Drug Resistance Patterns Research Articles

Diagnostics Evaluation of Smart Sure™ Mycobacterium tuberculosis Screening Kit and Smart Sure™ Multidrug-resistant Tuberculosis Detection Kit on Nonsputum Specimens at a Tertiary Care Center of North India.

Tuberculosis (TB) is caused due to the infection of Mycobacterium tuberculosis (MTB) and it can infect the various parts of the human body. The disease is highly prevalent and is the second most common cause of death worldwide after COVID-19. Apart from sputum specimen, it is exceedingly difficult to diagnose due to its paucibacillary nature. The current study was intended to evaluate the accuracy of Smart Sure™ MTB and multidrug-resistant-TB (MDR-TB) kits (Genetix Biotech Asia Pvt. Ltd., India) with Xpert ultra and Mycobacterium growth indicator tube (MGIT) culture on nonsputum specimens from TB suspects. A total of 205 nonsputum specimens were received between October 2023 and May 2024 at Intermediate Reference Laboratory, Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. Xpert ultra and Smart Sure™ MTB and MDR-TB tests were done directly on samples. However, processed specimens were used for MGIT culture and drug-susceptibility testing (DST). Invalid and MGIT contaminated specimens were excluded from the final calculation. Overall, sensitivity and specificity of Smart Sure™ MTB screening kit was 71.59% and 98.28%, respectively, with Xpert ultra and 68.35% and 90.83%, respectively, with MGIT culture. While comparing with both Xpert ultra and MGIT-DST to detect rifampicin (RIF) resistant, Smart Sure™ MDR-TB kits showed sensitivity of 75.0% and 100% of specificity. However, for isoniazid (INH) resistance, Smart Sure™ MDR-TB kits showed 100% of sensitivity and specificity with MGIT-DST. For the detection of MTB and its drug-resistance patterns (RIF and INH) in the specimens other than sputum, Smart Sure™ MTB and MDR-TB kits could play a vital role in TB endemic countries. While comparing the set-ups and skilled staffs, it required almost same as compared with previously approved WHO diagnostics used in resource-limited countries.

A 10-year review of isoniazid-resistant TB management in Uzbekistan 2009-2020.

Isoniazid (INH, H) resistance is the most common drug-resistant TB pattern, with treatment success rates lower than those in drug-susceptible TB. The WHO recommends a 6-month regimen of rifampicin (RIF, R), ethambutol (EMB, E), pyrazinamide (PZA, Z), and levofloxacin (Lfx) (6REZLfx) for INH-resistant, RIF-susceptible TB (HRRS-TB). Uzbekistan has a high burden of TB (62/100,000 population) and multidrug-resistant TB (12/100,000 population). We conducted a retrospective, descriptive study of microbiologically confirmed HRRS-TB using routinely collected programmatic data from 2009 to 2020. We included 854 HRRS-TB cases. Treatment success was 80.2% overall. For REZLfx, the treatment success rate was 92.0% over a short treatment duration, with no amplifications to RIF or second-line anti-TB drug resistance. We documented 46 regimens with REZLfx plus linezolid (success 87.0%) and 539 regimens using kanamycin or capreomycin (success 76.6%). We identified 37 treatment failures (4.3%), 30 deaths (3.5%), 25 resistance amplifications (2.9%), including eight to RIF (0.9%), and 99 lost to follow-up (LTFU) cases (11.6%). Unsuccessful outcomes were more common with older age, diabetes, chest X-ray cavities, smear positivity, smear-positive persistence, and male sex. LTFU was more common with injection-containing regimens. REZLfx is a safe and effective first-line treatment for INH-resistant, RIF-susceptible TB. Treatment success was lower and LTFU was higher for injection-containing regimens.

Integrons and multidrug resistance across phylogenetic groups of clinical isolates of Escherichia coli.

This study was aimed to investigate the multidrug resistance patterns in clinical isolates of Escherichia coli and their correlation with integrons and phylogenetic groupings. A total of 37 clinical E. coli isolates were evaluated for drug resistance patterns by disk diffusion method. Phylogenetic groupings and the presence of integrons among E. coli were determined by multiplex PCR assays. Multidrug resistance was identified in 84% of the clinical isolates of E. coli with higher resistance found against cephalosporins (94.6%) and fluoroquinolones (83.8%), while lower resistance was observed against polymyxins (24.3%) and carbapenems (29.7%). Metallo-β-lactamases were found in all carbapenem resistant isolates. The phylogenetic group B2 was the most dominant (40.5%), followed by groups A (35.1%), D (13.5%) and B1 (10.8%). Integrons were detected in 25 (67.6%) isolates and intI1, intI2, and intI3 genes were found in 62.2%, 18.9% and 10.8% of isolates respectively. Our results show that phylogenetic classification of E. coli is not relevant with antimicrobial resistance. However, there was strong association between the integron classes and resistance against β-lactam and fluoroquinolones antimicrobials. Additionally, this study highlighted that the presence of integrons plays a crucial role in the development of multidrug resistance in clinical isolates of E. coli. Most significantly, this is the first report of detection of three classes of integron among clinical isolates of E. coli in Pakistan.

Drug Resistance and Mutation Patterns Among Tuberculosis Patients in National Tuberculosis and Leprosy Training Centre Zaria

Drug Resistance and Mutation Patterns Among Tuberculosis Patients in National Tuberculosis and Leprosy Training Centre Zaria

Risk factors and clinical impact of multidrug resistance in healthcare-associated bacteraemic urinary tract infections: a post-hoc analysis of a multicentre prospective cohort in Spain

The global burden associated with antimicrobial resistance is of increasing concern. To evaluate risk factors associated with multidrug-resistant (MDR) infection and its clinical impact in a cohort of patients with healthcare-associated bacteraemic urinary tract infections (BUTIs). This was a prospective, multicentre, post-hoc analysis of patients with healthcare-associated-BUTI (ITUBRAS-2). The primary outcome was MDR profile. Secondary outcomes were clinical response (at 48-72h and at hospital discharge) and length of hospital stay from onset of BUTI. Logistic regression was used to evaluate variables associated with MDR profile and clinical response. Length of hospital stay was evaluated using multivariate median regression. In all, 443 episodes were included, of which 271 (61.17%) were classified as expressing an MDR profile. In univariate analysis, MDR profile was associated with E.coli episodes (odds ratio (OR): 3.13; 95% confidence interval (CI): 2.11-4.69, P < 0.001) and the extensively drug-resistant (XDR) pattern with P.aeruginosa aetiology (7.84; 2.37-25.95; P= 0.001). MDR was independently associated with prior use of fluoroquinolones (adjusted OR: 2.43; 95% CI: 1.25-4.69), cephalosporins (2.14; 1.35-3.41), and imipenem or meropenem (2.08; 1.03-4.20) but not with prior ertapenem. In terms of outcomes, MDR profile was not associated with lower frequency of clinical cure, but was associated with longer hospital stay. MDR profile was independently associated with prior use of fluoroquinolones, cephalosporins, imipenem, and meropenem, but not with prior ertapenem. MDR-BUTI episodes were not associated with worse clinical cure, although they were independently associated with longer duration of hospital stay.

Risk factors associated with multidrug-resistant tuberculosis in areas with a moderate tuberculosis burden.

The emergence of multidrug-resistant tuberculosis (MDR-TB) or rifampicin-resistant (RR) TB poses a significant challenge for TB control initiatives on a global scale. This study's aim was to estimate the incidence of MDR-/RR-TB and identify the risk factors associated with their incidence in four provinces in northern Iran. Drug susceptibility testing was conducted using the proportion method on Lowenstein-Jensen media. The demographic and clinical data were collected from the Iranian TB registry. Among 1083 individuals diagnosed with TB, 27 (2.5%) were identified as having MDR-/RR-TB, while 73 cases (6.7%) were any drug resistant (ADR). The statistical analysis revealed a significant association between marital status and MDR-/RR-TB (p=0.003). In addition, significant associations were observed between ADR-TB and gender (p=0.035) and previous treatment for TB (p=0.02). Our findings provide important information on the drug resistance pattern of Mycobacterium tuberculosis strains, as well as risk factors in northern Iran. Given the identified risk factors, creative approaches to promote treatment adherence in TB patients, particularly divorced/widowed women and individuals with a previous history of TB treatment, are required.

Molecular transmission network analysis of newly diagnosed HIV-1 infections in Nanjing from 2019 to 2021

ObjectiveThe objective of this study was to conduct a comprehensive analysis of the molecular transmission networks and transmitted drug resistance (TDR) patterns among individuals newly diagnosed with HIV-1 in Nanjing.MethodsPlasma samples were collected from newly diagnosed HIV patients in Nanjing between 2019 and 2021. The HIV pol gene was amplified, and the resulting sequences were utilized for determining TDR, identifying viral subtypes, and constructing molecular transmission network. Logistic regression analyses were employed to investigate the epidemiological characteristics associated with molecular transmission clusters.ResultsA total of 1161 HIV pol sequences were successfully extracted from newly diagnosed individuals, each accompanied by reliable epidemiologic information. The analysis revealed the presence of multiple HIV-1 subtypes, with CRF 07_BC (40.57%) and CRF01_AE (38.42%) being the most prevalent. Additionally, six other subtypes and unique recombinant forms (URFs) were identified. The prevalence of TDR among the newly diagnosed cases was 7.84% during the study period. Employing a genetic distance threshold of 1.50%, the construction of the molecular transmission network resulted in the identification of 137 clusters, encompassing 613 nodes, which accounted for approximately 52.80% of the cases. Multivariate analysis indicated that individuals within these clusters were more likely to be aged ≥ 60, unemployed, baseline CD4 cell count ≥ 200 cells/mm3, and infected with the CRF119_0107 (P < 0.05). Furthermore, the analysis of larger clusters revealed that individuals aged ≥ 60, peasants, those without TDR, and individuals infected with the CRF119_0107 were more likely to be part of these clusters.ConclusionsThis study revealed the high risk of local HIV transmission and high TDR prevalence in Nanjing, especially the rapid spread of CRF119_0107. It is crucial to implement targeted interventions for the molecular transmission clusters identified in this study to effectively control the HIV epidemic.

Burden and Patterns of Multidrug-Resistant Tuberculosis in Pediatric and Adolescent Patients at a Tertiary Care Hospital in Pakistan.

Background Multidrug-resistant tuberculosis (MDR-TB) presents a significant global health challenge, particularly in developing countries. This study focuses on the burden and pattern of pediatric and adolescent MDR-TB in a tertiary care hospital setting. Aims/objectives The main objective is to evaluate MDR-TB's prevalence and resistance patterns among pediatric and adolescent patients, highlighting critical demographic factors and resistance trends. Materials and methods The study utilized a prospective analytical design in two tertiary care facilities, focusing on children aged four months to 18 years diagnosed with extra-pulmonary tuberculosis. Data on demographic profiles, clinical outcomes, and drug resistance patterns were collected and analyzed using theStatisticalPackage for the Social Sciences (IBMSPSSStatisticsforWindows,IBMCorp., Version 27.0, Armonk,NY). Results Out of 99 enrolled participants, 63 (63.64%) met the inclusion criteria. The mean age was 70.22±48.90 months. A significant proportion, 60 (95.2%) of the cases, originated from Punjab. Notably, 10 (15.9%) of the cultures demonstrated MDR, with specific resistance observed to isoniazid (INH) in 10 (15.9%) cases, rifampicin (RIF) in 11 (17.5%) cases, and pyrazinamide (PZA) in seven (11.1%) cases. The study also recorded a high prevalence of tuberculous meningitis, affecting 52 (82.5%) participants, and malnutrition, affecting 49 (77.8%). Conclusions MDR-TB in 10 (15.9%) of the study children and adolescents presenting in Pakistan's specialized health centresis a notable burden.This points to a need for better diagnostic methods and treatment plans for pediatric patients. Implementing advanced diagnostics and personalized therapies is crucial for managing MDR-TB in susceptible demographics. Our findings emphasize the importance of updating treatment protocols to tackle the impacts of MDR-TB and its evolving resistance.

The Accessibility, Affordability, and Early Detection of Tuberculosis

Tuberculosis (TB) stands as the leading cause of death from an infectious agent worldwide, with a high fatality rate. It is primarily transmitted through the airborne Mycobacterium tuberculosis (M. tb) from an infected patient to a healthy individual. Annually, millions of people go undiagnosed for TB at an early stage and lose the opportunity for timely treatment, making early TB diagnosis a high priority. Prevalence surveys also have shown that many individuals with lab-confirmed TB disease lack symptoms and do not seek diagnosis or care. Moreover, delays in initiating treatment are commonly observed even after TB diagnosis, heightening the risk of disease transmission in the community. This research paper aims to address these challenges by analyzing the impact of various socioeconomic, policy, and healthcare factors on the accessibility of TB diagnosis. Furthermore, it aims to analyze current effective tuberculosis diagnosis techniques, assessing their strengths and weaknesses. Despite the presence of promising new drugs in the clinical trial stage offering hope for patients with extensively drug-resistant tuberculosis (XDR-TB) or very drug-resistant TB, the primary challenge remains the timely and species-specific detection of Tuberculosis. In addition to the detection of disease, identifying its drug resistance patterns and ensuring the availability of highly active short-course drug treatments are imperative, ideally lasting just a few weeks. This is essential to support the World Health Organization’s (WHO) Global efforts to “END TB” by 2030, to reach 90% of people primarily through early diagnosis, innovative treatments, and vaccine development.

Antibiotic resistance of Escherichia coli isolated from food and clinical environment in China from 2001 to 2020

Antibiotics are widely used in China's aquaculture, agricultural, and clinical settings and can lead to antibiotic resistance in various pathogens. Although the pooled prevalence estimate (PPE) and antibiotic resistance of Escherichia coli (E. coli) in food and clinical settings has been extensively studied, a comprehensive analysis of the published literature is lacking. We conducted a comprehensive search for research indicators for 2001–2020 in eight major Chinese and English literature databases. Antibiotic PPE and resistance trends of 5933 and 29,451 E. coli isolates were screened and analysed in 35 food studies (total 1821) and 62 clinical studies (total 5159). E. coli strains derived from food had the highest antibiotic resistance rate to tetracycline (TET, 71.3 %), followed by trimethoprim-sulfamethoxazole (SXT, 62.5 %) and cefazolin (CFZ, 36.2 %). E. coli strains isolated from clinical environments were highly resistant to piperacillin (PIP, 71.7 %), TET (68.3 %) and CFZ (60.9 %), consistent with foodborne E. coli drug resistance patterns. E. coli strains isolated from food and clinical samples collected in laboratories carry multiple antibiotic resistance genes (ARGs), such as blaTEM, gryA, gryB, sul1, and tetA, making E. coli a reservoir of ARGs. This study highlights the presence of drug-resistant E. coli pathogens and ARGs in food and clinical environments.

Bacterial profile, drug resistance pattern, clinical and laboratory predictors of ascites infection in cirrhosis patients

Ascites is a pathological collection of free fluid in the peritoneal cavity, which is a common complication in patients with cirrhosis, an advanced liver disease. Bacterial infection increases the mortality rate of hospitalized patients with cirrhosis, irrespective of the severity of the liver disease. Around 60% of patients with compensated cirrhosis developed ascites within 10 years during the course of their disease. The in-hospital mortality rate due to spontaneous bacterial peritonitis (SBP) could exceed 90%, but with early diagnosis and prompt antibiotic therapy, this rate has been shown to decrease to 20%. Here, we enrolled adult (age ≥ 18) patients with liver disease with evidence of cirrhosis who developed ascites and assessed the presence of spontaneous ascites fluid infection (SAFI) in these patients. Of the total 218 patients, 22.9% (50/218) develop ascites infection. The liver organ function tests like alanine aminotransferase, aspartate aminotransferase, total bilirubin, and direct bilirubin were found to be significantly (P < 0.05) higher in patients with ascites fluid infection compared to patients with non-ascites fluid infection. Of the gram-negative bacteria, K. pneumonia and E. coli were isolated and found to be 100% resistant to amoxicillin and clavulanate. From the gram-positive bacterial isolates, S. aureus was only resistant to penicillin, whereas Str. viridans was resistant to ceftriaxone, cefotaxime, cefepime, and penicillin. On the other hand, clinical features such as a history of jaundice, low arterial blood pressure, and ultrasound results such as a shrunken liver and enlarged spleen were also independent predictors of spontaneous bacterial peritonitis. In conclusion, given the high probability of death following SAFI, early detection, and treatment, as well as knowledge of the microbial agent, resistance profile, and predictive markers in various contexts, are essential for the timely diagnosis and management of SAFI in these patients.

Evaluation of genetic correlation with fluoroquinolones resistance in rifampicin-resistant Mycobacterium tuberculosis isolates

ObjectiveTo detect levofloxacin (LFX) and moxifloxacin (MFX) resistance among rifampicin-resistant tuberculosis (RR-TB) isolates, and predict the resistance level based on specific mutations in gyrA and gyrB genes. MethodsA total of 686 RR-TB isolates were collected from Chinese Drug Resistance Surveillance Program from 2013 to 2020. The minimum inhibitory concentrations (MICs) of 12 anti-TB drugs were acquired using the broth microdilution method, followed by whole genome sequencing (WGS) analysis. ResultsAmong the 686 RR isolates, the most prevalent resistance was to isoniazid (80.5 %) and ethambutol (28.4 %), followed by LFX (26.1 %) and MFX (21.9 %). The resistance rate of LFX (26.1%–99.4 %) was higher than that of MFX (21.9%–83.3 %) across various drug resistance patterns. Of the 180 fluoroquinolones (FQs) resistant isolates, 168 (93.3 %) had mutations in quinolone-resistant determining regions (QRDRs) with 21 mutation types, and Asp94Gly (32.7 %, 55/168) was the predominant mutation. Isolates with mutations in Asp94Asn and Asp94Gly were associated with high levels of resistance to LFX and MFX. Using broth microdilution method as gold standard, the sensitivities of WGS for LFX and MFX were 93.3 % and 98.0 %, and the specificities were 98.6 % and 95.0 %, respectively. ConclusionThe resistance rate of LFX was higher than that of MFX among various drug resistance patterns in RR-TB isolates. The gyrA Asp94Gly was the predominant mutation type underlying FQs resistance. However, no significant difference was observed between mutation patterns in gyrA gene and resistance level of FQs.

The distribution and antibiotic-resistant characteristics and risk factors of pathogens associated with clinical biliary tract infection in humans.

Biliary Infection in patients is a common and important phenomenon resulting in severe complications and high morbidity, while the distributions and drug resistance profiles of biliary bacteria and related risk factors are dynamic. This study explored the characteristics of and risk factors for biliary infection to promote the rational use of antibiotics in clinically. Bacterial identification and drug susceptibility testing were completed using the Vitek 2 Compact analysis system. The distribution and antibiotic-resistant characteristics of 3,490 strains of biliary bacteria in patients at Nankai Hospital from 2019 to 2021 were analyzed using Whonet 5.6 and SPSS 26.0 software. We then retrospectively analyzed the clinical data and risk factors associated with 2,340 strains of Gram-negative bacilli, which were divided into multidrug-resistant bacteria (1,508 cases) and non-multidrug-resistant bacteria (832 cases) by a multivariate Cox regression model. A total of 3,490 pathogenic bacterial strains were isolated from bile samples, including 2,340 (67.05%) Gram-negative strains, 1,029 (29.48%) Gram-positive strains, and 109 (4.56%) fungal strains. The top five pathogenic bacteria were Escherichia coli, Klebsiella pneumoniae, Enterococcus faecium, Enterococcus faecalis, and Pseudomonas aeruginosa. The rate of Escherichia coli resistance to ciprofloxacin increased (p < 0.05), while the resistance to amikacin decreased (p < 0.05). The resistance of Klebsiella pneumoniae to cephalosporins, carbapenems, β-lactamase inhibitors, cephalases, aminoglycosides, and quinolones increased (p < 0.05), and the resistance of Pseudomonas aeruginosa to piperacillin, piperacillin/tazobactam, ticacillin/clavulanic acid, and amicacin declined significantly (p < 0.05). The resistance of Enterococcus faecium to tetracycline increased by year (p < 0.05), and the resistance of Enterococcus faecalis to erythromycin and high-concentration gentamicin declined (p < 0.05). Multivariate logistic regression analysis suggested that the administration of third- or fourth-generation cephalosporins was an independent risk factor for biliary infection. In summary, Gram-negative bacilli were the most common pathogenic bacteria isolated from biliary infection patients, especially Escherichia coli, and the rates and patterns of drug resistance were high and in constant flux; therefore, rational antimicrobial drug use should be carried out considering risk factors.

Actionable mechanisms of drug tolerance and resistance in Mycobacterium tuberculosis.

The emergence of antimicrobial resistance (AMR) across bacterial pathogens presents a serious threat to global health. This threat is further exacerbated in tuberculosis (TB), mainly due to a protracted treatment regimen involving a combination of drugs. A diversity of factors contributes to the emergence of drug resistance in TB, which is caused by the pathogen Mycobacterium tuberculosis (Mtb). While the traditional genetic mutation-driven drug resistance mechanisms operate in Mtb, there are also several additional unique features of drug resistance in this pathogen. Research in the past decade has enriched our understanding of such unconventional factors as efflux pumps, bacterial heterogeneity, metabolic states, and host microenvironment. Given that the discovery of new antibiotics is outpaced by the emergence of drug resistance patterns displayed by the pathogen, newer strategies for combating drug resistance are desperately needed. In the context of TB, such approaches include targeting the efflux capability of the pathogen, modulating the host environment to prevent bacterial drug tolerance, and activating the host anti-mycobacterial pathways. In this review, we discuss the traditional mechanisms of drug resistance in Mtb, newer understandings and the shaping of a set of unconventional approaches to target both the emergence and treatment of drug resistance in TB.

Detection and antibiogram of bacterial contaminants in some commonly consumed indigenous street vended foods in Kasua Central Market in Kaduna North, Kaduna State, Nigeria

Some indigenous ready-to-eat foods, due to its affordability and availability serve as a major alternative to restaurants and high profiled eateries in developing countries. The hygiene standard of these foods is a critical point that needs to be considered due to microbial contamination by potential pathogens. A triplicate of three different food samples: Fura, Nunu, and Tuwo were collected and analysed to determine their microbiological safety. Bacterial isolates were identified using standard methods while antibiotic sensitivity test and multiple drug resistance pattern were carried out. The isolated bacteria: Escherichia coli, Klebsiella pneumoniae, Salmonella 100yphi, Staphylococcus aureus, and Enterobacter sp. While fungal isolates include: Aspergillus niger, Aspergillus flavus, Rhizopus. oryzae and Penicillium sp. Salmonella sp. was observed to be resistant to 70% of the antibiotics while both Klebsiella sp. And Enterobacter sp. exhibited resistance to 60% of the tested antibiotics. S. aureus had the least resistance to about 30% of the tested Gram-positive antibiotics. Out of all the tested antibiotics, only Tarivid was observed to be effective against all the Gram-negative bacterial isolates, while Reflacine and Ciprofloxacine were effective against 80% of them. The presence of coliform bacteria in the sampled foods raise a great concern about the safety of the street vended foods in the sampled region in Nigeria. The microbiologically low quality of the vended ready-to-eat foods assayed in this study might have resulted from a relatively low level of hygiene observed by the vendors, as well as absence of regulatory body or hygiene codes to guide the street food vendors. From the results of this study, efforts should be intensified by all concerned to make sure that the safety of people remains paramount in the ways the vended foods are produced and distributed.

Molecular tools are crucial for malaria elimination.

The eradication of Plasmodium parasites, responsible for malaria, is a daunting global public health task. It requires a comprehensive approach that addresses symptomatic, asymptomatic, and submicroscopic cases. Overcoming this challenge relies on harnessing the power of molecular diagnostic tools, as traditional methods like microscopy and rapid diagnostic tests fall short in detecting low parasitaemia, contributing to the persistence of malaria transmission. By precisely identifying patients of all types and effectively characterizing malaria parasites, molecular tools may emerge as indispensable allies in the pursuit of malaria elimination. Furthermore, molecular tools can also provide valuable insights into parasite diversity, drug resistance patterns, and transmission dynamics, aiding in the implementation of targeted interventions and surveillance strategies. In this review, we explore the significance of molecular tools in the pursuit of malaria elimination, shedding light on their key contributions and potential impact on public health.

Prevalence and Antibiotic Susceptibility of Urinary Tract Infections in Diabetic and Non Diabetic Individuals: A Prospective Study

Background &amp; Objectives: Diabetes mellitus is increasingly recognized as a major health concern worldwide, particularly in developing countries like India. Diabetic individuals are known to have a higher susceptibility to urinary tract infections (UTIs), compounded by the emergence of drug-resistant uropathogens. This study aims to determine the prevalence and etiology of UTIs in diabetic patients. Materials and Methods: A cross-sectional prospective study involving 220 individuals was conducted from March to April 2023 to assess the spectrum of pathogens causing UTIs and their antibiotic susceptibility. Primary cultures were performed on McConkey agar and sheep blood agar, followed by identification and antimicrobial susceptibility testing (AST) using the Vitek2 system and Kirby Bauer's disc diffusion method on Mueller-Hinton agar. Results: Of the 220 samples tested, 150 exhibited significant bacteriuria, with 36 (75%) of 48 diabetic individuals testing positive for UTIs. Gram-negative bacilli (GNB) accounted for 135 (61.4%) isolates, with Escherichia coli (E. coli) being the most prevalent pathogen (52.7%), followed by Klebsiella spp. (25.3%). Among gram-positive organisms, Enterococcus spp. (5.3%) were predominant, with Candida isolates detected in 3 cases (2%). Meropenem (87.6%) exhibited the highest susceptibility against GNB, followed by Netilmycin (87.6%) and Imipenem (82.5%). For gram-positive organisms, Imipenem and Nitrofurantoin demonstrated high susceptibility. Conclusion: E. coli emerged as the predominant pathogen in both diabetic and non-diabetic populations. High sensitivity to meropenem, imipenem, amikacin, and fosfomycin was observed in both groups, suggesting their potential for empirical treatment. Regular surveillance of drug resistance patterns is crucial for identifying evolving resistance trends and optimizing treatment strategies.

The Abundance of Plasmid-Mediated Quinolone Resistance Genes in Enterobacter cloacae Strains Isolated from Clinical Specimens in Kermanshah, Iran.

Enterobacter cloacae (E. cloacae) is one of the most common Enterobacteriaceae causing nosocomial infections. Plasmid-mediated quinolone resistance (PMQR) determinants have been considered recently. This study evaluated the abundance of PMQR genes in strains of E. cloacae obtained from clinical samples in Kermanshah, Iran. In this descriptive cross-sectional study, after collecting 113 isolates of E. cloacae, their identity was confirmed using specific biochemical tests. After determining their drug resistance patterns using disc diffusion, the phenotypic frequency of extended-spectrum beta-lactamase (ESBL)-producing isolates was measured by the double-disk synergy test (DDST) method. The isolates were examined for the presence of qnrA, qnrB, qnrS, and aac(6')-Ib-cr genes by the polymerase chain reaction (PCR) assay. The antibiotic resistance rate of E. cloacae isolates varied from 9.7% to 60.2%; among them, 78% were multidrug-resistant (MDR). The highest quinolone resistance was observed in ESBL-producing strains of E. cloacae. The frequency of positive isolates for PMQR and ESBL was 79.6% and 57.5%, respectively. The genes aac(6')-ib-cr (70.8%) and qnrB (38.1%) had the highest frequency among other genes. The number of isolates simultaneously carrying 2 and 3 genes was 64 and 5 isolates, respectively. The obtained results indicate a high degree of quinolone resistance among ESBL-producing E. cloacae strains. Nevertheless, there was a significant relationship between the PMQR gene and ESBL-positive isolates. Therefore, special attention should be paid to molecular epidemiological studies on antibiotic resistance to quinolones and beta-lactamases in these strains.

Isolation and Identification of Vibrio Species from Different Types of Water Sources Along with Their Drug Susceptible Pattern

Abstract Background: Human activities are almost usually the cause of contaminated water supplies and places with large population densities and intensive land usage are particularly prone to pollution of drinking water sources. It is challenging to detoxify polluted water sources. Cholera is an acute form of diarrheal disease that plagued human civilization over the centuries. Vibrio spp., commonly found in aquatic environments, are the most common cause of bacterial gastroenteritis in the world, those may spread to humans through the ingestion of contaminated drinking water or exposure to seawater. Methods: In the present study, a total of 12 samples were collected from four types of water sources for the isolation of Vibrio spp. along with their drug-resistant pattern through conventional, biochemical, and antibiotic disc diffusion methods. Results: The samples were enriched into alkaline peptone water and then inoculated into culture media such as nutrient agar, MacConkey, and TCBs agar medium. After incubation for 24 h at 37°C on TCBS agar, yellow and green colonies were screened out for biochemical identification. Nonsucrose-fermenting Vibrio parahaemolyticus, Vibrio mimicus, and Vibrio vulnificus showed green colonies, and sucrose-fermenting Vibrio cholera and Vibrio alginolyticus showed yellow colonies on TCBS. The antibiotics ERY (15 μg), PCN (10 μg), CEX (30 μg), and VAN (30 μg) were completely resistant while the more effective antibiotics against Vibrio spp. were SXT (25 μg), CHL (30 μg), and GEN (30 μg). However, ciprofloxacin and nitrofurantoin showed moderate efficacy. Conclusion: To expand current knowledge on the occurrence, ecological niche, and persistence of potential human pathogenic Vibrio spp. in aquatic environments, the extensive laboratory experiment is required. To sum up, this kind of information is crucial for bringing attention to the existence of Vibrio spp. and enabling prompt implementation of preventive measures.

Drug Resistant XDR Typhoid in Children Admitted in a Tertiary Care Hospital

Objective: To evaluate the prevalence and patterns of drug-resistant typhoid fever, including extensively drug-resistant (XDR) and multidrug-resistant (MDR) strains, among children admitted to a tertiary care Hospital. Methodology: This descriptive observational study was done at Paediatric department of LUMHS from May 2022-november 2022. Children aged 1-12 years, both gender and with confirmed diagnosis of typhoid fever based on positive blood cultures were included. Blood culture samples were collected from pediatric patients presenting with suspected typhoid fever are processed according to standard microbiological techniques. Isolation and identification of Salmonella Typhi are performed using appropriate culture media and biochemical tests. Antimicrobial susceptibility testing was conducted using standardized methods. Drug resistance patterns, including multidrug resistance (MDR) and extensively drug-resistant (XDR) phenotypes, are determined based on susceptibility testing results. MDR was defined as resistance to at least three classes of antibiotics commonly used for typhoid fever treatment, while XDR indicates additional resistance to fluoroquinolones and third-generation cephalosporins, which are frontline treatment options for typhoid fever. Data was entered and analyzed using SPSS version 26. Results: A total of 43 patients were studied, their mean age was 5.91 years. Boys were 72.15 and girls were 27.9%. Most of the cases 65.1% were consuming tap water. MDR resistance was observed in 9.4% of the cases, while XDR resistance was highly frequent among 83.7% of the patients. Very few cases 16.3% had history of typhoid vaccination. However, MDR and XDR resistance were statistically insignificant according to type of water consumption (p-&gt;0.05). Conclusion: In conclusion, the study revealed alarmingly high prevalence rates of extensively drug-resistant (XDR) typhoid with multidrug-resistant (MDR) strains observed in 9.4% of cases. These findings emphasize the urgent need for comprehensive strategies that address both antimicrobial resistance and vaccination efforts to combat the increasing burden of XDR typhoid in children.