Occurrence Of Multidrug-resistant Bacteria Research Articles

Potential for Biofilm Formation and Antibiotic Resistance of Staphylococci Isolated from Bulk Tank Milk Samples

The prevalence of staphylococci in the environment of humans, including food, may lead to the production of toxins and food poisoning in consumers. Additionally, staphylococci constitute a reservoir of genes determining antibiotic resistance. The study aimed to compare the antibiotic resistance and biofilm-forming ability of staphylococci isolated from bulk tank milk and assess the occurrence of animal-associated methicillin-resistant Staphylococcus aureus. The study consisted of isolation of strains from cow milk, confirming their belonging to Staphylococcus sp. and S. aureus, investigation of the presence of a gene determining the production of coagulase, and genes determining resistance to β-lactams, tetracyclines, vancomycin, natural penicillins, and aminopenicillins, as well as virulence genes determining biofilm production. There were 56 bacterial strains isolated, which belong to Staphylococcus spp. All isolates showed resistance to amoxicillin, erythromycin, and tetracycline. The lowest resistance was demonstrated for vancomycin (48.2%). The mecA gene was not detected in any of the isolates and there was no positive reaction to the PB2 protein, which indicates that none of the isolated strains was methicillin resistant. Only 26.8% of isolated strains did not show the ability to produce biofilm. Special attention should be paid to the health of dairy cows and the supervision of the use of antibiotics in the dairy herd environment because, even in milk from healthy cows, there is a real risk of the occurrence of multi-drug resistant bacteria.

Ograniczanie zużycia antybiotyków w leczeniu zwierząt na terenie UE na podstawie raportów Europejskiego Nadzoru nad Weterynaryjnym Spożyciem Substancji Przeciwbakteryjnych

Misusage of antimicrobial substances in human and veterinary medicine may lead to increased occurrence of multidrug resistant bacteria, which causes a serious risk to public health. In order to monitor usage of antibiotics in the European Union, in 2009 the European Medicines Agency launched a project of European Surveillance of Veterinary Antimicrobial Consumption (ESVAC). The report presents data on the amount of antibiotics used as a part of treatment of infectious diseases in various species of animals in 31 European countries. The main aim of this article is to present newest statistical data on the amount of antimicrobials used in EU, as well as provide information on applicable legal regulations regarding the use of antibiotics. Information provided by EMA proves that in most countries of the EU, with the exception of Poland, the sales of antimicrobial agents significantly decreased.

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

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

Antibacterial Chemodynamic Therapy: Materials and Strategies.

The wide and frequent use of antibiotics in the treatment of bacterial infection can cause the occurrence of multidrug-resistant bacteria, which becomes a serious health threat. Therefore, it is necessary to develop antibiotic-independent treatment modalities. Chemodynamic therapy (CDT) is defined as the approach employing Fenton and/or Fenton-like reactions for generating hydroxyl radical (•OH) that can kill target cells. Recently, CDT has been successfully employed for antibacterial applications. Apart from the common Fe-mediated CDT strategy, antibacterial CDT strategies mediated by other metal elements such as copper, manganese, cobalt, molybdenum, platinum, tungsten, nickel, silver, ruthenium, and zinc have also been proposed. Furthermore, different types of materials like nanomaterials and hydrogels can be adopted for constructing CDT-involved antibacterial platforms. Besides, CDT can introduce some toxic metal elements and then achieve synergistic antibacterial effects together with reactive oxygen species. Finally, CDT can be combined with other therapies such as starvation therapy, phototherapy, and sonodynamic therapy for achieving improved antibacterial performance. This review first summarizes the advancements in antibacterial CDT and then discusses the present limitations and future research directions in this field, hoping to promote the development of more effective materials and strategies for achieving potentiated CDT.

Dynamics of Genotypic and Phenotypic Antibiotic Resistance in a Conventional Wastewater Treatment Plant in 2 Years.

Wastewater treatment plants (WWTPs) are considered a sink and a source of antibiotic resistance. In this study, we applied both culture-dependent and SmartChip-based culture-independent approaches for the investigation of antibiotic-resistant bacteria (ARB) and antibiotic resistance genes (ARGs) at Jungnang (JN), located in the Han River, Seoul, South Korea, for 2 years, i.e., 2017 and 2018. The JN WWTP reduced the diversity and abundance of ARB and ARGs but was not sufficient for removing them all. Interestingly, through the treatment process in the JN WWTP, the composition of diverse multidrug-resistant (MDR) bacteria was concentrated mainly into some genera of the Gammaproteobacteria class (Citrobacter, Escherichia-Shigella, and Stenotrophomonas), which could be key carriages to spread ARGs into the environments. In addition, SmartChip analyses showed that the relative abundance and the number of ARGs were significantly decreased from the influents to the effluents in both 2017 and 2018. SmartChip analyses for 2 years also allowed to notify the core ARGs in the influents and the effluents with the presence of clinically relevant core ARGs, such as vanC, blaOXA, and blaNDM, which persisted in the treatment process. Considering diverse bacterial mechanisms for exchanging and transferring ARGs, the occurrence of MDR bacteria and core ARGs could be a source for the blooming of the antibiotic resistome in the WWTP and nearby environments.

Associations between antimicrobial use and antimicrobial resistance of Escherichia coli isolated from poultry litter under field conditions in Cameroon

Lack of hygiene and biosecurity measures in poultry farms has influence on the emergence of pathogens and antimicrobial use. Antimicrobial residues in poultry meat and their excretion by poultry can exert a selective pressure and the occurrence of multidrug resistant bacteria in litter. The objective of this study was to investigate the relationship between antimicrobial use and antimicrobial resistance using Escherichia coli as indicator isolated from poultry litter.From January to August, 2019, antimicrobial use was measured in 47 broiler farms based on daily dose (TIUDD) and animal daily dose (TIADD) methods. Antimicrobial susceptibility testing was performed on Escherichia coli isolated from poultry litter using the disk diffusion method.Overall, an average of 143.8 mg (ranging from 0.5 to 2061.79 mg/kg) of antimicrobials was used per kg of chicken produced, and treatment incidences of 69.7 daily doses per 1,000 broilers (44.44–106.35) and 87.3 daily doses per 1,000 broilers (1.74–376.43) were obtained for TIUDD and TIADD, respectively. After a susceptibility testing, 18 E. coli strains were resistant with a prevalence of 56.3% [95% CI: 39.1–73.5]. High levels of resistance were observed with doxycycline, ampicillin and norfloxacin which were observed to be mostly overdosed in farms. The high resistance of E. coli to ciprofloxacin (4/32: 13%), imipenem (6/32: 19%), levofloxacin (12/32: 38%) and ceftriaxone (22/32: 69%) which are second line treatment in hospital settings in Cameroon, and classified as Watch group by WHO, was associated to high AMR risk for public health in Cameroon. Intensification of health and educational sensitisation of farmers is essential to reduce widespread antimicrobial use in poultry farms and its impact public health.

Multidrug resistance in bacteria isolated from indoor air of female hostels in a tertiary institution

Objective: To determine the occurrence of multidrug resistant bacteria from the indoor environment of female hostels in a tertiary institution in order to provide epidemiological data. Methods: The bacterial quality of the three female hostels was evaluated using the settle plate method, where Petri dishes containing different types of culture media were opened in the rooms. Isolated bacteria were identified using standard microbiological procedures. Using disc diffusion method, the antibiogram of the isolates was determined and based on this, the multiple antibiotics resistance index was also determined. Results: The total heterotrophic colony forming units (CFU) for Hall A ranged from 2.09 x102 to 1.73 x103 CFU/m3 while that of Hall B ranged from 4.71 x102 to 1.10 x103 CFU/m3 and a statistically significant difference between the counts of both halls was observed (P=0.04). Microorganisms isolated included Staphylococcus aureus, Staphylococcus epidermidis, Bacillus subtilis, Corynebacterium sp., Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis. All the isolates exhibited multidrug resistance to amoxycillin-clavulanic acid, cefuroxime and ceftriaxone. Proteus mirabilis, Klebsiella pneumoniae and Corynebacterium sp. had the least multiple antibiotic resistance index with 0.2 while Staphylococcus aureus had the highest with 0.8. Conclusions: Female university hostels may become sources of exchange of microorganisms, especially in overcrowded rooms. A large percentage of isolates were multidrug resistant which could pose difficulty and increased cost of treatment of their resulting infections. Regular surveillance and control of the agents that encourage the growth of these bacteria present in indoor air is needed.

Intervention of antimicrobial peptide usage on antimicrobial resistance in aquaculture

Antibiotic resistance genes (ARGs) widely exist in diverse matrices to pose potential risks and attract global attention. This study performed tilapia-cultivation experiment to discuss the intervention of antimicrobial peptide usage on antimicrobial resistance in aquaculture by analyzing 29 target ARGs in water, residue, and fish muscle samples. The sul1 gene was the dominant ARG in most of samples while absolute abundances of total ARGs were in the range of 1.5 × 102-2.3 × 107 copies/mL in water samples and 2.1 × 108-3.9 × 109 copies/g in the residue and fish muscle samples. Compared with antibiotic treatment, the cecropin treatment could significantly reduce the absolute abundance of ARGs and intI1 in all samples. Proteobacteria were the dominant phylum for most of samples while Aeromonas/Cetobacterium served as the dominant genus for samples with antibiotic/cecropin treatment. Network analysis showed that cecropin treatment could significantly reduce occurrence of multi-drug resistant bacteria and the correlation between genera and ARGs. Results of partial least squares structural equation modeling which was used to discuss the influential factors of ARGs exhibited that antibiotics could increase ARGs, further proving that cecropin peptide could effectively reduce ARGs in aquaculture. This study will provide important information on controlling ARGs in aquaculture in terms of antimicrobial peptide application.

Poultry Litter Contamination by Escherichia coli Resistant to Critically Important Antimicrobials for Human and Animal Use and Risk for Public Health in Cameroon.

Residues of antimicrobials used in farm can exert selective pressure and accelerate the occurrence of multidrug resistant bacteria in litter. This study aimed to investigate the resistance profile of Escherichia coli isolated from poultry litter. A total of 101 E. coli strains was isolated from 229 litter samples collected and stored for two months in the laboratory at room temperature. Antimicrobial susceptibility testing was performed using the disk diffusion method. An overall resistance prevalence of 58.4% (95% CI: 48.8–68.0) was obtained with 59 E. coli strains resistant to various antimicrobial agents. High levels of resistance were observed with ciprofloxacin (21/59: 36%), imipenem (27/59: 45%), norfloxacin (44/59: 74%), ceftriaxone (44/59: 74%), and levofloxacin (44/59: 75%). These antimicrobials classified under the Watch group by WHO are indicators of the high AMR risk to public health in Cameroon. Multivariable logistic regression analysis revealed that a greater probability of high level of E. coli multidrug resistance was associated with lack of training in poultry farming (OR = 0.13, p = 0.01), less experience in poultry farming (OR = 11.66 p = 0.04), and the high frequency of digestive tract disease (OR = 0.10; p = 0.001). This study revealed that poultry litter constitutes a potential source of dissemination of resistant germs from farm animals to the environment and humans.

The Occurrence of Multidrug Resistant Bacteria in the Urine of Healthy Dogs and Dogs with Cystitis.

Simple SummaryAntimicrobial resistance is a global health issue. The “One Health” concept describes animals and environments playing an important role in the resistance to antimicrobials. In this study, we survey healthy companion animals (dogs) as a potential source of multidrug resistant (MDR) bacteria, and compare them with dogs with cystitis. Both groups have a similar isolated genus profile and frequency of multidrug resistance. In our study, both healthy and cystitis animals were found to be carriers of MDR bacteria.The objectives of this study were to evaluate the occurrence of microorganisms, the antimicrobial susceptibility profile, and the presence of multidrug resistant (MDR) bacteria in the urine of clinically healthy dogs and dogs with cystitis. The urine was collected through cystocentesis. Subsequently, culture and antimicrobial susceptibility tests were performed. The isolates were classified based on their resistance profile, to evaluate the presence of MDR bacteria. Statistical analyses were performed using the chi-squared or Fisher’s exact tests. Bacterial isolates were present in 24.39% of the dogs in the control group, and 60.27% of the dogs in the cystitis group. The cystitis group was associated with a higher risk of bacterial isolates than the control group (odds ratio = 7.5; 95% confidence interval = 2.81–22.40). The main isolates were Staphylococcus spp., Escherichia coli, Proteus spp., and Enterobacter spp. in both groups. A high percentage of isolates were resistant to ampicillin in both groups. The lowest resistance presented by the isolates in both groups was to meropenem. Only the resistance to quinolones was different between the groups. The proportions of MDR isolates were 70% (7/10) and 65.91% (29/44) in the control and cystitis groups, respectively. The results showed the presence of MDR bacteria in the urine of both the healthy dogs, and the dogs with cystitis. The drug resistance was high, reinforcing the importance of establishing an effective treatment approach against urinary tract infections in pets, to minimize the spread of bacterial resistance and its impact on public health.

Occurrence of Multi-drug Resistant Bacteria in Some Selected Street Food Samples

Antimicrobial resistance is a subject of great concern in the public health. The prevalence of antimicrobial resistance among food pathogens has increased during recent decades.
 Studying the incidence and antibiotic resistance pattern of bacterial species isolated from fish and vended street fruits. 
 Eleven fish swabs and thirteen sliced fruit samples were collected and prepared for isolation of bacterial species through inoculation onto selective and non-selective nutrient media. The grown colonies were purified through subculturing on nutrient agar plates then identified by morphological and biochemical methods. The obtained pure cultures were then kept on nutrient agar slants. Testing antibiotic resistance of the isolated bacterial strains was studied by Kirby-Bauer disk diffusion method on Mueller Hinton agar using ten antibiotics belonging to different classes. The resultant inhibition zone was interpreted according to Clinical Laboratory Standard Institute.
 Twenty-eight bacterial cultures were isolated from the collected food samples. The conventional identification using morphological and biochemical methods of these cultures revealed presence of three Gram positive species; Staphylococcus aureus, Streptococcus sp. and Bacillus subtilis in addition to four Gram negative; Escherichia coli, Brucella sp., Enterococcus faecalis and Proteus mirabilis. The incidence of the obtained bacterial species was arranged as 29.16% for both S. aureus and E. faecalis followed by Brucella sp. 16.66%; B. subtilis & E. coli 12.5% then Streptococcus sp. and P. mirabilis with an incidence of 8.33% each. Testing antibiotic resistance pattern of seven bacterial species against ten antibiotics showed that, among three Gram positive bacterial species, only one (33.33%) strain S. aureus exhibited resistance to six antibiotics; amoxicillin, erythromycin, ciprofloxacin, ceftriaxone, fluconazole and dicloxacillin. Among four Gram negative bacterial strains only one (25.0%) strain Enterococcus faecalis exhibited resistance to eight antibiotics; amoxicillin, streptomycin, chloramphenicol, cotrimoxazole, ciprofloxacin, ofloxacin, sparfloxacin and cloxacillin.
 Occurrence of multi-drug resistant bacteria in fish and vended street fruits poses not only risk of disease to the foods but public health hazard to food handlers and consumers in general. Also the result of this study recommended augmentin and cephazolin as good choice antibiotics for treatment of infection in the study area.

Strategies to control antibiotic resistance: results from a survey in Italian children's hospitals.

Antimicrobial stewardship programs and comprehensive infection control programs represent the main strategies to limit the emergence and transmission of multi-drug resistant bacteria in hospital settings. The purpose of this study was to describe strategies implemented in Italian children's hospitals for controlling antibiotic resistance. Cross sectional multicenter study. Four tertiary care Italian children's hospitals were invited to participate in a survey aimed at collecting information on activities implemented as of December 2015 using a self-administered online questionnaire. The questionnaire was divided in three sections focalizing on: i) policies for prevention and control of hospital-acquired infection, ii) prevention and control of multi-drug resistant bacteria, and iii) antibiotic prescribing policies and Antimicrobial stewardship programs. Questionnaires were compiled between May and July 2016. All hospitals had multidisciplinary infection control committee, procedures on hand hygiene, isolation measures, disinfection/sterilization, waste disposal and prevention on infections associated to invasive procedures. All sites screened patients for multi-drug resistant bacteria colonization in selected units, and adopted contact precautions for colonized patients. Screening during hospitalization, or in case of infections in the same ward were not universally implemented. All hospitals had policies on surgical prophylaxis, while policies on medical prophylaxis and treatment of bacterial infections varied among sites. Two sites recommended to review the appropriateness of antibiotic prescribing after 48-72 hours and one recommended de-escalation therapy. This study highlighted several areas of improvement, such as actions for screening patients in case of occurrence of multi-drug resistant bacteria, antimicrobial stewardship programs and implementation of policies targeting antibiotic prescriptions for therapeutic purposes and medical prophylaxis.

Two novel roles of buffalo milk lactoperoxidase, antibiofilm agent and immunomodulator against multidrug resistant Salmonella enterica serovar Typhi and Listeria monocytogenes.

The increasing occurrence of multidrug resistant bacteria causing bacteremia infection, constitutes a major health problem, difficult-to-treat bacteremia due to its ability to form biofilm. Buffalo milk lactoperoxidase (BMLpo) is effective and safe to use as bacteriostatic agent. The MIC of BMLpo and amikacin were used to evaluate the antibiofilm activity against resistant L.monocytogenes and S.typhi. Prophylactic effects of BMLpo against L.monocytogenes and S.typhi bacteremia invivo have been tested and ELISA test used to evaluate serum cytokines. Significant antibiofilm activity of BMLpo observed against the highest biofilm producer isolates. Our results showed that the prophylactic effect of BMLpo in BALB/c mice bacteremic model. A significant clearance of L.monocytogenes and S.typhi, investigated in blood and different organs tissues in BMLpo-treated infected groups when compared to the non-treated groups. Further, analysis of serum cytokines levels revealed that BMLpo prophylaxis modulates their release in different way when it compared to the control. This study showed, BMLpo effects as an alternative antibiofilm agent to compact gram negative pathogens, and protects the host against bacteremia infection. Moreover, the BMLpo role as an immunomodulatory. These investigations indicated the BMLpo crucial role in the practical clinical applications.

Increased risk of infections and infection-related mortality in children undergoing haematopoietic stem cell transplantation compared to conventional anticancer therapy: a multicentre nationwide study

This nationwide multicentre study analysed the epidemiology of bacterial, viral and fungal infections in paediatric haematopoietic stem cell transplantation (HSCT) and paediatric haematology and oncology (PHO) patients over a period of 24 consecutive months, including incidence, hazard risk and outcome of infections as well as occurrence of multidrug-resistant bacteria. During this period, 308 HSCTs were performed and 1768 children were newly diagnosed for malignancy. Compared to PHO, the risk in HSCT patients was significantly higher for all infections (hazard ratio (HR) 2.7), bacterial (HR 1.4), fungal (HR 3.5) and viral (HR 15.7) infections. The risk was higher in allo- than auto-HSCT for bacterial (HR 1.4), fungal (HR 3.2) and viral (HR 17.7) infections. The incidence of resistant bacteria was higher in HSCT than in PHO patients for both G-negative (72.5% vs. 59.2%) and G-positive (41.4% vs. 20.5%) strains. Cumulative incidence of bacterial, fungal and viral infections in HSCT patients was 33.9, 22.8 and 38.3%, respectively. Cumulative incidence of viral infections in allo-HSCT was 28.0% for cytomegalovirus, 18.5% for BK virus, 15.5% for Epstein-Barr virus, 9.5% for adenovirus, 2.6% for varicella zoster virus, 0.9% for influenza, 0.9% for human herpesvirus 6 and 0.3% for hepatitis B virus. Survival rates from infections were lower in HSCT than in PHO patients in bacterial (96.0 vs. 98.2%), fungal (75.5 vs. 94.6%) and most viral infections. In conclusion, the risk of any infections and the occurrence of resistant bacterial strains in allo-HSCT patients were higher than in auto-HSCT and PHO patients, while the outcome of infections was better in the PHO setting.

Occurrence Of Multidrug Resistant Bacteria (Mdrb) Among Oporative Theatres In Various Hospitals Of Al-Basrah Province

Occurrence Of Multidrug Resistant Bacteria (Mdrb) Among Oporative Theatres In Various Hospitals Of Al-Basrah Province

Complicated Skin and Skin Structure Infections (cSSSI’s): A Comprehensive Review

Complicated skin and skin structure infections (cSSSI’s) are among the most common microbial infections occurring both in the community and the hospitals. Aetiology of cSSSI’s is complex and includes various microorganisms (bacteria, fungi, parasites and viruses). cSSSI’s in general are poly microbial in nature including both anaerobic and aerobic bacterial species. Primary cSSSI’s resulting from single bacterial species and secondary bacterial infections in patients suffering from skin conditions due to autoimmune conditions (eczema) or other microbial causes (viruses, fungi and parasites) have been reported in the literature. Occurrence of multi-drug resistant bacteria, underlying co-morbidities contribute to the complications in the management of cSSSI’s. Formulating effective guidelines for clinical, laboratory diagnosis, treatment and management of patients suffering from cSSSI’s would certainly be beneficial in the reduction of morbidity and mortality.

Multidrug‐Resistant Bacteria Among Patients Treated in Foreign Hospitals: Management Considerations During Medical Repatriation

The repatriation of patients from foreign hospitals can foster the emergence and spread of multidrug-resistant bacteria (MRB). We aimed to evaluate the incidence of MRB in patients treated in foreign hospitals and repatriated by international inter-hospital air transport in order to better manage these patients and adjust our procedures. The records from all consecutive aeromedical evacuations and overseas repatriations carried out by Mondial Assistance France between December 2010 and November 2011 were reviewed for this study. Only inter-hospital transfers with inpatient destination of an acute care unit were considered. Patients were allocated to one of two groups: those identified as MRB carriers at their arrival in France and those who were not identified as such (either negative for MRB or not tested). Data were compared between the two groups. Analysis was performed on 223 patients: 16 patients (7%) were identified as MRB carriers. Compared with confirmed non-MRB patients, MRB carriers came more frequently from a high-risk unit (88% vs 59%, p = 0.05) and had a longer foreign hospital stay [13 (3-20) vs 8 (6-14) d, p = 0.01]. The occurrence of MRB among patients repatriated from foreign hospitals is noted in a significant minority of such individuals transferred back to their home country. The typical MRB patient was admitted to a high-risk unit in a foreign hospital prior to repatriation with longer foreign hospital admissions. The prospective identification of these patients prior to transport is difficult. While these factors are associated with MRB presence, their absence does not rule out highly resistant bacterial colonization. A systematic review of this important medical issue is warranted with the development of guidelines.

Prevalence of resistance phenotypes in Staphylococcus aureus and coagulase-negative isolates of venous ulcers of primary healthcare patients

In venous ulcers, the presence of Staphylococcus aureus and coagulase-negative staphylococcus resistance phenotypes can aggravate and limit the choices for treatment. Staphylococcus isolated from 69 patients (98 ulcers) between October of 2009 and October of 2010 were tested. The macrolide, lincosamide, streptogramin B (MLS B) group resistance phenotype detection was performed using the D-test. Isolates resistant to cefoxitin and/or oxacillin (disk-diffusion) were subjected to the confirmatory test to detect minimum inhibitory concentration (MIC), using oxacillin strips (E-test®). The prevalence of S. aureus was 83%, and 15% of coagulase-negative staphylococcus (CoNS). In addition were detected 28% of methicillin-resistant Staphylococcus aureus (MRSA) and 47% of methicillin-resistant coagulase-negative staphylococcus (MRCoNS). Among the S. aureus, 69.6% were resistant to erythromycin, 69.6% to clindamycin, 69.6% to gentamicin, and 100% to ciprofloxacin. Considering the MRSA, 74% were highly resistant to oxacillin, MIC ≥ 256µg/mL, and the MLS Bc constitutive resistance predominated in 65.2%. Among the 20 isolates sensitive to clindamycin, 12 presented an inducible MLS B phenotype. Of the MRCoNS, 71.4%were resistant to erythromycin, ciprofloxacin and gentamicin. Considering the isolates positive for β-lactamases, the MIC breakpoint was between 0.5 and 2µg/mL. The results point to a high occurrence of multi-drug resistant bacteria in venous ulcers in primary healthcare patients, thus evidencing the need for preventive measures to avoid outbreaks caused by multi-drug resistant pathogens, and the importance of healthcare professionals being able to identifying colonized versus infected venous ulcers as an essential criteria to implementing systemic antibacterial therapy.

Re-evaluation by the Korean Government is urgent 10 years after the introduction of a policy that separates the prescription and dispensing of pharmaceuticals

The separation of pharmaceutical prescription and dispensing has been mandatory in Korea since July 1, 2000. This policy aimed to reduce drug abuse, prevent the distribution of drugs without a prescription, decrease medical costs and insurance premiums, and provide high-quality health-care services. However, the policy was launched without careful consideration of actual benefits to patients or the resulting national financial burden, and its initial aims remain unfulfilled. Koreans have complained that the policy is inconvenient; a 2008 survey revealed that 87% of people would prefer to have their medications dispensed at medical institutes, rather than at pharmacies. People wish to select a convenient dispensing site; the current policy particularly inconveniences disabled and elderly individuals. From 2000 to 2009, dispensing fees totaled 18,432.4 billion Korean won (16.4 billion US$), comprising 27% of all pharmaceutical costs. These fees have contributed to the accelerated rise in national health-care expenses (the most rapid in the world) and to the 2.2-fold increase in insurance-premium payments in 2009, in contrast to those in 2000. Pharmaceuticals continue to be dispensed without a physician's prescription and antibiotic abuse has not been controlled. The increasingly prevalent occurrence of multi-drug resistant bacteria constitutes a serious social problem. The Korean government should recognize the difficulties posed by the financial burden of this policy and its failure to achieve a separation between pharmaceutical prescription and dispensing. To improve this policy, we urge the government to undertake a fair and scientific re-evaluation, despite objections by interest groups to such actions.

Analysis of clinical characteristics and antimicrobial susceptibilities in very low birth weight infants and extremely low birth weight infants with neonatal sepsis

Objective To review the basic clinical characteristics and the pathogens and their antimicrobial susceptibilities to neonatal sepsis in very low birth weight infants (VLBWI) and extremely low birth weight infants ( ELBWI) for selection of appropriate antibiotics. Methods A retrospective chart review of 56 cases with neonatal sepsis(early onset neonatal sepsis 3 cases, late onset 53 cases) in VLBWI and ELBWI admitted to the neonatal intensive care unit of Yuying Children's Hospital of Wenzhou Medical College from January 1, 1999 to December 31, 2008 was conducted. The basic clinical characteristics and the results of blood culture and antimicrobial susceptibilities were analyzed. Results Among the 56 cases, the clinical presentations were non-specific. A total of 43 strains of bacteria were isolated, and the most important pathogens responsible for neonatal sepsis in VLBWI and ELBWI were opportunistic pathogenic bacteria. In early onset neonatal sepsis, there was only one culture-proven sepsis that was Chryseobacterium meningosepticum. In the late onset neonatal sepsis cases, the main pathogens of Gram-negative organisms were Klebsiella pneumoniae (33. 3%, 14/42), and the most common Gram-positive organisms were coagulase-negative Staphylococci (26. 2%, 11/42), followed by Enterococcus species (11. 9%,5/42). Furthermore, there were 2 fungal sepsis(4. 8%, 2/42), which were infected by Candida albicans. All of the coagulase-negative Staphylococci were methicillin-resistant coagulase-negative Staphylococci, and they were resistant to common antibiotics and sensitive to vancotnycin and rifampicin. And all of the Klebsiella pneumoniae produced extended-spectrum (Hactamases, which were sensitive only to a few antibiotics such as carbopenems, aminoglycosides and quinolones. Among those 56 cases, 43 patients were cured, 13 died, including six patients who refused any treatments, the mortality rate of neonatal sepsis in VLBWI and ELBWI was 23. 2%. Conclusions The clinical presentations of neonatal sepsis in VLBWI and ELBWI were non-specific, and the most important pathogens were opportunistic pathogenic bacteria, which were multi-drug resistant. Routine blood culture should be taken from infants who are suspected of neonatal sepsis and empirical use of appropriate antibiotics should be initiated as soon as the blood specimen for culture has been drawn. To reduce the occurrence of multi-drug resistant bacteria, we should restrict the use of antibiotics especially the third generation of cephalosporins in neonates as much as possible. Key words: Infant, extremely low birth weight; Sepsis; Drug resistance, bacterial