Prevalence Of MDR Research Articles

Antibacterial effect of green tea extract against multi drug resistant Escherichia coli isolated from urine sample of patients visiting tertiary care hospital of Eastern Nepal

Urinary tract infections (UTIs) caused by drug resistant (DR) Uropathogenic Escherichia coli have become a significant worldwide public health problem. Green tea (Camellia sinensis), has been reported to have antimicrobial activities against various pathogenic bacteria. The main aim of our study was to estimate the antibacterial effect of green tea extract against drug resistant Uropathogenic E. coli isolated from urine samples of patients visiting in tertiary care hospital from eastern Nepal. During the study 360 urine samples were collected from UTI suspected patients visiting a tertiary care hospital of Biratnagar. Urine samples were cultured by using semi-quantitative culture technique and bacteria was identified by standard microbiological procedure. Antibiotic susceptibility testing was done by Kirby-Bauer Disk Diffusion method according to NCCLS (2011) guidelines. The antibacterial effect of green tea extract was performed by preparing the 95% ethanol extract in Soxhlet apparatus which was dispensed in DMSO solution and sterilized by membrane filtration. Antibacterial activity of Green Tea Extract against MDR Uropathogenic Escherichia coli was performed by making different concentration of green tea. The overall prevalence of E. coli was 27.22% in study population whereas the prevalence of MDR E. coli was 21.08%. All the isolated E. coli exhibited 100% sensitivity towards Nitrofurantoin and it was still a drug of choice for the treatment of Urinary tract infection caused by E. coli. The green tea extracts exhibited effective antibacterial activity against MDR E. coli. The MIC of Green Tea Extract was found to be 600µg/ml for 24 MDR isolates and 1000µg/ml for remaining 11 isolates. Based on the present study it is concluded that Green Tea extracts have great potential as an antimicrobial agent against E. coli.
 Int. J. Appl. Sci. Biotechnol. Vol 8(1): 45-51

Prevalence and Antibiogram of MDR E. coli Strains Isolated from UTI Patients—1-Year Retrospective Study at Nishtar Medical Hospital, Multan

MDR uropathogens lead to high-level morbidity and mortality and pose a tremendous threat towards treatment failure and survival of UTI patients. This study was conducted to evaluate the demographic characteristics, antibiogram, and resistance pattern of Escherichia coli against antibiotics—a retrospective study at Nishtar Medical Hospital in Multan, from June 2016 to July 2017. A total of 150 clinical samples were collected and biochemically characterized by Berge’s manual, and antimicrobial susceptibility testing was performed by using the Kirby–Bauer disc diffusion method and the results were interpreted according to Clinical and Laboratory Standards Institute standards. Data was analyzed by the XL-stat software. Results indicate that UTI was more prevalent in rural areas such as Alipur (28.6%) and Jalalpur (18%) and less common in urban areas like Muzaffargarh (2.66) and Multan (2%). A total of 150 patients were examined, of which 88 were females and 62 males in which more frequently found pathogens were E. coli (33%) and others Klebsiella pneumonia (18%), Proteus (10%), Staphylococcus saprophyticus (8.66%), Staphylococcus aureus (7.33%), Pseudomonas aeruginosa (6.66%), Enterobacter (6%), Candida (5.33%), and Citrobacter (4.66%). The antimicrobial susceptibility testing was carried out against E. coli strains that showed the highest overall resistance patterns of imipenem (IMI), Cip, Aug, Cfm, and CN, which were 80%, 72%, 68%, 60%, and 52%, respectively. MDR E. coli strains showed the highest resistance pattern towards IMI which put through alarming situation in Pakistan. Significant results showed that TZP, AK, and F were found sensitive in vitro against E. coli isolates of UTIs. Prevalence of MDR uropathogens near around Multan has been first time documented in this study with respect to possible risk factors associated with UTI. These alarming signs of MDR E. coli have been rarely addressed and warrant attention on urgent basis.

Prevalence and antimicrobial drug resistance of Staphylococcus aureus isolated from cow milk samples

Background and Aim:Staphylococcus aureus infections and antimicrobial resistance (AMR) in mastitis cases are both of clinical and economic importance. This study investigated the prevalence and AMR patterns of S. aureus isolated from composite milk samples of dairy cows submitted to the Onderstepoort Milk Laboratory for routine diagnosis.Materials and Methods:A total of 2862 cow milk samples randomly selected from submitted samples were tested for the presence of S. aureus using microbiological and biochemical tests. Confirmation of isolates was done using the analytical profile index. Antimicrobial susceptibility of S. aureus isolates against 12 antimicrobial agents was determined using the disk diffusion method.Results:S. aureus was isolated from 1.7% (50/2862) of the samples tested. All (100%) S. aureus isolates were resistant to at least one antimicrobial, while 62% (31/50) were resistant to three or more categories of antimicrobials (multidrug-resistant [MDR]). Most S. aureus isolates were resistant to erythromycin (62%; 31/50) and ampicillin (62%; 31/50). Almost half of S. aureus isolates were resistant to oxacillin (46%; 23/50) and only 8% (4/50) were resistant to cefoxitin.Conclusion:Although the prevalence of S. aureus among mastitis cases in this study was low, isolates exhibited high resistance to aminoglycosides, macrolides, and penicillins, all of which are important drugs in human medicine. The high prevalence of MDR S. aureus and the presence of methicillin resistance among S. aureus observed in this study are of both clinical and public health concerns.

Prevalence of Multidrug Resistance Mycobacterium Bovis in Human: A Systematic Review and Meta-Analysis

Introduction: Human infection with multidrug resistant mycobacterium bovis (MDR-M.bovis) is very rare. Recently, infection with this type of bacteria has been described. The WHO strategy to end TB by 2035, recall for more efforts in the diagnosis and treatment of mycobacterium bovis particularly in resource limited countries. The aim of this systematic review was to determine the prevalence of multidrug resistant tuberculosis M.bovis infects human. Methods: International database including Medline, EMBASE, and Web of Sciences, Scopus, and ScienceDirect were searched for related literature. Google Scholar searching engines as well as references list were explored. Studies met the inclusion criteria were included in the systematic review. Random effects model was used to estimate the pooled prevalence. Results: A total number of (4275) studies were retrieved and nine studies were included in the meta analysis. The overall estimated prevalence of the multidrug resistant Mycobacterium bovis was 0.04 (95% CI: 0.02, 0.06). Based one study quality, time and area of study, subgroup analysis were conducted to check for heterogeneity. The prevalence of MDR- M bovis in low quality studies was 0.04 (95% CI: 0.00, 0.06), and in high quality studies was 0.05 (95% CI: 0.02, 0.08). Conclusions: The finding of this study indicated that the prevalence of multidrug resistant M.bovis in human is low. However, more attention is needed in the diagnosis and treatment of M.bovis infection in Human. Keywords: Tuberculosis, Multidrug-Resistant Mycobacterium bovis review meta-analysis Human DOI : 10.7176/JHMN/69-01 Publication date: December 31 st 2019

Prevalence of Integrons and Antibiotic Resistance Pattern in Acinetobacter baumannii Isolated from Clinical Samples of Iranian Patients: A Systematic Review and Meta-analysis.

Acinetobacter baumannii is an important opportunistic nosocomial pathogen. Class 1 integrons in A. baumannii plays a significant role in antibiotic resistance. Therefore, this study aimed to investigate the prevalence of integrons and antibiotic resistance pattern in A. baumannii isolated from clinical samples of Iranian patients. The Medical Subject Headings (MeSH) and the keywords with the help of Boolean operators ("AND" or "OR") were used alone or in combination to conduct the search. The searching process was conducted in the Web of Science, PubMed, Cochrane Library, Scopus, and Google Scholar databases and, also Iranian databases. The search was restricted to relevant English and Persian cross-sectional publications reporting the prevalence of Int1 in A. baumannii isolated from clinical samples from 1 January 2000 to 31 December 2018. The data were analyzed using Comprehensive Meta-Analysis software. Regarding the heterogeneity of studies, the random effects model was used. Cochrane Q and I2 tests was used to evaluate statistical heterogeneity between the studies. Fifteen studies were included in the analysis. The combined prevalence of class 1 integrons in A. baumannii was 55.2% (95% CI: 44.8-65.1). The pooled prevalence of MDR A. baumannii isolates was 68.1%. The highest resistance belonged to Aztreonam, followed by Ciprofloxacin, and Ceftazidime with a resistance rate of 97.6%, 92.8%, and 91.6%, respectively. Tobramycin was reported as an effective antibiotic. The present study reported an alarmingly high prevalence of class 1 Integrons, and MDR isolates of A. baumannii recovered from clinical samples that should be considered.

Antimicrobial stewardship approach: Prevalence of antimicrobial resistant bacteria at a regional hospital in South Africa.

Antimicrobial stewardship practices are crucial for the regular surveillance to change the antimicrobial policy. This study was conducted to decide the prevalence of common bacteria and their antibiogram regarding antimicrobial stewardship program within one year, at the regional and district, Stanger hospital in South Africa. It was based the study on clinical data and laboratory records of the patients. It reviewed the clinical and laboratory data. The prevalence/proportion rate was calculated and correlated with the majority of microorganism vs empirical therapy. The prevalence of MRSA, MRSE, VRSA, ESBL+ K. pneumoniae; E. coli cultured from the blood was 25%, 49%, 2%, 62% and 27% respectively. Similarly, we analysed for other targeted MDROs organisms (Acinetobacter species and P. aeruginosa, CRE, CPE) isolated from blood culture and endotracheal aspirate. The prevalence of MDR Acinetobacter species exceeded 61%, 33% from the blood and ETA respectively. The prevalence of MDR P. aeruginosa was 10% from ETA. The MRSA, MRSE, VRSA, VRE were observed in blood specimen. The majority of the microorganisms cultured from the CSF was Cryptococcus neoformans and followed by bacteria: Streptococcus pneumonia, Streptococcus group B and Haemorphilus influenza. The selection of empirical antimicrobial therapy relates not only the institutions or unit-specific antibiogram but also the site of infection. We can further suggest continuing to do surveillance of antibiogram and prevalence of MDR organisms for infection control as well as for empirical therapy, part of the antimicrobial stewardship program based on yearly records to change the local hospital antibiotic policy.

Time trend of prevalence and susceptibility to nitrofurantoin of urinary MDR Escherichia coli from outpatients.

To assess the time trend of the prevalence of urinary MDR Escherichia coli in Belgian outpatients (2005 versus 2011-12), the antibiotic susceptibility of urinary MDR E. coli, and the time trend of non-susceptibility to nitrofurantoin, i.e. first-line treatment for uncomplicated urinary tract infections (UTIs), of urinary MDR E. coli (2005 versus 2011-12). In this secondary analysis of a multicentre study, which collected a convenience sample of voluntary participating laboratories (15 and 8 in 2005 and 2011-12, respectively), we analysed antimicrobial susceptibilities (ampicillin, amoxicillin/clavulanate, cefalotin, ciprofloxacin, nitrofurantoin and trimethoprim/sulfamethoxazole) of urinary E. coli. MDR was defined as resistance to three or more of these agents. The prevalence of MDR E. coli and its non-susceptibility to nitrofurantoin was compared between 2005 and 2011-12 using a generalized estimating equation model. MDR status could be determined for 9704 and 12512 urinary E. coli isolates from 7911 and 9441 patients in 2005 and 2011-12, respectively, with most patients being women (79% in both study periods). The prevalence of MDR increased from 28.4% (2758/9704) in 2005 to 34.3% (4286/12512) in 2011-12 (adjusted OR 1.305; 95% CI 1.220-1.397). Within the MDR isolates, the prevalence of nitrofurantoin non-susceptibility decreased from 23.2% (623/2684) in 2005 to 10.7% (455/4253) in 2011-12 (adjusted OR 0.424; 95% CI 0.363-0.494). Despite a high prevalence of MDR E. coli in urinary samples from Belgian outpatients, nitrofurantoin could still be recommended as first-line empirical treatment in uncomplicated UTIs.

Oral fosfomycin for the treatment of chronic bacterial prostatitis

BackgroundChronic bacterial prostatitis (CBP) is a difficult-to-treat infection as only a few antibiotics achieve therapeutic concentrations in the prostate. Data on the efficacy and safety of oral fosfomycin for the treatment of CBP are limited.ObjectivesTo analyse the efficacy and safety of fosfomycin in CBP due to MDR pathogens.MethodsIn a prospective observational study, an oral regimen of 3 g of fosfomycin q24h for 1 week followed by 3 g q48h for a treatment duration of 6–12 weeks was administered. The outcome was clinical and microbiological cure rate at the end of treatment (EOT) and rate of relapse at 3 and 6 months.ResultsThe study included 44 patients. The most common pathogen was Escherichia coli (66%), followed by Klebsiella spp. (14%) and Enterococcus faecalis (14%). Most strains were MDR (59%) and 23% had an ESBL phenotype; 33 of 44 strains were resistant to fluoroquinolones, but all were susceptible to fosfomycin (median MIC for Gram-negative pathogens 1.5 mg/L). In 25 patients, treatment was administered for 6 weeks, whereas in the remaining 19 patients it was prolonged to 12 weeks based on the presence of calcifications in the prostate. Cure rate was 82% at EOT and 80% and 73% at 3 and 6 months accordingly. Microbiological eradication was achieved in 86% and 77% at EOT and at 6 months, respectively. Failure was observed in 12 patients. The most common adverse event was diarrhoea (18%).ConclusionsOral fosfomycin, particularly in the era of MDR prevalence, represents an attractive, safe and effective alternative to fluoroquinolones for the treatment of CBP.

Maternal-Infant Correlation of Multidrug-Resistant Staphylococcus aureus Carriage: A Prospective Cohort Study.

Objectives: We aim to assess the correlation of multidrug-resistant Staphylococcus aureus (MDR S. aureus) carriage between mothers and their newborn infants.Materials and Methods: We conducted a prospective cohort study of mothers and their newborn infants in two hospitals in Shenzhen, China, from August to November 2015. We collected demographic and clinical information from mothers and newborn infants by face-to-face questionnaires and medical datasets. Serial swabs were collected from mothers and their newborn infants for further experiments. Maternal-infant correlation was assessed using the Poisson regression model.Results: The prevalence of MDR S. aureus vaginal carriage in mothers was 4.7% (86/1834). The incidence of MDR S. aureus carriage in newborn infants was 1.3% (23/1834). The adjusted relative risk and 95% confidence interval of maternal-infant MDR S. aureus carriage was 7.63 (2.99–19.49). Six MDR S. aureus maternal-infant pairs were concordant. The phenotypic and molecular characteristics of MDR S. aureus isolates were similar between mothers and their newborn infants.Conclusion: MDR S. aureus vaginal carriage in mothers was associated with an increased risk for MDR S. aureus carriage in their newborn infants.

327. Comparison of Clinical Outcome, Causative Serotypes, and Antimicrobial Susceptibilities Between Pneumococcal Meningitis and Pneumococcal Bacteremic Pneumonia in Adult Patients in the Republic of Korea

BackgroundPneumococcal meningitis (PM) is one of invasive pneumococcal disease (IPD) and is considered as a medical emergency with notable morbidity and mortality. This study was designed to characterize differences in clinical characteristics and outcomes, pneumococcal serotypes, and antimicrobial susceptibilities between PM and pneumococcal bacteremic pneumonia (PBP) in adult patients in the Republic of Korea (ROK) from a prospective observational cohort.MethodsAdult IPD cases (≥18 years) were prospectively collected from 20 hospitals participated in the pneumococcal surveillance program in the ROK from 2013 through 2015. Serotyping and antimicrobial susceptibility testing were performed by a multiplexed serotyping assay and Microscan system, respectively.ResultsDuring the study period, 30 cases of PM and 205 cases of PBP were compared. Serotypes 19A, 15B/15C, and 35B were the most prevalent among PM cases, whereas serotypes 3, 11A/D/F, and 19A were the most common serotypes in PBP. There were significant female predominance (46.7% vs. 2.3%, P = 0.022), younger age (56.7% vs. 36.1%, P = 0.031), less immunocompromised states (3.3% vs. 28.8%, P = 0.005), less underlying chronic lung diseases (3.3% vs. 16.6%, P = 0.04), and lower mortality rate (16.7% vs. 44.4%, P = 0.004) in PM, compared with PBP. However, PM cases showed higher penicillin resistance (76.7% vs. 19.2%, P < 0.001), and ceftriaxone resistance (53.3% vs. 13.4%, P < 0.001), consistent with higher MDR prevalence in PM cases (76.7% vs. 53.2 P = 0.016). All PM cases except for three cases received empiric or definite vancomycin treatment. Multiple logistic regression analysis showed that penicillin resistance (odds ratio [OR] 15.75, 95% confidence interval (CI) 3.82–64.72, P < 0.001) and survival (OR 20.73, 95% CI 3.1–136.74, P = 0.002) were significantly associated with PM.ConclusionThis study indicates that adult PM showed favorable clinical outcomes, compared with PBP, despite of differences in clinical characteristics.Disclosures All authors: No reported disclosures.

Characterization, distribution, antimicrobial resistance and resistance risk factors in staphylococci isolated from cats from 2001 to 2014.

Relatively few studies have been published describing the patterns of staphylococcal isolation and antimicrobial resistance over time in cats. The objective of this retrospective study was to determine the frequency, location, characteristics and antimicrobial resistance profiles of staphylococci isolated by the Louisiana Animal Disease Diagnostic Laboratory between the years 2001 and 2014. All feline staphylococcal isolates were classified phenotypically. Isolates corresponding to known or possibly pathogenic species (Staphylococcus intermedius group (SIG) and Staphylococcus aureus (SA)) as well as Staphylococcus epidermidis (SE) and non‐speciated coagulase‐negative staphylococci (CNS) were further evaluated to determine antimicrobial resistance patterns. A total of 519 staphylococci were isolated. The largest percentage of isolates was CNS, representing 39.3% of the total, while SIG, SE, SA and non‐speciated coagulase positive staphylococci (CPS) represented 18.1%, 10.2%, 8.3% and 7.3%, respectively. Methicillin resistance (MR) was identified in 57.1% of SA and 20.5% of SIG. Resistance to 3 or more antimicrobial classes (multidrug resistance; MDR) was demonstrated in 54.5% of SA and 23.9% of SIG. The prevalence of MDR increased over time in both SIG and SA, while the prevalence of MR increased over time in SIG. An increase in mean antimicrobial resistance score over time was seen in SIG. This study demonstrates a high and increasing prevalence of MDR in SIG and SA, as well as increasing prevalence of MR in SIG isolated from cats.

Extended-spectrum β-lactamase prevalence and virulence factor characterization of enterotoxigenic Escherichia coli responsible for acute diarrhea in Nepal from 2001 to 2016

BackgroundMultidrug-resistant (MDR) Gram-negative bacterial species are an increasingly dangerous public health threat, and are now endemic in many areas of South Asia. However, there are a lack of comprehensive data from many countries in this region determining historic and current MDR prevalence. Enterotoxigenic Escherichia coli (ETEC) is a leading cause of both acute infant diarrhea and traveler’s diarrhea in Nepal. The MDR prevalence and associated resistance mechanisms of ETEC isolates responsible for enteric infections in Nepal are largely unknown.MethodsA total of 265 ETEC isolates were obtained from acute diarrheal samples (263/265) or patient control samples (2/265) at traveler’s clinics or regional hospitals in Nepal from 2001 to 2016. Isolates were screened for antibiotic resistance, to include extended spectrum beta-lactamase (ESBL) production, via the Microscan Automated Microbiology System. ETEC virulence factors, specifically enterotoxins and colonization factors (CFs), were detected using multiplex PCR, and prevalence in the total isolate population was compared to ESBL-positive isolates. ESBL-positive isolates were assessed using multiplex PCR for genetic markers potentially responsible for observed resistance.ResultsA total of 118/265 (44.5%) ETEC isolates demonstrated resistance to ≥2 antibiotics. ESBL-positive phenotypes were detected in 40/265 isolates, with isolates from 2008, 2013, 2014, and 2016 demonstrating ESBL prevalence rates of 1.5, 34.5, 31.2, and 35.0% respectively. No difference was observed in overall enterotoxin characterization between the total ETEC and ESBL-positive populations. The CFs CS2 (13.6%), CS3 (25.3%), CS6 (30.2%), and CS21 (62.6%) were the most prevalent in the total ETEC population. The ESBL-positive ETEC isolates exhibited a higher association trend with the CFs CS2 (37.5%), CS3 (35%), CS6 (42.5%), and CS21 (67.5%). The primary ESBL gene identified was blaCTX-M-15 (80%), followed by blaSHV-12 (20%) and blaCTX-M-14 (2.5%). The beta-lactamase genes blaTEM-1 (40%) and blaCMY-2 (2.5%) were also identified. It was determined that 42.5% of the ESBL-positive isolates carried multiple resistance genes.ConclusionOver 30% of ETEC isolates collected post-2013 and evaluated in this study demonstrated ESBL resistance. Persistent surveillance and characterization of enteric ETEC isolates are vital for tracking the community presence of MDR bacterial species in order to recommend effective treatment strategies and help mitigate the spread of resistant pathogens.

Multidrug Resistant Pseudomonas aeruginosa in Iran: A Systematic Review and Metaanalysis.

Background:Multidrug-resistant Pseudomonas aeruginosa (MDR P. aeruginosa) is known as a serious threat to human health worldwide. Limited information is available concerning the prevalence of MDR P. aeruginosa in Iran. The aim of the present study was to investigate the relative frequency of MDR P. aeruginosa in different parts of Iran.Materials and Methods:Using appropriate keywords and well-known English and Persian database, available data about MDR P. aeruginosa in Iran were retrieved. After applying predefined criteria, relevant studies were selected.Results:By using random-effect models, the pooled incidence of MDR P. aeruginosa was estimated 58% (95% confidence interval [CI]; 0.54–0.61). The highest and lowest prevalence of MDR P. aeruginosa were observed in Tehran (100%) (95% CI; 0.94–1.00) and Zahedan (16%) (95% CI; 0.10–0.24), respectively. The highest resistance rate was against ceftazidime (50%) (95% CI; 0.46–0.54) and amikacin (50%) (95% CI; 0.46–0.54).Conclusion:Our findings are of concern since they demonstrate the high prevalence rate of MDR P. aeruginosa in the majority of Iranian hospitals.

A 23-year retrospective investigation of Salmonella Typhi and Salmonella Paratyphi isolated in a tertiary Kathmandu hospital.

BackgroundSalmonella serovars Typhi (S. Typhi) and Paratyphi A (S. Paratyphi A), the causative agents of enteric fever, have been routinely isolated organisms from the blood of febrile patients in the Kathmandu Valley since the early 1990s. Susceptibility against commonly used antimicrobials for treating enteric fever has gradually changed throughout South Asia since this time, posing serious treatment challenges. Here, we aimed to longitudinally describe trends in the isolation of Salmonella enterica and assess changes in their antimicrobial susceptibility in Kathmandu over a 23-year period.MethodsWe conducted a retrospective analysis of standardised microbiological data from April 1992 to December 2014 at a single healthcare facility in Kathmandu, examining time trends of Salmonella-associated bacteraemia and the corresponding antimicrobial susceptibility profiles of the isolated organisms.ResultsOver 23 years there were 30,353 positive blood cultures. Salmonella enterica accounted for 65.4% (19,857/30,353) of all the bacteria positive blood cultures. S. Typhi and S. Paratyphi A were the dominant serovars, constituting 68.5% (13,592/19,857) and 30.5% (6,057/19,857) of all isolated Salmonellae. We observed (i) a peak in the number of Salmonella-positive cultures in 2002, a year of heavy rainfall and flooding in the Kathmandu Valley, followed by a decline toward pre-flood baseline by 2014, (ii) an increase in the proportion of S. Paratyphi in all Salmonella-positive cultures between 1992 and 2014, (iii) a decrease in the prevalence of MDR for both S. Typhi and S. Paratyphi, and (iv) a recent increase in fluoroquinolone non-susceptibility in both S. Typhi and S. Paratyphi isolates.ConclusionsOur work describes significant changes in the epidemiology of Salmonella enterica in the Kathmandu Valley during the last quarter of a century. We highlight the need to examine current treatment protocols for enteric fever and suggest a change from fluoroquinolone monotherapy to combination therapies of macrolides or cephalosporins along with older first-line antimicrobials that have regained their efficacy.

Antimicrobial resistance in the next 30years, humankind, bugs and drugs: a visionary approach.

To describe the current standards of care and major recent advances with regard to antimicrobial resistance (AMR) and to give a prospective overview for the next 30 years in this field. Review of medical literature and expert opinion were used in the development of this review. There is undoubtedly a large clinical and public health burden associated with AMR in ICU, but it is challenging to quantify the associated excess morbidity and mortality. In the last decade, antibiotic stewardship and infection prevention and control have been unable to prevent the rapid spread of resistant Gram-negative bacteria (GNB), in particular carbapenem-resistant Pseudomonas aeruginosa (and other non-fermenting GNB), extended-spectrum β-lactamase (ESBL)-producing and carbapenem-resistant Enterobacteriaceae (CRE). The situation appears more optimistic currently for Gram-positive, where Staphylococcus aureus, and particularly methicillin-resistant S. aureus (MRSA), remains a cardinal cause of healthcare-associated infections worldwide. Recent advancements in laboratory techniques allow for a rapid identification of the infecting pathogen and antibiotic susceptibility testing. Their impact can be particularly relevant in settings with prevalence of MDR, since they may guide fine-tuning of empirically selected regimen, facilitate de-escalation of unnecessary antimicrobials, and support infection control decisions. Currently, antibiotics are the primary anti-infective solution for patients with known or suspected MDR bacteria in intensive care. Numerous incentives have been provided to encourage researchers to work on alternative strategies to reverse this trend and to provide a means to treat these pathogens. Although some promising antibiotics currently in phase 2 and 3 of development will soon be licensed and utilized in ICU, the continuous development of an alternative generation of compounds is extremely important. There are currently several promising avenues available to fight antibiotic resistance, such as faecal microbiota, and phage therapy.

Prevalence and risk factors of multi-drug resistant tuberculosis in Dalian, China.

ObjectivesTo investigate the prevalence and risk factors associated with multi-drug resistant tuberculosis (MDR–TB) in Dalian, China.MethodsThis was a retrospective review of data from patients attending a TB clinic in Dalian, China between 2012 and 2015. Demographic and drug susceptibility data were retrieved from TB treatment cards. Univariate logistic analysis was used to assess the association between risk factors and MDR–TB.ResultsAmong the 3552 patients who were smear positive for Mycobacterium tuberculosis (MTB), 2918 (82.2%) had positive MTB cultures and 1106 (31.1%) had isolates that showed resistance to at least one drug. The overall prevalence of MDR–TB was 10.1% (359/3552; 131/2261 [5.8%] newly diagnosed and 228/1291 [17.7%] previously treated patients). Importantly, 75 extensively drug-resistant TB isolates were detected from 25 newly treated and 50 previously treated patients. In total, 215 (6.1%) patients were infected with a poly-resistant strain of MTB. Previously treated patients and older patients were more likely to develop MDR–TB.ConclusionsThe study showed a high prevalence of MDR–TB among the study population. History of previous TB treatment and older age were associated with MDR–TB.

Inconsistency in the reporting of antitubercular drug susceptibility tests in an endemic region.

Background:Individualized treatment for multidrug-resistant tuberculosis (MDR TB) is associated with improved outcomes. Therapy needs to be tailored to drug susceptibility testing (DST) results. We present our observations on the inconsistency in DST reporting in an endemic region with a high prevalence of MDR TB.Methods:We retrospectively analyzed 118 DST reports from 10 different laboratories.Observations:Of 118 patients, only 79 (67%) had DST reports with results to all first-line drugs, a fluoroquinolone (excluding ciprofloxacin), all aminoglycosides, and a polypeptide. Twenty-one (18%) isolates did not have DST reports for all first-line drugs; 4 (3%) did not have DST reports for any second-line drugs; 9 (8%) did not have DST reports for a fluoroquinolone; and 31 (26%) did not have DST reports for all second-line aminoglycosides and polypeptide.Conclusion:Inconsistencies were observed in several of the 118 DST reports. A case is made for sensitization toward standardization and completeness in TB DST reporting in India.

Prevalence of Gene Mutations profiles by GenoType MTBDRplus/sl to First Line Antituberculosis Drugs and Clinical Characteristics in Drug Resistant Tuberculosis Patients Referred to the National Institute of Respiratory Diseases in Mexico City

BackgroundDrug resistance tuberculosis, specially MDR and XDR are a big challenge for diagnosis and treatment. In Mexico the prevalence of MDR is between 3–5%, a number probably underestimated due to lack of diagnostic tests for susceptibility. The National Institute of Respiratory Diseases in Mexico City is the national referral center for MDR/XDR tuberculosis. In our country there is no data about the gene mutations involved in drug resistance to first line antituberculosis treatment nor the clinical characteristics that accompany these findings.Objective: Evaluate the prevalence of genotyping profiles according to a line probe assay (LPA) in patients with drug resistance tuberculosis and their associated clinical characteristicsMethodsRetrospective cohort from 2010 to 2014 of M. tuberculosis isolates with any type of resistance to first line antituberculosis drugs identified by MGIT SIRE and in which GenoType MTBDRplus/sl were performed, we evaluate prevalence of genotyping profiles according to the LPA within the isolates and gather data from those with complete medical records to asses clinical characteristics.ResultsIn 52 and 33 isolates phenotyping and genotyping MTBDRplus/sl respectively were performed, 41 resistant to Isoniazid INH with 75% genotypic concordance, 33 resistant to rifampicin RIF with 75.6% concordance, 14 to streptomycin SM with 23% concordance and 10 to ethambutol EMB with 100% concordance, 54% MDR tuberculosis. The genotyping profile for RIF was absence of probes rpoB Wild Type 8 (WT) 57.7%, WT 7 30.8% and presence of rpoB mutation 3 (MUT) 19.2%. For INH absence of InhA WT2 48.1% and InhA WT1 19.2%. For EMB absence of embB WT1 30.8% and for SM absence of rrs WT1 (19%). Absence of InhA WT1 was associated with female (P = 0.01) and DM2 (P = 0.032) patients, other clinical/biochemical characteristics and mortality was not different in patients with o without the genotypic profile for each drug. Cavitary disease by CT was more frequent in patients with WT probe absence in RIF and INH than those who did not have a LPA suggestive of resistance for this drugs.ConclusionWild Type probe absense is the frequent finding in our isolates according to LPA in RIF, INH, EMB and SM, intrisic host factors and clinical characteristics seem not to be related to a particular resistant gene profile.Disclosures All authors: No reported disclosures.

Epidemiology and patterns of drug resistance among tuberculosis patients in Northwestern Iran

Background: Multidrug-resistant tuberculosis (MDR-TB) has emerged as an important global health concern and is on the rise throughout the world. Objective: The aim of this study was to examine the epidemiology and pattern of TB drug resistance. Methods: In this cross-sectional study, 180 pulmonary TB patients from two Northwestern provinces of Iran were selected. The first and second line drug susceptibility testing was carried out using the 1% proportion method on the Löwenstein–Jensen medium. Full demographic, environmental and clinical history was evaluated. Results: Prevalence of resistance to any TB drug was 13.8%. Eight (4.4%) patients had MDR-TB (2.4% in the province of East Azerbaijan and 9.3% in the province of Ardabil) and one patient had extensively drug-resistant TB. Patient resistance to both isoniazid and streptomycin was the most prevalent at a rate of 8.3%. Patients showed the least resistance to ethambutol (2.8%). There was a significant relationship between the previous history of TB drug treatment and TB drug resistance. Migrants from rural to urban areas were in high-risk groups for the occurrence of TB drug resistance. Conclusion: In our study, prevalence of MDR was less than the global average. It is essential to monitor the patients with previous history of TB treatment and migrants by rapid and accurate techniques in terms of drug-resistance odds.

Multidrug Resistant Salmonella enterica Strains in South Western Nigeria: Prevalence and Susceptibility to Ceftriaxone

Aims: To investigate the prevalence and susceptibility pattern Salmonella enterica strains to ceftriaxone in southwestern Nigeria. Place and Duration of Study: Faculty of Pharmacy, University of Ibadan, Nigeria from November 2012-May 2013. Methodology: Isolates of Salmonella enterica were characterized by established standard cultural and biochemical tests and was screened in-vitro for their sensitivity to different antibiotics (ampicillin, amoxicillin, chloramphenicol, cotrimoxazole and ceftriaxone) using the agar well diffusion method and their MICs determined. Original Research Article Idowu et al.; JAMPS, 6(4): 1-7, 2016; Article no.JAMPS.23533 2 Results: The susceptibility pattern of these strains to ceftriaxone and other antibiotics was examined to determine their prevalence among patients in South West Nigeria. 21 clinical isolates were screened in-vitro against five antibiotics. A higher number of the isolates showed MDR (76.19%) even at higher concentration of the antibiotics, while 61.9% were sensitive to ceftriaxone. Among the isolates, 71.43% resistance was recorded against ampicillin, 66.67% against amoxicillin, 38.1% resistance against ceftriaxone, 80.95% resistance against chloramphenicol and 57.14% resistance against cotrimoxazole. However, 3 isolates (14.29%) were completely sensitive to all of the antibiotics. The MICs obtained were higher (ranging from 30μg/ml to >100μg/ml), compared to the CSLI breakpoint standard. The result obtained showed an increased in incidence of MDR S. enterica strain in southwestern Nigeria, and that ceftriaxone is still remain the drug of choice against Salmonella enterica strains, even though the number of isolates producing resistance against the antibiotics is on the increase. Conclusion: The results above proces that the rate and prevalence of MDR Salmonella enterica strains are of major concern mostly in developing countries, therefore clinicians and public health practitioners should reduce the rate of antibiotic prescriptions and encourage public health and personal hygiene to prevent S. enterica infection.