Prevalence Of MDR Research Articles

Epidemiology of Biofilm Producing Acinetobacter baumannii Nosocomial Isolates from a Tertiary Care Hospital in Egypt: A Cross-Sectional Study.

ObjectiveThis cross-sectional study aims to determine the prevalence and associated risk factors of biofilm-producing A. baumannii nosocomial isolates from a tertiary care hospital, as well as to investigate any possible association of biofilm formation with the distribution of biofilm-related genotypes and antibiotic resistance phenotypes.MethodsA total of 94 non-duplicate A. baumannii nosocomial isolates were identified, their biofilm formation was quantitatively detected using the modified microtiter plate assay, and their susceptibilities to different antibiotics were determined using the breakpoint method. Isolates were then subjected to PCR assays targeting bap, ompA and blaPER-1 genes.ResultsThe majority (70.1%) of isolates were biofilm producers. The most prevalent biofilm gene was ompA (63.8%), followed by bap (13.8%) and blaPER-1 (10.6%). The presence of multi- and extensive-drug resistance (MDR and XDR) was significantly associated with biofilm producers (p = 0.017 and 0.002, respectively). The length of hospital stay (aOR= 0.023), the presence of ompA gene (aOR = 0.286) or bap gene (aOR = 0.346), ampicillin/sulbactam resistance (aOR = 1), and the presence of MDR (aOR = −0.329) or XDR (aOR = −0.252) were considered significant risk factors associated with biofilm-producing isolates.ConclusionThe high prevalence of biofilm-producing MDR and XDR nosocomial isolates in this study is worrisome and alarming. Characterization of risk factors could help control the continuous selection and transfer of this serious A. baumannii phenotype inside hospitals and improve the quality of patients’ care.

The Emergence of Klebsiella pneumoniae with Reduced Susceptibility Against Third Generation Cephalosporins and Carbapenems in Lagos Hospitals, Nigeria.

This study investigated the prevalence of Klebsiella (K.) pneumoniae isolates among clinical samples of patients in four medical centers in Lagos, Nigeria and the burden of extended-spectrum beta-lactamases (ESBL) and carbapenem-resistant K. pneumoniae (CRKP) strains. Different samples (stool, blood, urine, wound swabs and nasal swabs) from 127 patients with suspected Gram-negative infections based on on-site performed Gram-stain from four public hospitals between March and September 2015 were analyzed. K. pneumoniae was identified in 43 (34%) patients. Resistance rates of these 43 strains according to the CLSI breakpoints were as followed: cotrimoxazole (90.7%), cefuroxime (74.4%), ofloxacin (55.8%), ceftazidime (46.5%), and cefixime (35%). Three isolates (7%) were resistant to imipenem. All isolates were susceptible to amoxicillin/clavulanic acid and nitrofurantoin. The prevalence of ESBL-producing, MDR and CRKP strains was 69.8%, 62.8%, and 7.0%, respectively. Of the ESBL-producing isolates, two K. pneumoniae isolates obtained from urine harbored both blaSHV and blaCTX-M-1, and a third isolate from urine harbored only the blaCTX-M-1. This study revealed the emergence of CRKP isolates and blaCTX-M-1 and blaSHV co-harboring K. pneumoniae strains in Lagos hospitals. The emergence of CRKP strains is an early warning signal for carbapenem antibiotics’ prudent use with concern for their efficacies.

Distribution of multidrug-resistant Salmonella spp. recovered from aquatic environment of Banda Aceh, Indonesia

Abstract. Suhartono S, Ismail YS, Aini Z. 2021. Distribution of multidrug-resistant Salmonella spp. recovered from aquatic environment of Banda Aceh, Indonesia. Biodiversitas 22: 881-886. The occurrence of pathogenic bacteria in an aquatic system might increase waterborne infections including salmonellosis. This might raise a concern related to the increasing pathogenic bacteria, including the multidrug-resistant Salmonella spp. in the two major rivers, namely Lamnyong and Krueng Aceh crossing the city of Banda Aceh, Indonesia. The objectives of the present study were to isolate and enumerate Salmonella spp. recovered from aquatic environment in Banda Aceh and to determine their antibiotic susceptibility. Bacterial enumeration was performed using most probable number (MPN) method followed by bacterial isolations using selective media Salmonella-Shigella Agar (SSA); whereas, antibiotic susceptibility test was conducted using a procedure as recommended by the National Committee for Clinical Laboratory Standards. There was no significant Salmonella spp. densities/mL of both locations (p = 0.200) although, on average there was about 441.67 Salmonella spp. MPN/mL in Krueng Aceh as opposed to 20.47 MPN/mL of Lamnyong river. There were 57 Salmonella spp. isolates recovered in the sampling sites, i.e. 38 isolates of Lamnyong and 19 isolates of Krueng Aceh. The results of antibiotic susceptibility tests showed that Salmonella spp. isolates recovered from Lamnyong and Krueng Aceh showed antibiotic resistance to azithromycin, tetracycline, and streptomycin. Moreover, Salmonella spp. isolates also showed high resistance to ofloxacin, ciprofloxacin, dan ceftriaxone. All Salmonella spp. isolates were classified as MDR with the number of isolates resistant to 4-6 antibiotics was 33 (57.9%), whereas those that were resistant to 7-9 antibiotics and over 10 antibiotics were 23 (40.4%%) and 5 (8.8%) respectively. The prevalence of MDR Salmonella spp. in the current study suggest that river remain the major reservoirs for the transmission of the pathogen in aquatic systems. An appropriate assessment and monitoring are necessary to reduce the potential health risks and to ensure water quality in the aquatic environment.

Dual Clarithromycin and Metronidazole Resistance Is the Main Cause of Failure in Ultimate Helicobacter pylori Eradication

Background/Aim: Antimicrobial resistance significantly affects the cure rate of Helicobacter pylori (H. pylori) eradication. We evaluated the risk factor of failure in ultimate H. pylori eradication and assessed the efficacy of current regimens to overcome antibiotic resistance. Methods: Patients with H. pylori infection were prospectively enrolled in a single center. They were classified into 3 groups according to the previous history of H. pylori eradication, and antibiotic susceptibility was evaluated by culture and minimum inhibitory concentrations (MICs). Results: Ninety-seven patients were successfully cultured for H. pylori and 81 (83.5%), 7 (7.2%), and 9 (9.3%) were classified into primary resistance, 1st eradication failure, and 2nd or more eradication failure groups; the resistance to clarithromycin (CLA), metronidazole (MET), and levofloxacin increased in the 1st eradication failure (85.7, 57.1, and 42.9%) and 2nd or more eradication failure (88.9, 88.9, and 55.6%) groups. The prevalence of MDR was 21.0% (17/81), 57.1% (4/7), and 88.9% (8/9) in the primary, 1st eradication failure, and 2nd or more eradication failure groups, respectively. In multivariate analysis, dual CLA/MET resistance (CLA/MET-R) (OR = 31.432, 95% CI: 3.094–319.266, p = 0.004) was an independent risk factor for ultimate H. pylori eradication failure. In patients with dual CLA/MET-R, the eradication ratio of concomitant therapy was 57.1% (4/7), whereas that of bismuth-containing quadruple therapy was 27.3% (3/11) (p = 0.350). Conclusions: Dual CLA/MET-R was the main cause of failure in ultimate H. pylori eradication, and 7-day bismuth quadruple or concomitant regimen would not be suitable for H. pylori eradication in the dual CLA/MET-R group.

Prevalence of Methicillin-Resistant Staphylococcus aureus Isolated from Clinical Samples at Narayani Samudayik Hospital, Chitwan, Nepal

Objectives: The main objective of this study was to determine the prevalence of Methicillin Resistance Staphylococcus aureus (MRSA) and MDR bacteria isolated from various clinical specimens from the patients attending Narayani Samudayik Hospital, Chitwan
 Methods: A cross sectional study was carried in NPI-Narayani Samudayik Hospital, Chitwan from June to December 2017. Altogether, 3610 clinical specimens mainly pus, blood and urine were collected, streaked on Mannitol Salt Agar and Blood Agar and incubated at 37°C for 24 hours. The confirmed colonies of S. aureus were sub-cultured on Nutrient Agar. The antibiotic susceptibility pattern of all isolates S. aureus was determined by Kirby Bauer disc diffusion method. Isolates resistant to cefoxitin (30mcg) were confirmed as MRSA.
 Result: Among 3610 total clinical samples, 17.6 % (635/3610) showed growth and 95(14.96%) S. aureus were isolated. Higher number of S. aureus was isolated from pus sample (93.15%). Out of 95 S. aureus isolates, 55 (57.89%) were identified as MRSA while 40 (42.10%) were MSSA. Vancomycin, ceftriaxone and chloramphenicol were found to be most effective antibiotic against isolates. Whereas, the least effective antibiotic was cefoxitin followed by amoxiclav, oxacillin and amoxicillin.
 Conclusion: This study concludes that the overall prevalence of MRSA and MDR among the bacterial isolates is higher compared to other studies. So, it is recommended to monitor the antibiotic susceptibility pattern of pathogens regularly and study the epidemiology of such isolates.

Caracterización de pacientes con cirrosis hepática y bacteriemia de un hospital universitario en Medellín, Colombia

Introducción: la bacteriemia en pacientes cirróticos es frecuente y se asocia con una alta mortalidad y hospitalización prolongada. Este estudio describe las características demográficas, clínicas y de laboratorio en pacientes con cirrosis hepática y bacteriemia en un hospital de cuarto nivel.
 Métodos: estudio observacional de cohorte retrospectiva. Incluyó pacientes con cirrosis hepática y bacteriemia entre el 1 de enero de 2010 y el 31 de diciembre de 2017 en el Hospital Pablo Tobón Uribe de Medellín, Colombia. Se recogieron variables demográficas, clínicas y de laboratorio. Se estimó la supervivencia durante el tiempo de hospitalización y hasta 30 días desde el diagnóstico de bacteriemia.
 Resultados: se hallaron 78 pacientes con cirrosis y bacteriemia. La media de edad fue de 65 años, 66,7 % fueron mujeres. Las principales etiologías de la cirrosis fueron: criptogénica (30,8 %) y esteatohepatitis no alcohólica (EHNA; 19,3 %). La principal fuente de infección fue la vía urinaria (24 %), seguida de colangitis (23 %) y la bacteriemia espontánea (19 %). Los bacilos gramnegativos (BGN) representaron la mayoría de los aislamientos (67,9 %). La prevalencia de multidrogorresistentes (MDR) fue de 25,6 % y el uso adecuado de antibiótico empírico fue de 80,8 %. La mortalidad a 30 días fue de 11,5 %. Como mejores predictores de mortalidad se encontraron la puntuación Child-Pugh y Model for End-stage Liver Disease (MELD) al ingreso con área bajo la curva ROC (AUROC) de 0,79 (p = 0,008) y 0.72 (p = 0,042), respectivamente. Conclusiones: los hallazgos permiten conocer las principales características de los pacientes con cirrosis que desarrollan bacteriemia en nuestro medio. Se encontró un número considerable de infecciones MDR. Los pacientes con un grado avanzado de la cirrosis son los que presentan un mayor riesgo de mortalidad.

First Insights into Clinical and Resistance Features of Infections by Klebsiella pneumoniae among Oncological Patients from a Referral Center in Amazon Region, Brazil.

Klebsiella pneumoniae appears as one of the most prevalent pathogens among cancer patients. The present study investigates the clinical, epidemiological and microbiological aspects related to infections caused by K. pneumoniae in cancer patients treated at an oncology referral center in the state of Pará, Amazon region, Brazil. Between July 2017 to July 2019, an epidemiological, observational, cross-sectional study, with a descriptive and analytical approach was conducted, including patients with confirmed diagnosis of cancer who acquired infection by K. pneumoniae 72 h after hospital admission. K. pneumoniae isolates included in the study were obtained from different clinical materials (blood, urine, catheter tip and bladder catheter, orotracheal secretions, oncological and surgical wounds). Antimicrobial susceptibility testing and molecular detection of the carbapenemase-encoding genes were performed. A high prevalence of MDR K. pneumoniae isolates was observed, including two colistin-resistant isolates and seven isolates harboring blaKPC-1 gene. To conclude, our findings provide the firsts insights into the epidemiology and infection by K. pneumoniae in the state of Pará, Brazil, and may be useful on treatment guidance and establishment of strategies to control the spread of resistance strains of K. pneumoniae in the region.

Exploring multidrug resistant E. coli carrying extended-spectrum β-lactamase from retail chicken meat and live bird market sewage in Bangladesh

Background: Antimicrobial resistance due to the emergence and spread of extended-spectrum β-lactamase (ESBL) producing E. coli are becoming a serious global public health concern. Contamination of retail chicken meat with ESBL-E. coli has been reported worldwide. Though ESBL-E. coli have been reported in cloacal swab of chickens in Bangladesh but no data on retail chicken meat and sewage samples are available. Therefore, we determined the prevalence, and resistance pattern of ESBL-E. coli in retail chicken meat and live bird market (LBM) sewage in Bangladesh. Methods and materials: The LBM survey was carried out on 64 LBMs of 32 upazilas of 16 districts in 8 divisions of Bangladesh during August 2018 to July 2019. A total of 320 retail chicken meat and 64 sewage water samples were subjected to cultural, biochemical and PCR assay for the detection of E. coli. The antimicrobial susceptibility test was done with 31 antimicrobial agents belong to 15 antimicrobial classes. ESBL-E. coli were screened by double-disc diffusion test and resistance genes were determined by mPCR. Results: The results showed that 71.3% and 79.7% of E. coli recovered from retail chicken meat and LBM sewage, respectively, of which 98.2% and 100% were ESBL producers. The prevalence of MDR E. coli was 98.2% in chicken meat and 92.2% in sewage sample. Notably, two isolates from chicken meat were identified as possible extensively drug-resistant (pXDR). All the isolates of both chicken meat and sewage samples were positive for blaTEM gene. Moreover, 0.9%, 0.4% and 0.4% of isolates from chicken meat were harboring blaCTX-M-1, blaCTX-M-2 and blaSHV, respectively, while 3.9% and 2% from sewage samples were carrying blaCTX-M-1 and blaCTX-M-2. In case of fluoroquinolones encoding gene, 8.8%, 3.1% and 71.1% isolates from chicken meat were harboring qnrA, qnrB and qnrS, respectively, while 21.6% and 62.7% isolates of sewage were carrying qnrA and qnrS. Conclusion: This study indicates that ESBL–E. coli, most of them MDR, are highly prevalent in retail chicken meat and LBM sewage in Bangladesh. Therefore, it is important to ensure the good hygienic practices during slaughtering and processing of chicken in the retail market and to monitor the resistance continuously.

Emergence of MDR and XDR Salmonella enterica serovar Typhi from pediatric septicemia patients in Lahore

Background: Typhoid fever is a systemic febrile illness that requires prompt antibiotic treatment. Over 21 million people contract typhoid each year mainly due to fecal contaminated food or water and among these 161,000 die globally. Moreover, in southeast Asia including Pakistan, 3.6 cases of typhoid occurred per 100,000 persons/year. Extensively drug-resistant typhoid fever is spreading in Pakistan, raising fears of antibiotic failure at a global level. Methods & Materials: Blood samples (n = 4543) were collected from children suspected of septicemia from a tertiary care hospital in Lahore, Pakistan. Blood samples were collected aseptically in peads BacT/ALERT plus blood culture bottles and placed in BacT/ALERT for up to 5 days. Positive blood culture bottles were sub-cultured on blood and MacConkey agar. Colonies were observed by morphological characteristics. Biochemical confirmation of isolates was carried out by VITEK 2 compact system using GN card. MIC (μg/mL) was determined against 15 different antibiotics using AST-N204 by VITEK 2 compact system. Results: Of 4543 blood cultures samples, 415 (9.1%) were positive for S. Typhi. Among these, 69.1% were MDR S. Typhi while 41.6% were XDR S. Typhi. The highest prevalence of MDR S. Typhi in Peads emergency (167; 40%) followed by peads OPD (90; 21%) and Peads Medical Ward (78; 11.5%). Antibiogram (μg/mL) showed that patients had MDR and XDR S. Typhi was resistant to ampicillin (90%), ciprofloxacin (73%), co-trimoxazole (72.6%) and cefotaxime (67.6%) and ceftriaxone (65.3%) however, 100% sensitive to meropenem and colistin. Conclusion: The present study concluded that the emergence of MDR and XDR S. Typhi in children is a serious public health concern that causes mortality due to treatment failure.

Prevalence and Antibiotic Susceptibility of Bacterial Isolates From Dogs With Ulcerative Keratitis in Midwestern United States.

The objective of this study was to describe bacterial culture and antibiotic susceptibility results in 476 dogs presenting with suspected bacterial keratitis in Iowa and surrounding Midwestern states, further detailing trends in patient characteristics, seasonality, and antimicrobial resistance. Corneal swabs yielded 465 bacterial isolates and 220 cultures (46.2%) with no apparent growth (0–5 isolates per culture). The most frequent bacterial genera were Staphylococcus (32.3%), Streptococcus (19.1%), and Pseudomonas (12.5%), while the most common bacterial species were Staphylococcus pseudintermedius (26.7%), Streptococcus canis (12%), and Pseudomonas aeruginosa (7.5%). Compared to mixed-breed dogs, canine breeds most likely to be examined for ulcerative keratitis included Boston terrier, Cavalier King Charles spaniel, miniature pinscher, pug, rat terrier, Saint Bernard, shih tzu, and silky terriers. In summer, the likelihood to yield a negative culture was reduced while the likelihood to culture Pseudomonas species was increased. Bacteria considered multidrug resistant (MDR, resistant to ≥ 3 antibiotic classes) represented 20% of all canine isolates and were most prevalent for Staphylococcus species (33%). An alarming, escalating trend of MDR prevalence was noted between 2016 (5%) and 2020 (34%). Individual ophthalmic preparations (i.e., single antibiotics or commercially available antibiotic combinations) with highest efficacy against all bacterial isolates included chloramphenicol (83%), ceftiofur (79%), amikacin (77%), neomycin-polymyxin B-bacitracin (77%), and gentamicin (74%). Efficacy of systemic antibiotics and combinations of ophthalmic preparations was also evaluated. Based on the present findings, triple antibiotic (Neo-Poly-Bac) is recommended as empirical monotherapy for prophylactic antibiotic therapy in dogs with simple corneal ulcers, while a chloramphenicol-ciprofloxacin combination is empirically recommended for therapeutic management of infected corneal ulcers. Pending culture and susceptibility results, appropriate selection of empiric antibiotic therapy is important to enhance therapeutic outcome and reduce antibacterial resistance in dogs with corneal ulceration.

Stewardship actions for device associated infections: An intervention study in the emergency intensive care unit

Improving the practices of antimicrobial use in hospitals, especially in developing countries, is a challenging duty. ObjectivesThe aim of the study was to determine the effect of certain stewardship actions on the use of antibiotics for device-associated infections in the emergency intensive care unit in Egypt. MehodsThe intervention included establishment of AS team, design an antibiogram and preparation of antibiotic use guidelines, education, and infection prevention and control measures. Pre- and postinterventions surveys tookplace including: antibiotic prescription compliance, antibiotic cost, bacterial profile and antibiotic resistance rates. ResultsAntibiotic prescription compliance improved, especially for prophylactic antibiotics prescription; in preintervention phase, 27.4% of cases received unindicated antibiotic prophylaxis vs 5.8% after intervention. A statistically significant decrease in cost after the intervention was reported (p = 0.04). Acinetobacter baumannii and Klebsiella pneumonia were the most frequently isolated pathogens (25.6%) and (21.8%) in pre and post-intervention phases respectively. A statistically significant decrease in the prevalence of MDR (X² = 11.9, p = 0.009) was observed. The most prevalent XDR is K-pneumonia (45% vs 17%) in phase 1&3. No pan drug-resistant isolates were detected. ConclusionSound antibiotic guidelines coupled with effective infection control precautions and education would be a good intervention, particularly with a leadership commitment.The use of microbiology tests to direct prescribing decisions should be a underscored. Sustained research initiatives may support the proper implementation of AS programmes in limited resource settings.

Prevalence and factors associated with multidrug-resistant tuberculosis in South India

India accounts for about one-fourth of the global burden of MDR-TB. This study aims to assess the prevalence and factors associated with tuberculosis drug resistance among patients from South India. MTBDRplus assay and MGIT liquid culture performed on 20,245 sputum specimens obtained from presumptive MDR-TB cases during a six-year period from 2013 to 2018 were analyzed retrospectively. Univariate and multivariate logistic regression analysis was carried out to evaluate factors associated with MDR, Rifampicin mono-resistance, and Isoniazid mono-resistance. MDR, Rifampicin mono- resistant and Isoniazid mono-resistant TB were found in 5.4%, 2.5%, and 11.4% cases of presumptive MDR-TB, respectively. Based on the rpoB gene, true resistance, hetero-resistance, and inferred resistance to Rifampicin was found in 38%, 29.3%, and 32.7% of the 1582 MDR cases, respectively. S450L (MUT3) was the most common rpoB mutation present in 59.4% of the Rifampicin resistant cases. Of the 3390 Isoniazid resistant cases, 72.5% had mutations in the katG gene, and 27.5% had mutations in the inhA gene. True resistance, heteroresistance, and inferred resistance accounted for 42.9%, 22.2%, and 17.3% of the 2459 katG resistant cases, respectively. True resistance, heteroresistance, and inferred resistance for the inhA gene were found in 54.5%, 40.7%, and 4.7% cases, respectively. MDR-contact (AOR 3.171 95% CI: 1.747–5.754, p-0.000) treatment failure (AOR 2.17595% CI: 1.703–2.777, p-0.000) and female gender (AOR 1.315 95% CI: 1.117–1.548, p-0.001), were positively associated with MDR-TB. Previous TB treatment did not show a significant positive association with MDR (AOR 1.113 95% CI: 0.801–1.546, p-0.523). Old age (AOR 0.994 95% CI: 0.990–0.999, p-0.023) and HIV seropositivity (AOR 0.580 95% CI: 0.369–0.911, p-0.018) were negatively associated with MDR-TB. Although Rifampicin mono-resistance had a positive association with treatment failure (AOR 2.509 95% CI: 1.804–3.490, p < .001), it did not show any association with previous TB treatment (AOR 1.286 95% CI: 0.765–2.164, p-0.342) or with history of contact with MDR-TB (AOR 1.813 95% CI: 0.591–5.560, p-0.298). However, INH mono-resistance showed a small positive association with the previous history of treatment for TB (AOR 1.303 95% CI: 1.021–1.662, p-0.033). It was also positively associated (AOR 2.094 95% CI: 1.236–3.548, p-0.006) with MDR-TB contacts. Thus INH resistance may develop during treatment if compliance has not adhered too and may be easily passed on to the contacts while Rifampicin resistance is probably due to factors other than treatment compliance. MDR-TB, i.e. resistance to both Rifampicin and Isoniazid, is strongly correlated with treatment failure, spread through contact, and not to treatment compliance. The temporal trend in this region shows a decrease in MDR prevalence from 8.4% in 2015 to 1.3% in 2018. A similar trend is observed for Rifampicin mono-resistance and Isoniazid mono-resistance, pointing to the effectiveness of the TB control program. The higher proportion of inferred resistance observed for Rifampicin compared with INH may indicate a surfeit of mechanisms that enable rifampicin resistance. Association of MDR-TB with age, gender, and HIV status suggest the role of the immune system in the emergence of the MDR phenotype.

Multi- and Extensive-Drug Resistant Acinetobacter baumannii in ICUs: Risk Factors, Antimicrobial Resistance Profiles and co-harboring of gyrA and parC mutations

Background: Acinetobacter baumannii is a gram-negative organism that is implicated in hospital acquired infections. It confers high resistance to many classes of antibiotics. Objectives: To assess the prevalence of multi and extensive drug-resistant (MDR &amp; XDR) Acinetobacter baumannii, their risk factors, antimicrobial resistance patterns and the presence of gyrA and parC gene mutations of quinolone resistance. Methodology: The study included 106 ICU patients (56 males &amp; 50 females), samples were collected according to sites of infections, Acinetobacter baumannii was identified by morphology, biochemical reactions &amp;API 20NE. Antimicrobial susceptibility testing was performed by disc diffusion method. The E-test was used to detect MIC of Ciprofloxacin &amp; Levofloxacin, then a polymerase chain reaction- restriction fragment length polymorphism was performed to detect the occurence of gyrA and parC gene mutations of Quinolone resistance. Results: Thirty isolates were identified as Acinetobacter baumannii, most of which from respiratory infections (P=0.005) prolonged hospitalization, antibiotic use, urinary catheters &amp; ventilator supports were found to be risk factors of infections. Acinetobacter baumannii isolates showed high resistance to most of the tested antibiotics (29 MDR &amp; 28 XDR). All isolates were resistant to Ciprofloxacin &amp; Levofloxacin with the co-presence of gyrA and parC mutations in all isolates (P&lt;0.001). Conclusions: There is an increased prevalence of MDR &amp; XDR Acinetobacter baumannii among ICU infections. The co-occurrence of gyrA and parC mutations is associated with high resistance to Quinolones.

Change in species distribution and antifungal susceptibility of candidemias in an intensive care unit of a university hospital (10-year experience).

Candidemia is a nosocomial infection mostly found in critically ill patients. Our objectives were to evaluate the change in distribution and resistance profile of Candida spp. isolated from candidemic patients in our intensive care unit over two 5-year periods spanning 15years and to evaluate the risk factors. Records from the microbiology laboratory were obtained, from January 2004 to December 2008 and from January 2013 to December 2017, retrospectively. Antifungal susceptibility was performed by E-test and evaluated according to EUCAST breakpoints. A total of 210 candidemia cases occurred; 238 Candida spp. were isolated in 197 patients (58.8% male; mean age, 59.2 ± 19.6years). The most predominant risk factor was central venous catheter use. Species distribution rates were 32%, 28%, 17%, and 11% for C. albicans (n = 76), C. parapsilosis (n = 67), C. glabrata (n = 40), and C. tropicalis (n = 27), respectively. Resistance rate to anidulafungin was high in C. parapsilosis over both periods and increased to 73% in the second period. Fluconazole showed a remarkable decrease for susceptibility in C. parapsilosis (94 to 49%). The prevalence of MDR C. parapsilosis (6%/33%) and C. glabrata (0%/44%) increased in the second period. We observed a predominance of non-albicans Candida spp., with C. parapsilosis being the most frequent and C. glabrata infections presenting with the highest mortality. High level of echinocandin resistance in C. parapsilosis and increasing prevalences of MDR C. parapsilosis and C. glabrata seem emerging challenges in our institution.

Prevalence of Community Acquired Uropathogens and their Antimicrobial Susceptibility in Patients from the Urology Unit of A Tertiary Care Medical Center

Urinary tract infections (UTI) are one of the most common community acquired infections and can also present with similar lower urinary tract symptoms (LUTS). Moreover, UTI can be a complication of these urological diseases. Thus, this study was conducted in patients with LUTS to find out the prevalence of uro-pathogens and their antibiotic susceptibility pattern so that appropriate antibiotics can be started on clinical suspicion of UTI. The study was conducted over a period of 12 months. Culture and susceptibility of urine specimen was done as per standard microbiological guidelines. Apart from the growth of common bacteria with their antibiogram, Methicillin-resistant Staphylococcus aureus (MRSA), high level aminoglycoside resistance (HLAR) was investigated among Enterococci, and metallo beta-lactamases(MBL) production was production was investigated among gram-negative pathogens. Out of 407 urine samples included in the study, 80 (19.6%) samples showed bacterial growth. The commonest isolate was E. coli 44 (55 %). Majority of the isolates were multidrug resistant with two E.coli strains showing pan-resistance to the first line drugs tested. Carbapenem resistance was seen in 67.2% of all gram negative isolates tested. Metallo beta-lactamases production was found to be highest among the Klebsiella isolates. Among the Enterobacterales, highest susceptibility was noted to Fosfomycin (87.7%) followed by Nitrofurantoin (62.7%). Similarly in gram positive group, highest susceptibility was again to Fosfomycin followed by Nitrofurantoin. Overall the prevalence of MDR is increasing however Fosfomycin or Nitrofurantoin, both oral antibiotics, can be the considered for starting empirical antibiotic therapy.

Prevalence and antimicrobial resistance of Salmonella recovered from pig-borne food products in Henan, China

Foodborne disease is one of the most important public health issues worldwide. Food of animal origin is considered as the main vehicle of transmission to humans. Pigs are carriers of numerous foodborne pathogens, including Salmonella which is linked to pork related infection and leads to significant public health concerns, particularly with emerging antimicrobial-resistant clones. Therefore, a continued and enhanced surveillance system of antimicrobial resistance (AMR) pathogens on animal-borne food is essential. This study aims to investigate the prevalence, serovars, and antimicrobial susceptibility pattern of Salmonella isolated from pig-borne food in Henan Province, China. The Salmonella isolates identification were subjected to microbiological culture and PCR assay with positive isolates were assayed for serotyping by slide agglutination test and antimicrobial resistance susceptibility by MIC test. Collectively, a total of 1441 pork and visceral pig products between March and October in 2019 were collected from retail market, we found that 219 (15.1%) were positive for Salmonella isolates from liver (n = 83), bile (n = 19) and pork (n = 117). The highest prevalence of positive Salmonella isolates was observed 25.86% in liver (n = 83/321), followed by 21.84% in bile (n = 19/87), and 11.33% in pork (n = 117/1033). Seventeen different serovars were identified and classified into five serogroups. The most prevalent identified serovar was S. Derby (32.87%), followed by S. Rissen (25.57%) and S. Goldcoast (10.50%). We also found high resistance rate against tetracycline (96.5%), sulfisoxazole (96.3%), followed by amoxicillin (85.2%), ampicillin (84.4%), and streptomycin (83.7%), respectively. An additional investigation of multi-drug resistance pattern (MDR ≥3 antimicrobial classes) indicated that serovar Indiana (n = 13) showed the highest MDR (ACSSuT-AMC-CIP) prevalence (100%), followed by Goldcoast and Derby. Collectively, this study showed considerable diversity among Salmonella isolates in the pig-borne food and highlighted a high prevalence and emerging foodborne MDR clones may increase the frequency of therapeutic failure in the clinical settings.

Impact of an antimicrobial stewardship programme on antimicrobial utilization and the prevalence of MDR Pseudomonas aeruginosa in an acute care hospital in Qatar.

BackgroundThe excessive and inappropriate use of antibiotics is universal across all healthcare facilities. In Qatar there has been a substantial increase in antimicrobial consumption coupled with a significant rise in antimicrobial resistance (AMR). Antimicrobial stewardship programmes (ASPs) have become a standard intervention for effective optimization of antimicrobial prescribing.MethodsA before–after study was conducted in Hamad General Hospital (603 bed acute care hospital): 1 year before implementation of a comprehensive ASP compared with the following 2 years. The ASP included a hospital-wide pre-authorization requirement by infectious diseases physicians for all broad-spectrum antibiotics. Prevalence of MDR Pseudomonas aeruginosa was compared with antimicrobial consumption, calculated as DDD per 1000 patient-days (DDD/1000 PD). Susceptibility was determined using broth microdilution, as per CLSI guidelines. Antibiotic use was restricted through the ASP, as defined in the hospital’s antibiotic policy.ResultsA total of 6501 clinical isolates of P. aeruginosa were collected prospectively over 3 years (2014–17). Susceptibility to certain antimicrobials improved after the ASP was implemented in August 2015. The prevalence of MDR P. aeruginosa showed a sustained decrease from 2014 (9%) to 2017 (5.46%) (P = 0.019). There was a significant 23.9% reduction in studied antimicrobial consumption following ASP implementation (P = 0.008). The yearly consumption of meropenem significantly decreased from 47.32 to 31.90 DDD/1000 PD (P = 0.012), piperacillin/tazobactam from 45.35 to 32.67 DDD/1000 PD (P < 0.001) and ciprofloxacin from 9.71 to 5.63 DDD/1000 PD (P = 0.015) (from 2014 to 2017).ConclusionsThe successful implementation of the ASP led to a significant reduction in rates of MDR P. aeruginosa, pointing towards the efficacy of the ASP in reducing AMR.

Bacterial Profile and ESBL Screening of Urinary Tract Infection Among Asymptomatic and Symptomatic Pregnant Women Attending Antenatal Care of Northeastern Ethiopia Region.

BackgroundUrinary tract infection is a common cause of morbidity in pregnant women. Emergence of antimicrobial resistance particularly ESBL production among bacterial uropathogens is increasing and becoming principal cause of treatment failure. The aim of this study was to determine the bacterial profile, their antimicrobial susceptibility patterns, risk factors and identify ESBL-producing bacterial uropathogens.Patients and MethodsA hospital-based cross-sectional study was conducted in the Northeastern Ethiopia region. A total of 323 pregnant women were included and structured questionnaire was used to collect sociodemographic and risk factor-related data. About 10mL freshly voided midstream urine specimen was collected, transported and processed according to standard operating procedures. The data obtained were entered into SPSS version 22 and descriptive statistics, chi-square, bivariate and multivariate logistic regression analyses were performed. P-value ≤0.05 with corresponding 95% confidence interval were considered for statistical significance.ResultsThe overall prevalence of UTI was 15.5% (50/323). The predominant bacterial isolates were Escherichia coli 17 (33.3%) followed by coagulase-negative staphylococci 15 (30.0%) and Staphylococcus aureus 14 (27.5%). Previous history of UTI (AOR=8.824, 95% CI: 3.769,20.654, P<0.001) and history of catheterization (AOR=3.270, 95% CI: 1.316,8.122, P=0.011) were significantly associated with the occurrence of bacterial UTI. Gram-negative isolates showed high level of resistance to ampicillin 12 (60.0%) and relatively low level of resistance to nitrofurantoin 5(25.0%), norfloxacin 5 (25.0%) and ceftazidime 3 (15.0%). Gram-positive uropathogens showed higher resistance for penicillin 29 (93.5%) and trimethoprim-sulfamethoxazole 23 (79.3%) whereas all isolates were sensitive 29 (100.0%) to nitrofurantoin. Moreover, multidrug resistance was observed among 41 (80.4%) of the isolates, and 3 (15.8%) of isolated gram-negative bacteria were ESBL producers.ConclusionHigh prevalence of bacterial UTI and MDR for commonly prescribed drugs were observed with significant number of ESBL producers. Therefore, instant UTI culture assessment of pregnant women, especially those having possible risk factors such as previous histories of UTI and catheterization; moreover, appropriate prescription and use of antibiotics are necessary.

Lytic Activity of Polyvalent Staphylococcal Bacteriophage PhiSA012 and Its Endolysin Lys-PhiSA012 Against Antibiotic-Resistant Staphylococcal Clinical Isolates From Canine Skin Infection Sites.

The spread of antibiotic-resistant bacteria (ARB) in human and veterinary medicine is of global concern. Notably, the emergence of methicillin-resistant Staphylococcus pseudintermedius has become a serious problem. In this context, bacteriophages and their lytic enzymes, endolysins, have received considerable attention as therapeutics for infectious diseases in place of antibiotics. The aim of the present study was to investigate the antibiotic-resistance patterns of staphylococcal species isolated from canine skin at a primary care animal hospital in Tokyo, Japan and evaluate the lytic activity of the staphylococcal bacteriophage phiSA012 and its endolysin Lys-phiSA012 against isolated antibiotic-resistant staphylococcal strains. Forty clinical staphylococcal samples were isolated from infection sites of dogs (20 from skin and 20 from the external ear canal). Susceptibility to antimicrobial agents was determined by a disk diffusion method. The host range of phiSA012 was determined by using a spot test against staphylococcal isolates. Against staphylococcal isolates that showed resistance toward five classes or more of antimicrobials, the lytic activity of phiSA012 and Lys-phiSA012 was evaluated using a turbidity reduction assay. Twenty-three S. pseudintermedius, 16 Staphylococcus schleiferi, and 1 Staphylococcus intermedius were detected from canine skin and ear infections, and results revealed 43.5% methicillin resistance in S. pseudintermedius and 31.3% in S. schleiferi. In addition, the prevalence multidrug resistance (MDR) S. pseudintermedius was 65.2%. PhiSA012 could infect all staphylococcal isolates by spot testing, but showed little lytic activity by turbidity reduction assay against MDR S. pseudintermedius isolates. On the other hand, Lys-phiSA012 showed lytic activity and reduced significantly the number of staphylococcal colony-forming units. These results demonstrated that ARB issues underlying in small animal hospital and proposed substitutes for antibiotics. Lys-phiSA012 has broader lytic activity than phiSA012 against staphylococcal isolates; therefore, Lys-phiSA012 is a more potential candidate therapeutic agent for several staphylococcal infections including that of canine skin.

Heading towards threat of resistant super bug…. current pattern of antimicrobial sensitivity to salmonella typhi in Karachi.

Objectives: The present study was aimed to find out the prevalence of MDR and XDR Typhoid and the remaining or alternate treatment options here in Karachi. Study Design: Descriptive retrospective analytical study. Setting: Department of Medicine, at Mamji Hospital Karachi. Period: From Jan 2019 till July 2019. Material &amp; Methods: The medical records of all the patient admitted, were reviewed by the department of Medicine, at Mamjee Hospital Karachi specifically diagnosed to have Typhoid fever during the period between Jan 2019 till July 2019. A total of 72 patients were included in this study. Chart reviews were used to obtain and later collect the data. Typhoid was confirmed over Blood culture yielding Salmonella typhi. Demographic data and pattern of antibiotic sensitivity were collected. Statistical analysis was performed on SPSS version 17. Continuous variables were expressed as mean ± SD. Discrete variables were expressed as percentages and proportions. Results: From January 2019 till July 2019, 72 patients were diagnosed to have Typhoid fever (Salmonella Typhi culture positive) of which 43(60%) were male and majority of the patients were aged between 18 to 40 years 37(51%). Out of 14 antibiotics checked for sensitivity to Salmonella Typhi the Quinolones were the most resistant (85%) antibiotics followed by Ampicillin (83%) and Trimethoprim-sulfamethoxazole (82%). 48(66%) among 72 patients had extended drug resistant typhoid, 14(19%) were multidrug resistant typhoid while 11(15%) were pan sensitive. Conclusion: Majority of the patients had extended drug resistant typhoid, whereas quite a few had multidrug resistant typhoid. Most sensitive drugs were Imipenem, meropenem and Azithromycin whereas Quinolones along with other agents were found to have most resistance against Salmonella Typhi.