Proportion Of Multidrug Resistance Research Articles

Multidrug-resistance and extended-spectrum beta-lactamase-producing lactose-fermenting enterobacteriaceae in the human-dairy interface in northwest Ethiopia.

Antimicrobial resistance (AMR) is among the top public health concerns in the globe. Estimating the prevalence of multidrug resistance (MDR), MDR index (MDR-I) and extended-spectrum beta-lactamase (ESBL)-producing lactose fermenting Enterobacteriaceae (LFE) is important in designing strategies to combat AMR. Thus, this study was designed to determine the status of MDR, MDR-I and ESBL-producing LFE isolated from the human-dairy interface in the northwestern part of Ethiopia, where such information is lacking. A cross-sectional study was conducted from June 2022 to August 2023 by analyzing 362 samples consisting of raw pooled milk (58), milk container swabs (58), milker's hand swabs (58), farm sewage (57), milker's stool (47), and cow's feces (84). The samples were analyzed using standard bacteriological methods. The antimicrobial susceptibility patterns and ESBL production ability of the LFE isolates were screened using the Kirby-Bauer disk diffusion method, and candidate isolates passing the screening criteria were phenotypically confirmed by using cefotaxime (30 μg) and cefotaxime /clavulanic acid (30 μg/10 μg) combined-disk diffusion test. The isolates were further characterized genotypically using multiplex polymerase chain reaction targeting the three ESBL-encoding- genes namely blaTEM, blaSHV, and blaCTX-M. A total of 375 bacterial isolates were identified and the proportion of MDR and ESBL-producing bacterial isolates were 70.7 and 21.3%, respectively. The MDR-I varied from 0.0 to 0.81 with an average of 0.30. The ESBL production was detected in all sample types. Genotypically, the majority of the isolates (97.5%), which were positive on the phenotypic test, were carrying one or more of the three genes. A high proportion of the bacterial isolates were MDR; had high MDR-I and were positive for ESBL production. The findings provide evidence that the human-dairy interface is one of the important reservoirs of AMR traits. Therefore, the implementation of AMR mitigation strategies is highly needed in the area.

Antibiotic resistance through the lens of One Health: A study from an urban and a rural area in Sri Lanka.

This study aimed to investigate and compare the proportion of AMR Escherichia coli (E. coli) between urban (Dompe in the Western province) and rural (Dambana in the Sabaragamuwa province) areas in Sri Lanka. The overall hypothesis of the study is that there is a difference in the proportion of AMR E. coli between the urban and the rural areas. Faecal samples were collected from healthy humans (n = 109), dairy animals (n = 103), poultry (n = 35), wild mammals (n = 81), wild birds (n = 76), soil (n = 80) and water (n = 80) from both areas. A total of 908 E. coli isolates were tested for susceptibility to 12 antimicrobials. Overall, E. coli isolated from urban area was significantly more likely to be resistant than those isolated from rural area. The human domain of the area had a significantly higher prevalence of AMR E. coli, but it was not significantly different in urban (98%) and rural (97%) areas. AMR E. coli isolated from dairy animals, wild animals and water was significantly higher in the urban area compared with the rural area. There was no significant difference in the proportion of multidrug resistance (MDR) E. coli isolated from humans, wild animals and water between the two study sites. Resistant isolates found from water and wild animals suggest contamination of the environment. A multi-sectorial One Health approach is urgently needed to control the spread of AMR and prevent the occurrences of AMR in Sri Lanka.

Arterial leg ulcers-Bacterial patterns, antimicrobial resistance and clinical characteristics, a retrospective single-centre cohort, 2012-2021.

Severe wound infections in patients with peripheral artery disease (PAD) are common, potentially life- and limb-threatening, and difficult to treat. Evidence on patients with infected leg ulcers in PAD is scarce. This study aims to provide insight into the microbiological patterns and antimicrobial resistance (AMR) of specific pathogens in patients with arterial leg ulcers. In this retrospective, consecutive, single-centre study 16,553 patients underwent an endovascular revascularization procedure between 2012 and 2021. Of these, 1,142 patients had PAD Rutherford category 5 or 6 with infected leg ulcers. Logistic regression was used to identify risk factors for Staphylococcus aureus-associated infections. A total of 3,431 bacterial isolates were detected, of which 2,335 (68.1%) bacterial isolates were gram-positive and 1,096 (31.9%) were gram-negative species. The most prevalent bacteria were S. aureus (18.6%), Enterococcus faecalis (9.1%) and S. epidermidis (7.8%). Pseudomonas aeruginosa (5.6%), Proteus mirabilis (3.7%) and Escherichia coli (3.4%). The resistance of S. aureus isolates to clindamycin was 11.0%. Resistance to oxacillin was rare (1.5%). P. aeruginosa is frequently resistant to ciprofloxacin (14.4%) whilst intrinsically resistant to trimethoprim/sulfamethoxazole. P. mirabilis and E. coli were frequently resistant to both ciprofloxacin (7.3; 20.7%) and trimethoprim/sulfamethoxazole (24.6; 22.6%), respectively. Resistance to amoxicillin/clavulanic acid was high among E. coli isolates (36.8%). Multi-drug resistance (MDR) was rare among S. aureus and P. aeruginosa isolates. In contrast, the proportion of MDR was high in E. coli isolates. End-stage renal disease was independently positively associated with S. aureus identification (p = .042). S. aureus was the most common pathogen in arterial leg ulcers with end-stage renal disease being an independent risk factor. Clindamycin resistance was common, making empirical therapy likely to fail. Isolated E. coli species had a high proportion of MDR.

Ceftazidime-avibactam and comparators against Pseudomonas aeruginosa isolates collected globally and in each geographical region between 2017–2020

The objective of this study was to assess the distribution and antimicrobial susceptibility of P.aeruginosa isolates against ceftazidime-avibactam (CAZ-AVI) and a panel of comparator agents collected globally and in each region from 2017-2020 from the Antimicrobial Testing Leadership and Surveillance (ATLAS) program. Susceptibility and minimum inhibitory concentration (MIC) of all P. aeruginosa isolates were determined using broth microdilution methodology for according to the Clinical and Laboratory Standards Institute guidelines. Of the total 29,746 isolates of P. aeruginosa collected, 20.9% were multidrug resistant (MDR), 20.7% were extremely drug resistant (XDR), 8.4% were CAZ-AVI-resistant (CAZ-AVI-R), and 3.0% were MBL-positive. Amongst the MBL-positive isolates, the proportion of VIM-positive isolates was highest (77.8%). The highest proportion of MDR (25.5%), XDR (25.0%), MBL (5.7%), and CAZ-AVI-R (12.3%) isolates were in Latin America. Amongst the sources, the highest proportion of isolates were from respiratory sources (43.0%) and the majority of isolates were from non-ICU wards (71.2%). Overall, CAZ-AVI showed high susceptibility to all P. aeruginosa isolates (90.9%). However, MDR and XDR isolates were less susceptible to CAZ-AVI (≤60.7). Amongst the comparators, only colistin (99.1%) and amikacin (90.5%) showed good overall susceptibility to all isolates of P. aeruginosa. However, only colistin was active (≥98.3%) against all the resistant isolates. CAZ-AVI presents a potential treatment option against P. aeruginosa infections. However, active monitoring and surveillance, especially of the resistant phenotypes is warranted for effective treatment of infections caused by P. aeruginosa.

Contamination of Automated Teller Machines Surfaces with Multi-drug Resistance Gram-negative Bacteria in Dar es Salaam, Tanzania

Background: In Tanzania, little is known about the proportion of Multi-drug resistance (MDR) Gram-negative bacteria contamination on Automated Teller Machine (ATMs) surfaces. The study aimed to determine the proportion of MDR Gram-negative bacteria contamination on ATMs surfaces, antimicrobial resistance patterns as well as associated factors. Methodology: A cross-sectional study was conducted between January and March -2021 in Dar es Salaam, involving 298 ATMs. Cultures were performed on Mac-Conkey agar while antimicrobial susceptibility was done using the Kirby Bauer disc diffusion method with Klebsiella pneumoniae ATCC 700603 and Escherichia coli ATCC 25922 used as controls. Data analysis was done using STATA version 15.1. Chi-square and Modified Poisson regression was used to assess factors associated with MDR contamination. Data was presented as prevalence ratio (PR) and 95% Confidence Interval. A p-value of <.05 was considered statistically significant. Results: More than half (55.4%) of ATMs in Dar es Salaam are contaminated with Gram negative bacteria, mostly by Klebsiella pneumoniae 18.5% (31/168). The highest level of resistance was observed against ampicillin (68.9%). About one-third (34.5%) of the isolates were MDR. About 35.7% were Extended-Spectrum Beta-Lactamases (ESBL) producers while 19.6% were quinolone/ fluoroquinolones-resistance. Risk factors for contamination of ATMs included highly populated location such as; Ubungo (PR adjusted = 3.62, 95%CI = 1.58-8.30, P=.002), Kigamboni (PR adjusted = 2.78, 95%CI = 1.20-6.42, P=.017), and Temeke (PR adjusted = 2.75, 95%CI = 1.04-3.72, P=.023), and less frequent cleaned ATMs (PR adjusted = 1.98, 95%CI = 1.04-3.73, P=.04). Conclusions: More than half of ATMs in Dar es Salaam are contaminated with Gram-negative and one-third of them with MDR bacteria, especially those located in highly populated areas and those that are less frequently cleaned. This calls for interventional measures regarding public awareness of ATMs as potential vehicles for the transmission of infectious agents.

Antibiotic Resistance of Helicobacter pylori in Patients with Peptic Ulcer.

Background and Objectives: To determine the antibiotic resistance rate of H. pylori among patients with peptic ulcer. Materials and Methods: A cross-sectional monocentric study was conducted from January to December 2021 among patients aged from 16 years with gastrointestinal symptoms and esophagogastroduodenoscopy. Gastric mucosa biopsies were collected at the edges of the ulcer or at lesion sites for H. pylori culture. Five antibiotics (amoxicillin (AMX), clarithromycin (CLR), metronidazole (MTZ), levofloxacin (LEV), and tetracycline (TET)) were selected for antibiotic susceptibility testing. Results: One hundred and twenty-five patients were included, and the sex ratio was 0.6. Their mean age was 47.3 ± 14.2 years. All of the participants had gastritis, and 24.0% had duodenitis. A total of 21.6% of patients had a duodenal ulcer, and 12.8% had an antral ulcer. A total of 40 specimens have grown in H. pylori culture. The proportion of resistance to AMX, CLR, MTZ, LEV, and TET was 27.5%, 50%, 67.5%, 35%, and 5%, respectively. The proportion of multidrug resistance was 22.5%. The proportion of double resistance to AMX + CLR was 20.0%, AMX + MTZ was 15.0%, AMX + LEV was 2.5%, CLR + MTZ was 32.5%, and TET + MTZ was 5.0%. Conclusions: Our research results show that the treatment with MTX-TET or LVX-AMOX has the highest sensitivity rate. Therefore, practitioners should refer to these regimes to eradicate H. pylori in patients with gastric and duodenal ulcers. The reports on H. pylori eradication from different geographic areas show heterogeneous results. Therefore, continuous monitoring of antibiotic resistance of H. pylori in each population is very important. Having evidence helps clinicians to treat patients most effectively, reduce treatment costs, and limit the rate of antibiotic resistance.

First study on virulence genes, antimicrobial resistance, and integrons in Escherichia coli isolated from cage, free-range, and organic commercial eggs in Phayao Province, Thailand.

Antimicrobial resistance (AMR) is a global problem that affects human and animal health, and eggs can act as a vehicle for pathogenic and non-pathogenic resistant bacteria in the food chain. Escherichia coli is an indicator of food contamination with fecal materials as well as the occurrence and levels of AMR. This study aimed to investigate the presence of AMR, integrons, and virulence genes in E. coli isolated from eggshell samples of three egg production systems, from supermarkets in Thailand. A total of 750 hen's egg samples were purchased from supermarkets in Phayao Province: Cage eggs (250), free-range eggs (250), and organic eggs (250). Each sample was soaked in buffered peptone water (BPW), and the BPW samples were incubated at 37°C for 18-24 h. All samples were tested for E. coli by the standard conventional culture method. Then, all identified E. coli were tested for antimicrobial susceptibility to 15 antimicrobial agents by the agar disk diffusion method. All E. coli strains were subsequently found to have virulence genes and Classes 1 and 2 integrons by polymerase chain reaction. Among the eggshell samples, 91 samples were identified as having E. coli (cage eggs, 24 strains; free-range eggs, 27 strains; and organic eggs, 40 strains). Then, among the E. coli strains, 47 (51.6%) were positive for at least one virulence gene. The proportion of AMR in the eggshell samples was 91.2% (83/91), and streptomycin (STR), ampicillin (AMP), and tetracycline (TET) had a high degree of resistance. Among the E. coli strains, 27 (29.7%) strains were positive for class 1 or 2 integrons, and integron-positive strains were commonly found in STR-, AMP-, and TET-resistant strains. Multidrug resistance (MDR) was detected in 57.1% (52/91) of the E. coli strains, with STR-AMP-TET (5.5%) as the most frequent pattern. The proportion of MDR in cage eggs was 75.0% (18/24), which was higher than in both free-range and organic eggs. On the other hand, 53.2% (25/47) of E. coli carrying virulence genes had MDR, distributed across the production systems as follows: Cage eggs, 76.9% (10/13); free-range eggs, 63.6% (7/11); and organic eggs, 34.8% (8/23). Escherichia coli was detected in eggshell samples from all three egg production systems. The high level of virulence genes, AMR, and integrons indicated the possibility of dissemination of AMR among pathogenic and commensal E. coli through eggshells. These findings could be a major concern to farmers, food handlers, and consumers, especially regarding raw egg consumption.

Nasopharyngeal Carriage and Antibiogram of Pneumococcal and Other Bacterial Pathogens from Children with Sickle Cell Disease in Tanzania.

BackgroundBacterial infections contribute significantly to morbidity and mortality in sickle cell disease (SCD) patients, particularly children under five years of age. In Tanzania, prophylaxis against pneumococcal infection among children with SCD advocates the use of both oral penicillin V (PV) and pneumococcal vaccines (PNV). Therefore, this study aimed to investigate nasopharyngeal carriage and antibiogram of Streptococcal pneumoniae (S. pneumoniae) and Staphylococcus aureus (S. aureus) in children with SCD in Tanzania.MethodsThis cross-sectional study was undertaken at the two Sickle Pan-African Research Consortium (SPARCO) study sites in Dar es salaam, Tanzania. The study was conducted for six months and enrolled children with SCD between the ages of 6 to 59-months. A semi-structured questionnaire was used to collect patient data. Nasopharyngeal swabs were collected from all participants and cultured for Streptococcal pneumoniae and other bacterial isolates. Antimicrobial susceptibility tests of the isolates were done using the disc diffusion method.ResultsOut of 204 participants, the overall prevalence of bacterial carriage was 53.4%, with S. aureus (23.5%), coagulase-negative Staphylococci (CoNS) (23%) and S. pneumoniae (7.8%) being commonly isolated. In antibiotic susceptibility testing, S. aureus isolates were most resistant to penicillin (81.8%), whereas 81.3% of S. pneumoniae isolates were resistant to co-trimoxazole. The least antimicrobial resistance was observed for chloramphenicol for both S. aureus and S. pneumoniae isolates (6.3% versus 0%). The proportion of multi-drug resistance (MDR) was 66.7% for S. aureus isolates and 25% for S. pneumoniae isolates.ConclusionThere are substantially high nasopharyngeal carriage pathogenic bacteria in children with SCD in Dar es Salaam, Tanzania. The presence of MDR strains to the commonly used antibiotics suggests the need to reconsider optimizing antimicrobial prophylaxis in children with SCD and advocacy on pneumococcal vaccines.

Antibiotic resistance among bacteria isolated from war-wounded patients at the Weapon Traumatology Training Center of the International Committee of the Red Cross from 2016 to 2019: a secondary analysis of WHONET surveillance data

BackgroundA substantial body of evidence has recently emphasized the risks associated with antibiotic resistance (ABR) in conflicts in the Middle East. War-related, and more specifically weapon-related wounds can be an important breeding ground for multidrug resistant (MDR) organisms. However, the majority of available evidence comes from the military literature focused on risks and patterns of ABR in infections from combat-related injuries among military personnel. The overall aim of this study is to contribute to the scarce existing evidence on the burden of ABR among patients, including civilians with war-related wounds in the Middle East, in order to help inform the revision of empirical antibiotic prophylaxis and treatment protocols adopted in these settings. The primary objectives of this study are to: 1) describe the microbiology and the corresponding resistance profiles of the clinically relevant bacteria most commonly isolated from skin, soft tissue and bone biopsies in patients admitted to the WTTC; and 2) describe the association of the identified bacteria and corresponding resistance profiles with sociodemographic and specimen characteristics.MethodsWe retrospectively evaluated the antibiograms of all consecutive, non-duplicate isolates from samples taken from patients admitted to the ICRC WTTC between 2016 and 2019, limited to skin and soft tissue samples and bone biopsies. We collected data on socio-demographic characteristics from patient files and data on specimens from the WHONET database. We ran univariate and multivariable logistic regression models to test the association between bacterial and resistance profiles with sociodemographic and specimen characteristics.ResultsPatients who were admitted with war-related trauma to the ICRC reconstructive surgical project in Tripoli, Lebanon, from 2016 to 2019, presented with high proportion of MDR in the samples taken from skin and soft tissues and bones, particularly Enterobacterales (44.6%), MRSA (44.6%) and P. aeruginosa (7.6%). The multivariable analysis shows that the odds of MDR isolates were higher in Iraqi patients (compared to Syrian patients) and in Enterobacterales isolates (compared to S. aureus isolates).ConclusionsOur findings stress the importance of regularly screening patients who present with complex war-related injuries for colonization with MDR bacteria, and of ensuring an antibiotic-sensitivity testing-guided antimicrobial therapeutic approach.

Multidrug resistance of Escherichia coli in fish supply chain: A preliminary investigation

AbstractNinety‐five Escherichia coli isolates recovered from different supply points of freshwater fish namely fish pond (W1, n = 16), wholesale fish market (W2, n = 14), retail fish market (R1, n = 29), street fish vending unit (R2, n = 30), and modern fish vending unit (R3, n = 6) were investigated for antimicrobial‐resistant profile and prevalence of antibiotic‐resistant genes. Overall, multidrug‐resistant (MDR) E. coli in the fish supply chain was 21% with higher MDR incidence in the downstream fish supply points. MDR was relatively higher in the tertiary fish supply points viz., retail fish market (45%), street fish vending unit (30%), and modern fish vending unit (15%) compared to the secondary fish supply point, that is, wholesale fish market (5%) and primary fish supply point, that is, fish pond (5%). All the ampicillin‐resistant isolates carried ampC gene, whereas only 21% of the β‐lactam resistant isolates carried blaCTX‐M‐gp1. The tetracycline resistance determinant, tetA (89%) was predominant in the tetracycline‐resistant isolates compared to tetB and tetD (11%). The trimethoprim resistance gene, dfrA and sulfonamide‐resistance gene, Sul1 were detected in 9% of the trimethoprim‐resistant isolates and 9% of the sulfonamide‐resistant isolates, respectively. Enterobacterial repetitive intergeneric consensus‐PCR has delineated the MDR isolates from the different fish supply points into three major clusters but all the MDR isolates from the street fish vending point are grouped into a single cluster. The results indicate an increase in the proportion of MDR E. coli and the occurrence of diverse MDR profiles in the downstream points of the fish supply chain that needs to be addressed to avoid fish‐food‐borne antimicrobial resistance.

Major bacterial isolate and antibiotic resistance from routine clinical samples in Southern Ethiopia

Currently, antibiotic-resistant bacterial infections are a challenge for the health care system. Although physicians demand timely drug resistance data to guide empirical treatment, local data is rather scarce. Hence, this study performed a retrospective analysis of microbiological findings at the Hawassa public hospital. Secondary data were retrieved to assess the prevalence and level of drug resistance for the most common bacterial isolates from clinical samples processed at Hawassa University Comprehensive Specialized Hospital. Out of 1085 clinical samples processed in the microbiology laboratory, the prevalence of bacterial infection was 32.6%. Bacterial bloodstream infection was higher in children than in adults (OR, 4; 95% CI 1.8–14.6; p = 0.005). E. coli and K. pneumoniae were the commonest bacterial isolate both in children (36.8%, 26.3%) and in adults (33.3%, 26.7%) from the urine sample while, the leading bacteria identified from the CSF sample was P. aeruginosa, 37% in children and 43% in adult. In this study, all identified bacterial isolates were multi-drug resistant (MDR) ranging from 50 to 91%. The highest proportion of MDR was S. aureus 91.1 followed by K. pneumoniae 87.6%. Since the nationwide investigation of bacterial isolate, and drug resistance is rare in Ethiopia, a report from such type of local surveillance is highly useful to guide empirical therapy by providing awareness on the level resistance of isolates.

Methicillin-Resistant Staphylococcus aureus (MRSA) Infection of Diabetic Foot Ulcers at a Tertiary Care Hospital in Accra, Ghana.

Aim: This study investigated the spectrum of bacteria infecting the ulcers of individuals with diabetes at the Korle Bu Teaching Hospital in Accra, Ghana, focusing on Staphylococcus aureus (S. aureus) and methicillin-resistant S. aureus (MRSA), with respect to their prevalence, factors predisposing to their infection of the ulcers, and antimicrobial resistance patterns. Methodology: This cross-sectional study was conducted at The Ulcer Clinic, Department of Surgery, Korle Bu Teaching Hospital, involving 100 diabetic foot ulcer patients. The ulcer of each study participant was swabbed and cultured bacteriologically, following standard procedures. Antimicrobial susceptibility testing was done for all S. aureus isolated, using the Kirby-Bauer method. Results: In total, 96% of the participants had their ulcers infected—32.3% (n = 31) of these had their ulcers infected with one bacterium, 47.9% (n = 46) with two bacteria, 18.8% (n = 18) with three bacteria, and 1.0% (n = 1) with four bacteria. The prevalence of S. aureus and MRSA were 19% and 6%, respectively. The distribution of the other bacteria was as follows: coagulase-negative Staphylococci (CoNS) (54%), Escherichia coli (24%), Pseudomonas spp. (19%), Citrobacter koseri and Morganella morgana (12% each), Klebsiella oxytoca (11%), Proteus vulgaris (8%), Enterococcus spp. (6%), Klebsiella pneumoniae (5%), Proteus mirabilis and Enterobacter spp. (4%), Klebsiella spp. (2%), and Streptococcus spp. (1%). The resistance rates of S. aureus decreased across penicillin (100%, n = 19), tetracycline (47.4%, n = 9), cotrimoxazole (42.1%, n = 8), cefoxitin (31.6%, n = 6), erythromycin and clindamycin (26.3% each, n = 5), norfloxacin and gentamicin (15.8% each, n = 3), rifampicin (10.5%, n = 2), linezolid (5.3%, n = 1), and fusidic acid (0.0%, n = 0). The proportion of multidrug resistance was 47.4% (n = 9). Except for foot ulcer infection with coagulase-negative Staphylococci, which was protective of S. aureus infection of the ulcers (OR = 0.029, p = 0.001, 95% CI = 0.004–0.231), no predictor of S. aureus, MRSA, or polymicrobial ulcer infection was identified. Conclusions: The prevalence of S. aureus and MRSA infection of the diabetic foot ulcers were high, but lower than those of the predominant infector, coagulase-negative Staphylococci and the next highest infecting agent, E. coli. Diabetic foot ulcers’ infection with coagulase-negative Staphylococci protected against their infection with S. aureus. The prevalence of multidrug resistance was high, highlighting the need to further intensify antimicrobial stewardship programmes.

Antibiogram Profiles of Bacteria Isolated from Different Body Site Infections Among Patients Admitted to GAMBY Teaching General Hospital, Northwest Ethiopia.

BackgroundInfections with multi-drug resistant (MDR) bacteria are serious threats to many low-income countries associated with overuse and misuse of antibiotics. This study determined the antibiogram profiles of bacteria isolated from different body site infections among patients admitted to GAMBY Teaching General Hospital, Bahir Dar, Northwest Ethiopia.MethodsA hospital-based cross-sectional study was done between November 2015 and May 2018. Various clinical specimens were sampled from patients and analyzed for aerobic bacterial isolation and Kirby–Bauer disk diffusion susceptibility testing. Chi-square test was calculated to see association among variables, and P-value <0.05 was taken as a cutoff value for statistical significance.ResultsFrom the 716 clinical specimens processed, 134 (18.7%) were culture-positive for aerobic bacterial pathogens. Culture-confirmed positivity was higher in ear discharge (27.3%) and urine (26.3%) samples. The prevalence of infection was significantly highest among females (P = 0.001). Escherichia coli 63 (47.4%) and 10 (7.4%) of Klebsiella spp. from Gram-negative bacteria were the predominant bacterial isolates, while Staphylococcus saprophyticus 17 (12.6%) and S. aureus 14 (10.4%) were from Gram-positive bacteria. Overall, 61.8% of the isolates were found to be MDR. The proportion of MDR among Klebsiella spp., S. aureus and E. coli isolates was 90.9%, 60.9% and 50%, respectively. Gram-positive bacteria demonstrated 20%, 48.6% and 100% of resistance against norfloxacin, ciprofloxacin and clindamycin, respectively. Gram-negative bacteria also revealed from 20% resistance for the antibiotic nitrofurantoin and 100% of resistance for ampicillin and penicillin.ConclusionInfections with bacterial isolates resistant to the majority of antibiotics are a major issue in the study area. Most of the identified bacteria were resistant to the routinely used antibiotics, and MDR isolates are alarmingly high. Therefore, clinicians should practice rational choice of antibiotics and treatment should be guided by antimicrobial susceptibility testing.

Drug Resistance Pattern of M. tuberculosis Complex in Oromia Region of Ethiopia

PurposeMultidrug resistant tuberculosis is an emerging problem in many parts of the world. The aim of this study was to determine the drug resistance pattern of Mycobacterium tuberculosis complex in Oromia Region of Ethiopia.Patients and MethodsA cross-sectional study was conducted from Jan 2017 to June 2018 on 450 pulmonary tuberculosis patients who visited health facilities in nine administrative zones of Oromia Region. Socio-demographic characteristics and relevant clinical information were obtained using a structured questionnaire. Line Probe Assay for first and second line drugs was used to assess the pattern of drug resistance. SPSS version 20 was used for statistical analysis.ResultsMedian age was 26 years and 240 (53.3%) patients were males. About 24% of them were previously treated for tuberculosis. Thirty-four (7.6%) were HIV co-infected. Line Probe Assay interpretable results were obtained for 387 isolates. Thirty (7.8%) were resistant to rifampicin and isoniazid and thus were multidrug resistant isolates. Among the multidrug resistant samples, three were found to be extensively drug resistant and one was pre-extensively drug resistant. Previous treatment history (AOR 9.94 (95% CI 3.73–26.51), P < 0.001) and nutritional status below normal (AOR 3.15 (95% CI 1.13–8.81), P < 0.029) were found to be associated with multidrug resistance. The chi-square tests have shown that there was a significant difference between the BCG vaccinated and the non-vaccinated in developing multidrug resistant tuberculosis at P = 0.027.ConclusionThe proportion of multidrug resistance is above the WHO estimate for the country, Ethiopia, and the fact that some zones were at risk of transmission of extensively drug resistant tuberculosis warrant great attention of the control program holders even though it has to be verified through the conventional method.

Methicillin-resistant Staphylococcus aureus in Nepal.

Staphylococcus aureus is both a frequent commensal and a leading cause of endocarditis, bacteremia, osteomyelitis and skin and soft tissue infections and device-related infections. We performed this minireview to summarize the prevalence of Staphylococcus aureus among clinical samples and estimate the proportion of methicillin-resistant Staphylococcus aureus. The prevalence of Staphylococcus aureus among clinical isolates in Nepal is 34.5%. On average, the proportion of multi-drug resistance in Staphylococcus aureus is 57.1%. Methicillin-resistant Staphylococcus aureus accounts for a total of 41.7%. Inducible clindamycin resistance was detected in about 35% of the isolates. A regular antimicrobial resistance surveillance mechanism is necessary to mitigate the development of resistance among organisms and further spread of superbugs like methicillin-resistance Staphylococcus aureus.

Investigation into infectability and antimicrobial susceptibility of Salmonella spp. isolated from fresh seafood at traditional markets in Ho Chi Minh city

In this study, a total of 380 fresh seafood samples (fish, shrimp, squid) were collected randomly at conventional markets of districts in Ho Chi Minh city. Salmonella strains were detected by the traditional method (ISO 6579-1:2017) and conformed by PCR technique (TCVN 8342:2010), serotyping according to ISO/TR 6579-3:2014 and Kirby-Bauer methods evaluated antibiotic resistance's ability. As a result, 85 Salmonella strains were isolated, and the proportion of infection was 22,37% (85/380). The proportion of Salmonella strains that resisted 01 antibiotics was 85,88% (73/85), and 10,59% (09/85) accounted for that of strains that resisted 02 to 05 antibiotics. Also, strains representing resistance towards 06 to 11 antibiotics occupied 4,71% (04/85). Antimicrobial drugs resisted the most were tetracycline 43, 53% (37/85). In contrast, 98,82% (84/85) of Salmonella strains were sensitive to ceftazidime. The proportion of multi-drug resistance was 15,29% (13/85). The familiar combinations of antibiotic resistance were ampicillin, streptomycin, tetracycline, and trimethoprim/sulfamethoxazole (AM, STR, TE, SXT), with 46,15% (6/13). There were six distinguished serovars, including S. Kentucky (05 strains); S. Infantis (02 strains); S. Agona and S. Postdam (01 strain); S. Saintpaul, S. Braenderup (01 strain). 92.31% of serovar detected resistance genes (blaTEM, strA: 53.85%; blaSHV: 7.69%; tetA: 92.31%; tetB: 7.69% and sul1: 23.08%). Three serovars with genotype (blaTEM, strA, tetA, sul1) matched the antibiotic resistance phenotype (AM, STR, TE, SXT), namely S. Kentucky (02) and S. Saintpaul (01), the both isolated from fish samples.

Resistance Status of Bacteria from a Health Facility in Ghana: A Retrospective Study.

Background Regardless of the global concerted effort to control the development and spread of antimicrobial resistance, increasing cases are continually documented at many medical centres. This situation is reinforced by inadequate information on the trend of resistance resulting from lack of regular antimicrobial resistance surveillance. The present study sought to detect the number of multidrug-resistant (MDR), extended drug-resistant (XDR), and pandrug-resistant (PDR) bacterial isolates at a health facility in Ghana from January 2018 to July 2020. Method A total of 800 data on antimicrobial testing results were extracted from the records of the health facility. The extracted data were explored for the detection of MDR, XDR, and PDR. The study further determined the use of antibiotics using the multiple-drug resistance index (MDRI). Results Except for Staphylococcus and Neisseria spp., all bacterial isolates showed extremely high (100%) proportion of MDR. Although only Staphylococcus spp. (38 (4.8%)) was observed to be XDR, the rest of the bacteria showed the potential to attain the status of XDR or PDR. MDRI indicated high use of antibiotics in the health facility. Conclusion The high antimicrobial resistance observed by the study underscores the need for prompt and effective antibiotic resistance control strategies.

Longitudinal Surveillance of Antibiotic Resistance in Escherichia coli and Enterococcus spp. from a Wastewater Treatment Plant and Its Associated Waters in KwaZulu-Natal, South Africa.

We assessed the prevalence, distribution, and antibiotic resistance patterns of Escherichia coli and Enterococcus spp. isolated from raw and treated wastewater of a major wastewater treatment plant (WWTP) in KwaZulu-Natal, South Africa and the receiving river water upstream and downstream from the WWTP discharge point. Escherichia coli and enterococci were isolated and counted using the Colilert®-18 Quanti-Tray® 2000 and Enterolert®-18 Quanti-Tray 2000 systems, respectively. A total of 580 quantitative PCR-confirmed E. coli and 579 enterococci were randomly chosen from positive samples and tested for in vitro antibiotic susceptibility using the disk diffusion assay against 20 and 16 antibiotics, respectively. The removal success of the bacterial species through the treatment procedure at the WWTP was expressed as log removal values (LRVs). Most E. coli were susceptible to meropenem (94.8%) and piperacillin-tazobactam (92.9%), with most Enterococcus susceptible to ampicillin (97.8%) and vancomycin (96.7%). In total, 376 (64.8%) E. coli and 468 (80.8%) Enterococcus isolates showed multidrug resistance (MDR). A total of 42.4% (246/580) E. coli and 65.1% (377/579) enterococci isolates had multiple antibiotic resistance indices >0.2. The LRV for E. coli ranged from 2.97 to 3.99, and for enterococci the range was observed from 1.83 to 3.98. A high proportion of MDR E. coli and enterococci were present at all sampled sites, indicating insufficient removal during wastewater treatment. There is a need to appraise the public health risks associated with bacterial contamination of environmental waters arising from such WWTPs to protect the health of users of the receiving water bodies.

Antimicrobial Susceptibility and Genetic Basis of Resistance of &amp;lt;i&amp;gt;Klebsiella spp&amp;lt;/i&amp;gt; Isolated from Diarrheic and Non-Diarrheic Children at Health Facilities in Mukuru Informal Settlement, Nairobi, Kenya

Antimicrobial resistance (AMR) is a global threat to public health and particularly to children. This study aimed to determine the prevalence of multidrug resistance of fecal Klebsiella spp on selected beta lactam (3rd generation cephalosporins and carbapenems) and fluoroquinolone classes of drugs in four health facilities serving the slum communities of Nairobi city in Kenya. Additionally, determine the genetic basis for the multidrug resistance observed. A cross sectional laboratory based study was undertaken where a total of 1171 children below 16 years were selected, from whom stool samples were collected, tested and analyzed. 395 (33.73%) Klebsiella spp were isolated, consisting of 365 (92.4%) Klebsiella pneumoniae and 30 (7.6%) Klebsiella oxytoca were isolated. The proportion of multi-drug resistance (MDR) K. pneumoniae and MDR K. oxytoca was 64.1% (234/365) and 96.67% (29/30) respectively. Third generation cephalosporins, cefotaxime ceftriaxone and ceftazidime showed the highest resistance of 30.7%, 29.9% and 27.4% respectively, whereas carbapenems including imipenem and meropenem had the least resistance of 1.6%, each, to K. pneumoniae. A significant association was observed in diarrheic children (OR = 1.88; p = 0.01) and those below 50 months (OR = 0.43; p = 0.002) and carrying K. pneumoniae resistance to one or more third generation cephalosporins. Genes associated with resistance included bla TEM 100%, bla CTX-M 95.2%, bla SHV 57.1%, bla OXA-1 66.7%, qnrS 54.1%, qnrB 47.6% and bla NDM 7.1%. In conclusion, there’s need for more effective infection control measures, antimicrobial stewardship to reduce emergence of antimicrobial resistance, improved drinking water, sanitation and hygiene (WASH) practices.

Antimicrobial resistance of acinetobacter baumannii infection of lower respiratory tract and mortality – A cross-sectional study from a tertiary care teaching hospital in Kerala

Background: Acinetobacter baumannii has evolved as a common Multi Drug Resistant (MDR) microbe. This study was conducted to find the profile of antimicrobial resistance and mortality and their associated factors in A. baumannii infection of lower respiratory tract. Materials and Methods: This was a record based cross sectional study done in a tertiary care teaching hospital in Kerala. Records of all the 63, A. baumannii lower respiratory infection in 2017, were retrieved and analyzed. MDR was defined as resistance to at least one agent of three or more antimicrobial classes. Proportion of MDR, carbapenam resistance and resistance to other major antimicrobials were calculated. Determinants of carbapenam resistance and its associated antimicrobial resistance were explored. Proportion of mortality and the associated factors were explored. Student’s t-test, chi-square test or fisher exact test were used appropriately. Results: Proportions of MDR and carbapenam resistance were 85.7% and 41.3% respectively. Highest proportion (90.5%) was resistant to piperazillin-tazobactam. Carbapenam resistance was associated with MDR (p-value95% CI: 63.9% to 85.3%). Older age and ICU stay prior to infection were associated with mortality (p-value Conclusions: Rates of antimicrobial resistance in Acinetobacter baumannii and the mortality were high in the setting, comparable to reports from other parts of India. The drug resistance increases hospital care burden. There is an urgent need to implement stringent infection control measures. Keywords: Acinetobacter baumannii; Nosocomial infection; Antimicrobial resistance; Multi Drug Resistance; ESKAPE.