Predominant Isolates Research Articles

Comparative evaluation of phenotypic methods for detection of MBL producing Pseudomonas aeruginosa strains isolated from burn wound infections

Introduction: Pseudomonas aeruginosa is a notorious nosocomial pathogen with a resistant drug profile and a predominant isolate in burn wound infections. Recently Metallo beta lactamase (MBL) producing isolates have emerged particularly in P.aeruginosa leading to failure of therapy with carbapenems with increased mortality and morbidity in burn units. Objectives: To detect MBL production among the imipenem resistant isolates of P.aeruginosa by different phenotypic methods – Modified Hodge test (MHT), Combined disc test (CDT), Imipenem-EDTA Double disc synergy test (DDST) and MBL-E-test. Materials and Methods: A total of 108 clinical isolates of P.aeruginosa obtained in 189 pus samples collected from different burn wound sites, were subjected to antimicrobial susceptibility testing by modified Kirby-Bauer disc diffusion method. All the imipenem resistant isolates were further tested for MBL-production by MHT, CDT, DDST and MBL-E-test. Results: Out of 108 isolates of P.aeruginosa 26 (24.07%) ware imipenem resistant. Among 26 imipenem resistant isolates 16(61.54%) were detected as MBL producers by MBL-E-test, 15(57.69%) by DDST, 14(53.85%) by CDT and 11(42.31%) by MHT. Considering MBL-E-test as standard, maximum sensitivity was shown with DDST (93.75%) followed by CDT (87.5%) and MHT (68.75%). Conclusion: A comparative evaluation of MHT, CDT and DDST against MBL-E-test proved DDST to be most effective, with higher sensitivity and specificity. DDST is observed to be an economical feasible alternative compared to MBL-E-test as a regular screening test in MBL detection in critically ill. Keywords: Pseudomonas aeruginosa, Metallo beta lactamases (MBLs), Modified Hodge test (MHT), Combined disc test (CDT), Imipenem -EDTA Double disc synergy test (DDST), MBL-E-test.

The use of antifungal oat‐sourdough lactic acid bacteria to improve safety and technological functionalities of the supplemented wheat bread

AbstractIn the present study, predominant lactic acid bacteria (LAB) were isolated from oat sourdough. Then, the isolates were screened based on their in vitro antifungal activity. Subsequently, biotechnological capabilities of the selected LAB were evaluated in wheat bread supplemented with controlled fermented oat containing the isolate. Pediococcus pentosaceus was molecular identified as predominant antifungal isolate. Based on our results, fermented oat not only significantly (p < .05) reduced the mold expansion on the produced breads, but also improved the quality attributes of the product. Crumb porosity and antioxidant capacity of the supplemented bread revealed the positive effects of the isolate on textural and functional characteristics of the enriched bread. Wheat bread supplemented with controlled fermented oat had also the highest 2,2‐diphenyl‐1‐picrylhydrazyl radical scavenging activity compared to the other samples. Accordingly, the potential applications of P. pentosaceus isolate as profunctional starter culture in processing of mixed wheat‐oat sourdough bread were verified.

Clinical and Bacteriologic Profile of Neonatal Sepsis in a Tertiary Care Hospital: A 5-Year Review

Background: Neonatal sepsis, a clinical syndrome characterized by non-specific signs and symptoms, is the most common cause of neonatal mortality and morbidity. It is classified into early or late-onset depending on the onset of symptoms, if within the first 72 hours or later. Early onset sepsis (EOS) occurs due to ascending infection following rupture of membranes or during passage through an infected birth canal. Late onset sepsis (LOS) can be nosocomial or community-acquired. A high index of suspicion and timely and judicious use of antibiotics are needed to achieve good outcomes. Objective: This study looked into the clinical and bacteriologic profile of neonatal sepsis in a tertiary care hospital from January 2013 to December 2017. Methodology: This was a retrospective observational study. Data on maternal risk factors, mode of delivery, gestational age, birth weight, birth setting, clinical manifestations, and blood culture and sensitivity were gathered. Descriptive statistics was used to analyze the data. Results: Majority of cases were late onset sepsis with an equal distribution in those born via normal spontaneous delivery (NSD) and cesarean section (CS). There were more culture- positives in low birth weight (LBW) infants and those not delivered within a hospital. The most common maternal risk factor was UTI. Majority of culture-positive newborns presented with respiratory distress, poor feeding, fever, and irritability with respiratory distress being the most common manifestation for both EOS and LOS. Predominant isolates were CONS, E. coli and Klebsiella sp. Both E. coli and Klebsiella were resistant to both first-line empiric antibiotics – ampicillin and gentamicin but highly sensitive to piperacillin-tazobactam and imipenem. Conclusion: Clinical signs and symptoms of neonatal sepsis are non-specific. The presence of respiratory distress, fever, poor feeding, and irritability together with other risk factors should raise suspicion for sepsis and prompt investigation and treatment. Predominant isolates seen were CONS, E. coli and Klebsiella sp. with resistance to first-line empiric antibiotics.

Bacterial etiology and risk factors of Community acquired pneumonia (CAP) among adult patients in a Tertiary Care Hospital in South India

Background: Community acquired pneumonia (CAP) is a significant cause of morbidity and mortality among adult patients worldwide. In India, data on the bacterial etiology of CAP, antimicrobial resistance profiles, risk factors and outcomes is limited. This study was aimed at determining the bacterial etiology of CAP, their antimicrobial resistance profile, and outcomes since the choice of empirical treatment of CAP often remains challenging due to the development of drug resistant pathogens. Methods and materials: A prospective pilot study was carried out among 100 adult subjects ≥18 years of age admitted to a tertiary care hospital in South India with the diagnosis of CAP for a period of 1 year. Blood, sputum, endotracheal tip and pleural fluid were obtained for microbiological investigations within 48 h of admission. Antimicrobial susceptibility testing was performed on culture positive isolates by Kirby Bauer disk diffusion technique. Descriptive statistics and odds ratio with its 95% confidence interval was conducted using SPSS statistical software package, version 22.0. Results: A total of 100 subjects diagnosed for CAP were enrolled in the study. Majority of patients were males (63%), aged >45 years (79%), and resided in a rural area (57%). Most patients had a severe clinical course including intensive care admission (46%), ventilatory support (15%) on admission with 16% mortality. Bacterial pathogens could be identified only among 30% of the participants. 13(43%) of the isolates were multidrug resistant. Klebsiella pneumoniae [n = 16(53%)] was the most predominant isolate followed by Pseudomonas aeruginosa, Streptococcus pneumoniae, and Staphylococcus aureus. Chronic cardiovascular disease [OR 5.76 (95%CI: 1.75-18.88)], chronic liver disease [OR 6.67(95%CI: 1.47-30.27)], chronic kidney disease [OR 3.79 (95%CI: 0.97-11.7)], altered sensorium [OR 6.6(95%CI: 1.85-23.6)], sepsis and septic shock [OR 8.53 (95%CI: 2.64-27.59)] were found to be significantly associated with mortality. Conclusion: Gram negative bacteria were the predominant etiological agent responsible for CAP in our setting with multidrug resistant strains and severe clinical course. Chronic comorbid conditions must be monitored in order to increase the chance of survival among CAP patients.

Prevalence of Colistin-resistant Gram-negative Isolates Carrying the mcr-1 Gene among Patients Visiting a Tertiary Care Center.

Gram-negative isolates harboring mobilized colistin resistance (mcr-1) gene are a great threat to human health. They have been reported worldwide among various bacterial isolates. This work aimed to study the prevalence of colistin resistance among Gram-negative bacteria and the incidence of mcr-1 gene among these isolates. A descriptive cross-sectional study was done at a tertiary care center from June 2016 to February 2017. An ethical approval was taken from review board of the Nepal Health Research Council (Reg. no: 274/2016). Convenience sampling was used. The data was collected and analyzed using Microsoft Excel 2010 and Statistical Package for Social Sciences (SPSS) Version 16 . Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. Among 485 gram-negative isolates, only 13 (2.68%) (1.26-6.62 at 95% Confidence Interval) isolates were colistin-resistant and mcr-1 was present in two isolates. Predominant colistin-resistant isolates were E. coli 6 (4.1%), Enterobacter spp 2 (2.81%), and Acinetobacter spp 2 (2.81%). A high level of colistin-resistance was noted in 4 (30.7%) isolates as indicated by the very high value of colistin MIC (>256 μg/ml). ICU was the major site of isolation of colistin-resistant and mcr-1 positive pathogens. The majority of colistin-resistant isolates were highly drug-resistant and were sensitive only to polymyxin B. Antibiotics like imipenem, amikacin, gentamicin, aztreonam, ciprofloxacin, and piperacillin-tazobactam were effective for few of these isolates. Though the prevalence of mcr-1 gene was low among colistin-resistant gram-negative isolates, the resistant pattern was quite alarming as these isolates were highly drug-resistant.

Factors and Causes of Puerperal Sepsis in Kilimanjaro, Tanzania: A Descriptive Study among Postnatal Women who Attended Kilimanjaro Christian Medical Centre.

Background:Puerperal sepsis is the major cause of maternal morbidity and mortality worldwide. About 94% of maternal mortality occur in low and middle-income countries including Tanzania.Objective:To estimate the prevalence, document factors and causes of puerperal sepsis among postnatal women who attended postnatal care in Kilimanjaro Christian Medical Centre Hospital in the year 2015.Methodology:A descriptive cross-sectional study was carried out at Kilimanjaro Christian Medical Centre, Tanzania. A total of 183 medical records of attendance in 2015 were used for the study. Information about the isolated organism in culture was retrieved from the Laboratory Information System.Results:The prevalence of puerperal sepsis was 11.5% (21/183). The most common factors and causes of puerperal sepsis included caesarean section 66.7% (14/21), postpartum haemorrhage 57.1% (12/21), moderate to severe anaemia 61.9% (13/21), prolonged labour 76.2% (16/21) and bacterial infection 90.5% (19/21). The difference was significant at p<.05. The most bacteria species isolated among women with puerperal sepsis was Staphylococcus spp 50.0% (7/14), Escherichia 28.6% (4/14) and Streptococcus spp 21.4% (3/14).Conclusion:Puerperal sepsis is prevalent (11.5%) at Kilimanjaro Christian Medical Centre. Staphylococcus spp was found to be a predominant isolate which causes puerperal sepsis followed by E. coli and Streptococcus spp.

Incidence of Urinary Tract Infection among Diabetic Patients in Abakaliki Metropolis

The investigation of urinary tract infection (UTI) among diabetic patients 15-51 years and above was assessed using 100 mid-stream urine specimen with the objective of isolating and identifying different types of bacteria and their respective frequencies among diabetic patients attending diabetic clinic at Alex Ekwueme Federal University Teaching Hospital, Abakaliki. A urine culture was performed combined with a full report of urine to establish the diagnosis. The result showed that the majority of bacteria in urinary tract infections were in 27-32 years of age group (71.4%) and lowest in 15-20 years age group (0%). The predominant bacteria isolates and their percentage occurrences include; Escherichia coli (39.13%), Klebsiella pneumonia (21.74%), Proteus (8.69%), Pseudomonas aeruginosa (8.69%), Streptococcus (8.69%), Staphylococcus aureus (6.52%), Enterococcus faecalis (4.25%). There was a high prevalence of the isolated organisms in female (47.7%) compared to males (36%). It follows that most predominant agent of UTI in diabetic patients in Abakaliki Metropolis is Escherichia coli followed by Klebsiella pneumonia.

Utility of polymerase chain reaction for rapid diagnosis of pediatric fungal keratitis : A comparative study with conventional mycological work up

Background: Fungal keratitis (FK) is a serious infection with bad complications in paediatric population. Thus, rapid diagnosis is necessary. Early diagnosis is a beneficial tool necessary for better management and prognosis of FK and also for prevention of subsequent complications such as endophthalmitis, amblyopia ,and loss of vision . In recent years, polymerase chain reaction became the predominant diagnostic method for mycotic keratitis, being frequently employed for complementing microbiological approaches.The aim of this study to determine the risk factors of paediatric fungal keratitis and evaluate the utility of polymerase chain reaction (PCR) in diagnosis by comparing its sensitivity and specificity with conventional fungal culture (the gold standard ).Methods: corneal scrapings obtained from clinical suspected patients with fungal keratitis and subjected to direct microscopic examination with 10% KOH, gram smear, fungal culture and conventional PCR using common probe to all fungi. Results: The most prominent predisposing factor for FK was ocular trauma (n=40, 57%) followed by vernal keratoconjunctivitis (n=14, 20%). Out of the 70 studied cases featuring presumed fungal keratitis, 35 were culture positive (50%), with Fusarium spp. (48.5%) and Aspergillus spp. (20%) were the predominant isolates. By comparing fungal culture (the gold standard) versus10 % KOH examination, Gram smear, and PCR were 57.1%, 28.6%, and 97.1%, respectively. Conclusion Ocular trauma and vernal keratoconjunctivitis are the most common risk factors for pediatrics fungal keratitis with Fusarium spp. and Aspergillus spp. are the most common isolated fungi. PCR is a sensitive technique for diagnosing of paediatric patients with fungal keratitis.

Aerobic bacteriological profile of acute exacerbations of chronic obstructive pulmonary disease in a tertiary care hospital

COPD is a major cause of morbidity and one of the predominant causes of the death across the world, characterised by a worsening in the patient’s respiratory symptoms which is beyond normal day-to-day variations and eventually leads to a change in the medication. Causative agents for the exacerbation includes factors such as viruses, bacteria and common pollutants. This was a retrospective study conducted from sputum samples received from 551 diagnosed cases of AECOPD to the department of microbiology KIMS Hubli. Out of 551 patient’s sputum samples, 335(60.79%) were Males and 216 (39.20%) were females. The total number of culture positive isolates were 51.17%. Among the 282 culture positive isolates, 280 were Mono-microbial (99.3%) and 2 were Polymicrobial (0.7%). Among 282 isolates, Gram Negative Bacilli were 263 (93.26%) and Gram Positive Cocci were 19 (6.74%) Among the total isolates 116 (41.13%) was the predominant isolate followed by 63 (22.34%), 28(9.93%), 26 (9.22%), NFGNB 25 (8.87%), 5 (1.79%), 16 (5.67%), CONS 2(0.7%) and 1(0.35%). 51(43.96%) of the isolates were found to be ESBL producers. In case of gram positive organisms, 2(12.5%) were methicillin resistant. This study shows that and are the commonest organisms associated with acute exacerbation of COPD. A high rate of ESBL producers was observed.

Microorganisms causing respiratory diseases in children in relation to age and diagnosis

Community-acquired pneumonia (CAP) in children is still one of the leading causes of morbidity and mortality, especially in developing countries. The World Health Organization (WHO) has reported that pneumonia accounts for 15% of all deaths of children under 5 years old. The aim of the present study was to find out the predominance of microorganisms in the respiratory tract in children. 334 strains of microorganisms were isolated: Gram-positive – 293 strains, Gram-negative – 41. From the pharynx 183 strains were isolated, from the nose – 94, from sputum – 57. Among Gram-positive microorganisms the following were isolated: Staphylococcus aureus 44 strains of microorganisms, S. epidermidis – 75, Group A β-hemolytic streptococci – 39, viridans streptococci – 55, Streptococcus pneumoniae – 34, Enterococcus faecalis – 2, Candida spp. – 38, Corynebacterium pseudodiphthericum – 6. Among Gram-negative microorganisms the following were isolated: Escherichia coli 4 strains of microorganisms, Klebsiella pneumoniae – 13, Pseudomonas aeruginosa – 6, Haemophilus influenzae – 11, Enterobacter cloacae – 7. Children were divided by age and diagnosis into four groups: I group – children with acute bronchitis (0–5 years of age), II group – children with acute bronchitis (5–18 years of age), III group – children with CAP (0–5 years of age), IV group – children with CAP (5–18 years of age). Materials used in the research – nasal swabs, throat swabs and sputum. Microorganisms were isolated and identified using standard microbiological methods. S. aureus was the predominant microorganism isolate from the pharynx in children with bronchitis (0–5 years). Group A β-hemolytic streptococci were isolated most often from the pharynx in children with bronchitis older than 5 years and in children with CAP less than 5 years of age. S. pneumoniae was most often isolated from the pharynx in children older than 5 years of age with CAP. S. aureus was the main microorganism, isolated from the nose in children with bronchitis in all age groups; in patients with CAP it was the predominant microorganism in children older than 5 years of age. S. aureus was the predominant microorganism, isolated from sputum in children with bronchitis older than 5 years. S. pneumoniae was the predominant microorganism, isolated from sputum in children with CAP older than 5 years. The research showed that S. pneumoniae is still one of the main pathogens that cause CAP in school aged children.

Study of Antibiotic Susceptibility among Bacterial Isolates in Neonatal Intensive Care Unit of a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

Neonatal sepsis is a major cause of neonatal morbidity and mortality worldwide, especially in developing countries like Nepal. Antibiotic resistance among microorganisms poses new challenges in the treatment of neonatal sepsis. The present study is conducted with the objectives of determining clinico-bacteriological profile and antibiotic susceptibility among isolated bacteria in a neonatal intensive care unit. A descriptive cross-sectional study was conducted from January 1, 2017, to December 31, 2019, in the neonatal intensive care unit of a tertiary care hospital after obtaining ethical clearance from Institutional Review Committee (Reference Number: 2020-064). The sample size was calculated and 77 neonates with culture-proven sepsis were included in the study. The antibiotic susceptibility tests of the isolates were done by Kirby-Bauer disc diffusion method. Data entry was done in Statistical Packages for the Social Sciences version 20. Of the 841 specimens (blood, cerebrospinal fluid, urine, tracheal aspirate and pus) processed for culture, bacteria were isolated in 84 (10.0%) specimens. Among the 84, gram-negative bacilli were the predominant isolates 76 (90.5%); of which Acinetobacter baumannii was the most common 27 (32.1%). Both the Gram-negative and the Gram-positive bacteria showed high resistance to Penicillin and Cephalosporins. Gram-negative bacteria showed maximum sensitivity to Colistin, Carbapenems, Tigecycline and Fluoroquinolones. Gram-positive bacteria showed maximum susceptibility to Amikacin, Vancomycin and Carbapenems. Judicious use of antibiotics based on the updated knowledge of prevalent organisms in the local hospital setting and their antibiotic sensitivity pattern is of utmost importance for the effective treatment of neonatal sepsis.

Detection and genetic characterization of community-based SARS-CoV-2 infections — New York City, March 2020

Identification of SARS-CoV-2 mutations allows tracking across geographic regions to inform public health responses and may elucidate the role of strain variability in COVID-19 clinical syndromes. Identification of SARS-CoV-2 mutations allows tracking across geographic regions to inform public health responses and may elucidate the role of strain variability in COVID-19 clinical syndromes. A striking feature of COVID-19 infection has been the extraordinary array of clinical manifestations of disease, including fever and lymphopenia, pneumonitis, myocarditis, thromboembolism, unusual skin findings, and neurological manifestations, coupled with an intense inflammatory syndrome. The diversity of syndromes suggests that variation in host immune responses and/or viral strain differences account for the observed variability. The identification of SARS-CoV-2 mutations allows construction of clades and the tracking of virus across geographic regions, including to new areas where they pose a public health risk.1Koyama T Platt D Parida L. Variant analysis of SARS-CoV-2 genomes.Bull World Health Organ. 2020; 98 (https://doi.org/10.2471/BLT.20.253591): 495-504Crossref PubMed Scopus (315) Google Scholar, 2Brufsky A. Distinct viral clades of SARS-CoV-2: implications for modeling of viral spread.J Med Virol. 2020; 92 (https://doi.org/10.1002/jmv.25902): 1386-1390Crossref PubMed Scopus (74) Google Scholar, 3Tang X Wu C Li X et al.On the origin and continuing evolution of SARS-CoV-2.Natl Sci Rev. 2020; 7 (https://doi.org/10.1093/nsr/nwaa036): 1012-1023Crossref PubMed Scopus (970) Google Scholar Some significant genetic changes have been identified between isolates from the proposed bat (host) and pangolin (intermediate host) and human strains. Large genetic shifts are likely due to homologous genome recombination. This may account for the acquisition, for example, of the novel 4 amino acid-insertion furin target, a protease that increases proteolytic activation of the virus, viral replication, and resultant cytopathology.4Hoffmann M Kleine-Weber H Pöhlmann S. A Multibasic cleavage site in the spike protein of SARS-CoV-2 is essential for infection of human lung cells.Mol Cell. 2020; 78 (e5): 779-784Abstract Full Text Full Text PDF PubMed Scopus (973) Google Scholar Tracking of point mutations across many human isolates from multiple regions provides epidemiological clues to viral spread and to the efficacy of preventative strategies.5Bushman D Alroy KA Greene SK et al.Detection and genetic characterization of community-based SARS-CoV-2 infections - New York City, March 2020.MMWR Morb Mortal Wkly Rep. 2020; 69 (https://doi.org/10.15585/mmwr.mm6928a5): 918-922Crossref PubMed Scopus (14) Google Scholar For example, sequence mutations in the viral spike protein, responsible for cell-surface receptor binding and membrane fusion in tissues, reveals differing amino acid residues in predominant isolates from east (A2a) and west (B1) coasts of the United States. Mutations in this highly conserved region could alter viral pathogenicity. Surprisingly, the analysis in MMWR by Bushman et al. reveals that isolates from New York City, presumed to be directly from China, apparently spread to New York through Italy and the rest of Europe.5Bushman D Alroy KA Greene SK et al.Detection and genetic characterization of community-based SARS-CoV-2 infections - New York City, March 2020.MMWR Morb Mortal Wkly Rep. 2020; 69 (https://doi.org/10.15585/mmwr.mm6928a5): 918-922Crossref PubMed Scopus (14) Google Scholar Characterization of the genetic sequences of SARS-CoV-2 isolates may elucidate the role of strain variability in COVID-19 syndromes.

Microbiological Screening and Antimicrobial Sensitivity Profiling of Wound Infections in a Tertiary Care Hospital of Bangladesh

Wound infection is a major problem in hospitals in developing countries. Wound infection causes morbidity and prolonged hospital stay thus this prospective study was conducted for a period of seven months (January 2019 to July 2019). A total of 217 specimens (wound swabs and pus exudates) from wound infected patients in a Tertiary Care Hospital in Bangladesh. A retrospective study of the microbiological evaluation was done by cultural growth as well as Gram staining and biochemical examination to identify the bacterial isolates. Finally, the antimicrobial vulnerability testing was performed by Kirby-Bauer disc diffusion conventional method. A total of 295 samples were tested. Out of which 217 (73.5%) were found culture positive. E. coli was the most predominant gram-negative isolates whereas Staphylococcus aureus and Coagulase-negative Staphylococcus were the most commonly isolated gram-positive organisms. Antimicrobial sensitivity profile of bacterial isolates revealed imipenem, meropenem, amikacin, and nitrofurantoin to be the most effective antimicrobials against gram-negative isolates, whereas imipenem, meropenem, amikacin, nitrofurantoin, amoxiclav, and gentamicin were the most effective drugs against gram-positive isolates. The result of this examination contributes to the identification of basic causative microbes involved in wound infection and findings of antibiotic susceptibility patterns can be helpful for primary care physicians to optimize the treatment modalities, articulate policies for empiric antimicrobial therapy, and to minimize the rate of infection among wound infected patients.

Antibiotics Profile, Prevalence of Extended-Spectrum Beta-Lactamase (ESBL), and Multidrug-Resistant Enterobacteriaceae from Different Clinical Samples in Khartoum State, Sudan.

One of the global requirements for controlling the occurrence of resistance to antimicrobial drugs is to understanding the resistivity profile of various clinical isolates. Therefore, this study aimed to deliver the indication of different resistant profiles of clinically isolated Enterobacteriaceae from different sources of samples from Khartoum state, Sudan, and to determine the prevalence rate of extended-spectrum beta-lactamase (ESBL), multidrug-resistant (MDR), extensively drug-resistant (XDR), and pandrug-resistant (PDR) bacteria. A total of 144 Gram-negative bacteria were collected from different sources (vaginal swab, urine, catheter tip, sputum, blood, tracheal aspirate, pus, stool, pleural fluid, and throat swab). Samples were subcultured and identified according to their cultural characteristics and biochemical tests. Antimicrobial susceptibility test was performed for twenty-four antibiotics from eleven categories against all isolated Enterobacteriaceae according to the recommendation of Clinical and Laboratory Standards Institute (CLSI). The result showed that out of 144 isolates, Escherichia coli and Klebsiella pneumoniae were predominant isolates with the percentage of 47.9 and 25%, respectively. The prevalence of ESBL was higher in K. pneumonia (38.9%) than E. coli (34.8%). All isolated E. coli were sensitive to nitrofurantoin and tigecycline. There was a high prevalence of MDR Enterobacteriaceae, and only one isolate was XDR, while PDR was zero for all isolated bacteria. Active antimicrobial-resistant (AMR) observation through constant data sharing and management of all stakeholders is crucial to recognize and control the AMR global burden. Also, effective antibiotic stewardship procedures would be applied to limit the unreasonable expenditure of antibiotics in Sudan.

Prevalence of enteric bacteria and enteroparasites in human immunodeficiency virus-infected individuals with diarrhoea attending antiretroviral treatment clinic, Arba Minch General Hospital, southern Ethiopia.

In Ethiopia, only limited data are available regarding the prevalence of enteric bacterial pathogens and enteroparasites in human immunodeficiency virus (HIV) -infected individuals with diarrhoea. Hence, this study aims to assess the prevalence of enteric bacteria and enteroparasites, and also the antibiotic susceptibility patterns of bacteria in them. An institution-based cross-sectional study was performed in HIV patients with diarrhoea, who visited the Anti-Retroviral Therapy Clinic of the Arba Minch General Hospital between 1 March and 31 August 2019. Data pertaining to sociodemographic characteristics and other factors were collected using a structured questionnaire. Stool culture is of utmost importance in the case of HIV-infected individuals with diarrhoea. Stool samples were collected and examined for bacterial and parasitic pathogens following standard procedures. The antibiotic susceptibility test was performed as per the Kirby–Bauer disc diffusion technique. Data were analysed using SPSS software. A total of 180 individuals were included in the stool collection process. The prevalence rates of enteric bacteria and enteroparasites were 8.3% and 36.1%, respectively. Parasitic infections were more frequent than bacterial infections in these HIV-infected individuals; commonly identified enteroparasites were Giardia lamblia (8.9%) and Cryptosporidium parvum (8.3%). Campylobacter sp. was the most predominant enteric bacterial isolate (4.4%), followed by Salmonella (2.1%) and Shigella (1.1%) species. CD4 counts <200 cells/μL was significantly associated with both bacterial infections (adjusted OR 9.55, 95% CI 1.54–59.3, p 0.015) and parasitic infections (adjusted OR 3.53, 95% CI 1.3–17.9, p 0.03). Multidrug resistance was also detected in 100%, 75% and 60% of Shigella, Campylobacter and Salmonella sp., respectively. We found that enteroparasitic infections were more frequent than bacterial infections. Statistical analysis revealed that CD4 T-cell counts <200 cells/μL, quality of drinking water sources, hand washing habits after toilet and the presence of domestic animals were significantly associated with the prevalence of enteric pathogens.

Antimicrobial Susceptibility Pattern and Associated Factors of Pediatric Septicemia in Southern Ethiopia.

BackgroundSepticemia is one of the major causes of morbidity and mortality in pediatric patients throughout the world. Drug-resistant pathogens are one of the major challenges to control. The study aimed to identify the major etiological agents, antimicrobial susceptibility pattern and associated factors of septicemia among pediatric patients in southern Ethiopia.MethodsA cross-sectional study was conducted on pediatric patients. Blood samples were cultured and antimicrobial susceptibility testing was conducted by Kirby-Bauer disc diffusion techniques. Data were collected by pre-tested questionnaire to identify potential associated factors of septicemia. A bivariate logistic regression analysis was used and adjusted odds ratio with 95% CI at ≤0.05 level of significance was computed to determine the presence and strength of the association.ResultsOf 238 participants, 27 (11.3%) of them had a positive blood culture. Staphylococcus aureus (32.2%), coagulase negative Staphylococci (25%), and Klebsiella pneumoniae (14.3%) were the predominant isolates. The isolated bacteria showed high rates of resistance to amoxicillin, ceftriaxone, streptomycin and ampicillin. Multi-drug resistance (MDR) was observed in 82.1% of the isolates. Being infant [AOR=4.18, 95% CI, (1.3–13.0)], admission >10 days [AOR=5.54, 95% CI, (1.51–20.41)], burn [AOR=3.55, 95% CI, (1.02–12.38)] and wound cases [AOR=5.52, 95% CI, (1.50–20.34)] were associated with pediatric septicemia.ConclusionGram positive bacteria were the predominant isolates and majority of isolates were MDR pathogens. Very young age, prolonged hospital stays, burn and wound cases were associated with pediatric septicemia. Establishing antibiotic stewardship is mandatory to minimize the high prevalence of drug resistance.

Uropathogens antibiotic susceptibility as an indicator for the empirical therapy used for urinary tract infections: a retrospective observational study.

Background and Objectives:Urinary tract infection (UTI) is a common infection affects people of different ages. It is important to explore the antibiotics susceptibility of the bacterial agents to improve the empirical antibacterial prescription because of emerging of multi-drug resistant (MDR) bacteria.Materials and Methods:This is a retrospective observational study including 322 patients with UTI at the largest hospital at the center of Al-Basrah Governorate in the far south of Iraq from August 2018 to November 2019. Bacterial isolates from urine samples with significant bacteria were investigated by automated VITEK® 2 compact system to determine the causative bacteria and their antibiotics susceptibility.Results:Escherichia coli and Klebsiella pneumoniae were the first and second most frequent Gram-negative isolates, whereas Staphylococcus haemolyticus and Enterococcus faecalis were the first and second most frequent Gram-positive isolates. Fosfomycin, tigecycline, colistin, meropenem, imipenem, amikacin and nitrofurantoin had high susceptibility rates against Gram-negative isolates. Nitrofurantoin, tigecycline, daptomycin, teicoplanin, vancomycin and linezolid had a high effect against Gram-positive isolates.Conclusion:The leading causative isolates especially the most predominant Gram-negative isolates E. coli and K. pneumoniae show high resistance rates against important antibiotics including penicillin/β-lactamase inhibitors piperacillin/tazobactam, ceftazidime cefepime, ciprofloxacin, levofloxacin and trimethoprim/sulfamethoxazole which call for reconsidering them for treatment of UTI.

Bacterial ecology and antibiotic resistance mechanisms of isolated resistant strains from diabetic foot infections in the north west of Algeria.

In front of the polymorphic bacterial ecology and antibiotic resistance in diabetic patients with foot infections and good patient care, collaboration between clinicians and microbiologists is needed to improve assessment and management of patients with this pathology. This study was designed to characterize the bacterial ecology of diabetic foot infection (DFIs) and to determine the different mechanisms of resistance involved. In this study bacterial strains and antibiotic resistance profiles were determined from diabetic foot infections patients (n = 117). The identification of resistance mechanisms, such as penicillinase and/or extended-spectrum β-lactamase production (ESBL), methicillin-resistant Staphylococcus aureus (MRSA) and efflux pump over-expression were performed. A high prevalence of Gram-negative bacteria (61%) with Escherichia coli, and other Enterobacteriaceae and Pseudomonas aeruginosa being the predominant isolates. Gram positive bacteria mainly represented by Staphylococcus aureus accounted for 39% of the isolates. 93.5% of the Enterobacteriaceae were resistant to, at least, one molecule in the β-lactam family, while the majority of the Staphylococci were resistant to penicillin G and tetracycline (93.3% and 71.7%). The majority of non-fermenting Gram negative bacteria were also resistant to fluoroquinolones. β-lactamase detection tests revealed the presence of extended-spectrum β-lactamase in 43.5% of the Enterobacteriaceae, while methicillin-resistant Staphylococcus aureus represented 18.2% of the isolates. Additionally, 50.9% of non-fermenting Gram negative bacteria were overproducing efflux pumps. All Acinetobacter Baumannii were Multidrug-Resistant (MDR), as the majority of Staphylococci, and Enterobacteriaceae. These results should be taken into account by the clinician in the prescription of probabilistic antibiotic therapy in this context.

Blood Stream Infections caused by Non-Fermenting Gram Negative Bacilli, Clinical Correlation, MIC for Colistin, Gene Detection

To study the risk factors and outcome of blood stream infection caused by non-fermenting gram negative bacilli (NFGNB) and their pattern of antibiotic susceptibility and genes. We included sepsis cases with blood culture positive for NFGNB. MIC for colistin was determined by broth microdilution method. Multiplex PCR was used to detect BlaIMP, BlaVIM, BlaKPC, BlaNDM-1 genes in cephalosporin and carbapenems resistant Acinetobacter spp. isolates. Out of 4,664 cases of sepsis, 50 (1.07%) were positive for NFGNB. Acinetobacter spp. 29 (58%) was the predominant isolate, of which 16 (55.17%) isolates were resistant to cephalosporins and carbapenems. We detected BlaKPC and BlaNDM-1 genes in two of these isolates. We did not detect BlaIMP, BlaVIM, BlaKPC and BlaNDM-1 genes in any other NFGNB isolates. Majority of the strains of Pseudomonas spp. showed sensitivity to all the antibiotics tested. NFGNB sepsis patients with respiratory illness correlated well with fatal outcome (p &lt;0.05; OR 21). More numbers of Acinetobacter spp. sepsis cases had fatal outcome (p &lt;0.05; OR 12.83). NFGNB sepsis patients with respiratory illness and those which yielded Acinetobacter spp. correlated positively with fatal outcome. We detected BlaKPC and BlaNDM-1 genes in two strains of drug resistant Acinetobacter spp.

Elucidation of Practices of Mobile Phone Hygiene and Identification of the Microorganisms: A Perspective Study from Riyadh, Saudi Arabia

Mobile phones (MPs) have become a tool for the transmission of microorganisms due to lack of personal hygiene and maybe the sharing of the mobile phone by more than one person that which leads it to be a suitable carrier for microbes. This study aimed to draw a bead on the practices of hygiene of MPs among people living in Riyadh, Saudi Arabia, by performing a cross-sectional survey of 204 participants. The response rate of this study was above ~95%. Results showed that 19.6 % of responders clean their MPs once in a day, but the majority (33.8%) never cleaned their MPs. More than a quarter of the respondents (28.4%) use tissue paper to clean MPs. Among the users, ~60% use MPs while eating, 76% realized that their MPs might be resource of transmitting microorganisms. The study was also carried out using standard techniques to identify and count the bacterial contamination using the MPs. A combined number of 75 MPs of the participants in the shopping malls of Riyadh were screened for microorganism identification. From 75 public MPs, 109 bacteria were isolated. Coagulase-negative staphylococci were the predominant organisms isolate (76.1%) and with 1.8% by Staphylococcus aureus. Micrococcus sps. was also found (12.8%). A small number of Kocuria sps. were also isolated (4.6%). These results showed that common peoples’ mobile phones were contaminated with various types of microorganisms. The results provide an evidence base for the development and enhancement of hygienic MPs using practices.