceptibility of drug-resistant microorganisms. This synergistic interaction is brought into play because it is very difficult to develop new antimicrobials. There are already only limited antimicrobials that are segregated into classes and cannot be used all the time. So this synergistic effect can bring about a change like it can be used to increase antimicrobials' effect and prevent resistance in the organisms. Thus, it might be helpful in the effective treatment against various infections.

Trends in microbial profile of burn patients following an event of dust explosion at a tertiary medical center

BackgroundMicrobial infection is the main cause of increased morbidity and mortality in burn patients, especially infections caused by multiple drug-resistant organisms (MDRO). The purpose of this study was to explore major microbial trends in burn patients.MethodsThis retrospective study was conducted at burn wards and intensive care units, where burn patients were admitted following an event of dust explosion. Data were collected for a number of variables including severity of burns, demographic and clinical characteristics, laboratory data, and therapeutic devices.ResultsA total of 1132 specimens were collected from 37 hospitalized burn patients with mean TBSA of 46.1%.The most commonly isolated species were Staphylococcus spp. (22.4%). The highest rate of antibiotic resistance was observed in carbapenem–resistant A. baumannii (14.6%), followed by methicillin-resistant S. aureus (11.3%). For each additional 10% TBSA, the isolation of MDRO increased 2.58–17.57 times (p < 0.05); for each additional 10% of the third-degree burn severity, the risk of MDRO significantly decreased by 47% (95% CI, 0.38–0.73, p < 0.001) by Cox model.ConclusionsThe proportion of overall microbial isolates increased with the increase in TBSA and duration of time after burns. The extent of TBSA was the most important factor affecting MDRO.

Identification and Distribution of Pathogens in a Major Tertiary Hospital of Indonesia.

The nosocomial persistence of multiple drug resistance organisms constitutes a global threat. Healthcare-setting acquired infections are subject to substantial selection pressure and are frequently associated with drug resistance. As part of the microbiological surveillance of the Sanglah tertiary referral hospital in the island province of Bali, the distribution of bacterial pathogen and their relative susceptibilities were recorded over a 30 months period. This is the first such detailed study benchmarking the type and sensitivity of bacterial pathogens in a major tertiary referral hospital within Indonesia and it is hoped that it will lead to similar reports in the near future, while informing local and national antimicrobial stewardship policies.

Cutaneous laser surgery for secondary burn reconstruction: Cost benefit analysis.

Thermal disease presents a major burden to individual patient morbidity, healthcare cost as well as to over all economy. Burns also also represent a significant per-patient utlilisation of finite healthcare resources. Secondary complications in these patients, such as multiple drug resistant organisms, may have a devastating effect. Laser surgery has recently come of age as an optimal tool in the secondary reconstruction of burn injury, that is able to simultaneously address significant sheet scar tightness, hypertrophic, atrophic, and keloid complications, pruritus, microstomia, ectropion, skin graft honeycombing, and improve range of movement whilst reducing the risk of infection to <1%. Yet, cutaneous laser surgery is often underutilised due to the perceived concerns about the sustainability of a new service with relatively high startup cost. We present a dual methodology to explore this concern: an evidence-based background review of the last 5 years of current best evidence, and a 22-year cost-analysis comparison at an established, high volume UK Centre of reconstructive surgery. We report that fiscal viability for laser surgery services for secondary burn reconstruction is supported by: level 2 (one systematic review) level 4 evidence (2 studies) and level 5 evidence (expert reports). Evidence over 22 years from an established super-regional NHS laser centre shows that introduction of this service led to sustained and substantial cost saving, producing excellent surgical results at a fraction of the cost of traditional surgery. Analysis of the potential dollar-effect of these advantages to the general population supports state investment in expertise and capital equipment as a medium to long-term cost saving strategy, which may also aid re-integrating patients into the workforce making a meaningful contribution to the economy.

Multiple Drug Resistant Urinary Tract Infection in Kidney Transplant Recipients: A Retrospective Cohort Study.

Urinary tract infection (UTI) is the most common infectious disease in post-kidney transplantation patients. The objective of the study was to investigate the prevalence, impact and risk factors of multiple drug resistant (MDR) UTI in kidney transplant recipients. This retrospective cohort study recruited 72 kidney transplant recipients between March 2017 and February 2018. Urine cultures performed during the 1st year of posttransplantation with reference to clinical data were evaluated. Predesigned questionnaire was used to collect data regarding demographic, transplant related, and microbiological information. Multivariate analysis was performed to ascertain risk factors of MDR UTI. Out of 72 patients, 28 (38.9%) had culture guided clinical UTI. Overall, 59 UTI episodes were noted throughout the duration of this study. Eschericia coli were found to be the most frequent uropathogen of UTI among kidney transplant recipients (n = 32, 54.2%). MDR bacteria were responsible for 27.1% (n = 16) of the post-transplantation UTI episodes among patients, with E. coli (n = 9, 56.3%) being the predominant bacterial pathogen. Most of the MDR strains of E. coli (n = 7, 77.8%) were extended spectrum beta-lactamase positive. Female gender (P <0.001), prolonged Foley's catheterization (P = 0.002), coexisting diabetes mellitus (DM) (P <0.001) and induction of anti-thymocyte globulin (ATG) therapy (P <0.001) were independently associated with high risk of MDR UTI. The allograft rejection was found to be significantly higher in patients of posttransplantation UTI with MDR uropathogen (P = 0.009). In conclusion, E. coli were the most prominent uropathogen of UTI with and without MDR pathogen in the present study. Female gender, prolonged Foley's catheterization, coexisting DM, and induction of ATG therapy were the risk factors independently associated with MDR UTI in kidney transplant recipients. MDR organisms were significantly associated with allograft rejection.

Development and challenges in setting up an international bone infection registry.

Osteomyelitis is an increasing burden on the society especially due to the emergence of multiple drug-resistant organisms. The lack of a central registry that prospectively collects data on patient risk factors, laboratory test results, treatment modalities, serological analysis results, and outcomes has hampered the research effort that could have improved and provided guidelines for treatments of bone infections. The current manuscript describes the lessons learned in setting up a multi-continent registry. This multicenter, international registry was conducted to prospectively collect essential patient, clinical, and surgical data with a 1-year follow-up period. Patients 18years or older with confirmed S. aureus long bone infection through fracture fixation or arthroplasty who consented to participate in the study were included. The outcomes using the Short Form 36 Health Survey Questionnaire (version 2), Parker Mobility Score, and Katz Index of Independence in Activities of Daily Living were assessed at baseline and at 1month, 6months, and 12months. Serological samples were collected at follow-ups. Contract negotiation with a large number of study sites was difficult; obtaining ethics approvals were time-consuming but straightforward. The initial patient recruitment was slow, leading to a reduction of target patient number from 400 to 300 and extension of enrollment period. Finally, 292 eligible patients were recruited by 18 study sites (in 10 countries of 4 continents, Asia, North and South America, and Central Europe). Logistical and language barriers were overcome by employing courier service and local monitoring personnel. Multicenter registry is useful for collecting a large number of cases for analysis. A well-defined data collection practice is important for data quality but challenging to coordinate with the large number of study sites.

VITORA: Clinical Study to Evaluate the Effect of KB109 on the Gut Microbiome in Subjects Whose Gastrointestinal Tracts Are Colonized With Multiple Drug-resistant Organisms

VITORA: Clinical Study to Evaluate the Effect of KB109 on the Gut Microbiome in Subjects Whose Gastrointestinal Tracts Are Colonized With Multiple Drug-resistant Organisms

Bacterial Colonization in COPD Patients Admitted to a Rehabilitation Respiratory Unit and Impact on Length of Stay: A Real-Life Study

Bacterial colonization is a well-known phenomenon in acute care, but scant information is available regarding the rehabilitation setting. We retrospectively analyzed, in COPD patients admitted to a Respiratory Rehabilitative unit in 2010, the number of cultures requested, of positive cultures, and of cultures showing multiple drug resistant (MDR) organisms. We also compared hospital admissions (HA) with versus without positive cultures and with versus without MDR and investigated which baseline variables may predict length of stay (LOS) > 30 days. Of 286 COPD admissions (involving 269 patients, age 71 ± 11 years, males 66%), culture samples were requested in 62 (22%). The rate of colonization and of MDR organisms was 61 and 39%, respectively. Patients with a positive culture had a worse clinical condition and disability, and were more frequently tracheostomized, on invasive mechanical ventilation (MV) and admitted from/discharged to acute care. Patients with MDR cultures showed a lower exercise tolerance. Factors predicting LOS > 30 days were the presence of comorbidities, invasive MV, age > 65 years, and lower functional status, but not a positive culture or MDR presence. To our knowledge, this is the first real-life Italian study investigating the epidemiology of colonization and the association between colonization and LOS in a respiratory rehabilitation setting. Further investigation is necessary to clarify the relationship between colonization burden and patients’ baseline clinical status and outcomes.

Synergistic Antibacterial Efficiency of Bacteriocin and Silver Nanoparticles Produced by Probiotic Lactobacillus paracasei Against Multidrug Resistant Bacteria

Contamination of wounds with multidrug-resistant microorganisms is one of the greatest challenges in the curing of many diseases, and therefore, the search for alternative antimicrobial agents becomes urgent. In the present study, out of 280 bacterial isolates recovered from 57 wound swabs of patients, 199 isolates (71.1%) showed multiple drug resistance (MDR). Staphylococcus aureus was the most predominant (80.0%), followed by Pseudomonas aeuroginosa (78.87%). A number of 121 isolates (60.80%) of MDR was sensitive to bacteriocin produced by a probiotic strain of Lactobacillus paracasei. However, considering that bacteriocins may be degraded before reaching its target, silver nanoparticles (AgNPs) can be used as a suitable candidate for combinations with bacteriocin in order to be more effective. AgNPs were synthesized using the same strain and then characterized by UV–Vis spectroscopy, TEM and XRD analyses. Bacteriocin/AgNPs bioconjugate exhibited a higher antibacterial efficiency against MDR strains than that of bacteriocin or AgNPs alone. Interestingly, the bioconjugate has significantly increased the disruption of cell membrane permeability, leakages of protein and DNA, in addition to the formation of bactericidal reactive oxygen species than any other extracts. Therefore, the combination of bacteriocin with metal nanoparticles is recommended as a promising approach for the elimination of MDR organisms.

RAGAM BERBAGAI PERBENIHAN BAKTERI TERKAIT KERENTANANNYA TERHADAP ANEKA JENIS ANTIBIOTIKA

Infection is the major public health problem in Indonesia which could increase its morbidity and mortality. The antibiotics treatmentwhich were given irrationally leads to bacteria susceptibility and worsen the problem. One of the efforts to manage the bacteriasusceptibility the physician has to know the bacterial pattern and its characteristic to resist various antibiotics. The information maycontribute as a reference to give antibiotic therapy in a rational manner. To know the bacterial susceptibility pattern against variousantibiotics a study was carried out using specimens derived from several hospitals which referred them to a private laboratory inSurabaya. The specimens consisted of blood, urine and sputum were referred during September 2007 up to July 2008. The identificationof the bacteria and it‘s susceptibility pattern were carried out by a conventional method and an auto analyzer (Vitek 2 Compact). Theantibiotic susceptibility test was carried out by conventional method using Kirby Bauer modifiied diffusion technique and Vitec 2 Compactusing MIC reference. The results showed that the most common bacteria found from blood was Escherichia coli which was still sensitiveto amoxicillin-clavulanic acid, amikacin, and cefepim. And from the urine was Escherichia coli which were still sensitive to meropenemfollowed by amikacin and gentamycin. Whereas from the sputum was found Streptococcus α haemolyticus which was still sensitive toamoxicillin-clavulanic acid, piperacillin tazobactam, linezolid. The result of the antibiotic susceptibility test is mostly dominated bythe Betalactam group, such as amoxicillin-clavulanic acid and carbapenem group like meropenem. Besides of that, in this study wasalso found multiple drug resistance organisms (MDRO), such as Escherichia coli ESBL, Enterobacter liquefaciens ESBL, Enterobacteragglomerans ESBL, Klebsiella ozaenae ESBL, and Klebsiella pneumoniae ESBL. The susceptibility pattern of the bacteria derived fromblood and sputum is dominated by gram positive cocci. Whereas from urine is dominated by Gram negative rods.