Prevalence Of Gram-negative Bacteria Research Articles

Epidemiological characteristics of ventilator-associated pneumonia in neurosurgery: A 10-year surveillance study in a Chinese tertiary hospital

BackgroundVentilator-associated pneumonia (VAP) is a significant and common health concern. The epidemiological landscape of VAP is poorly understood in neurosurgery patients. This study aimed to explore the epidemiology of VAP in this population and devise targeted surveillance, treatment, and control efforts. MethodsA 10-year retrospective study spanning 2011 to 2020 was performed in a large Chinese tertiary hospital. Surveillance data was collected from neurosurgical patients and analyzed to map the demographic and clinical characteristics of VAP and describe the distribution and antimicrobial resistance profile of leading pathogens. Risk factors associated with the presence of VAP were explored using boosted regression tree (BRT) models. ResultsThree hundred ten VAP patients were identified. The 10-year incidence of VAP was 16.21 per 1000 ventilation days. All-cause mortality was 6.1%. The prevalence of gram-negative bacteria, fungi, and gram-positive bacteria among the 357 organisms isolated from VAP patients was 86.0%, 7.6%, and 6.4%, respectively; most were multidrug-resistant organisms. Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa were the most common pathogens. The prevalence of carbapenem-resistant A. baumannii, P. aeruginosa, and K. pneumoniae was high and increased over time in the study period. The BRT models revealed that VAP was associated with number of days of ventilator use (relative contribution, 47.84 ± 7.25), Glasgow Coma Scale score (relative contribution, 24.72 ± 5.67), and tracheotomy (relative contribution, 21.50 ± 2.69). ConclusionsOur findings provide a better understanding of the epidemiology of VAP and its risk factors in neurosurgery patients.

Isolation, Identification and Comparative Analysis of Oral Microbial Communities in Smokers and Non-Smokers: A Scientific Investigation

Smoking tobacco considerably changes the Gram-positive bacteria in saliva, including pathogens that may be involved in the development of tobacco-related illnesses such as periodontitis and peri-implantitis. A poor diet, poor oral hygiene, and other health problems can change the balance between these bacteria, allowing the dangerous bacteria to gain control. Pathogens can spread to distant places in the body if they overgrow in the mouth and blood vessels. Some bacteria have adapted to survive in the oral cavity by surviving within our bodies' defense mechanisms. Smokers are more likely to experience issues following gum and oral surgery, gum disease, tooth loss, decay on the roots of teeth, and oral cancer of the mouth. It has been reported that smoking has an impact on the oral microbiota, which has been connected to a number of human disorders. This study was designed for the isolation of bacteria from smokers and non-smokers. Oral health can be impacted by smoking. Smokers are more likely to experience issues following gum and oral surgery, gum disease, tooth loss, decay on the roots of teeth, and oral cancer of the mouth. The bacterial were isolated from the samples collected from non- smokers and smokers. The culture technique was used to grow bacteria. For further identification Gram staining, microscopy and biochemical tests were performed. Gram positive and gram negative bacteria were isolated from both smokers and non-smokers. The prevalence of gram positive bacteria was high in smokers and the prevalence of gram negative bacteria among smokers was high. Total 33% of gram positive bacteria were isolated from non-smokers and 67% from smokers. The gram positive species isolated were S. aureus and S. pneumoniae and 33% of gram negative bacteria were isolated from non-smokers and 67% from smokers. The gram negative species isolated were E.coli and K. pneumoniae.

The prevalence of gram-negative bacteria with difficult-to-treat resistance and utilization of novel β-lactam antibiotics in the southeastern United States.

To evaluate temporal trends in the prevalence of gram-negative bacteria (GNB) with difficult-to-treat resistance (DTR) in the southeastern United States. Secondary objective was to examine the use of novel β-lactams for GNB with DTR by both antimicrobial use (AU) and a novel metric of adjusted AU by microbiological burden (am-AU). Retrospective, multicenter, cohort. Ten hospitals in the southeastern United States. GNB with DTR including Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp. from 2015 to 2020 were tracked at each institution. Cumulative AU of novel β-lactams including ceftolozane/tazobactam, ceftazidime/avibactam, meropenem/vaborbactam, imipenem/cilastatin/relebactam, and cefiderocol in days of therapy (DOT) per 1,000 patient-days was calculated. Linear regression was utilized to examine temporal trends in the prevalence of GNB with DTR and cumulative AU of novel β-lactams. The overall prevalence of GNB with DTR was 0.85% (1,223/143,638) with numerical increase from 0.77% to 1.00% between 2015 and 2020 (P = .06). There was a statistically significant increase in DTR Enterobacterales (0.11% to 0.28%, P = .023) and DTR Acinetobacter spp. (4.2% to 18.8%, P = .002). Cumulative AU of novel β-lactams was 1.91 ± 1.95 DOT per 1,000 patient-days. When comparing cumulative mean AU and am-AU, there was an increase from 1.91 to 2.36 DOT/1,000 patient-days, with more than half of the hospitals shifting in ranking after adjustment for microbiological burden. The overall prevalence of GNB with DTR and the use of novel β-lactams remain low. However, the uptrend in the use of novel β-lactams after adjusting for microbiological burden suggests a higher utilization relative to the prevalence of GNB with DTR.

717. Antimicrobial Resistance of Gram-Negative Bacteria in Respiratory Isolates from an Intensive Care Unit in Guatemala

Abstract Background Antimicrobial resistance (AMR) among Gram-negative bacteria (GNB) is a growing concern in public health, particularly in ICU settings. Over the past few decades, there has been a significant increase in ESBL and carbapenem resistance in Latin America, which has resulted in higher mortality rates and increased healthcare costs. One way to understand local bacterial resistance profiles is to examine respiratory isolates, which can serve as a proxy for resistance observed in the clinical setting. It is critical for clinicians to be aware of these profiles in order to make informed decisions about treatment options. Methods A retrospective study was conducted on all respiratory isolates from the ICU of a third-level national hospital over a 6-month period. All respiratory isolates were analyzed for to identify microorganisms and their AMR to selected antibiotics, including Ceftriaxone (CRO), Ceftazidime (CAZ), Cefepime (CEF) and carbapenems. Results A total of 500 isolates were obtained during the study period, resulting in the isolation of 988 microorganisms. GNB represented 92.3% (n=912) of these isolates. Pseudomonas spp was the most common GNB identified (28.07%), followed by Acinetobacter (26.97%) and Klebsiella spp (20.94%). Stenotrophomona isolates were excluded from the analysis as resistance profiling for this organism is not routinely performed in the institution, leaving a total of 868 isolates for AMR analysis. A total of 527 GNB isolates (60.78%) were identified as resistant to both 3rd generation cephalosporines and CEF. Strains with this resistance pattern were considered highly suggestive of ESBL production. Moreover, 66.78% (n=579) of GNB’s analyzed evidenced resistance to carbapenems, with 13.61% (n=118) of strains having been identified as carbapenemase-producing bacteria. Some GNB exhibited alarming levels of resistance as evidenced in table 1.Table 1.Resistance of selected GNBPercentage of bacterial strains from respiratory isolates resistant to selected antibiotics. Conclusion The high level or resistance observed in GNB from respiratory isolates in this study is concordant with other data from Latin America. While the prevalence of GNB in respiratory isolates does not necessarily correlates with clinical infection rates, the high level of resistance found may be an indicator of the AMR epidemiology of infections in this ICU. Disclosures All Authors: No reported disclosures

Prevalence of gram-negative bacteria and their antibiotic resistance in neonatal sepsis in Iran: a systematic review and meta-analysis

BackgroundNeonatal sepsis, particularly gram-negative (GN) bacteria-induced, is a significant cause of morbidity and mortality in newborns. Healthcare professionals find this issue challenging because of antibiotic resistance. This study aims to combine findings to identify the prevalence of GN bacteria and their antibiotic resistance in Iranian neonates with sepsis.MethodsThis systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The literature search was performed through international databases, including (PubMed/MEDLINE, EMBASE, Scopus, and Web of Science), Iranian local databases (Magiran, Iranmedex, Irandoc, Scimed, and SID), and the first 100 records of Google Scholar. Analytical cross-sectional study checklist from the Joanna Briggs Institute (JBI) was used for the quality assessment of included studies. Comprehensive Meta-Analysis Software Version 2 was used to conduct the meta-analysis. The between-study heterogeneity was investigated by I2 statistics.ResultsThe prevalence of GN bacteria was estimated to be 53.6% [95% CI: 45.9– 61.1: P = 0.362] in Iranian neonates with sepsis, based on 31 studies with a sample size of 104,566. klebsiella pneumoniae (K.pneumonia) (23.2% [95% CI: 17.5–30.0, P < 0.001]) followed by Escherichia coli (E.coli) (13.5% [95% CI: 9.4–18.9, P < 0.001]) were more prevalent among GN bacteria. The highest resistance in K.pneumoniae was observed in Cefixime (80.6%, [95% CI: 56.3–93.1, P = 0.018]). E.coli showed greater resistance to Ampicillin (61.8%, [95% CI: 44.2–76.5, P = 0.188]. The prevalence of GN bacteria in Iranian neonates with sepsis has a decreasing trend based on the year, as shown by a meta-regression model (P < 0.0004).ConclusionGN pathogens, particularly K.pneumoniae, and E.coli, are the leading cause of neonatal sepsis in Iran. GN bacteria showed the highest resistance to Third-generation cephalosporin and Aminoglycosides.

Prevalence of Gram-negative bacteria and their antibioticresistance pattern at tertiary care hospital Amreli Gujarat India

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Prevalence of Gram-negative Bacteria in Maternal Cervical Secretions: A Systematic Review and Meta-analysis

Prevalence of Gram-negative Bacteria in Maternal Cervical Secretions: A Systematic Review and Meta-analysis

Antibiogram And Prevalence Of ESBL Genes In Escherichia Coli From Clinical Specimen

The members of the Enterobacteriaceae family are among the most common causative agents of various clinical infections. Some pathogens produce enzymes to escape the effect of antibiotics and the ESBL enzyme is the new strategy of the bacterial pathogen which is responsible for emerging antimicrobial resistance. The prevalence of Gram Negative bacteria that are usually associated with the production of ESBLs enzymes is on the rise around the globe, both in residing area and hospital setups, as a result, multiple therapeutic problems including antibiotic resistance are being faced. The current study was aimed to look at the characteristics, the pattern of antibiotic resistance, and to estimate the prevalence of ESBL-producing Escherichia coli in clinical isolates. The samples after collection were streaked and cultured on MacConkey, and chocolate, and blood agar. The identification of the isolates was done based on various biochemical characteristics, and the API 20-E test. The modified Disc Diffusion method was used to confirm ESBL enzyme synthesis, and the Kirby Bauer disc diffusion method was used to assess antibiotic susceptibility. Out of 121 isolates of E. coli, 51.2% (n=62) were recovered from female patients and 48.8% (n=59) were obtained from male patients. The genotypic detection of ESBL genes was done by PCR followed by gel electrophoresis. Of total 47 E. coli confirmed for the production of ESBLs, 91.4% (n=43) were found harbouring blaCTX-M followed by blaTEM and blaSHV with 21.2% (n=10) and 8.5% (n=4) prevalence. The table gives an overview of ESBL gene distribution in clinically isolated E. coli. The current study indicates the magnitude of antimicrobial resistance and the underlying genes especially the blaCTX-M gene among the E. coli isolates.

409. Temporal Trends in Antibiotic Use of New β-lactams for Gram-Negative Bacteria with Difficult-to-Treat Resistance in the Southeastern United States

Abstract Background Several new β-lactam antibiotics were recently developed for treatment of serious infections due to gram-negative bacteria (GNB) with difficult-to-treat resistance (DTR). This multicenter retrospective cohort study examined temporal trends in prevalence of GNB with DTR and the use of new β-lactams in the southeastern United States. Methods The prevalence of GNB with DTR, including Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter species was determined in 9 hospitals geographically spread within the Southeastern Research Group Endeavor (SERGE-45) between 2015 to 2020. Antibiotic use (AU) of new β-lactams was also obtained from the 9 hospitals during the study period. New β-lactams included ceftolozane/tazobactam, ceftazidime/avibactam, meropenem/vaborbactam, imipenem/cilastatin/relebactam, and cefiderocol. Logistic regression analysis was utilized to examine temporal trends in prevalence of GNB with DTR and cumulative AU of new β-lactams. Results The overall prevalence of GNB with DTR in the 9 hospitals was 0.78% with a numerical increase from 0.67% to 0.97% between 2015 and 2020 (p=0.067) [Figure]. DTR was more prevalent among Acinetobacter spp., followed by P. aeruginosa, and Enterobacterales (11.8%, 3.5%, and 0.2%, respectively). There was a significant increase in the prevalence of DTR isolates among Acinetobacter spp. from 2.7% to 20.7% (p&amp;lt; 0.001) and Enterobacterales from 0.07% to 2.6% (p=0.025), but not P. aeruginosa (p=0.46) between 2015 and 2020. The cumulative AU of new β-lactams in the 9 hospitals was 2 days of therapy per 1000 patient-days. There was numerical increase in AU of these agents from 0.03 to 2.22 days of therapy per 1000 patient days during the 6-year study period (p=0.096) [Figure]. Conclusion The overall prevalence of GNB with DTR and cumulative use of new β-lactams remain relatively low in the southeastern United States. However, the upward trend in prevalence of DTR isolates, particularly among Acinetobacter spp. and Enterobacterales, is concerning and may drive future increased use of β-lactams. Additional efforts to benchmark the use and appropriateness of new β-lactams are crucial to preserve their efficacy against bacteria with DTR. Disclosures P. Brandon Bookstaver, PharmD, Spero Therapeutics: Advisor/Consultant Julie Ann Justo, PharmD, MS, FIDSA, BCPS-AQ ID, bioMerieux: Honoraria|bioMerieux: Honoraria|Entasis Therapeutics: Advisor/Consultant|Entasis Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Merck &amp; Co: Advisor/Consultant|Merck &amp; Co: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi Inc.: Advisor/Consultant|Spero Therapeutics: Honoraria|Spero Therapeutics: Honoraria|Vaxart: Stocks/Bonds Julie Ann Justo, PharmD, MS, FIDSA, BCPS-AQ ID, bioMerieux: Honoraria|bioMerieux: Honoraria|Entasis Therapeutics: Advisor/Consultant|Entasis Therapeutics: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Gilead Sciences: Advisor/Consultant|Merck &amp; Co: Advisor/Consultant|Merck &amp; Co: Advisor/Consultant|Shionogi: Advisor/Consultant|Shionogi Inc.: Advisor/Consultant|Spero Therapeutics: Honoraria|Spero Therapeutics: Honoraria|Vaxart: Stocks/Bonds Bruce M. Jones, Pharm.D., FIDSA, BCPS, AbbVie: Advisor/Consultant|AbbVie: Honoraria|La Jolla: Honoraria|Melinta: Advisor/Consultant|Paratek: Honoraria|Regeneron: Honoraria.

Microbial Profile and Antibiotic Susceptibility Pattern in Diabetic Patients with Mild, Moderate, and Severe Foot Infections in Tehran.

It is estimated that 10-25% of diabetic patients will encounter diabetic foot ulcers (DFU) during their lifetime. This study evaluated the microbiology of DFUs and determined the antibiotic resistance pattern of bacterial isolates based on the severity of wounds and infections in different grades of ulcer. The specimens were collected from115 diabetic foot infections (DFI) deep tissue by needle aspiration and biopsy. The aerobic and anaerobic cultures and antimicrobial susceptibility testing were carried out. The presence of resistance genes including metallo-beta-lactamases (MBL), extended-spectrum β-lactamase (ESBL), ermA, ermC, and mecA was also determined. A total of 222 microorganisms were isolated. The prevalence of poly-microbial infections was 69.6%. Bacterial isolates comprised 64.2% Gram-positive bacteria (GPB), 33.5% Gram-negative bacteria (GNB), and five isolates of anaerobic bacteria were also detected. The most prevalent GPB and GNB were Staphylococcus spp. (52.2%) and Escherichia coli (33.3%), respectively. The prevalence of poly-microbial infections and GNB was positively associated with increased grades of Wagner and IDSA classifications. Among Staphylococcus aureus isolates, resistance to clindamycin (73.5%), ciprofloxacin (70.6%), and erythromycin (70.6%) were noticeable. GNB was also highly resistant to cephalosporins and ciprofloxacin. ESBL genes were detected in approximately 40% of isolates of Enterobacteriaceae. The prevalence of ermA, ermC, and mecA genes in S. aureus isolates were 8.8%, 32.3%, and 14.7%, respectively. In conclusion, our data suggest that GPBs are the most common isolates from DFIs. Furthermore, with the development of wounds and infection, the prevalence of GNB in DFIs are increased.

Prevalence of ESBL Producing Bacteria in Community-Acquired UTI from Eastern Part of India

Urinary tract infection (UTI) in the community is a common infection in humans. The causative microorganisms for UTIs may vary in different places and also vary in their antibiotic sensitivity and resistant patterns. This study aimed to find out the incidence of gram-negative bacteria along with their antibiotic sensitivity pattern in community-acquired UTIs and to calculate the existence of Extended-spectrum beta-lactamase (ESBL) positivity among them. A Sum of 515 urine samples was tested and the causative organisms were identified. Antibiotic susceptibility tests were executed where it had shown growth for bacteria by both manual and automated methods. ESBL tests were performed to identify ESBL-producing isolates. From a total of 515 samples, 65 (12.65%) were culture positive for UTIs. The rate of infection was higher in females than in males. The most prevailing bacteria were Escherichia coli and Klebsiella pneumoniae. Out of total culture-positive isolates, only 43.08% were ESBL positives. The study found that the organisms displayed resistance to Ciprofloxacin and Cefixime and sensitivity to Gentamicin, Ertapenem, and Nitrofurantoin. Females have a higher prevalence of UTIs than males. Mostly, females suffer from UTIs in their reproductive years whereas males suffer in their old age. The prevalence of gram-negative bacteria is higher in community-acquired UTIs. These pathogens though present in the community, becoming resistant to commonly used antibiotics like Ciprofloxacin and Cefixime because of overuse and misuse of antibiotics at the community level.

COMMUNITY ACQUIRED URINARY TRACT INFECTIONS AND ANTIMICROBIAL SUSCEPTIBILITY PATTERNS OF ISOLATED UROPATHOGENS IN MALWA REGION OF PUNJAB

Background- Community acquired urinary tract infection (CA-UTI) is the second most common infection in the community. The etiology and antimicrobial susceptibility of the uropathogen vary widely with time and space. Although its forms the basis of the empirical of CA-UTI yet it has not been showed extensively in India. Methods- The study was conducted for 6 months. Urine samples of clinically suspected UTI patients attending OPD were collected and direct microscopy and cultures were done. Antimicrobial susceptibility was performed on the all bacteria by Kirby Bauer's disk diffusion method. Results- CA-UTI prevalence was 60.5% in patients. However, the prevalence was signicance in the female patients than male (females 66.1% and males 33.9%). Prevalence of gram negative bacteria (91%) over the gram positive bacteria (9%) only causes the CA-UTI. The majority of infections were due to Escherichia coli (63.2%). Most of the uropathogen are resistance to the ampicillin and cephalosporin and least infection to colistin/ polymyxin-B. In the gram positive bacteria they are suspectible to vancomycin and linezolid. Conclusion- The empirical therapy to treat CA-UTI should be chosen from amongst the antimicrobial agents who show sensitivity to these uropathogens after culture and sensitivity.

Assessment the Role of Phagocytic Neutrophil Cells among Different Wagner’s Grades of Diabetic Foot Ulcers Infection

Foot ulcers complications in diabetes mellitus (DM) patients are one of the significant medical problems. This study aimed to assessment the role of phagocytic neutrophil cells and its relationship with the incidence of diabetic foot ulcers (DFU) infection in diabetic patients. A case-control analytical study was conducted on 60 DM, DFU patients and healthy control group. Blood samples were collected for phagocytic activity testing and swabs samples of DFU were collected and processed for culture and antibiotics susceptibility testing after the ulcers classified according to Wagner’s grades system. Findings revealed that Gram-positive bacteria were the most prevalent in the DFU 57.1% with statistically significant relationship between the bacterial species and grades of Wagner’s classification. Wagner’s ulcers grade I and II were the most prevalence in DFU patients 30% for both. There was a weak negative correlation between phagocytic activity and grade ulcers classified. Amikacin and ciprofloxacin were the most effective antibiotics against bacterial isolates, whereas ampicillin, cefepime and cefadroxil were the most common resistance antibiotics of bacterial isolates. In conclusion, this is the first study carried out in Hadhramout, Yemen to assessment the phagocytic neutrophil cells and its role to fight the bacterial infection of diabetic foot ulcers. When the grade of ulcer increased, the bacterial resistance to antibiotics increased, and this was emphasis the correlation with prevalence of Gram-negative bacteria in the high grade of ulcers with high resistance of antibiotics. In contrast, the grade of ulcer increased, the efficiency of phagocytic neutrophil cells decreased.

Bacteriological Spectrum of Sputum in Acute Exacerbation of Chronic Obstructive Pulmonary Disease (COPD)

Background: Acute Exacerbation of COPD (AECOPD) is natural course of Chronic ObstructivePulmonary Disease (COPD), where bacterial infection is the major cause. Bacterial infection worse thesign symptoms of the patients and ultimately increase morbidity &amp; mortality. Methods: This is a cross-sectional observational study. 100 clinically diagnosed cases of AECOPD agedbetween 18 and 85 years were included in the study. The sputum specimen was processed by conventionalMethods and subjected to culture and sensitivity in standard laboratory. Results: The prevalence of AECOPD was more common in age group of fifty-six to sixty- five years(38%) with ratio between male and female of 4.6:1. The prevalence of Gram-negative bacteria was 65.21%and Gram-positive bacteria was 34.79%. K. pneumoniae was the commonest bacteria isolated (36.95%)followed by P. aeruginosa (21.73%), S. aureus (15.21), S. pneumoniae (10.86), S. pyogenes and E. coli(6.52%), MRSA (2.17%). The drug sensitivity reveals that 79.55% of the isolates were sensitive to Amikacin(79.55%) followed by Azithromycin (70.45%), Amoxy clavulanic acid (68.18%) and Ciprofloxacin (63.63%). Conclusion: Repeated exacerbation and hospital admission leads to a major impact on the quality of life ofpatients with COPD. Antibiogram helps in screening resistant pathogens and prescribing right treatment protocol. J MEDICINE 2022; 23: 30-35

Assessment the Role of Phagocytic Neutrophil Cells among Different Wagner’s Grades of Diabetic Foot Ulcers Infection

Foot ulcers complications in diabetes mellitus (DM) patients are one of the significant medical problems. This study aimed to assessment the role of phagocytic neutrophil cells and its relationship with the incidence of diabetic foot ulcers (DFU) infection in diabetic patients. A case-control analytical study was conducted on 60 DM, DFU patients and healthy control group. Blood samples were collected for phagocytic activity testing and swabs samples of DFU were collected and processed for culture and antibiotics susceptibility testing after the ulcers classified according to Wagner’s grades system. Findings revealed that Gram-positive bacteria were the most prevalent in the DFU 57.1% with statistically significant relationship between the bacterial species and grades of Wagner’s classification. Wagner’s ulcers grade I and II were the most prevalence in DFU patients 30% for both. There was a weak negative correlation between phagocytic activity and grade ulcers classified. Amikacin and ciprofloxacin were the most effective antibiotics against bacterial isolates, whereas ampicillin, cefepime and cefadroxil were the most common resistance antibiotics of bacterial isolates. In conclusion, this is the first study carried out in Hadhramout, Yemen to assessment the phagocytic neutrophil cells and its role to fight the bacterial infection of diabetic foot ulcers. When the grade of ulcer increased, the bacterial resistance to antibiotics increased, and this was emphasis the correlation with prevalence of Gram-negative bacteria in the high grade of ulcers with high resistance of antibiotics. In contrast, the grade of ulcer increased, the efficiency of phagocytic neutrophil cells decreased.

Characteristics of Adult Sepsis Patients in the Intensive Care Units in a Tertiary Hospital in Jordan: An Observational Study.

Sepsis is a global health issue that is commonly encountered in the intensive care unit (ICU) and is associated with high morbidity and mortality. Available data regarding sepsis in low- and middle-income countries (LMIC) is lacking compared to higher income countries, especially using updated sepsis definitions. The lack of recent data on sepsis in Jordan prompted us to investigate the burden of sepsis among Jordanian ICU patients. We conducted a prospective cohort study at Jordan University Hospital, a tertiary teaching hospital in the capital, Amman. All adult patients admitted to the adult ICUs between June 2020 and January 2021 were included in the study. Patients' clinical and demographic data, comorbidities, ICU length of stay (LOS), medical interventions, microbiological findings, and mortality rate were studied. Descriptive and inferential statistics were used to analyse data from patients with and without sepsis. We observed 194 ICU patients during the study period; 45 patients (23.3%) were diagnosed with sepsis using the Sepsis-3 criteria. Mortality rate and median ICU LOS in patients who had sepsis were significantly higher than those in other ICU patients (mortality rate, 57.8% vs. 6.0%, p value < 0.001, resp., and LOS 7 days vs. 4 days, p value < 0.001, resp.). Additionally, sepsis patients had a higher combined number of comorbidities (2.27 ± 1.51 vs. 1.27 ± 1.09, p value < 0.001). The use of mechanical ventilation, endotracheal intubation, and blood transfusions were all significantly more common among sepsis patients. A causative organism was isolated in 68.4% of sepsis patients with a prevalence of Gram-negative bacteria in 77.1% of cases. While the occurrence of sepsis in the ICU in Jordan is comparable to other regions in the world, the mortality rate of sepsis patients in the ICU remains high. Further studies from LMIC are required to reveal the true burden of sepsis globally.

Epidemiology and Pattern of Resistance of Gram-Negative Bacteria Isolated from Blood Samples in Hospitalized Patients: A Single Center Retrospective Analysis from Southern Italy.

Background: Blood culturing remains the mainstream tool to inform an appropriate treatment in hospital-acquired bloodstream infections and to diagnose any bacteremia. Methods: A retrospective investigation on the prevalence of Gram-negative bacteria (GNB) and their resistance in hospitalized patients by age, sex, and units from blood cultures (BCs) was conducted from January 2018 to April 2020 at Sant’Elia hospital, Caltanissetta, southern Italy. We divided the patient age range into four equal intervals. Results: Multivariate demographic and microbiological variables did not show an association between bacteria distributions and gender and age. The distribution by units showed a higher prevalence of Klebsiella pneumoniae and Acinetobacter baumannii in the intensive care unit (ICU) and Escherichia coli in the non-intensive care units (non-ICUs). The analysis of antibiotic resistance showed that E. coli was susceptible to a large class of antibiotics such as carbapenem and trimethoprim-sulfamethoxazole. K. pneumoniae showed a significant susceptibility to colistin, tigecycline, and trimethoprim-sulfamethoxazole. From the survival analysis, patients with E. coli had a higher survival rate. Conclusions: The authors stress the importance of the implementation of large community-level programs to prevent E. coli bacteremia. K. pneumoniae and E. coli susceptibility patterns to antibiotics, including in the prescription patterns of general practitioners, suggest that the local surveillance and implementation of educational programs remain essential measures to slow down the spread of resistance and, consequently, increase the antibiotic lifespan.

Prevalence of gram negative bacteria in infected burn wounds and antibiotic susceptibility pattern; a study conducted on stable burn patients reporting to out-patient department.

Objective: To study prevalence of various gram negative bacteria in infected burn wounds among stable burn patients reporting to out-patient department on follow-ups. Study Design: Cross Sectional study. Setting: Department of Pathology, Sahara Medical College Narowal. Period: January to June 2020. Material &amp; Methods: Patients with burn wounds with clinical signs and symptoms of infection but vitally stable, wound less than one month old involving &lt; 20% body surface, reporting to out-patient door of study institution on follow-ups were enrolled into the study. Swabs of infected wounds were taken and sent for bacterial culture and sensitivity to the pathology department of the institution, where micro flora were isolated and their antibiotic susceptibility pattern was determined using standard techniques. Consent was taken from patients before including them in study. Results: Total 210 cases were studied. Gram negative bacteria were isolated from 190 cases, out of them 30% were oxidase positive ad 70% were oxidase negative. Most common organism isolated was Pseudomonas Aeruginosa (30%), followed by Proteus Sps. (25.3%) and Entero bacter Sps. (15.8%) etc. Conclusion: Among gram negative bacteria pseudomonas is a major isolated organism from infected burn wounds having high susceptibility to imipenem and cefepime.

Detection of tetM, armA, blaPER-1 and blaIMP genes in E. coli isolates among the gram negative bacteria that cause urinary tract infections

The purpose of this study was to define the prevalence of gram negative bacteria that cause urinary tract infections (UTIs) and to look for the genes tetM, blaIMP, and ND M-1 in uropathogenic Escherichia coli isolates. This study was conducted on 205 urine samples collected from outpatients having a urinary tract infection for Baquba teaching hospital. The VITEK 2 compact device, which is fully automated, was used to identify the causative microorganisms and also used in antimicrobials susceptibility test. Combined-disk test was used for phenotypic determination of beta lactamases producing isolates and after DNA extraction, PCR was used to determine the genotypic status of the 16S rRNA, tetM, blaIMP, and NDM-1 genes..Out of 205 urine samples, only 72(35.12%) were found to have gram negative bacteria, isolated microorganisms were Escherichia coli 44 (35.7%), K. Pneumonia 18(14.6%), P. aeruginosa 8(6.5 %) were 2 (1.6 %) diagnosed as Burkholderia cepacia. Overall highest susceptibility was observed for imipenem, meropenem, amikacin, momocycline, colistin and to tazobactam and 32 isolates from E. coli were confirmed to be ESBL producers. 16S rRNA gene sequencing attributed the isolates to Escherichia coli. Among the 10 E. coli isolates recovered from the UTI patients, isolates which positive for tetM ( 90%) and which negative for armA, blaPER-1 and blaIMP. The most common gram negative bacteria found to cause UTIs were E. coli and K. pneumoniae. This study found that a few pathogens of E. coli are resistant to IPM and MEM. The frequency of tetM genes that are responsible for this resistance among pathogenic E. coli isolates in diyala, was high.

In vitro activity of cefiderocol and comparators against Gram-negative bacterial isolates from a series of surveillance studies in England: 2014–2018

The prevalence of Gram-negative bacteria (GNB) demonstrating extensive, multiple antimicrobial resistance is increasing in England, leaving few treatment choices. Cefiderocol is a novel siderophore cephalosporin approved in Europe for the treatment of aerobic GNB infections in adults with limited treatment options. We report pooled data for a clinical isolate set collected in England between 2014-2018. MICs were determined by broth microdilution according to International Organization for Standardization guidelines. Cefiderocol susceptibility was tested using iron-depleted cation-adjusted Muller-Hinton broth. Susceptibility rates were based on EUCAST breakpoints. In the absence of a species-specific breakpoint, pharmacokinetic/pharmacodynamic breakpoints were used. Of 1886 isolates from England [74.1% Enterobacterales (18.7% Escherichia coli, 17.2% Klebsiella pneumoniae), 25.9% non-fermenters (18.4% Pseudomonas aeruginosa, 3.7% Acinetobacter baumannii)], 98.7% were cefiderocol-susceptible. Cefiderocol susceptibility in Enterobacterales (99.0%) was significantly (P < 0.01) greater than ceftolozane/tazobactam (94.3%), but similar to meropenem (99.3%) and ceftazidime/avibactam (99.4%). Overall, cefiderocol susceptibility (98.0%) in non-fermenters was significantly (P < 0.01) higher than comparators (range, 84.5-92.4%). Susceptibility to cefiderocol was 98.3-99.6% by infection source and was significantly (P < 0.01) greater than comparators for isolates from patients with nosocomial pneumonia (cefiderocol, 98.3%; comparators range, 79.8-93.8%). Excluding intrinsically meropenem-resistant Stenotrophomonas maltophilia, 47/1846 isolates (2.5%) were meropenem-resistant. A high proportion of meropenem-resistant P. aeruginosa were susceptible to cefiderocol (95.0%). All S. maltophilia isolates (40/40) were cefiderocol-susceptible. A substantial proportion of clinical isolates from England, representing a wide range of pathogens across multiple infection sources, was cefiderocol-susceptible. Cefiderocol retained activity against meropenem-resistant strains.