Hospital Pathogens Research Articles

Investigation of EpsA, OmpA, and Bap Genes among MDR and XDR Acinetobacter baumannii Isolates in Khorramabad, Iran.

Acinetobacter baumannii is an opportunistic hospital pathogen with high antibiotic resistance, and the ability to produce biofilm. This study aimed to investigate epsA, ompA, and bap genes involved in biofilm formation in MDR and XDR clinical isolates of Acinetobacter baumannii in Khorramabad, Iran. In this study, 79 A. baumannii isolates were collected from various samples of the patients admitted to tertiary hospitals in Khorramabad city, Iran, between January and August 2019. After performing the semi-quantitative evaluation of biofilm production by microtiter plate assay, screening of isolates carrying epsA, ompA, and bap genes was done by PCR method. Finally, statistical analyses were conducted using SPSS 22. Among 79 A. baumannii isolates, 52% XDR, 40% MDR, and 16% non-XDRMDR isolates were found to be biofilm producers. All XDR and 94% MDR isolates had ompA and epsA genes, and bap genes were detected among > 80% of these isolates. Moreover, the presence of biofilm-related genes and biofilm production among non-XDRMDR isolates were less than among resistant isolates (p≤ 0.01). Based on the results, biofilm production and simultaneous presence of epsA, ompA, and bap genes among MDR, and XDR A. baumannii isolates have been found to be significantly more than non-XDR-MDR isolates.

Discovery of <i>Brevibacterium</i> predominating in fecal samples from three children with persistent diarrhea negative for common pathogens

Acute diarrhea is a common disease in children under 5 years old and can develop into persistent diarrhea, greatly affecting the children's health. Although advanced techniques had been used to diagnose and detect common pathogens in hospitals, however, 40% of cases are negative for the pathogens. In this study, to investigate dominant bacteria in stool samples of three persistent-diarrheal children with unidentified pathogenic agents, the V3 and V68 regions of the 16S rRNA gene were amplified from fecal bacterial metagenomic DNA, separated on DGGE gel, and the dominant DNA bands were sequenced. As a result, the V3 and V68 regions of bacteria in persistent diarrheal children were less diverse and different from the corresponding DNA bands of the indicator strains. Sequence analysis and similarity comparison of six DNA bands of V3 regions and seven DNA bands of V68 regions showed that two V3 sequences (of 160 bp) derived from two samples were novel and did not match any genes from the non-redundant database, but they shared 93.75% similarity to each other. The four V3 sequences left derived from all three samples were the most similar (94.53-100%) with the corresponding genes of Brevibacterium. Six of the seven V68 sequences derived from dominant DNA bands of all three samples were the most similar (from 99.4% to 100%) to the corresponding genes of referent strains belonging to the genus Enterococcus. In sample D3, a sequence of the V68 region possessed 100% identity to the E. faecalis ATCC 19433 strain. This is the first study report that Brevibacterium was the dominant bacteria in the gastrointestinal microflora of children with persistent diarrhea although the bacterial genus has been reported to cause dangerous diseases in humans with immunodeficiency.

Characteristics of the Klebsiella Pneumoniae Strain Isolated from a Positive Blood Culture of a Premature Newborn Baby According to the Results of Whole Genome Sequencing

Relevance. K. pneumoniae is a common nosocomial pathogen in pediatric hospitals, often characterized by the presence of a wide range of virulence factors and genetic determinants of antibiotic resistance. Аim. To analyze the results obtained during wholegenome sequencing of a Klebsiella pneumoniae strain isolated from a positive blood culture of a premature newborn. Materials and methods. An ESBL-producing strain of K. pneumoniae isolated from a positive blood culture of a newborn premature infant. Sequencing was performed on the MiSeq platform (Illumina). Analysis of DNA nucleotide sequences of the complete genome of K. pneumoniae was carried out using the website of the Center for Genomic Epidemiology. The search for genetic determinants of antibiotic resistance and virulence was carried out using online services. Results and its discussion. The resulting nucleotide sequence was 5,414,099 bp in length, and the proportion of GC nitrogenous bases was 57.3%. The isolated strain belonged to the sequence type ST3559, had 4 genes encoding the synthesis of enzymes that hydrolyze antibacterial drugs from the beta-lactam group, 2 genes providing resistance to quinolones/fluoroquinolones, 1 resistance gene each to trimethoprim, chloramphenicol, fosfomycin and aminoglycoside antibiotics. Most of the virulence factor genes identified in the studied strain ensure the recognition and absorption of iron ions necessary for the competitive functioning of the bacterial cell. K. pneumoniae possesses the acrA efflux pump gene and its regulators, as well as 4 prophage particles and 1 CRISPCas IE system. Conclusions. Whole-genome sequencing of the K. pneumoniae strain isolated from a positive blood culture of a premature newborn allows us to characterize in detail the causative agent of a generalized infection and detect a wide range of genetic determinants of virulence factors and antibiotic resistance. The ESBL-producing strain of K. pneumoniae, as the etiological agent of neonatal sepsis, was characterized by the presence of virulence genes, multidrug resistance, both due to genes encoding enzymes that hydrolyze antibiotics, and due to the presence of efflux pumps and their regulators. The use of the results of traditional cultural research methods together with high-throughput sequencing data is a promising area of scientific research and has a reserve of practical application in the field of clinical medicine, genetics of microorganisms, molecular epidemiology at the local and global levels

Carbapenemase-producing enterobacterales colonisation status does not lead to more frequent admissions: a linked patient study

BackgroundHospitals in any given region can be considered as part of a network, where facilities are connected to one another – and hospital pathogens potentially spread – through the movement of patients between them. We sought to describe the hospital admission patterns of patients known to be colonised with carbapenemase-producing Enterobacterales (CPE), and compare them with CPE-negative patient cohorts, matched on comorbidity information.MethodsWe performed a linkage study in Victoria, Australia, including datasets with notifiable diseases (CPE notifications) and hospital admissions (admission dates and diagnostic codes) for the period 2011 to 2020. Where the CPE notification date occurred during a hospital admission for the same patient, we identified this as the ‘index admission’. We determined the number of distinct health services each patient was admitted to, and time to first admission to a different health service. We compared CPE-positive patients with four cohorts of CPE-negative patients, sampled based on different matching criteria.ResultsOf 528 unique patients who had CPE detected during a hospital admission, 222 (42%) were subsequently admitted to a different health service during the study period. Among these patients, CPE diagnosis tended to occur during admission to a metropolitan public hospital (86%, 190/222), whereas there was a greater number of metropolitan private (23%, 52/222) and rural public (18%, 39/222) hospitals for the subsequent admission. Median time to next admission was 4 days (IQR, 0–75 days). Admission patterns for CPE-positive patients was similar to the cohort of CPE-negative patients matched on index admission, time period, and age-adjusted Charlson comorbidity index.ConclusionsMovement of CPE-positive patients between health services is not a rare event. While the most common movement is from one public metropolitan health service to another, there is also a trend for movement from metropolitan public hospitals into private and rural hospitals. After accounting for clinical comorbidities, CPE colonisation status does not appear to impact on hospital admission frequency or timing. These findings support the potential utility of a centralised notification and outbreak management system for CPE positive patients.

Genotypic and phenotypic characteristics of Acinetobacter baumannii isolates from the people’s hospital of Qingyang City, Gansu province

BackgroundAcinetobacter baumannii (A. baumannii) is a common opportunistic pathogen in hospitals that causes nosocomial infection. In order to understand the phenotypic and genotypic characteristics of A. baumannii isolates, we sequenced and analyzed 62 A. baumannii isolates from a hospital in Gansu province.ResultsNon-repeated 62 A. baumannii isolates were collected from August 2015 to November 2021. Most isolates (56/62) were resistant to multiple drugs. All the 62 A. baumannii isolates were resistant to aztreonam and contained blaADC-25 gene which exists only on chromosome contigs. The 62 isolates in this study were not clustered in a single clade, but were dispersed among multiple clades in the common genome. Seven sequence types were identified by Multilocus sequence type (MLST) analysis and most isolates (52/62) belonged to ST2. The plasmids were grouped into 11 clusters by MOB-suite.ConclusionsThis study furthers the understanding of A. baumannii antimicrobial-resistant genotypes, and may aid in prevention and control nosocomial infection caused by drug-resistant A. baumannii.

Phytochemical screening and antioxidant properties of alcoholic extract and antibacterial activity of Rosmarinus officinalis L., Leaves

Antibiotic resistance is increasing due to the increased use of antibiotics. The emergence of new antibacterial drugs with fewer side effects than antibiotics is an issue. The medicinal plant rosemary is widely used in traditional medicine. In this study, an ethanol extract from the leaves of this plant was tested against the most common hospital-acquired infections. The following study aimed to ascertain the phytochemicals, antibacterial, and antioxidant activities of commercial rosemary flavonoids in leaf extract used on major hospital pathogens through disc diffusion and MIC tests. The Rosmarinus officinalis plant was used in this experimental study to evaluate its antimicrobial efficacy against pathogens by disc diffusion and MIC tests. The leaves of this plant were extracted in ethanol at concentrations of 200, 100, 50, and 25 mg/ml and evaluated for their antimicrobial effect against several pathogenic strains. In addition, the optical density in the spectrophotometer (620 nm) was used to calculate the minimum inhibitory concentration (MIC) test. In this investigation, Pseudomonas aeruginosa, Enterobacter faecalis, Staphylococcus aureus, and Escherichia coli were all sensitive to the effects of the ethanolic extract of rosemary leaves at a concentration of 200 mg/mL. The minimum inhibitory concentration (MIC) of E. coli and P. aeruginosa in this extract changed from 25 mg/ml to 100 mg/ml concentration, while the other types of bacteria required only 200 and 100 mg/ml. These findings imply that high concentrations of rosemary extract inhibited all species, including E. coli, S. aureus, P. Aeruginosa, and E. faecalis.

Evidence of Correlation between Membrane Phase Transition and Clonogenicity in Dehydrating Acinetobacter baumannii: A Combined Micro-Raman and AFM Study.

The Gram-negative bacterium Acinetobacter baumannii is one of the most resilient multidrug-resistant pathogens in hospitals. Among Gram-negative bacteria, it is particularly resistant to dehydration (anhydrobiosis), and this feature allows A. baumannii to persist in hospital environments for long periods, subjected to unfavorable conditions. We leverage the combination of μ-Raman spectroscopy and atomic force microscopy (AFM) to investigate the anhydrobiotic mechanisms in A. baumannii cells by monitoring the membrane (both inner and outer membranes) properties of four A. baumannii strains during a 16-week dehydration period and in response to temperature excursions. We noted that the membranes of A. baumannii remained intact during the dehydration period despite undergoing a liquid-crystal-to-gel-phase transition, accompanied by changes in the mechanical properties of the membrane. This was evident from the AFM images, which showed the morphology of the bacterial cells alongside modifications of their superficial mechanical properties, and from the alteration in the intensity ratio of μ-Raman features linked to the CH3 and CH2 symmetric stretching modes. Furthermore, employing a universal power law revealed a significant correlation between this ratio and bacterial fitness across all tested strains. Additionally, we subjected dry A. baumannii to a temperature-dependent experiment, the results of which supported the correlation between the Raman ratio and culturability, demonstrating that the phase transition becomes irreversible when A. baumannii cells undergo different temperature cycles. Besides the relevance to the present study, we argue that μ-Raman can be used as a powerful nondestructive tool to assess the health status of bacterial cells based on membrane properties with a relatively high throughput.

Device and surgical procedure-related infections in Canadian acute care hospitals, 2018-2022.

Healthcare-associated infections (HAIs) are a significant healthcare burden in Canada. National surveillance of HAIs at sentinel acute care hospitals is conducted by the Canadian Nosocomial Infection Surveillance Program. This article describes device and surgical procedure-related HAI epidemiology in Canada from 2018 to 2022. Data were collected from over 60 Canadian sentinel acute care hospitals between January 1, 2018, and December 31, 2022, for central line-associated bloodstream infections (CLABSIs), hip and knee surgical site infections (SSIs), cerebrospinal fluid shunt (CSF) SSIs and paediatric cardiac SSIs. Case counts, rates, patient and hospital characteristics, pathogen distributions and antimicrobial resistance data are presented. Between 2018 and 2022, 2,258 device-related infections and 987 surgical procedure-related infections were reported. A significant rate increase was observed in adult mixed intensive care unit CLABSIs (1.07-1.93 infections per 1,000 line days, p=0.05) and a non-significant rate increase was observed in SSIs following knee arthroplasty (0.31-0.42 infections per 100 surgeries, p=0.45). A fluctuating rate trend was observed in CSF shunt SSIs over the time period and a significant rate decrease in paediatric cardiac SSIs was observed (68%, from 7.5-2.4 infections per 100 surgeries, p=0.01). The most commonly identified pathogens were coagulase-negative staphylococci (22.8%) among CLABSIs and Staphylococcus aureus (42%) among SSIs. Epidemiological and microbiological trends among selected device and surgical procedure-related HAIs are essential for benchmarking infection rates nationally and internationally, identifying any changes in infection rates or antimicrobial resistance patterns and helping inform hospital infection prevention and control and antimicrobial stewardship policies and programs.

Reversion to sensitivity explains limited transmission of resistance in a hospital pathogen.

Bacterial pathogens that are successful in hospital environments must survive times of intense antibiotic exposure and times of no antibiotic exposure. When these organisms are closely associated with human hosts, they must also transmit from one patient to another for the resistance to spread. The resulting evolutionary dynamics have, in some settings, led to rising levels of resistance in hospitals. Here, we focus on an important but understudied aspect of this dynamic: the loss of resistance when the resistant organisms evolve in environments where the antibiotic pressure is removed. Based on prior data, we hypothesize that resistance arising in the context of strong selection may carry a high cost and revert to sensitivity quickly once the selective pressure is removed. Conversely, resistant isolates that persist through times of no antibiotic pressure should carry a lower cost and revert less quickly. To test this hypothesis, we utilize a genetically diverse set of patient-derived, daptomycin-resistant Enterococcus faecium isolates that include cases of both de novo emergence of resistance within patients and putatively transmitted resistance. Both of these sets of strains have survived periods of antibiotic exposure, but only putatively transmitted resistant strains have survived extended periods without antibiotic exposure. These strains were then allowed to evolve in antibiotic free laboratory conditions. We find that putatively transmitted resistant strains tended to have lower level resistance but that evolution in antibiotic-free conditions resulted in minimal loss of resistance. In contrast, resistance that arose de novo within patients was higher level but exhibited greater declines in resistance in vitro. Sequencing of the experimentally evolved isolates revealed that reversal of high level resistance resulted from evolutionary pathways that were frequently genetically associated with the unique resistance mutations of that strain. Thus, the rapid reversal of high-level resistance was associated with accessible evolutionary pathways where an increase in fitness is associated with decreased resistance. We describe how this rapid loss of resistance may limit the spread of resistance within the hospital and shape the diversity of resistance phenotypes across patients.

Preparation of Luvangetin Nanoemulsions: Antimicrobial Mechanism and Role in Infected Wound Healing.

Incorporation of luvangetin in nanoemulsions for antimicrobial and therapeutic use in infected wound healing. Luvangetin nanoemulsions were prepared by high-speed shear method and characterized based on their appearance structure, average droplet size, polydispersity index (PDI), electric potential, storage stability. Optimized formulation of luvangetin nanoemulsion by Box-Behnken design (BBD). The antimicrobial activity and antimicrobial mechanism of luvangetin nanoemulsions against common hospital pathogens, ie, Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli), were investigated using luvangetin nanoemulsions. The biosafety of luvangetin nanoemulsion was evaluated through cytotoxicity, apoptosis, and reactive oxygen species (ROS) assay experiments using human normal epidermal cells and endothelial cells. Finally, the effect of luvangetin nanoemulsion on healing of infected wounds was investigated in B6 mice. Luvangetin nanoemulsion formulation consists of 2.5% sunflower seed oil, 10% emulsifier Span-20 and 7 minutes of shear time, and with good stability. Luvangetin nanoemulsion produces antibacterial activity against S. aureus and E. coli by disrupting the structure of bacterial cell membranes. Luvangetin nanoemulsion are biologically safe for HaCat and HUVEC. Luvangetin nanoemulsion showed good therapeutic effect on MRSA infected wounds in mice. For the first time, developed a new formulation called luvangetin nanoemulsion, which exhibited superior antibacterial effects against Gram-positive bacteria. Luvangetin nanoemulsion has a favorable effect in promoting infected wound healing. We have combined luvangetin, which has multiple activities, with nanoemulsions to provide a new topical fungicidal formulation, and have comprehensively evaluated its effectiveness and safety, opening up new possibilities for further applications of luvangetin.

The role of aztreonam in rational antibacterial therapy of resistant nosocomial gram-negative infections. The new life for a well-known β-lactam

Background. The situation regarding the prevalence of resistant pathogens, types of β-lactamase products, and, accordingly, the justification of rational approaches to antibacterial therapy in Ukraine remains insufficiently studied. Objective: based on the determination of the etiological structure of the causative agents of hospital infections in the Kharkiv region and the state of their resistance due to the production of β-lactamases, to propose rational approaches to antibacterial therapy and assess the feasibility of using aztreonam as a potentially effective mean of treating infections caused by resistant bacteria. Materials and methods. In 251 patients, samples of biomaterials were tested by the polymerase chain reaction for the presence of the following gram-negative pathogens: P.aeruginosa, Enterobacter, E.coli, K.pneumoniae, Proteus spp. and A.baumanii. A molecular genetic study was also conducted to identify certain types of β-lactamases. Results. In the structure of hospital pathogens, the absolute majority of gram-negative bacteria belong to the enterobacteria family. When determining the profile of β-lactamases, we found that in 59.38 % of cases, E.coli was able to produce metallo-β-lactamases, which makes the therapy with carbapenems or ceftazidime-avibactam impossible. An alternative in such cases is a combination of aztreonam and ceftazidime-avibactam. When the causative agent K.pneumoniae is detected, in some cases there may also be a need for combined therapy with the use of aztreonam. It was found that Enterobacter spp. in most cases is sensitive to carbapenems. A.baumanii is completely insensitive to carbapenems and requires alternative approaches to antibacterial therapy, including aztreonam, ceftazidime-avibactam, and polymyxins. P.aeruginosa was found only as part of polymicrobial associations, so it was impossible to analyze its β-lactamase production profile. Conclusions. The results of the conducted study demonstrate an extremely high detection of gram-negative antibiotic-resistant pathogens in patients of the intensive care units in the Kharkiv region. Microorganisms such as E.coli and A.baumanii have the most unfavorable profile of antibiotic resistance, which is due to the high frequency of production of serine carbapenemases and metallo-β-lactamases, whose presence makes the effective use of carbapenems impossible.

A Trial of Automated Outbreak Detection to Reduce Hospital Pathogen Spread

BackgroundDetection and containment of hospital outbreaks currently depend on variable and personnel-intensive surveillance methods. Whether automated statistical surveillance for outbreaks of health care–associated pathogens allows earlier containment efforts that would reduce the size of outbreaks is unknown.MethodsWe conducted a cluster-randomized trial in 82 community hospitals within a larger health care system. All hospitals followed an outbreak response protocol when outbreaks were detected by their infection prevention programs. Half of the hospitals additionally used statistical surveillance of microbiology data, which alerted infection prevention programs to outbreaks. Statistical surveillance was also applied to microbiology data from control hospitals without alerting their infection prevention programs. The primary outcome was the number of additional cases occurring after outbreak detection. Analyses assessed differences between the intervention period (July 2019 to January 2022) versus baseline period (February 2017 to January 2019) between randomized groups. A post hoc analysis separately assessed pre–coronavirus disease 2019 (Covid-19) and Covid-19 pandemic intervention periods.ResultsReal-time alerts did not significantly reduce the number of additional outbreak cases (intervention period versus baseline: statistical surveillance relative rate [RR]=1.41, control RR=1.81; difference-in-differences, 0.78; 95% confidence interval [CI], 0.40 to 1.52; P=0.46). Comparing only the prepandemic intervention with baseline periods, the statistical outbreak surveillance group was associated with a 64.1% reduction in additional cases (statistical surveillance RR=0.78, control RR=2.19; difference-in-differences, 0.36; 95% CI, 0.13 to 0.99). There was no similarly observed association between the pandemic versus baseline periods (statistical surveillance RR=1.56, control RR=1.66; difference-in-differences, 0.94; 95% CI, 0.46 to 1.92).ConclusionsAutomated detection of hospital outbreaks using statistical surveillance did not reduce overall outbreak size in the context of an ongoing pandemic. (Funded by the Centers for Disease Control and Prevention; ClinicalTrials.gov number, NCT04053075. Support for HCA Healthcare’s participation in the study was provided in kind by HCA.)

Shedding light on the problem: Influence of the radiator power, source-sample distance, and exposure time on the performance of UV-C lamps in laboratory and real-world conditions.

Effective surface disinfection is crucial for preventing the spread of pathogens in hospitals. Standard UltraViolet-C (UV-C) lamps have been widely used for this purpose, but their disinfection efficiency under real-world conditions is not well understood. To fill this gap, the influence of the power of the ultraviolet radiator, source-sample distance, and exposure time on the performance of UV-C lamps against Escherichia coli and Staphylococcus epidermidis were experimentally determined in the laboratory and hospital. The obtained results showed that the UV irradiance and, thus, the UV-C disinfection efficiency decreased significantly at distances greater than 100 cm from the UV-C lamp. Moreover, increasing the total power of the radiators does not improve the performance of UV-C lamps under real conditions. The UV-C disinfection efficiency greater than 90% was achieved only under laboratory conditions at a close distance from the UV-C lamp, i.e., 10 cm. These findings provide novel insights into the limitations of UV-C lamps in real-world conditions and highlight the need for more effective disinfection strategies in hospitals.

Simultaneous detection and characterization of common respiratory pathogens in wastewater through genomic sequencing

Genomic surveillance of SARS-CoV-2 has given insight into the evolution and epidemiology of the virus and its variant lineages during the COVID-19 pandemic. Expanding this approach to include a range of respiratory pathogens can better inform public health preparedness for potential outbreaks and epidemics. Here, we simultaneously sequenced 38 pathogens including influenza viruses, coronaviruses and bocaviruses, to examine the abundance and seasonality of respiratory pathogens in urban wastewater. We deployed a targeted bait capture method and short-read sequencing (Illumina Respiratory Virus Oligos Panel; RVOP) on composite wastewater samples from 8 wastewater treatment plants (WWTPs) and one associated hospital site. By combining seasonal sampling with whole genome sequencing, we were able to concurrently detect and characterise a range of common respiratory pathogens, including SARS-CoV-2, adenovirus and parainfluenza virus. We demonstrated that 38 respiratory pathogens can be detected at low abundances year-round, that hospital pathogen diversity is higher in winter vs. summer sampling events, and that significantly more viruses are detected in raw influent compared to treated effluent samples. Finally, we compared detection sensitivity of RT-qPCR vs. next generation sequencing for SARS-CoV-2, enteroviruses, influenza A/B, and respiratory syncytial viruses. We conclude that both should be used in combination; RT-qPCR allowed accurate quantification, whilst genomic sequencing detected pathogens at lower abundance. We demonstrate the valuable role of wastewater genomic surveillance and its contribution to the field of wastewater-based epidemiology, gaining rapid understanding of the seasonal presence and persistence for common respiratory pathogens. By simultaneously monitoring seasonal trends and early warning signs of many viruses circulating in communities, public health agencies can implement targeted prevention and rapid response plans.

Evaluation of Antimicrobial Properties of Bam Date Kernel Extract and Investigation of the Structure of Extract

Background & Aims: The prevalence of hospital infections, especially of bacterial origin, is increasing and uncontrollable in many countries. Controlling them, because of their damage to the health and economy, is essential. Therefore, numerous efforts have been made to find new antibiotics as suitable alternatives to current ones. This study aimed to investigate the antibacterial activity of date kernel extract against several hospital pathogens. Materials and Methods: Acetone extract of Mozafati date kernel from Bam city was prepared by immersion method and its antibacterial effects on hospital pathogens such as Escherichia coli, Staphylococcus aureus, Salmonella enterica, Pseudomonas aeruginosa, Acinetobacter baumannii were investigated by the minimum inhibitory concentration (MIC), minimum bactericidal concentration (MBC), and well diffusion method. Then, the structure of the obtained extract was determined by high-performance liquid chromatography (HPLC). Results: The MIC was observed at 400 mg/mL of extract for S. aureus bacteria. In addition, the MBC of date kernel extract was 500 mg/ mL for the tested bacteria, except for A. baumannii, where a decreasing trend was detected. The antibacterial activity was determined by the well diffusion method against all bacteria, and the greatest activity was observed against S. aureus with a growth inhibition zone diameter of 31 mm. The HPLC analysis showed the presence of 7 different structures, of which rutin was the most abundant. Conclusion: This study indicates the high antibacterial effect of acetone extract of date kernel on the tested bacteria; however, further studies should be conducted on this plant as a new and powerful antibacterial agent.

Bacteriological Analysis and Plasmid Profiles of Surfaces of Some Hospital Kitchen Equipment in Benin City, Nigeria

The surfaces of hospital kitchen equipment could be a major source of transmission of resistant pathogens to patients. Hence, the objective of this paper was to assess the bacteriological and plasmid profiles of surfaces of tables, sinks, chopping-boards, gas cookers and freezer handles hospital kitchen equipment in Benin City, Nigeria using appropriate standard microbiological techniques. Bacterial plasmids were isolated and separated using the agarose gel electrophoresis. Plasmid curing was performed using acridine orange. The antimicrobial sensitivity pattern showed that the bacterial isolates exhibited varying degree of resistance to the antibiotics. Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa were highly resistant to the antibiotics, having multiple antibiotic resistances (MAR) index of 0.6. Micrococcus spp. and Klebsiella pneumoniae were the least resistant to the antibiotics. Plasmid analysis revealed the presence of single and multiple-banded plasmids with sizes ranging from 100-1000bp. After curing, all the isolates (except S. aureus, E. coli and P. aeruginosa) were sensitive to all the antibiotics, indicating a significant reduction in antibiotic resistance after curing. The results revealed that plasmids played a significant role in conferring resistance on the isolates. Regular cleaning and disinfection should be strictly observed in hospital kitchens to prevent outbreaks and spread of resistant pathogens in hospitals.

Prevalence of Extended-spectrum Beta-lactamase (ESBL), Metallo Beta-lactamase (MBL) and Carbapenemase Producing Acinetobacter Species Isolated from Various Clinical Samples in Tertiary Care Hospital

Acinetobacter is an important nosocomial pathogen causing health care associated infections. It is highly antibiotic resistant gram-negative bacilli. The study was done to determine the prevalence of Acinetobacter species isolated from various clinical samples with their antibiotic susceptibility pattern. To determine the antimicrobial susceptibility pattern of the isolated Acinetobacter species and also the multidrug resistant mechanisms by phenotypic characterization. The retrospective study was carried out in patients diagnosed with Acinetobacter infection in the Microbiology Department, Krishna Institute of Medical Sciences, Krishna Vishwa Vidyapeeth, Deemed To Be University, Karad, a tertiary care hospital, including the clinical departments, during the period of two years from November 2020 till November 2022. Organism identification, biochemical test, antibiotic resistance pattern and phenotypic tests such as ESBL, MBL and Carbapenemase production were performed as per the Clinical and Laboratory Standards Institute (CLSI). The Modified Hodge test (MHT) was performed for Carbapenemase production detection in Acinetobacter species. A total of 150 Acinetobacter species were isolated from clinical samples. Acinetobacter baumannii was the most prevalent species 138 (92%), followed by Acinetobacter lwoffii 10 (7%) and Acinetobacter hemolyticus 2 (1%). The isolates showed highest resistance to Ampicillin 130 (87%) and sensitive to Colistin 113 (75.3%). Most of the isolates of of Acinetobacter baumannii showed maximum ESBL 21(14%) and MBL 75 (93%) production. Modified Hodge test showed positive results in Acinetobacter baumannii, only 11 (7%). The study showed that Acinetobacter baumannii was the most prevalent species showing drug resistance by phenotypic detection methods. At present Acinetobacter is a frequent pathogen in hospital acquired infections in critically ill patients admitted to ICU. The isolates of Acinetobacter species in our study showed resistant to most commonly used antibiotics. The study showed that ESBL production in Acinetobacter was 22 (15%) and MBL 80 (53%). Most Acinetobacter isolates were Multi Drug Resistant (MDR). MDR Acinetobacter is widely increasing due to inappropriate use of antibiotics in healthcare hospital. In our study, detection of carbapenemase by Modified Hodge test was positive in 11 (7%) isolates.

Use of Hydrogen Peroxide Vapour for Microbiological Disinfection in Hospital Environments: A Review.

Disinfection of nosocomial pathogens in hospitals is crucial to combat healthcare-acquired infections, which can be acquired by patients, visitors and healthcare workers. However, the presence of a wide range of pathogens and biofilms, combined with the indiscriminate use of antibiotics, presents infection control teams in healthcare facilities with ongoing challenges in the selection of biocides and application methods. This necessitates the development of biocides and innovative disinfection methods that overcome the shortcomings of conventional methods. This comprehensive review finds the use of hydrogen peroxide vapour to be a superior alternative to conventional methods. Motivated by observations in previous studies, herein, we provide a comprehensive overview on the utilisation of hydrogen peroxide vapour as a superior high-level disinfection alternative in hospital settings. This review finds hydrogen peroxide vapour to be very close to an ideal disinfectant due to its proven efficacy against a wide range of microorganisms, safety to use, lack of toxicity concerns and good material compatibility. The superiority of hydrogen peroxide vapour was recently demonstrated in the case of decontamination of N95/FFP2 masks for reuse to address the critical shortage caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the COVID-19 pandemic. Despite the significant number of studies demonstrating antimicrobial activity, there remains a need to critically understand the mechanism of action by performing studies that simultaneously measure damage to all bacterial cell components and assess the correlation of this damage with a reduction in viable cell count. This can lead to improvement in antimicrobial efficacy and foster the development of superior approaches.

Great Plasticity in a Great Pathogen: Capsular Types, Virulence Factors and Biofilm Formation in ESBL-Producing Klebsiella pneumoniae from Pediatric Infections in Uruguay.

Klebsiella pneumoniae is widely recognized as an opportunistic hospital and community pathogen. It is one of the priority microorganisms included in the ESKAPE group, and its antibiotic resistance related to extended-spectrum β-lactamases (ESBL) is a global public health concern. The multi-drug resistance (MDR) phenotype, in combination with pathogenicity factors, could enhance the ability of this pathogen to cause clinical infections. The aim of this study was to characterize pathogenicity factors and biofilm formation in ESBL-producing K. pneumoniae from pediatric clinical infections. Capsular types, virulence factors, and sequence types were characterized by PCR. Biofilm formation was determined by a semiquantitative microtiter technique. MDR phenotype and statistical analysis were performed. The K24 capsular type (27%), virulence factors related to iron uptake fyuA (35%) and kfuBC (27%), and sequence types ST14 (18%) and ST45 (18%) were the most frequently detected. Most of the strains were biofilm producers: weak (22%), moderate (22%), or strong (12%). In 62% of the strains, an MDR phenotype was detected. Strains with K24 capsular type showed an association with ST45 and the presence of fyuA; strains with kfuBC showed an association with moderate or strong biofilm production and belonging to ST14. Weak or no biofilm producers were associated with the absence of kfuBC. The MDR phenotype was associated with the main ESBL gene, blaCTX-M-15. The high plasticity of K. pneumoniae to acquire an MDR phenotype, in combination with the factors exposed in this report, could make it even more difficult to achieve a good clinical outcome with the available therapeutics.

Present Strategy and Tactics of Antibacterial Therapy for Hospital Infections: Lessons Learned from the COVID-19 Pandemic

A significant increase in sales of antibacterial drugs in pharmacies and their purchases by medical institutions of the Russian Healthcare System was observed against the background of the past pandemic of a novel coronavirus infection in Russia. Microbiological monitoring that was carried out at City Clinical Hospital No. 67 named after. L. A. Vorokhobov (Moscow) in 2020–2021, revealed a pressing problem — primarily gram-negative bacteria, with a predominance of multidrug-resistant (MDR) strains, were isolated from patients with healthcare-associated infections (HAIs). As shown by pharmacoeconomic studies conducted by the authors, the cost of one course of targeted antibacterial therapy for HAI in this case could increase by 6–12 times compared to a similar course of therapy in the absence of both MDR strains and XDR strains of hospital pathogens. In order to achieve a reduction in the cost of antibacterial therapy developed and used by the authors, in addition to the development of effective antibacterial therapy regimens for HAIs caused by MDR/XDR pathogens, another study was carried out as a continuation of the work on creating and improving biotherapy regimens for HAIs, namely the development of personalized phage therapy regimens for patients with hospital-acquired pneumonia caused by MDR bacterial strains. Based on the data obtained, the concept of a personalized approach to phage therapy of various nosological forms of HAIs caused by hospital-acquired MDR pathogens in patients of a multidisciplinary hospital was proposed and tested. As a result of this approach, the effectiveness of phage therapy for various nosological forms of HAIs caused by MDR and XDR strains of hospital pathogens in City Clinical Hospital No. 67 named after. L. A. Vorokhobov increased by 30%, and the effectiveness of the initial antibiotic regimen was 70%. The economic effect of the combination of antibiotic therapy and phage therapy («booster therapy») amounted to 3,000,000 rubles, compared with the use of antibiotics alone in the treatment of patients with HAIs caused by MDR/XDR strains of hospital pathogens.