Presence Of Multidrug-resistant Bacteria Research Articles

Detection of multidrug-resistant bacteria in the nasal cavities and evaluation of sinus disorders in patients undergoing Le Fort I osteotomy

IntroductionOrthognathic surgery can lead to sinus alterations, including sinusitis, attributed to the exposure of maxillary sinuses during Le Fort I osteotomy. Furthermore, being a hospital-based procedure, there is potential risk of complications arising from bacteria prevalent in such environments. This study evaluated maxillary sinusitis occurrence and the presence of multidrug-resistant bacteria in the nasal cavity before and after orthognathic surgery.MethodsTen patients with dentofacial deformities underwent Le Fort I osteotomy. Clinical evaluations using SNOT-22 questionnaire were performed, and nasal cavity samples were collected pre-surgery and 3–6 months post-surgery to quantify total mesophilic bacteria and detect Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumoniae. Cone Beam Computed Tomography (CBCT) was performed pre- and post-operatively, and the results were evaluated using the Lund-Mackay system. This study was registered and approved by the Research Ethics Committee of PUCRS (No. 4.683.066).ResultsThe evaluation of SNOT-22 revealed that five patients showed an improvement in symptoms, while two remained in the same range of interpretation. One patient developed post-operative maxillary sinusitis, which was not detected at the time of evaluation by SNOT-22 or CBCT. CBCT showed a worsening sinus condition in three patients, two of whom had a significant increase in total bacteria count in their nasal cavities. The Brodsky scale was used to assess hypertrophy in palatine tonsils, where 60% of the subjects had grade 1 tonsils, 20% had grade 2 and 20% had grade 3. None of the patients had grade 4 tonsils, which would indicate more than 75% obstruction. Two patients harboured S. aureus and K. pneumoniae in their nasal cavities. Notably, K. pneumoniae, which was multidrug-resistant, was present in the nasal cavity of patients even before surgery, but this did not result in maxillary sinusitis, likely due to the patients’ young and healthy condition.ConclusionThere was an improvement in signs and symptoms of maxillary sinusitis and quality of life in most patients after orthognathic surgery. However, some patients may still harbour multidrug-resistant bacteria, even if they are asymptomatic. Therefore, a thorough pre-operative assessment is essential to avoid difficult-to-treat post-operative complications.

Silver Mineralized Protein Hydrogel with Intrinsic Cell Proliferation Promotion and Broad-Spectrum Antimicrobial Properties for Accelerated Infected Wound Healing.

The presence of multidrug-resistant bacteria has challenged the clinical treatment of bacterial infection. There is a real need for the development of novel biocompatible materials with broad-spectrum antimicrobial activities. Antimicrobial hydrogels show great potential in infected wound healing but are still being challenged. Herein, broad-spectrum antibacterial and mechanically tunable amyloid-based hydrogels based on self-assembly and local mineralization of silver nanoparticles are reported. The mineralized hydrogels are biocompatible and have the advantages of sustained release of silver, prolonged antimicrobial effect, and improved adhesion capacity. Moreover, the mineralized hydrogels display a significant antimicrobial effect against both Gram-positive and Gram-negative bacteria in cells and mice by inducing membrane damage and reactive oxygen species toxicity in bacteria. In addition, the mineralized hydrogels can rapidly accelerate wound healing by the synergy between their antibacterial activity and intrinsic improvement for cell proliferation and migration. This study provides a modular approach to developing a multifunctional protein hydrogel platform based on biomolecule-coordinated self-assembly for a wide range of biomedical applications.

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

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

Safety Concerns on Microbes Associated with Fresh and Smoked Fish Sold in Igbokoda Fish Market, Nigeria

Fishes are important source of food for human globally because man gets a lot of minerals, vitamins, lipids and proteins from fishes and theirs products. Microbiological quality of fish is important to public health as indicative parameters to ensure safe consumption of fish by man. This study was carried out in order to evaluate microbes associated with fresh and smoked fishes on sales at Igbokoda fish market and their antimicrobial susceptibility profiles. Ten different fresh and smoked fish samples were collected from different fish-sellers at different selling points in Igbokoda fish market, aseptically using sterile containers. Samples from the skin, intestine and gill were obtained and cultured into three different media (MacConkey Agar, Nutrient Agar, Salmonella-Shigella Agar) for bacteria isolation and characterization. Other samples from the skin, intestine and gill were also cultured into Potato Dextrose Agar for fungal isolation and characterization. After 48 hours, on examination the total bacterial counts obtained from the skin, intestine and gill ranged between 2.4 to 8.7 x 106 cfu/ml while the total fungal counts ranged between 4.6 to 9.2 x 104 cfu/ml. Highest microbial load was obtained from the skin of the fish samples (7.2 x 106 cfu/ml), while the gill had the lowest microbial load (4.6 x 104 cfu/ml). The bacteria species isolated from the fish samples and their percentage of occurrence were; Aeromonas hydrophilia (11.2%), Bacillus species (6.8%), Citrobacter freundii (3.3%), Escherichia coli (23.2%), Enterobacter cloacae (6.1%), Enterococcus faecalis (6.5%), Listeria monocytogenes (4.5%), Pseudomonas aeroginosa (8.2%), Salmonella species (10.2%), Staphylococcus aureus (16.5%) and Streptococcus species (3.5%). The fungi isolated and their percentage of occurrence were; Penicillium species (16.2%), Aspergillus flavus (8.4%), Aspergillus niger (25.5%), Candida species (16.4%), Fusarium species (6.5%), Mucor species (8.6%), Rhodotorula species (7.2%) and Rhizopus stolonifer (11.2%). Antibiotics susceptibility testing showed that all bacteria isolates were susceptible to Chloramphenicol, Ciprofloxacin, Augmentin, and Amoxillin. While Salmonella species, Staphylococcus aureus and Streptococcus species showed strong resistance to Septrin, Gentamycin and Streptomycin but intermediate susceptible to Erythromycin, Ampiclox, and Tetracycline. The antifungal susceptibility testing of the fungal isolated from fish samples showed that all the isolates were susceptible to all the antifungal agents used except Candida species that showed little resistance to clotrimazole. The study showed that microbial loads in the fish samples were low and, also there was no presence of multidrug resistant bacteria in sampled fish; therefore the fishes were safe for consumption. Although, it is recommended that good processing method should be adopted by fish handlers to prevent health risks to the fish consumers.

Effect of the Presence of Antibiotic Residues on the Microbiological Quality and Antimicrobial Resistance in Fresh Goat Meat.

A total of 11 fresh goat legs were collected at the retail level. Mesophiles, Pseudomonas spp., Enterobacteriaceae, staphylococci, enterococci, Clostridium perfringens, Campylobacter spp., and Listeria monocytogenes counts were determined. Nine samples were free of antibiotic residues, while in the other two samples the presence of sulfadiazine and doxycycline was detected. The antimicrobial resistance of E. coli, staphylococci, Macrococcus spp., and enterococci isolates was also evaluated. Clostridium perfringens was found in two samples. Methicillin-resistant Staphylococcus aureus was detected in one sample. S. epidermidis isolated from one sample containing doxycycline residues showed resistance to mupirocin. Moreover, multi-resistant S. epidermidis and M. caseolyticus were found. Most of the isolated Enterococcus faecium were multi-resistant. Neither extended-spectrum β-lactamase -producing E. coli nor vancomycin-resistant enterococci were detected in any sample. The presence of doxycycline or sulfadiazine could affect the goat meat microbiota since less microbial diversity was found in these samples compared to those free of antibiotics. The presence of antibiotic residues could increase the antimicrobial resistance of enterococci in fresh goat meat. The presence of multidrug-resistant bacteria in goat meat could be considered a potential threat and should be monitored. Special measures should be taken at the farm level and during slaughter to reduce antimicrobial resistance.

Antibiotic resistance genes correlate with metal resistances and accumulate in the deep water layers of the Black Sea

Seas and oceans are a global reservoir of antibiotic resistance genes (ARGs). Only a few studies investigated the dynamics of ARGs along the water column of the Black Sea, a unique environment, with a peculiar geology, biology and history of anthropogenic pollution. In this study, we analyzed metagenomic data from two sampling campaigns (2013 and 2019) collected across three different sites in the Western Black Sea at depths ranging from 5 to 2000 m. The data were processed to annotate ARGs, metal resistance genes (MRGs) and integron integrase genes. The ARG abundance was significantly higher in the deep water layers and depth was the main driver of beta-diversity both for ARGs and MRGs. Moreover, ARG and MRG abundances strongly correlated (r = 0.95). The integron integrase gene abundances and composition were not influenced by the water depth and did not correlate with ARGs. The analysis of the obtained MAGs showed that some of them harbored intI gene together with several ARGs and MRGs, suggesting the presence of multidrug resistant bacteria and that MRGs and integrons could be involved in the selection of ARGs. These results demonstrate that the Black Sea is not only an important reservoir of ARGs, but also that they accumulate in the deep water layers where co-selection with MRGs could be assumed as a relevant mechanism of their persistence.

Prevalence and Characterization of Extended-Spectrum β-Lactamase- and Carbapenemase-Producing Enterobacterales from Tunisian Seafood.

Aquaculture is a rapidly expanding sector in which it is important to monitor the occurrence of multi-drug resistant (MDR) bacteria. The presence of extended-spectrum β-lactamase (ESBL-) or carbapenemase-producing Enterobacterales is a commonly used indicator of the resistance burden in a given sector. In this study, 641 pieces of farmed fish (sea bream and sea bass), as well as 1075 Mediterranean clams, were analyzed. All ESBL- and carbapenemase-producing Enterobacterales collected were whole-genome sequenced. The proportion of ESBL-producing Enterobacterales was 1.4% in fish and 1.6% in clams, carried by Escherichia coli (n = 23) and Klebsiella pneumoniae (n = 4). The ESBL phenotype was exclusively due to the presence of blaCTX-M genes, the most frequent one being blaCTX-M-15. The blaCTX-M-1 gene was also identified in six E. coli, among which four were carried by IncI1/pST3 plasmids, possibly betraying an animal origin. Carbapenemases were absent in fish but identified in two K. pneumoniae isolates from clams (blaNDM-1 and blaOXA-48). Several sequence types (STs) identified were associated with human MDR clones such as E. coli ST131 and ST617, or K. pneumoniae ST307 and ST147. Our results might indicate that bacteria from hospital or farm effluents can reach the open sea and contaminate seafood and fish that are living or raised nearby. Therefore, monitoring the quality of water discharged to the sea and the presence of MDR bacteria in seafood is mandatory to ensure the quality of fishery products.

Risk factors for antimicrobial resistance among Staphylococcus isolated from pets living with a patient diagnosed with methicillin-resistant Staphylococcus aureus infection.

It has been suggested that pets play a critical role in the maintenance of methicillin‐resistant (MR) and multidrug‐resistant (MDR) Staphylococcus spp. in the household. We examined risk factors for carriage of antimicrobial‐resistant coagulase‐positive staphylococci, with particular attention to Staphylococcus aureus and Staphylococcus pseudintermedius isolated from pets living in households of people diagnosed with methicillin‐resistant S. aureus (MRSA) skin or soft‐tissue infection. We analyzed data collected cross‐sectionally from a study conducted in 2012 that evaluated the transmission of MRSA and other staphylococci from humans, their pets and the environment (Pets and Environmental Transmission of Staphylococci [PETS] study). We used unadjusted and adjusted stratified logistic regression analyses with household‐clustered standard errors to evaluate the association between demographic, healthcare‐related, contact‐related and environmental risk factors and MDR Staphylococcus spp. isolated from dogs and cats. Staphylococcal isolates obtained from dogs (n = 63) and cats (n = 47) were included in these analyses. The use of oral or injectable antimicrobials by the pets during the prior year was the main risk factor of interest. Based on our results, 50% (12/24) of S. aureus, 3.3% (1/30) of S. pseudintermedius and 25% (14/56) of other coagulase‐positive staphylococci (CPS) were determined to be MDR. S. aureus isolates were more likely to be MDR compared with S. pseudintermedius. We did not find a significant statistical association between the use of oral or injectable antimicrobials in the prior year and the presence of MDR bacteria. The results suggest that drivers of antimicrobial resistance in household staphylococci may vary by bacterial species, which could have implications for one health intervention strategies for staphylococci and inform the investigation of other reverse zoonoses, such as COVID‐19.

Presence of multidrug resistant bacteria in Hurricane Ida overtop sediments in Southeast Louisiana, USA

AbstractOn August 29, 2021, Hurricane Ida made landfall as a category 4 hurricane, bringing a torrent of wind, rain, and storm surge to Southeast Louisiana. This hurricane brought several feet of sediment into the residential areas of southeast Louisiana affecting homes and businesses. The sediment contains industrial waste and sewage sludge. A study was conducted to find the presence of antibiotic‐resistant bacteria (ARB) in the sediments. The results of this study show the presence of human polyomavirus BK in the sediments indicating the presence of human feces. The sediment also showed high levels of antibiotics such as tetracycline and sulfonamide. Presence of many multidrug resistant bacteria were found in the sediments along with the presence of various antibiotic resistance genes (ARGs) such as sul1 and sul2 for sulfonamide resistant and tetA gene for resistant to tetracycline. The heavy metal analysis revealed an elevated presence of heavy metal contamination.

Genetic characterization of clinically relevant class 1 integrons carried by multidrug resistant bacteria (MDRB) isolated from the gut microbiota of highly antibiotic treated Salmo salar

The main objective of this study was the genetic characterization of clinically relevant class 1 integrons carried by multidrug resistant bacteria isolated from the intestinal microbiota of aquaculture salmon treated with high concentrations of antibiotics. In 82 multidrug resistant bacterial isolates, the prevalence of both the conserved elements of the integrons, qacEΔ1 and sul1 genes, and the variable region (VR) was determined. Further, whole genome sequencing and complete genetic analysis was performed in VR-positive isolates. Despite the fact that 100% of the bacterial isolates presented the intI1 gene, only 12.3% carried the qacEΔ1 and sul1 genes and only two (2.4%) presented a VR with gene cassettes. In the Pseudomonas baetica 25P2F9 isolate, a VR carrying aac(6')31, qacH, and blaOXA-2 gene cassettes was described, whereas the VR of Aeromonas salmonicida 30PB8 isolate showed a dfrA14 gene cassette. The array of gene cassettes found in the Pseudomonas isolate appears with high frequency in clinically relevant pathogens such as Pseudomonas aeruginosa or Escherichia coli. Additionally, it was possible to determine that these integrons are contained in plasmids and coul be easily transferred. Resistome analysis demonstrated that both isolates carried a great diversity of antibiotic resistance genes, including many β-lactamases. Even in the Aeromonas isolate a new oxacillin-hydrolyzing beta-lactamase gene was described (blaOXA-956). The presence of multidrug resistant bacteria and clinically relevant genetic elements in the salmon intestinal microbiota make the aquaculture a hotspot in the phenomenon of antibiotic resistance; therefore, the control of antibiotics used in this activity is a key point to avoid its escalation.

Draft genome sequence of colistin-resistant and extended-spectrum β-lactamase (ESBL)-producing multidrug-resistant Escherichia coli isolated from poultry meat

The presence of multidrug-resistant bacteria in the food chain represents a major public-health concern and has significant economic repercussions. Here we describe the draft genome sequence of serotype O21:H16, multilocus sequence typing (MLST) ST3270 and ribosomal MLST rST120701, multidrug-resistant Escherichia coli Ch7_4SIAU, which was isolated from poultry meat collected from a local market in Jeddah, Saudi Arabia. Ch7_4SIAU was grown on MacConkey agar and was identified using matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF/MS). An Illumina MiSeq platform was used to generate 2.4 million paired-end reads of 150 bp. The draft genome of Ch7_4SIAU is ∼5.1 Mb with a GC content of ∼50% and contains five plasmid replicons [ColpVC, IncFII, IncHI2, IncI(Gamma) and IncX1]. The isolate is resistant to third- and fourth-generation cephalosporins. It carries the mobile colistin resistance gene mcr-1.1 and the extended-spectrum β-lactamase (ESBL) gene blaCTXM-15 as well as the astA gene encoding enteroaggregative E. coli heat-stable enterotoxin 1 (EAST-1). This report presents the first draft genome of ESBL-positive E. coli isolated from poultry meat in Saudi Arabia. The findings can be used as a reference for genomic epidemiological studies of antimicrobial resistance in Enterobacteriaceae in the local food chain.

Inactivation, removal, and regrowth potential of opportunistic pathogens and antimicrobial resistance genes in recycled water systems

With two thirds of the global population living in areas affected by water scarcity, wastewater reuse is actively being implemented or explored by many nations. There is a need to better understand the efficacy of recycled water treatment plants (RWTPs) for removal of human opportunistic pathogens and antimicrobial resistant microorganisms. Here, we used a suite of probe-based multiplex and SYBR green real-time PCR assays to monitor enteric opportunistic pathogens (EOPs; Acinetobacter baumannii, Arcobacter butzlieri, Escherichia coli, Enterococcus faecalis, Klebsiella pneumoniae, Legionella spp., Listeria monocytogenes, Pseudomonas aeruginosa, Salmonella Enteritidis, Streptococcus spp.) and antimicrobial resistance genes (ARGs; qnrS, blaSHV, blaTEM, blaGES, blaKPC, blaIMI, blaSME, blaNDM, blaVIM, blaIMP, blaOXA-48-like, mcr-1 and mcr-3) of key concern from an antimicrobial resistance (AMR), waterborne and foodborne disease perspective. The class 1 integron-integrase gene (intl1) was quantified as a proxy for multi-drug resistance. EOPs, intl1 and ARGs absolute abundance (DNA and RNA) and metabolic activity (RNA) was assessed through three RWTPs with differing treatment trains. Our results indicate that RWTPs produced high quality recycled water for non-potable reuse by removing >95% of EOPs and ARGs, however, subpopulations of EOPs and ARGs survived disinfection and demonstrated potential to become actively growing members of the recycled water and distribution system microbiomes. The persistence of functional intl1 suggests that significant genetic recombination capacity remains in the recycled water, along with the likely presence of multi-drug resistant bacteria. Results provide new insights into the persistence and growth of EOPs, and prevalence and removal of ARGs in recycled water systems. These data will contribute towards the emerging evidence base of AMR risks in recycled water to inform quantitative risk-based policy development regarding water recycling schemes.

Investigation of the environmental presence of multidrug-resistant bacteria at small animal hospitals in Hungary.

Multidrug-resistant bacteria can cause severe nosocomial infections in both human and veterinary clinics. The aim of this study was to investigate the presence and antibiotic susceptibility of Enterococcus, Staphylococcus and Pseudomonas strains at four small animal clinics of Hungary in 2018, as these bacteria can reliably represent the level of antimicrobial resistance in the investigated environment. A total of 177 Staphylococcus colonies were found, including 22 Staphylococcus pseudintermedius and 13 Staphylococcus aureus. As regards enterococci, 9 Enterococcus faecium, 2 E. faecalis and further 286 Enterococcus strains were isolated. The number of Pseudomonas aeruginosa isolates (n = 34) was considered too low for relevant susceptibility testing. Among staphylococci, the highest resistance was found to sulphamethoxazole (82.9%), penicillin (65.7%) and erythromycin (54.3%), while in the case of enterococci, resistance to norfloxacin and rifampicin was the most common, with 25.5% of the strains being resistant to both antibiotics. Ten methicillin-resistant S. pseudintermedius (MRSP) and six vancomycin-resistant Enterococcus (VRE) strains could be identified. Only 5.7% of the Staphylococcus isolates were susceptible to all tested agents, while this ratio was 36.2% among enterococci. The results of this study have revealed a high prevalence of antibiotic-resistant bacteria in Hungarian small animal clinics, which highlights the importance of regular disinfection processes and stringent hygiene measures in veterinary clinics.

Multicentre study of the burden of multidrug-resistant bacteria in the aetiology of infected diabetic foot ulcers.

BackgroundInfected diabetic foot ulcer (IDFU) is a public health issue and the leading cause of non-traumatic limb amputation. Very few published data on IDFU exist in most West African countries.ObjectiveThe study investigated the aetiology and antibacterial drug resistance burden of IDFU in tertiary hospitals in Osun state, Nigeria, between July 2016 and April 2017.MethodsIsolates were cultured from tissue biopsies or aspirates collected from patients with IDFU. Bacterial identification, antibiotic susceptibility testing and phenotypic detection of extended-spectrum beta-lactamase and carbapenemase production were done by established protocols. Specific resistance genes were detected by polymerase chain reaction.ResultsThere were 218 microorganisms isolated from 93 IDFUs, comprising 129 (59.2%) Gram-negative bacilli (GNB), 59 (27.1%) Gram-positive cocci and 29 (13.3%) anaerobic bacteria. The top five facultative anaerobic bacteria isolated were: Staphylococcus aureus (34; 15.6%), Escherichia coli (23; 10.6%), Pseudomonas aeruginosa (20; 9.2%), Klebsiella pneumoniae (19; 8.7%) and Citrobacter spp. (19; 8.7%). The most common anaerobes were Bacteroides spp. (7; 3.2%) and Peptostreptococcus anaerobius (6; 2.8%). Seventy-four IDFUs (80%) were infected by multidrug-resistant bacteria, predominantly methicillin-resistant S. aureus and GNB producing extended-spectrum β-lactamases, mainly of the CTX-M variety. Only 4 (3.1%) GNB produced carbapenemases encoded predominantly by blaVIM. Factors associated with presence of multidrug-resistant bacteria were peripheral neuropathy (adjusted odds ratio [AOR] = 4.05, p = 0.04) and duration of foot infection of more than 1 month (AOR = 7.63, p = 0.02).ConclusionMultidrug-resistant facultative anaerobic bacteria are overrepresented as agents of IDFU. A relatively low proportion of the aetiological agents were anaerobic bacteria.

Detection and prevalence of multidrug-resistant Klebsiella pneumoniae strains isolated from poultry farms in Blitar, Indonesia

Abstract. Permatasari DA, Witaningrum AM, Wibisono FJ, Effendi MH. 2020. Detection and prevalence of multidrug-resistant Klebsiella pneumoniae strain isolated from poultry farms in Blitar, Indonesia. Biodiversitas 21: 4642-4647. Antibiotics are commonly used as therapy and disease control in humans and animals. However, the widespread use of antibiotics may also trigger the rise of antibiotic resistance. Therefore, the aim of this study was to study the occurrence of Multidrug-Resistant (MDR) of Klebsiella pneumoniae from poultry farms in Blitar. Chicken cloacal swabs were collected from 63 poultry farms (32 broilers and 31 layers) were taken randomly, using total samples 160 broilers and 155 layers. The collected swab samples were inoculated on MacConkey agar medium for isolation and identification. Single colonies were isolated after primary positive cultures and identified by using the IMViC test and TSIA. 28 (8.88%) out of samples were positive for Klebsiella pneumoniae. The antimicrobial confirmation test showed that 53.57% of the K. pneumoniae isolates were Multi-Drug Resistance (MDR) bacteria. The percentage of MDR bacteria against different antibiotics included ampicillin 75%, Erythromycin 42.86%, Tetracycline 35.72%, Sulfamethoxazole 32.14% and Streptomycin 21.4%. This study confirms that the percentage of resistant isolates of Klebsiella pneumoniae from 5 antimicrobial agents of broiler chicken is higher than layer chicken. The presence of multidrug-resistant bacteria is a threat to public health and livestock. The impact of these conditions leaves a limited treatment option as chicken farmers in Indonesia still using antibiotics without veterinarian supervision.

Long-term complications and implant survival rates after cranioplastic surgery: a single-center study of 392 patients

Cranioplasty (CP) is a standard procedure in neurosurgical practice for patients after (decompressive) craniectomy. However, CP surgery is not standardized, is carried out in different ways, and is associated with considerable complication rates. Here, we report our experiences with the use of different CP materials and analyze long-term complications and implant survival rates. We retrospectively studied patients who underwent CP surgery at our institution between 2004 and 2014. Binary logistic regression analysis was performed in order to identify risk factors for the development of complications. Kaplan-Meier analysis was used to estimate implant survival rates. A total of 392 patients (182 females, 210 males) with a mean age of 48 years were included. These patients underwent a total of 508 CP surgeries. The overall complication rate of primary CP was 33.2%, due to bone resorption/loosening (14.6%) and graft infection (7.9%) with a mean implant survival of 120 ± 5 months. Binary logistic regression analysis showed that young age (< 30 years) (p = 0.026, OR 3.150), the presence of multidrug-resistant bacteria (p = 0.045, OR 2.273), and cerebrospinal fluid (CSF) shunt (p = 0.001, OR 3.137) were risk factors for postoperative complications. The use of titanium miniplates for CP fixation was associated with reduced complication rates and bone flap osteolysis as well as longer implant survival rates. The present study highlights the risk profile of CP surgery. Young age (< 30 years) and shunt-dependent hydrocephalus are associated with postoperative complications especially due to bone flap autolysis. Furthermore, a rigid CP fixation seems to play a crucial role in reducing complication rates.

Therapeutic Potential of Plant Extracts Against Multidrug Resistance Poultry Bacteria

Plant extracts were evaluated on bacteria isolated from poultry farm for developing substitutive therapeutic agent of antibiotics. A diverse range of bacterial load observed both in total viable count (TVC) and in total coliform count (TCC) in 30 samples randomly collected from poultry feeds, drinking water and faeces. A total of six bacterial isolates e.g. Pseudomonas spp., Aeromonas spp., Citrobacter spp., Vibrio spp., Escherichia coli and Plesiomonas spp. were found in the samples cultured in MacConkey Agar medium. Fifteen antibiotics were studied against bacterial susceptibility. All the bacterial isolates exhibited multi-antibiotic resistance (MAR) with gross resistance to erythromycin and ampicillin. E. coli had the highest MAR (53.3%), and Vibrio spp. as well as Plesiomonas spp. both had the same MAR (46.7%). Methanolic extract of Terminalia chebula and Azadirachta indica showed significant zone of inhibition against all the tested bacteria. These findings confirm the presence of multidrug resistant bacteria in poultry environment that reveals a possibility of cross-contamination to human and animals. The plant extracts could be developed into therapeutic drugs to rein antibiotic poultry resistant bacteria.&#x0D; Plant Tissue Cult. &amp; Biotech. 30(1): 119-130, 2020 (June)

MON-626 Frequency and Associated Factors with Multidrug-Resistant Organism Infection in Diabetic Foot Ulcers in a Peruvian Public Hospital

Objective: To determine the frequency and associated factors with multidrug-resistant organism (MDRO) infection among patients with diabetic foot ulcers in a Peruvian Public Hospital. Materials and methods. Cross-sectional survey was conducted from January 2017 -December 2018 at National Hospital in Lima Perú. Ulcers with clinical signs of infection (erythema, edema, pain, purulent exudate) according Infectious Diseases Society of America clinical practice guideline were included1. Wounds with only skin involvement were excluded. On admission, specimens for culture were obtained after cleansing and debriding of the wound. Samples were promptly sent to the microbiology laboratory for culture using appropriate transport media. Bacterial identification and antibiotic susceptibility testing were performed using the VITEK® 2 automated system (BioMérieux Laboratory, Argentina). Multidrug-resistant organisms were identified according to the recommendations of International Expert Proposal2. Prevalence ratios derived from bivariate analysis are given with their 95% CI, which was performed to study factors associated with the presence of multidrug-resistant bacteria; and a multivariate analysis with a lineal model to associated variables found in the bivariate analysis. This study has the approval of the Research Ethics Committee of the María Auxiliadora Hospital. Results Among 153 selected subjects, 75% were male, with an average age of 59 yo, 70% had ≥10 years of diabetes duration and only 16% had HbA1C <7%. A frequency of 85% of patients with MDRO infection was found and was associated with minor amputation RP 1.18 (95% CI 1.01-1.44) and with hospitalization time of ≥ 28 days RP 1.21 (95% CI 1.03-1.30). Conclusion. 6 of 7 patients have MDRO infection among patients with diabetic foot ulcers and are associated with the occurrence of minor amputation and hospitalization time ≥ 28 days.

β-Lactam allergy and risk of multidrug-resistant bacteria in the intensive care unit: A cohort study

Patients identified as allergic to β-lactams are frequently exposed to treatment with broad-spectrum antibiotics. However, the risk of carriage of extended-spectrum β-lactamase (ESBL)-producing isolates in this population has been poorly investigated. The aim of this study was to evaluate the characteristics and clinical outcomes of patients admitted to the intensive care unit (ICU) with and without declared β-lactam allergy at admission. A retrospective monocentric study was performed including adult patients admitted to the ICU between 2007 and 2012. The presence of multidrug-resistant bacteria was documented in rectal and nasal swabs at admission and discharge. Patients labelled allergic to β-lactams and unlabelled patients were compared. Patients labelled allergic had significantly higher rates of ESBL at admission (13.3% vs. 4.3%; P = 0.0220) and discharge (20.0% vs. 9.0%; P = 0.0460) compared with unlabelled patients, but no significant difference in rates of ESBL acquisition in the ICU was detected. No differences in mortality, duration of hospitalisation or typical risk factors for ESBL acquisition (intubation, central venous catheter and duration of hospitalisation) were reported. No differences in carriage of methicillin-resistant Staphylococcus aureus were detected. This study showed that patients with declared β-lactam allergy had a higher risk of ESBL carriage at ICU admission and discharge.

Mobile Phone Contamination in Clinical Environments ‘The True Extent’

Smart phones are integral , especially within healthcare. However, there are increasing concerns regarding their contamination and potential infection control risk. Bacteria under selective pressure can rapidly acquire resistant mechanisms leading to the assumption; mobile phones used within clinical environment may harbour bacteria associated with a higher infection mortality rate. Using next generation sequencing technology, characterise the true extent of bacterial contamination on mobile phones of hospital staff and determine the presence of multi-drug resistant bacteria associated with hospital acquired infections. DNA was extracted from the swab tips of 450 Particpant’s mobile phones. 16S rRNA primers were used to characterise and compare the microbiome on devices from the hospital staff and a control group. Staphylococcus aureus and Enterococcus faecalis underwent Kirby Baur disc diffusion. Results The microbiome revealed the extent of contamination far exceeds anything previously reported. In particular, gram-negative bacteria (including several important potential pathogens) were grossly under detected. 198 bacteria genus were discovered on mobile phones of which 34 were unique to the hospital. Differences were also detected between hospital departments. MRSA, VRSA and VRE were only detected within the hospital group. Our results indicate traditional culture-dependent swabbing methods don’t provide an accurate account of mobile phone contamination. This may also be true in other areas relevant to infection control. Used within clinical environments could expose patients to unknown levels of multi drug resistant bacteria. Decontamination between patient contact should be a necessity to prevent the undermining of hand hygiene and the transmission of MDR bacteria.