Prevalence Of Multidrug Resistance Research Articles

Treatment of Hospital-Acquired Infections in Patients with Cirrhosis - New Challenges.

BackgroundHospital acquired infections (HAI) in the cirrhotic patients contribute to hepatic decompensation. With emergence of bacterial drug resistance, designing the treatment protocol of HA infection has become the foremost challenge.PurposeTo analyze the resistance pattern of organisms isolated from hospital-acquired (HA) infections and determine appropriate antibiotics treatment protocols for these infections.Study DesignA prospective hospital based observational study was undertaken.Patients and MethodsThe present study was conducted over 18 months at Kasturba Medical College, Mangalore, Karnataka, India. Patients with suspected HA infections were subjected to clinical, hematological and microbiological evaluation. Antibiotic sensitivity evaluation was undertaken for the bacteria isolated from these patients.ResultsDuring the study period, 398 patients with cirrhosis were 472 times admitted to the hospital for treatment. Out of these patients, 40 patients were diagnosed with 50 HA infections. Fifty five different organisms were isolated from these infections. It was found that these 55 bacteria isolates comprised 30 (54.54%) gram-negative (GN) and 25 (45.45%) gram-positive (GP) bacteria. Quite seriously, extended-spectrum beta-lactamase (ESBL) producers and methicillin-resistant Staphylococcus aureus (MRSA) were detected in 40% and 58% of GN and GP infections respectively. A total of 36 (65.4%) and (14.5%) 8 out of 55 isolated organisms exhibited multi–drug resistance (MDR) and extensive drug resistance (XDR) behavior, respectively.ConclusionCirrhosis patients with HA infection possess higher prevalence of MDR and XDR infections. In such sick patients, cephalosporin and quinolones are not the appropriate empirical antibiotics. Herein, we propose a tigecycline with carbapenem like meropenem and vancomycin based empirical antibiotics protocol to be prescribed for such patients. De-escalation is advised after the culture sensitivity report is obtained.

Prevalence and characterization of antibiotic resistant bacteria in raw community sewage from diverse urban communities

Community sewage is a useful medium for antimicrobial resistance (AMR) surveillance of populations residing in urban dwellings as it provides the resolution of tracking sources of AMR from different waste streams within a community. Antibiotic resistance profiles of 4 opportunistic pathogens were compared from 3 sewage sources: raw community sewage from 2 housing estates, a foreign workers dormitory and a pet centre. Sewage was collected from receiving manholes and a culture-based method was used to quantify opportunistic pathogens Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterococcus spp. K. pneumoniae was the most prevalent opportunistic pathogen detected while P. aeruginosa was the least abundant across the sample. A total of 892 bacterial isolates were selected for antibiotic susceptibility testing using the VITEKⓇ 2 Compact System (bioMérieux, Singapore). E. coli isolated from the pet centre exhibited higher resistance towards all 16 antibiotics tested, and P. aeruginosa showed at least 75% resistance towards the classes of antibiotics, except for carbapenems, aminoglycosides and quinolones (below 30%). For K. pneumoniae, resistance towards the classes of antibiotics was below 10%, except for penicillin and nitrofurans. Enterococcus spp. had high resistance towards gentamicin and clindamycin (both almost 100%), while resistance towards vancomycin was below 18% for all 4 locations. Multidrug resistant (MDR) P. aeruginosa and Enterococcus spp. showed the highest prevalence with percentages above 96%. MDR E. coli and MDR K. pneumoniae was lower, ranging between 9% to 54% and 8% to 23% respectively. Highest prevalence of MDR E. coli and K. pneumoniae were detected in the pet centre, with a percentage of 54% and 23% respectively. These results show that wastewater based surveillance is not only a useful method of understanding emerging trends of AMR across the community but also provides the resolution of capturing AMR data from key sewage sources based on population demographics. This information could provide a basis for devising better control measures to mitigate the spread of MDR.

A Systematic Review of Multi-decade Antibiotic Resistance Data for Ocular Bacterial Pathogens in the United States.

IntroductionSince 2009, the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) surveillance study has been assessing in vitro antibiotic resistance for bacterial isolates sourced from ocular infections in the US. The main goal of this systematic review was to compare in vitro resistance data for ocular pathogens from published US studies with the most recently published data from the ARMOR study (2009–2018) and, where possible, to evaluate trends in bacterial resistance over time over all studies.MethodsA literature search was conducted using MEDLINE®, BIOSIS Previews®, and EMBASE® databases (1/1/1995–6/30/2021). Data were extracted from relevant studies and antibiotic susceptibility rates for common ocular pathogens (Staphylococcus aureus, coagulase-negative staphylococci [CoNS], Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae), longitudinal changes in susceptibility, and multidrug resistance (MDR) were compared descriptively.ResultsThirty-two relevant studies were identified. High in vitro resistance was found among S. aureus and CoNS to fluoroquinolones, macrolides, and methicillin/oxacillin across studies, with high rates of MDR noted, specifically among methicillin-resistant staphylococci. Data from studies pre-dating or overlapping the early years of ARMOR reflected increasing rates of S. aureus resistance to fluoroquinolones, macrolides, methicillin/oxacillin, and aminoglycosides, while the ARMOR data suggested slight decreases in resistance to these classes between 2009 and 2018. Overall, methicillin-resistant S. aureus (MRSA) prevalence peaked from 2005 to 2015 with a possible decreasing trend in more recent years.Discussion and ConclusionsData from local and regional US datasets were generally consistent with data from the national ARMOR surveillance study. Continued surveillance of ocular bacterial pathogens is needed to track trends such as methicillin resistance and MDR prevalence and any new emerging antibiotic resistance phenotypes. Susceptibility data from ARMOR can inform initial choice of therapy, especially in practice areas where local antibiograms are unavailable.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40123-021-00449-9.

Prevalence of common carbapenemase genes and multidrug resistance among uropathogenic Escherichia coli phylogroup B2 isolates from outpatients in Wasit Province/ Iraq.

Carbapenems are the last resort antimicrobials for the treatment of extended spectrum β-lactamases (ESBLs) producing Enterobacteriaceae. Emergence of carbapenems resistant group B2 uropathogenic E. coli (UPEC) is a major concern because of their high virulence. Prevalence of these enzymes and multidrug resistance (MDR) among B2 UPEC isolates from Iraqi outpatients with acute urinary tract infection (UTI) was evaluated in this research. Urine cultures were performed and the isolates were identified biochemically. Escherichia coli isolates were tested for phylogroup reference by quadraplex PCR, then B2 isolates were detected for antimicrobial resistance by disc diffusion test and carbapenemase genes by PCR. Escherichia coli was the most prevalent among Gram-negative isolates (66.6%) and B2 was the most detected phylogroup among E. coli isolates (33.9%). Most of B2 isolates showed high resistance rates to tested antimicrobials, especially β-lactams with MDR revealed in 100% of them. Whereas, low resistance rates were noted against carbapenems, aminoglycosides and nitrofurantoin. Carbapenemase genes were detected in 76.3% of B2 isolates. Of which, blaOXA-48 was the most frequent (57.8%), followed by blaPER (47.3%), blaKPC (15.7%), blaVEB and blaVIM (10.5%, for each). Whereas, blaGES and blaIMP genes were not found. Coproduction of these genes occurred among 17 isolates. The combination of blaOXA-48 and blaPER was the most frequent (41.1%). All carbapenemase producing isolates were MDR. These results revealed high prevalence of carbapenemase genes and MDR among B2 UPEC recovered in this study. In the study area. it is strongly advised to use aminoglycosides and nitrofurantoin for empirical treatment of UPEC.

Antibiotic resistance in Escherichia coli from clinical and drinking water sources of Northern India

The distribution of antibiotic resistance rate to Ampicillin, Augumentin, Cephelexin Cefuroxime, Ceftriaxone, Gentamycin, Amikacin, Netilmycin, Ciprofloxacin, Ofloxacin, Chloramphenicol, Trimethioprim, Tetracycline & Furazolidone in E. coli isolated from drinking water sources and clinical sources have been investigated. The antibiotic resistance rate was significantly higher (p < .05, <. 01 & <. 001) in E. coli isolated from clinical sources in comparison to those from drinking water sources except for three antibiotics i.e. Cephelexin, Amikacin and Netilmycin. The Multidrug resistant (MDR) has also been observed in all these strains of E. coli. The prevalence of MDR was significantly (p<. 05) higher in clinical sources of E. coli for (10-12), numbers of antibiotics when compared to those from drinking water sources. These results suggested that the antibiotics resistance is significantly higher in clinical sources in comparison to drinking water sources.

Multidrug-Resistant Bacteria in Hospital Wastewater of the Korle Bu Teaching Hospital in Accra, Ghana.

Background:Antimicrobial resistance (AMR) is one of the top 10 public health threats. One approach to tackling the AMR menace could involve expanding the range of AMR surveillance domains to include hospital wastewater (HWW), a domain that has largely been overlooked by researchers.Aim:To evaluate the occurrence of multidrug-resistant bacteria in hospital wastewater of the Korle Bu Teaching Hospital (KBTH).Methodology:This was a longitudinal study involving 288 HWW samples consecutively collected across 12 weeks from the pool of wastewater emanating from 2 critical care units of KBTH—The Child Health Unit and the Maternity Unit—on Mondays and Thursdays, each week. The samples were cultured for bacteria, which were identified using the Matrix-Assisted Laser Desorption/Ionization-Time of Flight (MALDI-TOF) technique and subjected to antimicrobial susceptibility testing via the Kirby-Bauer method.Results:In total, 294 bacteria of 23 different types, all being Gram-negative, were isolated from the 288 samples. The predominant ones were Escherichia coli (30.6%, n = 90), Klebsiella pneumoniae (11.2%, n = 33), Citrobacter freundii (10.9%, n = 32), Alcaligenes faecalis (5.8%, n = 17), and Pseudomonas mendocina (5.4%, n = 16). The prevalence of multidrug resistance among the isolates was 55.4% (n = 163). Moreover, the prevalence of extended-spectrum beta-lactamase (ESBL) producers was 15.6% (n = 46). E. coli accounted for the most ESBL-producing organisms (28.9%, n = 26).Conclusion:The wastewater generated by the Maternity and Child Health Units of KBTH harbored a wide range of multidrug resistant bacteria, with a good proportion of these being ESBL producers, and the predominant one being E. coli. The study thus identifies the wastewater of KBTH as an important source of multidrug resistant organisms, and underscores the significance of appropriate treatment of wastewater of the hospital and other clinical, and related settings prior to its discharge.

Prevalence and microbiological and genetic characteristics of multidrug-resistant Pseudomonas aeruginosa over three years in Qatar.

Antimicrobial resistance (AMR) is a global priority with significant clinical and economic consequences. Multidrug-resistant (MDR) Pseudomonas aeruginosa is one of the major pathogens associated with significant morbidity and mortality. In healthcare settings, the evaluation of prevalence, microbiological characteristics, as well as mechanisms of resistance is of paramount importance to overcome associated challenges. Consecutive clinical specimens of P. aeruginosa were collected prospectively from 5 acute-care and specialized hospitals between October 2014 and September 2017, including microbiological, clinical characteristics and outcomes. Identification and antimicrobial susceptibility test were performed using the BD Phoenix identification and susceptibility testing system, matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS), and minimum inhibitory concentration (MIC) test strips. Overall, 78 selected MDR P. aeruginosa isolates were processed for whole-genome sequencing (WGS). The overall prevalence of MDR P. aeruginosa isolates was 5.9% (525 of 8,892) and showed a decreasing trend; 95% of cases were hospital acquired and 44.8% were from respiratory samples. MDR P. aeruginosa demonstrated >86% resistance to cefepime, ciprofloxacin, meropenem, and piperacillin-tazobactam but 97.5% susceptibility to colistin. WGS revealed 29 different sequence types: 20.5% ST235, 10.3% ST357, 7.7% ST389, and 7.7% ST1284. ST233 was associated with bloodstream infections and increased 30-day mortality. All ST389 isolates were obtained from patients with cystic fibrosis. Encoded exotoxin genes were detected in 96.2% of isolates. MDR P. aeruginosa isolated from clinical specimens from Qatar has significant resistance to most agents, with a decreasing trend that should be explored further. Genomic analysis revealed the dominance of 5 main clonal clusters associated with mortality and bloodstream infections. Microbiological and genomic monitoring of MDR P. aeruginosa has enhanced our understanding of AMR in Qatar.

A systematic review on the prevalence of multidrug-resistant Staphylococcus aureus from milk and milk products in Nigeria

The reports of increasing occurrence of multidrug-resistant (MDR) Staphylococcus aureus from milk and milk products across Nigeria constitute a significant public health threat. This study systematically reviewed the prevalence of MDR S. aureus in milk and milk products from all the geopolitical zones in Nigeria. Extensive literature search through African Journal Online, Google Scholar, Google, Semantic Scholar, PubMed, and Scopus was conducted. Articles published between August 8, 2007 and May 4, 2020 were included in the study and evaluated according to geopolitical zones where such studies were conducted. Of the 46 articles gathered, 28 were selected. The highest and lowest prevalence of MDR S. aureus recorded were 100% and 3.21% respectively. The phenotypic patterns of antibiotic resistance as evaluated from the studies examined consisted of different antibiotics combinations with multiple antibiotic resistance (MAR) indices ≥ 0.2. Furthermore, mecA was the dominant antibiotic resistance gene detected from S. aureus isolates exhibiting phenotypic resistance to the antibiotics tested. The high occurrence of MDR S. aureus in milk and milk products in Nigeria is worrisome, however, there was under-reporting or unavailable reports from some geopolitical zones. The MAR index > 2.0 recorded from the majority of the studies depicts the over use and/or misuse of antibiotics in Nigeria. The fight against MDR S. aureus should be holistic, involving the relevant authorities and stakeholders through the one health perspective which would ensure food safety and improve public health.

Prevalence of Multidrug Resistant Gram-negative Bacteria in Tissues of Diseased Chicken in Chitwan District, Nepal

For increasing productivity in poultry, antibiotics are overused. This increased use in antibiotics has raise the prevalence of Multidrug resistant (MDR) bacteria in poultry. Treatment of chicken infected with MDR bacteria is difficult to achieve, thereby increasing treatment cost and productivity cost. MDR bacteria of poultry can also infect humans if they are not handled properly. Thus, the purpose of this study was to find bacteria responsible for infecting chicken and prevalence of MDR bacteria in diseased chicken. Out of total 516 diseased chicken, 212(41.09%) chicken were infected by bacteria. The prevalence of E. coli (63.2%) was high in diseased chicken followed by Salmonella spp. (12.26%), Pseudomonas spp. (5.2%) and, Pasteurella spp. (4.7%). Out of total number of isolates, the prevalence of MDR was 42.5 %. This study also showed that Pasteurella spp. isolates had high MDR with prevalence of 50%. It is thus concluded that there was high prevalence of MDR bacteria among diseased chicken in Chitwan district.

Phylogenetic study, distribution of virulence genes and antibiotic resistance profiles of Escherichia coli isolated from Bushehr coastal water

ObjectiveMicrobial pollution of coastal water continues to rise human health concerns, following the consecutive population growth, especially in urban communities along beaches. Bushehr coastal water was evaluated to understand the intensity of human health risks. In this study, E. coli strains isolated from Bushehr coastal water samples were characterized for their pathotypes, phylogenetic groups, and antibiotic resistance pattern. MethodsA total of 120 E. coli environmental isolates obtained from coastal water samples were analyzed for susceptibility to 22 different antibiotics by using the agar disc diffusion method. The polymerase chain reaction was performed to detect the distribution of virulence-associated genes and phylogenetic groups among selected isolates. ResultsAmong the isolates, the prevalence of multidrug resistance (MDR) and non- multidrug resistance (Non-MDR) phenotypes were 60% and 34.17%, respectively. Moreover, the rate of resistance was highest to cotrimoxazole (24.17%) followed by ampicillin (22.50%) and nalidixic acid (18.33%). While the rate of resistance was lowest to cefepime, imipenem, and meropenem at the same rate of 0.83%. The pathogenic isolates contrived 10% of the population study and included EPEC, EIEC, and ETEC.The Clermont phylogenic analysis revealed phylogroup B1 (20.00%) was most prevalence followed A (19.17%), C (17.50%), E (13.33%), Clade I/II (3.33%), and B2 (2.50%). Moreover, 24.17% of isolates were not classified in the defined Clermont phylogroups. ConclusionsAny recreational use or food exploitation of the polluted areas of Bushehr beaches may cause transmission of multidrug-resistant and pathogenic E. coli strains to individuals and threaten human health.

A STUDY OF BACTERIAL PATTERN OF VENTILATOR ASSOCIATED PNEUMONIA AT A TERTIARY CARE CENTRE OF WESTERN INDIA

Background: Ventilator associated pneumonia (VAP) remains the commonest co-morbid infection in patients admitted to ICU leading to increased morbidity and mortality, despite the technological advancements in health care. Hence, a study of the local bacterial pattern of VAP along with antibiotic sensitivity is essential to frame institutional antibiograms to ensure appropriate empirical treatment of VAP. Aim:The present study aims to study the bacterial pattern of VAP in medical ICUs in a tertiary care center along with the antibiotic sensitivity of the isolates. Method: A descriptive, observational, cross-sectional study was conducted in combined 45 bedded, medical ICUs, at Sawai Man Singh Medical College and Hospital, from March 2020 to 2021. A total of 105 cases were enrolled after application of appropriate exclusion and inclusion criteria from patients on mechanical ventilation for > 48 hours without prior evidence of pneumonia or sepsis. Data regarding demographic and clinical features, laboratory parameters, culture and sensitivity and outcome in terms of death or discharge were collected in a pre-structured proforma and analyzed. Results: Out of the 105 patients evaluated in the study, 71(67.6%) were males. The mean age of the study population was 45.1 years (45.1 17.57) with a range of 18-85 years. Majority were below the age of 40 years (46.7%) followed by those above 60 years (26.7%). The incidence of VAP in the study was 49.5%. Most common co-morbidities underlying patients of VAP was chronic obstructive pulmonary disease (14.3%), coronary artery disease (13.3%), and chronic kidney disease (10.5%). Patients of VAP had a mean temperature of 101.1F (Mean ± SD; 101.1 0.99), along with leukocytosis (Mean ± SD;14399 5373), elevated serum creatinine (Mean ± SD; 1.9 5.9), alanine aminotransferase (Mean ± SD; 84.4 153.7), aspartate aminotransferase (Mean ± SD; 128.7 238.4), and LDH (Mean ± SD; 861.6 690.2), and decreased serum albumin(Mean ± SD; 3.0 0.5). The predominant isolate from endotracheal aspirate culture was Enterobacter species (17.2%), followed by Pseudomonas (15.2), Klebsiella (6.7%), Acinetobacter species (6.7%), and E. coli (4.9%). Those isolated from blood were Enterobacter species (17.2%), followed by Pseudomonas (6.7%), Klebsiella (6.7%), Enterococcus species (5.7%), and coagulase positive S.aureus (5.7%). The antibiotic sensitivity in the study revealed sensitivity predominantly to polymyxin (57.9%) and tigecycline (52.6%) followed by piperacillin-tazobactam (47.4%) and aztreonam (23.7%). The mortality observed in the study was 46.7%. Conclusion: The incidence of VAP in our study was 49.5% attributed to the use of microbiological definition to select cases of VAP and to lack of adequate nursing staff. Most of the isolated organisms isolated from endotracheal aspirate were multidrug resistant organisms sensitive to polymyxin and tigecycline. The mortality observed was also high due to prevalence of multi drug resistance and polymicrobial infection and delay in institution of appropriate antibiotics. Large multicentric studies with large sample size are needed to study the risk factors and their relation in causation of VAP.

Migratory wild birds carrying multidrug-resistant Escherichia coli as potential transmitters of antimicrobial resistance in China.

Migratory birds play an important role in the spread of multidrug-resistant (MDR) bacteria. To investigate the prevalence of MDR Escherichia coli in migratory birds in China and potential relationships with the environment, a total of 1387 samples (fecal samples, cloacal swabs, or throat swabs) were collected from migratory birds from three different river basins in China. The collected samples were processed and subjected to bacteriological examinations. Antimicrobial susceptibility testing of the recovered isolates was performed using the E-test for the detection of minimum inhibitory concentrations (MICs). Some antibiotic resistance genes were detected and the PCR products were confirmed by sequencing. In total, 478 (34.7%) E. coli isolates were recovered. The results showed that the drug-resistant E. coli isolates were highly resistant to β-lactams (43.7%) and tetracycline (22.6%), and 73 (15.3%) were MDR, including eight that were extended spectrum β-lactamase-positive. The retrieved strains harbored the blaCTX-M, blaTEM-1, tet(A), tet(B), tet(M), sul1, sul2, sul3, cmlA, floR, and intI1 genes with a prevalence of 5.9%, 36.4%, 80.5%, 11.9%, 6.8%, 6.8%, 47.5%, 12.7%, 50.8%, 37.3%, and 61.0%, respectively. The drug resistance rate of the isolates from southern China was higher than those from northern China. The E. coli samples collected for migratory birds in the Pearl River Basin had the highest proportion (46.7%) MDR isolates. Furthermore, MDR bacteria carried by migratory birds were closely related to the antibiotic content in the basin, which confirms that MDR bacteria carried by migratory birds are likely acquired from the environment. This study also confirmed that migratory birds are potential transmitters of MDR bacteria, demonstrating the need to reduce the use and emission of antibiotics and further in-depth studies on the mechanisms underlying drug resistance of bacteria.

Multidrug Resistance among Gram Negative E. coli in Chicken Meat (Rafha-Saudi Arabia)

Aims: Multidrug resistant (MDR) bacteria pose a major public health issuer globally. The genes for antibiotic resistance are transferred vertically in the form of genomic DNA and horizontally in the form of plasmids or transposons. Antibiotic are extensively used in animal farming to treat and prevent animal diseases, and at sub-therapeutic doses, they are used to promote animal growth. This extensive use of antibiotics is causing an increase in resistance among bacteria. More frequent, chicken meat available at retail shops is reported to be contaminated with a variety of drug resistant bacteria including E. Coli. The aim of the present study was to investigate antibiotic resistance in Escherichia coli strains isolated from chicken meat available in the local shops of Rafha, Saudi Arabia.
 Place and Duration of Study: Department of basic health sciences, College of Pharmacy, Northern Border University, Rafha, Saudi Arabia, between February and October, 2019
 Methodology: Eighty-six E. coli strains, isolated from chicken meat, were tested for their antibiotic resistance profile, using the disc diffusion method. 
 Results: All the isolated E. coli strains were tested against 14 antibiotics. The maximum resistance was found against penicillin G (95%) followed by amoxicillin (85%), Cephalothin (81%), Erythromycin (72%), and Tetracycline (50%). Imipenem was the most effective agent of all with only 1% resistance followed by Cefepime with almost 6% resistance.
 A high percentage of the isolates (57%,) were multidrug resistant as they were non—susceptible to at least one antimicrobial in ≥3 antimicrobial classes including amoxicillin, erythromycin and tetracycline.
 Conclusion: The prevalence of MDR E. coli in retail chicken meat is very high and could pose a serious threat to public health.

Molecular characterization and genetic diversity of multidrug- and extensively drug-resistant A. baumannii clinical isolates

ObjectiveThe increasing prevalence of multi-drug resistant (MDR) strains is now a serious menace for public health. The purpose of the study is to investigate the relationship between the variation of carbapenemases and antibiotic resistance profile among A. baumannii strains isolated from Tabriz, North-west Iran. MethodsA total of 127 A. baumannii isolates were obtained from two teaching hospitals in Tabriz, North-west Iran. Multiplex PCR was performed for the detection of carbapenemase-encoding genes. Furthermore, the genetic relationship of isolates was investigated by the enterobacterial repetitive intragenic consensus (ERIC)-PCR technique. ResultsAll isolates were resistant to carbapenem based on resistance to meropenem and imipenem. The frequency of multidrug-resistant (MDR) and extensively drug-resistant (XDR) was equal to 74.80% and 33.07% respectively. The most prevalent of MDR and XDR was related to patients up to 50 years (p < 0.05). The blaOXA-23-like genes were the most predominant among tested isolates 82 (64.5%), followed by blaOXA-143-like, 54 (42.51%); blaOXA-72, 39 (30.7%). None of the isolates were positive for the blaOXA-58-like gene. There was a significant relationship between the presence of the blaOXA-23 gene and the frequency of XDR strains (p < 0.01). Based on ERIC-PCR, 88 isolates were clustered into seven groups, while the remaining 21 were as single isolates. Most of the MDR isolates were related to B and C clusters (p < 0.05). The frequency of OXA-143 and OXA-72 was significantly high in A and B clusters (p < 0.05). This is the first report of the high incidence of blaOXA-143 and blaOXA-72 positive A. baumannii strains in Iran. The genetic relatedness of A. baumannii isolates was high, indicating cross-transmission within hospitalized patients. ConclusionA high prevalence of MDR and XDR A. baumannii strains with new resistance mechanisms was observed in our region. The incidence rate of OXA-type carbapenemases was different in the clusters classified by ERIC -PCR typing.

Prevalence of antimicrobial resistance in Gram-negative clinical isolates from a major secondary hospital in Kuwait: a retrospective descriptive study.

Building an antimicrobial resistance (AMR) surveillance system in a country requires analysis of available data on AMR in clinical isolates. This study's objective was to determine the AMR prevalence of Gram-negative bacterial (GNB) isolates cultured from clinical specimens at a major general hospital in Kuwait. A retrospective descriptive study was conducted on AMR profiles of GNB clinical isolates (n=5290) between January and December 2018. Data were extracted from the laboratory information system in the hospital. The GNB organisms (i.e., Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii) were isolated from five main locations at the hospital (i.e., intensive care units [ICUs], surgical wards, medical wards, pediatric wards, and outpatient polyclinics). Overall, high AMR prevalence (>50%) against ampicillin, cefuroxime, cefotaxime, ceftazidime, ciprofloxacin, and trimethoprim/sulfamethoxazole, were observed across the GNB organisms. However, low resistance prevalence (<10%) were observed against amikacin, ertapenem, meropenem, and piperacillin/tazobactam. In general, AMR prevalence in E. coli isolates from ICU, medical and surgical wards was significantly (p<0.05) higher compared to other locations, whereas, AMR prevalence in P. aeruginosa isolates from pediatric ward was higher (p<0.05) compared to other locations. The overall multidrug resistance (MDR) prevalence was 38.7% (95% CI: 37.4-40.0). The highest MDR prevalence was among E. coli isolates from respiratory specimens (48%); wounds, bones, or other tissues (47.7%); and body fluids (47.1%). Similarly, MDR prevalence in K. pneumoniae, P. aeruginosa, and A. baumannii isolated from respiratory specimens was significantly (p<0.05) higher compared to other specimen types. The most frequent MDR phenotypes in the four GNB organisms and across the different specimen types included three antimicrobial drug classes: penicillins, cephalosporins, and fluroquinolones. Our findings demonstrate high AMR prevalence among common Gram-negative bacteria at this major hospital. Monitoring data on antimicrobial susceptibility of common bacterial organisms is critical for assessing trends in AMR at hospitals and for informing policy decisions.

Aerobic bacteria isolated from diabetic foot ulcers of Egyptian patients: types, antibiotic susceptibility pattern and risk factors associated with multidrug-resistant organisms.

Diabetic foot infection (DFI) is one of the common diabetic complications. Pathogens causing DFI and their antibiotic susceptibility vary with location. Therefore, empirical antibiotic therapy should be based on the pathogens that are most likely to be present. Aim: To identify the frequent aerobic bacteria causing DFI with detection of their antibiotic susceptibility to help clinicians in our community choose the best empirical antibiotic for DFI. Swabs were collected from 104 diabetic foot ulcers (DFUs). Aerobic bacterial cultures were done followed by bacterial identification and antibiotic susceptibility testing on VITEK® 2 system. Extended-spectrum beta-lacatamase (ESBL) detection was performed phenotypically and confirmed by multiplex-PCR for bla CTX-M, bla TEM, and bla SHV genes. Aerobic bacterial infection was detected in 82/104 (78.8%) of the DFUs. Gram-negative bacilli (GNB) were isolated more frequently (56.1%) than Gram-positive cocci (GPC) (43.9%). The most common single-isolated bacteria were K. pneumoniae (26.8%), S. aureus and coagulase negative staphylococci (22% for each). The only significant independent predictors of DFI with GNB or GPC were long DM duration and frequent hospitalizations, respectively. The most active antibiotics were amikacin, tigecycline and meropenem for GNB, and linezolid and vancomycin for staphylococci. Multidrug-resistance prevalence was 95.1%. ESBL was detected in 52.6% of Enterobacteriaceae; the bla CTX-M gene was the most common (90%), followed by bla TEM (65%) and bla SHV (35%). Peripheral neuropathy was the single independent predictor for DFI with ESBL producers (adjusted OR=15.5). There is a notable local pattern of DFI bacteriology in our community. Our findings could be valuable in developing the future empirical treatment guidelines for DFIs.

Therapeutic effect of biosynthetic gold nanoparticles on multidrug-resistant Escherichia coli and Salmonella species isolated from ruminants.

Background and Aim:Multidrug-resistant (MDR) pathogenic microorganisms have become a global problem in ruminants as a result of the intensive use of antibiotics, causing the development of resistance among gut microbiota. The antibiotic-resistant microorganisms can be transferred from diseased animals to humans. This study aimed to determine the prevalence of MDR Escherichia coli and Salmonella spp. isolated from cattle, buffaloes, sheep, and goats suffering from respiratory signs, diarrhea, and mastitis and to screen the antibiotic sensitivity of selected isolated bacteria. It also detected antibiotic-resistance genes by polymerase chain reaction (PCR), produced green gold nanoparticles (AuNPs) using plant extracts (Artemisia herba-alba and Morus alba), and evaluated the antimicrobial activities of these biosynthesized nanoparticles on selected pathogens (E. coli and Salmonella spp.).Materials and Methods:MDR E. coli and Salmonella spp. were investigated using fecal samples (n=408), nasal swabs (n=358), and milk samples (n=227) of cattle, buffaloes, sheep, and goats with or without clinical signs, including respiratory manifestations, pneumonia, diarrhea, and mastitis, from different governorates in Egypt. E. coli and Salmonella spp. were isolated and identified on selective media, which were confirmed by biochemical reactions and PCR. Antimicrobial susceptibility testing against 10 commonly used antibiotics was performed using the Kirby-Bauer disk diffusion method. Antibiotic resistance genes blaTEM, blaSHV, blaOXA, and blaCTX−M were detected by PCR. The antibacterial effect of the biosynthesized AuNPs was evaluated by MIC and well diffusion assay. The biosynthesized AuNPs were also characterized by ultraviolet-visible spectrophotometry and transmission electron microscopy (TEM).Results:Among all fecal samples, the prevalence of E. coli was 18.4% (183/993) and that of Salmonella spp. was 16.7% (66/408), as determined by cultural and molecular tests. All isolates of E. coli and Salmonella spp. were 100% resistant to ampicillin (AM) and amoxicillin and highly resistant to cefoxitin and AM-sulbactam. The total rate of resistance genes in E. coli was 61.2% (112/183), while that in Salmonella was 63.6% (42/66) for pathogens isolated from ruminants with respiratory manifestations, pneumonia, diarrhea, and mastitis. Among the resistance genes, blaTEM had the highest prevalence rate in E. coli (25.9%, 21/81) while blaSHV had the lowest (9.8%, 8/81) in fecal swabs. AuNPs were successfully synthesized using aqueous leaf extract of A. herba-alba and M. alba as bioreducing agents. TEM analysis showed particle size of 10-42 nm for A. herba-alba and M. alba AuNPs. The biosynthesized AuNPs showed antibacterial activity against MDR E. coli and Salmonella spp.Conclusion:Rapid and accurate diagnostic methods are the cornerstone for effective treatment to reduce the risk of antimicrobial-resistant pathogenic microorganisms. This is particularly important for overcoming the increasing rate of MDR in ruminants with respiratory manifestations, pneumonia, diarrhea, and mastitis. This can be complemented by the development of AuNPs synthesized in an environmentally friendly manner AuNPs using natural plant extracts for the treatment of antibiotic-resistant microorganisms.

Emerging Trends of Multidrug-Resistant (MDR) and Extensively Drug-Resistant (XDR) Salmonella Typhi in a Tertiary Care Hospital of Lahore, Pakistan.

Salmonella Typhi is a Gram-negative pathogen that causes typhoid fever in humans. The use of antibiotics to treat typhoid has considerably mitigated its fatality risk, but rising multidrug-resistant (MDR) and extensively drug-resistant (XDR) resistance in Pakistan threatens effective treatment. This study determined the prevalence of MDR and XDR S. Typhi at a local hospital in Lahore. Blood samples (n = 3000) were obtained and processed for bacterial identification. Antibiotic susceptibility test was performed using VITEK® 2 Compound 30 System. Statistical data analysis was performed using a Mann–Whitney U and Kruskal–Wallis H test, respectively. The results revealed 600 positive cultures, of which the majority were found to be XDR S. Typhi (46.1%) and MDR S. Typhi (24.5%) strains. The disease burden of resistant Salmonella strains was greater in males (60.67%) than females (39.33%), with the most affected age group being 0–10 years old (70.4 %). In both the outpatient department (OPD) and general ward, the prevalence of XDR S. Typhi cases was found to be alarmingly high (48.24%), followed by MDR S. Typhi (25.04 %). The results of the statistical analysis demonstrated that the incidence of resistance in MDR and XDR S. Typhi strains was not affected by the age as well as the gender of patients (p > 0.05). The occurrence of resistant strains against four tested antibiotics (azithromycin, ciprofloxacin, imipenem, and meropenem) was found to be similar in different wards and among hospitalized and OPD patients (p > 0.05). Maximum resistance was observed against chloramphenicol and ampicillin in the OPD and pediatric ward. Piperacillin/Tazobactam was observed to be the most effective antibiotic, followed by co-amoxiclav (p < 0.001). This study is effective in validating the existence of MDR and XDR S. Typhi in Lahore, where stringent methods should be applied for controlling its spread.

The Impact of Omega-3 Fatty Acids on the Evolution of Acinetobacter baumannii Drug Resistance.

ABSTRACTThe bacterial pathogen Acinetobacter baumannii has emerged as an urgent threat to health care systems. The prevalence of multidrug resistance in this critical human pathogen is closely associated with difficulties in its eradication from the hospital environment and its recalcitrance to treatment during infection. The development of resistance in A. baumannii is in part due to substantial plasticity of its genome, facilitating spontaneous genomic evolution. Many studies have investigated selective pressures imposed by antibiotics on genomic evolution, but the influence of high-abundance bioactive molecules at the host-pathogen interface on mutation and rates of evolution is poorly understood. Here, we studied the roles of host fatty acids in the gain in resistance to common antibiotics. We defined the impact of the polyunsaturated fatty acids arachidonic acid and docosahexaenoic acid on the development of resistance to erythromycin in A. baumannii strain AB5075_UW using a microevolutionary approach. We employed whole-genome sequencing and various phenotypic analyses to characterize microbe-lipid-antibiotic interactions. Cells exposed to erythromycin in the presence of the fatty acids displayed significantly lower rates of development of resistance to erythromycin and, importantly, tetracycline. Subsequent analyses defined diverse means by which host fatty acids influence the mutation rates. This work has highlighted the critical need to consider the roles of host fatty acids in A. baumannii physiology and antimicrobial resistance. Collectively, we have identified a novel means to curb the development of resistance in this critical human pathogen.IMPORTANCE The global distribution of multidrug resistance in A. baumannii has necessitated seeking not only alternative therapeutic approaches but also the means to limit the development of resistance in clinical settings. Highly abundant host bioactive compounds, such as polyunsaturated fatty acids, are readily acquired by A. baumannii during infection and have been illustrated to impact the bacterium’s membrane composition and antibiotic resistance. In this work, we show that in vitro supplementation with host polyunsaturated fatty acids reduces the rate at which A. baumannii gains resistance to erythromycin and tetracycline. Furthermore, we discover that the impact on resistance development is closely associated with the primary antimicrobial efflux systems of A. baumannii, which represent one of the major drivers of clinical resistance. Overall, this study emphasizes the potential of host macromolecules in novel approaches to circumvent the difficulties of multidrug resistance during A. baumannii treatment, with fatty acid supplements such as fish oil providing safe and cost-effective ways to enhance host tolerance to bacterial infections.

High Prevalence of Multidrug Resistance and Biofilm-Formation Ability Among Avian Escherichia coli Isolated from Broilers in Iran.

The present study was conducted to determine the antimicrobial resistance pattern and biofilm-formation ability in 100 Avian-Pathogenic Escherichia coli (APEC) isolated from colibacillosis-suspected broilers and 100 Avian Fecal E. coli (AFEC) isolates from healthy broilers in Hamedan, Iran. All isolates were screened by polymerase chain reaction for antimicrobial resistance genes, class 1 and 2 integrons, and biofilm-associated genes. Besides, we assessed the possible relationship between biofilm-formation ability antibiotic resistance patterns, genetic background, and the pathogenicity of APEC strains. 81% of APEC and 73% of AFEC isolates showed multidrug resistance (MDR) phenotype; in addition, 45% of the APEC and 21% of the AFEC strains showed biofilm-formation ability. This is the first report of the biofilm formation ability in E. coli isolated from broilers in Iran. The most prevalent antibiotic resistance gene in APEC strains was tetA (68%), followed by sul1 (63%), dfrA1-like (51%), and blaTEM (30%), whereas in AFEC strains, the frequencies of the antibiotic resistance genes were tetA (63%), sul1 (58%), dfrA1-like (49%), and blaTEM (22%). Out of 81 MDR APEC isolates, 53 (65.4%) and 38 (46.91%) isolates were positive for intI1 and intI2 genes, respectively. In the AFEC strains intI1 and intI2 genes were presented in 57 and 33 isolates, respectively. All APEC isolates belonging to phylogenetic groups B1, B2, and C were MDR. The results of the present study indicate that isolates with biofilm-forming ability show more MDR properties and probably have more pathogenicity to broilers.