Prevalence Of MDR Research Articles

Microbial Spectrum, Antimicrobial Resistance, and Prevalence of MDR/XDR Pathogens in Medical Device-Associated Infections

Background: Medical device-associated infections (MDAIs) are a major healthcare concern due to their high morbidity, mortality, and rising prevalence of MDR and XDR bacteria. This study examined the microbiological composition, antimicrobial susceptibility, and prevalence of MDR/XDR infections in MDAI patients at Dr. D.Y. Patil Medical College, Pune. Methods: One-year retrospective research included 100 MDAI patients. Antimicrobial susceptibility testing was done on microbial isolates from blood, urine, and wound swabs according to CLSI standards. The prevalence of MDR and XDR pathogens was determined. Results: Escherichia coli (30%) and Klebsiella pneumoniae (20%) caused most infections, while Staphylococcus aureus (25%) was the most common Gram-positive bacteria. Antimicrobial susceptibility testing showed that 40% of the isolates were MDR and 15% were XDR. Klebsiella pneumoniae had the highest resistance rate (70%), followed by Pseudomonas aeruginosa. Conclusion: The study shows that MDAIs are dominated by MDR and XDR infections, mainly Gram-negative bacteria, making therapy difficult. These findings highlight the critical need for improved infection control, antimicrobial stewardship, and regular surveillance to address medical device-associated resistance infections. Keywords: Medical device infections, multidrug-resistant, extensively drug-resistant organisms, antimicrobial susceptibility, microbiological profile, healthcare-associated infections.

Characterization and Prevalence of Antibiotic Resistance Staphylococcus aureus in Street Food: A Public Health Concern

Food samples containing Staphylococcus aureus pose a serious health risk. This study aimed to examine the prevalence of S. aureus strains in various food samples sourced from Mailsi and Multan. Many food samples including yogurt, bakery products, and raw and cooked food were examined for S. aureus. The isolated strains were confirmed through Mannitol agar fermentation, catalase, coagulase, and urease tests. Hemolysis on blood agar and biofilm formation were also assessed to determine toxin production. Antibiotic sensitivity testing was conducted using the Kirby Bauer method on MH agar, and multiple antibiotics were tested. Out of all samples, a total of 50 S. aureus strains were obtained, mainly from milk and milk-based products. Yellow colonies on mannitol salt agar confirmed S. aureus presence, with all isolates testing positive for coagulase, catalase, and urease. The presence of hemolysins: beta, gamma, and alpha were revealed by hemolysis assays. Biofilm assay results showed variation among the strains, with some categorized as strong, moderate, or weak biofilm formers. Regarding antibiotic sensitivity, most strains exhibited multidrug resistance, particularly against certain antibiotics. Vancomycin showed varying susceptibility patterns, some strains showed susceptibility and intermediate resistance, whereas only milk samples showed resistance. This study emphasizes the prevalence of MDR S. aureus strains in food samples. The study underscores the significance of antimicrobial stewardship programs and stringent food safety measures in preventing the spread of antibiotic-resistant strains and reducing foodborne illnesses. Further research is needed to explore the mechanisms behind antibiotic resistance and toxin production in S. aureus strains from food samples.

Genomic insights into prevalence of virulence and multi drug resistance genes in milk borne Klebsiella pnuemoniae: Face of emerging resistance to last resort antibiotics

Spread of hypervirulent and multi-drug resistant Klebsiella pneumoniae in raw milk is public health concern due to its potential impact on food safety and public health. Therefore, this study investigated antibiotic susceptibility test (AST), antibiotic resistance genes (ARGs), mutations conferring ARGs, virulence factor and plasmid replicons to check prevalence of fosfomycin resistant MDR K. pneumoniae isolated from raw milk samples collected from Saurashtra region of Gujarat, India. K. pneumoniae isolated from raw milk and subjected to disk diffusion assay. From that, MDR along with fosfomycin resistant isolates were analysed for multi locus sequence typing, presence of ARGs, mutations conferring resistance, virulence factors and plasmid replicon types by using its whole genome sequence. Results shows that, among 32 K. pneumoniae, 8 were phenotypically resistant to fosfomycin. As per WGS analysis, 8 MDR isolates were assigned into different sequence types such as ST3321, ST37, ST2715, ST1087, ST3157, ST299 and ST29. Among that, ST37 is well recognized MDR high risk clone reported worldwide and first time reported from raw milk of Saurashtra region of Gujarat, India. ARGs responsible for resistance to fosfomycin (fosA) were found in all 8 isolates. Other ARGs such as blaSHV, kdeA, OqxA, OqxB, dfrA1, sul1, qnrB4, aadA2 and ere(A) were also detected. High diversity of virulence factors was also identified by detection of genes encoding virulence factors related to iron uptake such as entE, fepD, entA, entB, Irp2, fepG, ybtU, ybtP, fepC, ybtA, ybtE, fepB, ybtS, fyuA, ybtQ, ybtT, ybtX, Irp1, adherence such as yagZ/ecpA, yagV/ecpE, yagX/ecpC, yagV/ecpE, ykgK/ecpR and invasion such as fimA, pla, fimC, fimH, fimB, fimE were detected in eight genomes. Mutations in murA, uhpT and glpT conferring a fosfomycin resistance were also present in genomes of 8 K. pneumoniae. IncF was the most common plasmid replicon type detected in all 8 genomes. The study reports high diversity of virulent and multidrug resistant K. pneumoniae in raw milk. Hence, genomic surveillance plans are urgently required for food borne pathogens.

Molecular and bacteriological investigations for the co-existence CRISPR/Cas system and β-lactamases of types extended-spectrum and carbapenemases in Multidrug, extensive drug and Pandrug-Resistant Klebsiella pneumoniae

The recent approach towards combating the antimicrobial resistance has led to the use of Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) and associated sequence to overcome the challenges of antimicrobial resistance. Thus, this study aimed to detect the underlying resistance mechanisms such as ESBLs and carbapenemases and whether there is a correlation between multidrug, extensive drug and pan drug resistance and the occurrence of CRISPR loci. A total of one hundred study isolates were subjected to antimicrobial susceptibility testing using the AST card of the Vitek technique to detect resistance patterns involving ESBLs and carbapenemase (CRE). An investigation of the genes encoding CRISPR/Cas systems using PCR was achieved. Out of 81 (81.0%) resistant Klebsiella pneumoniae isolates, 71 (71%) and 21 (21.0%) produced ESBLs and carbapenemases, respectively. Also, 53 (53.0%), 19 (19.0%) and 9 (9.0%) were MDR, XDR, and PDR respectively. It was noted that Cas1, Cas3, CRISPR1, CRISPR2 and CRISPR3 were positive in 38 (38.0%) of the isolates, while CRISPR1 for incomplete CRISPR1-Cas systems alone was detected in 78 (78.0%). Further, the number of intact CRISPR1, intact CRISPR2 and intact CRISPR3 types were 7 (27.0%), 34 (34%) and 18 (18.0%) respectively. It is concluded that antibiotic resistance levels were inversely correlated with the existence of CRISPR/Cas systems. The absence of the CRISPR/Cas system increases the prevalence of MDR, XDR and PDR in ESBL and carbapenem-producing Klebsiella pneumoniae. With the increase in the degree of antibiotic resistance (MDR, XDR to PDR), the occurrence ratio of the (CRISPR)/CRISPR-associated sequence decreased.

Extended spectrum beta-lactamase production and blaCTX-M gene in Escherichia coli and Klebsiella pneumoniae causing urinary tract infection at a tertiary care hospital in Nepal

Background and objective: Urinary tract infections (UTIs) are the most common bacterial infections where Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) are the predominating pathogens. These pathogens have a high rate of antibiotic resistance and exhibit the production of extended-spectrum beta-lactamase (ESBL). This study investigated the antibiotic resistance pattern and ESBL production of E. coli and K. pneumoniae isolated from patients with UTIs attending a tertiary care hospital in Nepal by both phenotypic and genotypic techniques. Materials and methods: A cross-sectional study was performed where 4664 mid-stream urine specimens from suspected UTI cases were cultured. Isolated E. coli and K. pneumoniae were subjected to antibiotic susceptibility testing by Kirby Bauer disc diffusion method. Genotypic detection of blaCTX-M gene was performed using polymerase chain reaction (PCR). Results: Out of 4664 urine samples processed, 564 (12.1%) were positive for E. coli (475, 10.2%) and K. pneumonia (89, 1.9%). Out of the total 564 studied samples, 267 (47.3%) were MDR isolates (E. coli: 222, 46.7%; K. pneumoniae: 45, 50.6%) and 96 (17%) were positive for ESBL by double disc confirmatory test. Out of 24 ESBL positive E. coli and 6 K. pneumoniae, 19 (79.2%) and 3 (50%) respectively were positive for blaCTX-M gene. Conclusion: This study indicates high prevalence of MDR and ESBL producing E. coli and K. pneumoniae causing UTIs at an urban hospital setting in Nepal. July 2024; Vol. 18(2):002. DOI: https://doi.org/10.55010/imcjms.18.014 *Correspondence: Gaurab Pandey, Department of Medical Laboratory Science, Nobel College Affiliated to Pokhara University, Kathmandu, Nepal. Email: pandeygaurab67@gmail.com

High prevalence of ceftriaxone-resistant and XDR Neisseria gonorrhoeae in several cities of Cambodia, 2022-23: WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP).

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a global public health concern. Ceftriaxone is the last effective and recommended option for empirical gonorrhoea therapy worldwide, but several ceftriaxone-resistant cases linked to Asia have been reported internationally. During January 2022-June 2023, the WHO Enhanced Gonococcal Antimicrobial Surveillance Programme (EGASP) investigated N. gonorrhoeae AMR and epidemiological factors in patients from 10 clinical sentinel sites in Cambodia. Urethral swabs from males with urethral discharge were cultured. ETEST determined the MIC of five antimicrobials, and EGASP MIC alert values and EUCAST breakpoints were used. EGASP demographic, behavioural and clinical variables were collected using a standardized questionnaire. From 437 male patients, 306 had positive N. gonorrhoeae cultures, AMR testing and complete epidemiological data. Resistance to ceftriaxone, cefixime, azithromycin and ciprofloxacin was 15.4%, 43.1%, 14.4% and 97.1%, respectively. Nineteen (6.2%) isolates were resistant to all four antimicrobials and, accordingly, categorized as XDR N. gonorrhoeae. These XDR isolates were collected from 7 of the 10 sentinel sites. No EGASP MIC alert values for gentamicin were reported. The nationally recommended cefixime 400 mg plus azithromycin 1 g (65.4%) or ceftriaxone 1 g plus azithromycin 1 g (34.6%) was used for treatment. A high prevalence of ceftriaxone-resistant, MDR and XDR N. gonorrhoeae in several cities of Cambodia were found during 2022-23 in WHO EGASP. This necessitates expanded N. gonorrhoeae AMR surveillance, revision of the nationally recommended gonorrhoea treatment, mandatory test of cure, enhanced sexual contact notification, and ultimately novel antimicrobials for the treatment of gonorrhoea.

Pattern of antibiotic resistance in surgical site infections in a tertiary care hospital of Nepal

Background: Surgical site infection (SSI) is the second most common hospital-acquired infection. The identification of bacterial pathogens and their antibiotic susceptibility pattern is required for the successful treatment of SSI and curb antimicrobial resistance, which is a major threat globally. This study aimed to assess the microbial profile of the organisms causing SSI and their antibiogram in a tertiary care hospital. Methods: This cross-sectional study was conducted at Microbiology Laboratory of tertiary care hospital, from March 2023 to August 2023. Swab or aspirate specimens were collected aseptically from the surgical site and processed for bacterial isolation following standard bacteriological techniques. Gram’s staining and biochemical tests were performed to identify the organisms at the species level. Antimicrobial susceptibility tests were done following Kirby–Bauer’s disc diffusion method. Statistical analysis was performed using SPSS software version16.0. Results: Out of 405 samples, 92 (22.7%) yielded bacterial growth. Eighty-three culture positive cases (90.2%) were monomicrobial while nine (15.7%) had mixed growth of at least two different bacteria. Out of 108 isolates, 43 (39.8%) were gram-positive and 65 (60.2%) were gram-negative bacteria. Escherichia coli (39.8%) was the most commonly isolated organism. All gram-negative isolates were resistant to ceftriaxone followed by amoxicillin-clavulanic acid (94.0%), amoxicillin (94.0%), cefixime (90.7%), and cefepime (89.8%). Similarly, none of the gram-positive isolates were susceptible to ampicillin, amoxicillin, and ampicillin/sulbactam. The most effective drugs against E. coli were imipenem (100%), followed by tigecycline (96%), meropenem (95.1%), chloramphenicol (84%), amikacin (81.5%), and gentamicin (81.5%). Overall prevalence of MDR was 59.3%. Conclusion: Our study demonstrates increased resistance of both gram-positive and gram-negative organisms to commonly used drugs like cephalosporins and even quinolones. Continued surveillance of antimicrobial susceptibility results at local level, dissemination of data, and prescribing the antibiotics accordingly based on culture and sensitivity results are necessary to ameliorate antimicrobial resistance.

Prevalence of phenotypic multi-drug resistant Klebsiella species recovered from different human specimens in Ethiopia: A systematic review and meta-analysis.

Multidrug-resistant (MDR) Klebsiella species are among public health important bacteria that cause infections difficult to treat with available antimicrobial agents. Infections with Klebsiella lead to high morbidity and mortality in developing countries particularly in patients admitted to the intensive care unit. This systematic review and meta-analysis aimed to determine the pooled prevalence of MDR Klebsiella species from different human specimens using studies conducted in Ethiopia from 2018-2022. We have systematically searched online databases such as PubMed/Medline, Google Scholar, Hinari, African journals online, Web of Science, Cochrane, and grey literature (Addis Ababa University and Hawassa University) to identify studies reporting the proportion of MDR Klebsiella species in Ethiopia. Published articles were selected based on the Preferred Reporting Item of Systematic Review and Meta-analysis (PRISMA). R-Studio version 4.2.3 was used to conduct pooled prevalence, heterogeneity test, and publication bias. A binary random effect model was used to determine the pooled prevalence. Heterogeneity was checked with the inconsistency index (I2). Publication bias was checked with a funnel plot and Egger test. Sensitivity analysis was conducted with leave-one-out analysis. Joanna Briggs Institute's critical appraisal tool for prevalence studies was used to check the quality of each article. In this systematic review and meta-analysis, 40 articles were included in which 12,239 human specimens were examined. Out of the total specimens examined, 721 Klebsiella species were isolated and 545 isolates were reported to be MDR Klebsiella species. The prevalence of MDR Klebsiella species ranged from 7.3%-100% whereas the pooled prevalence of MDR Klebsiella species was 72% (95% CI: 63 - 82%, I2 = 95%). Sub-group analysis based on region revealed the highest prevalence of MDR from Addis Ababa (97%) and the least from the Somali region (33%); whereas sub-group analysis based on the specimen type indicated the highest prevalence was from blood culture specimens 96% and the least was from other specimens (ear and vaginal discharge, and stool) (51%). Our finding indicated a high prevalence of MDR Klebsiella species found in different human specimens. The prevalence of MDR Klebsiella varies across regions in Ethiopia, age, the type of specimens, source and site of infection. Therefore, integrated action should be taken to reduce the prevalence of MDR Klebsiella species in regional states and focus on clinical features. Effective infection and prevention control should be applied to reduce the transmission within and outside health care settings.

Exploring the Prevalence of Antimicrobial Resistance in Salmonella and commensal Escherichia coli from Non-Traditional Companion Animals: A Pilot Study.

Companion animal ownership has evolved to new exotic animals, including small mammals, posing a new public health challenge, especially due to the ability of some of these new species to harbour zoonotic bacteria, such as Salmonella, and spread their antimicrobial resistances (AMR) to other bacteria through the environment they share. Therefore, the objective of the present pilot study was to evaluate the current epidemiological AMR situation in commensal Escherichia coli and Salmonella spp., in non-traditional companion animal small mammals in the Valencia region. For this purpose, 72 rectal swabs of nine different species of small mammals were taken to assess the antimicrobial susceptibility against 28 antibiotics. A total of one Salmonella enterica serovar Telelkebir 13,23:d:e,n,z15 and twenty commensal E. coli strains were isolated. For E. coli strains, a high prevalence of AMR (85%) and MDR (82.6%) was observed, although neither of them had access outside the household. The highest AMR were observed in quinolones, one of the highest priority critically important antimicrobials (HPCIAs) in human medicine. However, no AMR were found for Salmonella. In conclusion, the results showed that small mammals' commensal E. coli poses a public health risk due to the high AMR found, and the ability of this bacterium to transmit its resistance genes to other bacteria. For this reason, this pilot study highlighted the need to establish programmes to control AMR trends in the growing population of new companion animals, as they could disseminate AMR to humans and animals through their shared environment.

Multidrug-resistant tuberculosis in Iran: a multicenter study.

The worldwide incidence of multi-drug-resistant tuberculosis (MDR-TB) is rapidly increasing, and it has emerged as a pressing public health issue in Iran. Nevertheless, there is a scarcity of up-to-date research on the prevalence of MDR-TB in individuals with pulmonary TB in the country. In this cross-sectional study, we gathered a total of 1216 respiratory samples, each corresponding to a unique patient, from five distinct regional TB laboratories in Iran. We identified clinical isolates as Mycobacterium tuberculosis using the IS6110-based PCR assay and Xpert MTB/RIF. Drug susceptibility testing (DST) was conducted using the conventional proportion method. Out of the collected specimens, 448 tested positive for M. tuberculosis. Among these isolates, 445 (99.4%) exhibited susceptibility to the tested drugs, while 3 (0.6%) were found to be MDR. The findings from this recent study indicate that the prevalence of MDR in Iran stands at 0.6%. The absence of recently approved treatment protocols in various regions of Iran, along with inadequately equipped laboratories lacking DST capabilities, could contribute significantly to the rise in TB/MDR-TB prevalence in Iran. Therefore, the implementation of enhanced treatment management strategies and the adoption of innovative technologies are essential steps towards improving the current situation.

An outbreak of multi-drug-resistant Acinetobacter baumannii on a burns ICU and its control with multi-faceted containment measures

BackgroundPatients in burn centres are at high risk of acquiring multidrug-resistant pathogens due to reduced skin barrier and long hospital stay. MethodsWe report the investigation and control of an outbreak due to multidrug-resistant Acinetobacter baumannii in a burn centre. The 27 patients hospitalized in the centre during the outbreak were regularly screened and a total of 132 environmental samples were performed to identify a potential source. Fourier-transform infrared (FT-IR) spectroscopy and multilocus sequence typing (MLST) were applied to characterise the outbreak strain. ResultsBetween August and November 2022, the outbreak affected eight patients with eleven infections and three potentially related fatal outcomes. An interdisciplinary and multiprofessional outbreak team implemented a bundle strategy with repetitive admission stops, isolation precaution measures, patient screenings, enhanced cleaning and disinfection, and staff education. FT-IR spectroscopy suggested that the outbreak started from an index patient, who was repatriated one month before from a country with high prevalence of MDR A. baumannii. Environmental sampling did not identify a common source. Acquisition of the outbreak strain was associated with larger burn lesions ≥ 2a (per percent increase odds ratio (OR) 1.05 (0.99-1.12), P=0.09), and inversely associated with a higher nurse-to-patient ratio (per 0.1 increase OR 0.34, 95%CI 0.10-1.12, P=0.06). ConclusionsBurn patients with a large area of affected body surface, are at high risk for colonization and infection due to MDRO, particularly during periods of high workload. A multifaceted containment strategy can successfully control outbreaks due to MDR A. baumannii in a burn centre.

Comparative Antimicrobial Activity of Lactobacillus acidophilus and Lactobacillus rhamnosus on Clinically Isolated Escherichia coli: An In vitro Study

Aim: The aim of present study is to evaluate the comparative antimicrobial activity of Lactobacillus acidophilus and Lactobacillus rhamnosus on clinical isolates of Escherichia coli.
 Study Design: Cross-sectional observational study.
 Place and Duration of Study: This study was conducted in Department of Medical Microbiology, School of Medical Education between January 2023 to September 2023.
 Methodology: A total of 100 E. coli isolates collected from various diagnostic laboratories were included in the sample population and the prevalence of XDR, MDR, and non MDR isolates among them were determined by Kirby-Bauer disk diffusion method. The inhibitory activity of untreated and treated (pH adjusted) suspension of standard strains of L. acidophilus and L. rhamnosus on E. coli were determined by agar overlay method and the data was statistically analysed using ANOVA single-factor.
 Results: The antimicrobial activity was confirmed for untreated and treated suspension of Lactobacillus spp. by measuring the zone of inhibition surrounding E. coli strains spotted on MRS medium but treated suspension exerted greater inhibitory activity than untreated suspensions of both Lactobacillus spp. and among the treated suspension L. rhamnosus exhibit greater inhibitory activity. Statistical analysis of this data using ANOVA single-factor was found to be not significant (P >0.05), that is treated suspension of both L. acidophilus and L. rhamnosus has the independent activity against E. coli. While untreated suspensions of both L. acidophilus and L. rhamnosus was significant (P =0.03), that is untreated suspension of L. rhamnosus (mean inhibition of 12.19 mm) has greater inhibitory activity than untreated cell cultures of L. acidophilus (mean inhibition of 11.39 mm).
 Conclusion: This result, disclosed that even if both Lactobacillus spp. exhibit antimicrobial activity against E. coli, L. rhamnosus showed greater inhibition than L. acidophilus. The study suggested the use probiotic Lactobacillus as a biotherapeutic in antibiotic resistant E. coli infection and should be further studied for their human health benefits.

Cefiderocol (CFDC): A Spy Antibiotic Future Replacement of Carbapenem

Cefiderocol, also known as CFDC, is an antibiotic in the class of cephalosporins. It is from the third generation. It is effective against gram-negative bacteria. 2019 was the year that it was given US FDA approval for use in the treatment of UTIs. In recent years, there has been a dramatic rise in the prevalence of MDR due to the increased use of antibiotics. Carbapenem, which is a broad-spectrum antibiotic, is unable to treat the illness for this reason because bacteria have developed resistance to it. In this scenario, cefiderocol may be used for the therapy of this kind of infection, and it would also be of special assistance for the treatment of GNB in individuals who have few other therapeutic options available to them. For this review, studies published between 2007 and 2023 are the primary focus of the debate. This review's supporting materials were sourced via a combined search of PubMed, PubChem, and Google Scholar, including the terms "Cefiderocol," "Carbapenem," "Gram-negative Bacteria," "Carbapenem Resistance," and "Cefiderocol clinical trials" from 2007 until May 2023. The focus of this paper is the difference in mode of action of these two antibiotics and shows valid issues for carbapenem resistance.

Multidrug-Resistant Staphylococcus aureus Strains Thrive in Dairy and Beef Production, Processing, and Supply Lines in Five Geographical Areas in Ethiopia.

Livestock, farms, abattoirs, and food supply systems can become the source of foodborne pathogens, including S. aureus, in the absence of monitoring, general hygienic practices, and control. Studies are scarce on reservoirs (hiding places) and routes of entry of S. aureus into the food supply chain in Ethiopia. To fill these gaps, we evaluated the role of cows (milk), meat, equipment, and food handlers on the abundance and AMR of S. aureus in five geographical areas in central Oromia, Ethiopia. We isolated S. aureus from 10 different ecologies per area in 5 areas and tested their sensitivity to 14 antimicrobials of 9 different classes. We ranked the 5 areas and 10 ecologies by computing their multiple AMR index (MARI) at a cut-off value of 0.2 to determine 'high-risk' ecologies for AMR. We recorded as MDR if an isolate had resistance to ≥3 antimicrobial classes. We used a circos diagram to analyze if isolates with identical AMR patterns were shared between different ecologies. S. aureus is prevalent in central Oromia (16.1-18.3%), higher in dairy farms than in abattoirs, and varied among 10 ecologies (p < 0.001) but not among 5 areas (p > 0.05). Of the 92 isolates, 94.6% were penicillin-resistant. Their AMR prevalence was above 40% for 9 of 14 antimicrobials. All isolates (100%) had AMR in at least one antimicrobial class (range = 1-9; median = 5), indicating MDR was prevalent. The prevalence of MDR S. aureus varied (p < 0.05) among areas and 10 ecologies; the highest was in slaughter lines. All isolates had a MARI of >0.2, indicating drug overuse, and S. aureus's AMR burden is high in central Oromia. Dairy farms had higher MARI values (0.44) than abattoirs (0.39). Of 10 ecologies, the highest and lowest MARI values were in the beef supply chain, i.e., slaughter line (0.67) and butcher's hand (0.25). Of the 68 different AMR patterns by 92 isolates against 14 antimicrobials, 53 patterns (77.9%) were unique to individual isolates, indicating they were phenotypically dissimilar. MDR S. aureus was widespread in central Oromia in dairy and meat supply chains, contaminating milk, meat, equipment, and workers in farm and abattoir settings. In the absence of strict regulations and interventions, MDR S. aureus can be disseminated from these epicenters to the public.

Prevalence of carbapenem-resistant and extended-spectrum beta-lactamase-producing Enterobacteriaceae in a teaching hospital in Ghana.

Carbapenem-resistant Enterobacteriaceae (CRE) and Extended-spectrum beta-lactamase (ESBL) production among Gram-negative Enterobacteriaceae is an increasing global challenge due to the high morbidity and mortality associated with their infections, especially in developing countries where there are little antibiotic treatment options. Despite these challenges, few studies in Ghana have described the burden of CRE. Therefore, this study aimed to determine the prevalence of carbapenem-resistant Enterobacteriaceae isolated from patients at the Cape Coast Teaching Hospital (CCTH) in the Central region of Ghana. Enterobacteriaceae isolates were collected from April to July 2019 at the bacteriology unit of CCTH using a consecutive sampling method. Isolates were identified by standard microbiological techniques and confirmed using API 20E. Kirby Bauer disc diffusion method was used to determine the antibiogram of isolates. Isolates were also subjected to ESBL testing using the single-disc combination method. Carbapenem-resistant isolates were identified by the Kirby Bauer disc diffusion method and then examined genotypically for the presence of blaKPC-1, blaIMP-1, blaVIM-1, blaNDM-1, and blaOXA-48 genes via polymerase chain reaction (PCR). Of the 230 isolates comprising E. coli (40.9%), Citrobacter spp. (32.6%), K. pneumoniae (9.1%), P. mirabilis (6.1%), P. vulgaris (5.2%), Enterobacter spp (3.5%)., K. oxytoca (2.2%), and Serratia marcenses (0.4%). Most isolates were from urine 162(70.4%) and wound samples. The isolates showed high resistance to ampicillin 171 (74.3%) and cefuroxime 134(58.3%). The prevalence of MDR was 35.2% (81), with E. coli 40(42.6%) being the majority that exhibited MDR. Of the 230 isolates, 113(49.1%) were ESBL producers, with E. coli 54(57.5%) accounting for the majority, while Serratia marcenses was the least. Of the 13 (5.7%) CRE isolates that showed resistance towards carbapenem in the disc diffusion method, 11 showed the presence of the blaNDM-1 gene, while all isolates showed the presence of the blaOXA-48 gene. The prevalence of carbapenem resistance and ESBL-producing Enterobacteriaceae pathogens among patients at the Cape Coast Teaching Hospital is high and alarming. Therefore, it is imperative to consider effective infection prevention and control measures should be implemented at the hospital to prevent the rapid spread of these dangerous organisms.

Recent Data Characterizing the Prevalence and Resistance Patterns of FimH-producing Uropathogenic Escherichia coli Isolated from Patients with Urinary Tract Infections in North Lebanon

Background: The adhesin gene (FimH) of uropathogenic Escherichia coli (UPEC) plays a critical role in mediating the first contact of UPEC bacterial strains with uroepithelial cells, leading to colonization and invasion of host cells. Objectives: This study aimed to determine the prevalence of FimH in UPEC strains isolated from patients with urinary tract infections (UTIs) in North Lebanon and characterize the resistance profile of UPEC isolates. Methods: A total of 881 urine samples were collected from UTI-symptomatic patients admitted to different hospitals and laboratories in North Lebanon. Seventy UPEC isolates were identified and transferred to the Biomedical Laboratory of Beirut Arab University (BAU) for further analysis. All UPEC isolates were subjected to antimicrobial susceptibility testing, phenotypic assays for ESBL detection, and PCR to detect the FimH gene. Results: The prevalence of UTIs reached 42% (370/881), with UPEC representing 19% (70/370) of the detected uropathogens. The highest and the lowest resistance among UPEC isolates were reported against Ampicillin (80%; 56/70) and carbapenem (0%; 0/70), respectively. A high prevalence of MDR (68%; 48/70) and ESBL (64%; 45/70) was reported. Molecular analysis revealed that most of the tested UPEC (98.6%; 69/70) harbored the FimH gene. A significant correlation was found between FimH and the antimicrobial resistance properties of UPEC (P &lt; 0.05). Conclusions: This study highlighted the high prevalence of the FimH adhesin gene among UPEC isolates, revealing its crucial role in enhancing the resistance of these bacteria to antimicrobial agents.

Assessment of risk factors associated with multi-drug resistant tuberculosis (MDR-TB) in Gulu regional referral hospital.

Multi-drug resistant tuberculosis (MDR-TB) is increasingly recognized as emerging infectious disease of public health concern. Globally, 206030 people were diagnosed with MDR-TB in 2019, representing a 10% increase from 186883people who had it in 2018. In Uganda, the prevalence of MDR among new TB cases is 4.4% and 17.7% among previously treated TB cases. To determine the risk factors associated with MDR-TB among tuberculosis patients in Gulu regional referral hospital. A cross-sectional analytical study using both quantitative and qualitative methods of data collection and analysis was used. Data was collected from 384 TB patients using data extraction form and 6 Key informant interviews conducted. Analysis using Pearson chi-square test was run. HIV positive patients were 2.6 times more likely to be infected with MDR-TB than HIV negative patients [AOR=2.6: 95% CI 1.34- 5.85: P=0.006]. Previously treated TB patients were 2.8 times more likely to be infected with MDR-TB than newly diagnosed TB patients [AOR=2.8: 95% CI 1.33- 5.85: P=0.006]. Defaulting TB patients were 3.1 times more likely to be infected with MDR-TB than the non-defaulting TB patients [AOR=3.1]. There is high prevalence of drug resistance among patients attending TB treatment at the facility.

Current status of β-lactam antibiotic use and characterization of β-lactam-resistant Escherichia coli from commercial farms by integrated broiler chicken operations in Korea

β-Lactam antibiotics are one of the most clinical importance in human and veterinary medicine because they are used for both preventive and therapeutic purposes against several gram-positive, gram-negative, and anaerobic organisms. In this study, it was confirmed that β-lactams (81.1%) were found to be significantly prescribed the most among 74 farms in 5 integrated broiler operations, and single prescription (84.6%), 2-day (41.5%) or 3-day (40.0%) administration, and 15 to 22 d of age (67.7%) administration was significantly higher in the farms (P < 0.05). Among the E. coli isolated from 74 farms in 5 integrated broiler operations, β-lactam-resistant E. coli isolates were detected more frequently in fecal sample (94.6%) than in dust sample (60.8%) (P < 0.05). The prevalence of MDR in β-lactam-resistant isolates, ranging from 88.1 to 96.5%, was significantly higher than that in non-β-lactam-resistant isolates (P < 0.05), without significant differences among operations. Of 466 β-lactam-resistant isolates, 432 (92.7%) isolates harbored β-lactamase genes. The non-extended-spectrum β-lactamase (ESBL) gene blaTEM-1 (81.8%) showed the highest prevalence among isolates, followed by the non-ESBL gene blaTEM-135 (6.4%) (P < 0.05). Five ESBL genes, SHV-12, OXA-1, CTX-M-27, CTX-M-55, and CTX-M-65, were found in 0.9 to 6.0% of the isolates. The pAmpC gene blaCMY-2 was detected in 17 isolates (3.6%). These results suggest that feces and dust are important reservoirs of antimicrobial-resistant bacteria, highlighting the need to strengthen farm management regulations, such as cleaning, disinfection, and litter disposal and to reduce the use of antibiotics in broiler operations.

Is there any role for surgery in post-tuberculosis sequelae? A retrospective institutional analysis

Despite the development of novel drugs to tackle MDR tuberculosis, the incidence and prevalence of PTB remains significant. While majority of the patients completed treatment, they often come back with post-TB sequelae. Surgical advancements in the form of VATS and robotic surgery, management of post-tuberculosis sequelae such as chronic empyema and abscess is simpler. However, adhesions make the surgical field very challenging due to distortion in anatomy. Hence, we present this study so that we could share our institutional knowledge regarding the outcomes of surgery performed for post-tuberculosis sequelae.

Antibiotic resistance and genetic diversity of Salmonella enterica serovar 1,4,[5],12:i:- isolated from animal-derived foods and humans in Shanghai, China

Salmonella enterica serovar 1,4,[5],12:i:- (S. 1,4,[5],12:i:-) is an emerging pathogen that poses a significant risk of foodborne outbreaks, particularly through the contamination of animal-derived foods. This study aimed to investigate the antibiotic susceptibility and genetic diversity of 32 S. 1,4,[5],12:i:- isolates from animal-derived foods and humans in Shanghai, China. The results revealed a high prevalence of resistance among these isolates, particularly against ampicillin (71.9%), tetracycline (65.6%), tobramycin (53.1%), trimethoprim-sulfamethoxazole (40.6%), and ciprofloxacin (40.6%). Furthermore, more than half of the isolates (56.3%) exhibited multidrug resistance. Pulsed-field gel electrophoresis analysis revealed ten distinct PFGE patterns. Several pork and clinical isolates grouped into the same pattern with 100% genetic similarity, indicating significant transmission of S. 1,4,[5],12:i:- through pork. Additionally, nine plasmid incompatibility groups (Inc) were identified, with IncQ1, IncHI2A, and IncHI2 being the most prevalent types. Interestingly, 15 isolates from foods and humans contained both IncHI2A-HI2 plasmids. These plasmids carried numerous resistance genes (e.g., blaCTX-M, blaTEM, blaOXA), suggesting their potential role in the transfer of resistance genes. The findings underscore the high prevalence of MDR S. 1,4,[5],12:i:- isolates in animal-derived foods and humans. Strengthening surveillance of animal-derived food isolates is crucial to prevent and control their spread in the food chain.