Resistance Trends Research Articles

Seasonal meropenem resistance in Acinetobacter baumannii and influence of temperature-driven adaptation

BackgroundRecognition of seasonal trends in bacterial infection and drug resistance rates may enhance diagnosis, direct therapeutic strategies, and inform preventive measures. Limited data exist on the seasonal variability of Acinetobacter baumannii. We investigated the seasonality of A. baumannii, the correlation between temperature and meropenem resistance, and the impact of temperature on this bacterium.ResultsMeropenem resistance rates increased with lower temperatures, peaking in winter/colder months. Nonresistant strain detection exhibited temperature-dependent seasonality, rising in summer/warmer months and declining in winter/colder months. In contrast, resistant strains showed no seasonality. Variations in meropenem-resistant and nonresistant bacterial resilience to temperature changes were observed. Nonresistant strains displayed growth advantages at temperatures ≥ 25 °C, whereas meropenem-resistant A. baumannii with β-lactamase OXA-23 exhibited greater resistance to low-temperature (4 °C) stress. Furthermore, at 4 °C, A. baumannii upregulated carbapenem resistance-related genes (adeJ, oxa-51, and oxa-23) and increased meropenem stress tolerance.ConclusionsMeropenem resistance rates in A. baumannii display seasonality and are negatively correlated with local temperature, with rates peaking in winter, possibly linked to the differential adaptation of resistant and nonresistant isolates to temperature fluctuations. Furthermore, due to significant resistance rate variations between quarters, compiling monthly or quarterly reports might enhance comprehension of antibiotic resistance trends. Consequently, this could assist in formulating strategies to control and prevent resistance within healthcare facilities.

Drug resistance trends of Mycobacterium tuberculosis before and after the COVID-19 pandemic in an Egyptian Cairo University tertiary-care hospital

Drug resistance trends of Mycobacterium tuberculosis before and after the COVID-19 pandemic in an Egyptian Cairo University tertiary-care hospital

Spatio-temporal spread of artemisinin resistance in Southeast Asia.

Current malaria elimination targets must withstand a colossal challenge-resistance to the current gold standard antimalarial drug, namely artemisinin derivatives. If artemisinin resistance significantly expands to Africa or India, cases and malaria-related deaths are set to increase substantially. Spatial information on the changing levels of artemisinin resistance in Southeast Asia is therefore critical for health organisations to prioritise malaria control measures, but available data on artemisinin resistance are sparse. We use a comprehensive database from the WorldWide Antimalarial Resistance Network on the prevalence of non-synonymous mutations in the Kelch 13 (K13) gene, which are known to be associated with artemisinin resistance, and a Bayesian geostatistical model to produce spatio-temporal predictions of artemisinin resistance. Our maps of estimated prevalence show an expansion of the K13 mutation across the Greater Mekong Subregion from 2000 to 2022. Moreover, the period between 2010 and 2015 demonstrated the most spatial change across the region. Our model and maps provide important insights into the spatial and temporal trends of artemisinin resistance in a way that is not possible using data alone, thereby enabling improved spatial decision support systems on an unprecedented fine-scale spatial resolution. By predicting for the first time spatio-temporal patterns and extents of artemisinin resistance at the subcontinent level, this study provides critical information for supporting malaria elimination goals in Southeast Asia.

Plasmid-mediated quinolone resistance in Escherichia coli isolates from commercial broiler chickens in Semnan, Iran

Background and Objectives: Antibiotic resistance within the poultry sector presents a considerable health concern due to treatment inefficacy and resistance transmission to humans and the environment. The investigation of plasmid-mediated quinolone resistance (PMQR) in Escherichia coli, acknowledged for its role in advancing resistance, remains inadequately studied in Iranian poultry. This study aimed to evaluate PMQR gene prevalence as well as to determine correlation between resistance phenotype and genotype in E. coli obtained from poultry colibacillosis. Materials and Methods: A collection of 100 E. coli isolates from the viscera of broilers suspected to colibacillosis was assessed. Using the Kirby-Bauer disk diffusion method, antimicrobial susceptibility tests were conducted for ofloxacin, nalidixic acid, levofloxacin, ciprofloxacin, and ampicillin. Additionally, PCR was employed to screen for qnrS, qnrB, and aac(6)Ib-cr genes. Results: Among the analyzed E. coli isolates, 51% demonstrated resistance to at least one of the tested antibiotics, with 17% exhibiting resistance to four different antibiotics. Nalidixic acid displayed the highest resistance rate at 48%, while ampicillin had the lowest at 16%. PMQR genes were detected in 28% of the E. coli isolates, with aac(6′)-Ib-cr being the most prevalent at 14%, followed by qnrB in 13%, and qnrS in 7%. Conclusion: The study underscores the vital need for careful antibiotic usage in poultry to curb the emergence of antibi- otic-resistant bacteria. The results illuminate the prevalence of PMQR genes and their association with resistance trends in Iranian poultry, forming a pivotal basis for forthcoming approaches to combat antibiotic resistance within the poultry sector.

Global trends in carbapenem- and difficult-to-treat-resistance among World Health Organization priority bacterial pathogens: ATLAS surveillance program 2018–2022

ObjectivesTo report trends in carbapenem resistance and difficult-to-treat resistance (DTR) among clinical isolates of Gram-negative priority pathogens collected by the ATLAS global surveillance program from 2018 to 2022. MethodsReference broth microdilution testing was performed in a central laboratory for 79,214 Enterobacterales, 30,504 Pseudomonas aeruginosa, and 13,500 Acinetobacter baumannii-calcoaceticus complex isolates collected by a constant set of 157 medical centres in 49 countries in Asia Pacific (APAC), Europe (EUR), Latin America (LATAM), Middle East-Africa (MEA), and North America (NA) regions. MICs were interpreted by 2023 CLSI M100 breakpoints. β-lactamase genes were identified for meropenem-nonsusceptible (MIC ≥2 mg/L) Enterobacterales isolates. ResultsCarbapenem-resistant Enterobacterales (CRE) detection increased (P < 0.05) in APAC, EUR, LATAM, and MEA regions and decreased in NA, while annual DTR percentages increased in all five regions. Carbapenem-resistant P. aeruginosa (CRPA; decreased in MEA region) and carbapenem-resistant A. baumannii-calcoaceticus complex (CRAB; decreased in MEA region and increased in EUR) remained relatively stable over time in all regions, although notably, annual percentages of CRAB and DTR A. baumannii-calcoaceticus complex isolates were consistently >25 percentage points lower in NA than in other regions. For all regions except NA, the majority of changes in CRE percentages could be attributed to hospital-acquired infections. Among meropenem-nonsusceptible Enterobacterales, KPC was the most frequent carbapenemase in NA and EUR each year. NDM was the most prevalent carbapenemase detected in 2022 in other global regions. ConclusionCRE, CRPA, CRAB, and DTR rates vary among global regions over time highlighting the need for continuing surveillance to inform treatment strategies and antimicrobial stewardship.

Prevalence and Antibiotic Susceptibility of Urinary Tract Infections in Diabetic and Non Diabetic Individuals: A Prospective Study

Background &amp; Objectives: Diabetes mellitus is increasingly recognized as a major health concern worldwide, particularly in developing countries like India. Diabetic individuals are known to have a higher susceptibility to urinary tract infections (UTIs), compounded by the emergence of drug-resistant uropathogens. This study aims to determine the prevalence and etiology of UTIs in diabetic patients. Materials and Methods: A cross-sectional prospective study involving 220 individuals was conducted from March to April 2023 to assess the spectrum of pathogens causing UTIs and their antibiotic susceptibility. Primary cultures were performed on McConkey agar and sheep blood agar, followed by identification and antimicrobial susceptibility testing (AST) using the Vitek2 system and Kirby Bauer's disc diffusion method on Mueller-Hinton agar. Results: Of the 220 samples tested, 150 exhibited significant bacteriuria, with 36 (75%) of 48 diabetic individuals testing positive for UTIs. Gram-negative bacilli (GNB) accounted for 135 (61.4%) isolates, with Escherichia coli (E. coli) being the most prevalent pathogen (52.7%), followed by Klebsiella spp. (25.3%). Among gram-positive organisms, Enterococcus spp. (5.3%) were predominant, with Candida isolates detected in 3 cases (2%). Meropenem (87.6%) exhibited the highest susceptibility against GNB, followed by Netilmycin (87.6%) and Imipenem (82.5%). For gram-positive organisms, Imipenem and Nitrofurantoin demonstrated high susceptibility. Conclusion: E. coli emerged as the predominant pathogen in both diabetic and non-diabetic populations. High sensitivity to meropenem, imipenem, amikacin, and fosfomycin was observed in both groups, suggesting their potential for empirical treatment. Regular surveillance of drug resistance patterns is crucial for identifying evolving resistance trends and optimizing treatment strategies.

Detection of Macrolide and/or Fluoroquinolone Resistance Genes in Mycoplasma genitalium Strains Isolated from Men in the Northwest Region of Croatia in 2018-2023.

Mycoplasma genitalium (M. genitalium) poses a significant public health challenge due to its association with non-gonococcal urethritis (particularly in men) and antimicrobial resistance. However, despite the prevalence of M. genitalium infections and the rise in resistance rates, routine testing and surveillance remain limited. This is the first study from Croatia that aimed to assess the prevalence and trends of resistance in M. genitalium strains isolated from male individuals by detecting macrolide and fluoroquinolone resistance genes. The study also aimed to explore the factors associated with resistance and changes in resistance patterns over time. Urine samples collected from male individuals in the Zagreb County and northwest region of Croatia between 2018 and 2023 were tested for M. genitalium with the use of molecular methods. Positive samples were subjected to DNA extraction and multiplex tandem polymerase chain reaction (MT-PCR) targeting genetic mutations associated with macrolide (23S rRNA gene) and fluoroquinolone (parC gene) resistance. Of the 8073 urine samples tested from 6480 male individuals (and following the exclusion of repeated specimens), we found that the prevalence of M. genitalium infection was 2.2%. Macrolide resistance was observed in 60.4% of strains, while fluoroquinolone resistance was found in 19.2%. Co-resistance to both antibiotics was present in 18.2% of cases. A statistically significant increase in fluoroquinolone resistance was noted over the study period (p = 0.010), but this was not evident for azithromycin resistance (p = 0.165). There were no statistically significant differences in resistance patterns between age groups, whereas re-testing of patients revealed dynamic changes in resistance profiles over time. The high burden of macrolide resistance and increasing fluoroquinolone resistance underscore the urgent need for comprehensive resistance testing and surveillance programs. The implementation of resistance-guided treatment strategies, along with enhanced access to molecular diagnostics, is pivotal for effectively managing M. genitalium infections.

Occurrence of antimicrobial resistance uropathogenic &lt;i&gt;Staphylococcus aureus&lt;/i&gt; isolates from pregnant women attending antenatal clinics within Ilorin

Background: Staphylococus aureus associated with urinary tract infection (UTI) has become a serious health problem especially with the emergence of methicillin resistant Staphylococus aureus (MRSA) due to the acquisition of mecA gene leading to increasing maternal and perinatal burden. This study aimed to evaluate the prevalence of antimicrobial resistance, β-lactamase production and methicillin resistance among uropathogenic S. aureus among pregnant women attending selected antenatal clinics in Ilorin.Methods: Forty-five (45) out of 79 presumptive uropathogenic S. aureus isolated over a period of 12 months from urine samples of pregnant women were identified using standard bacteriological methods. Antibiogram studies was performed using gentamicin (CN-10μg), ciprofloxacin (CIP-5μg), ofloxacin (OFX-5μg), tetracycline (TE-30μg), sulphamethaxozole-trimethoprim (SXT-25μg), ampicillin (AMP-10 μg), penicillin G (P-10 units), nitrofurantoin (F-30 μg) and cefoxitin (FOX-30 μg) for the detection of MRSA by disc diffusion method. Furthermore, detection of β - lactamase producing S. aureus (BL-PSA) was carried out using Iodometric paper strip method.Results: Of the 45 S. aureus isolates, 80% were BL-PSA, MRSA (87%), exhibiting high resistance to penicillin G (97.8%), ampicillin (95.5%), tetracycline (77.8%) and sulphamethaxozole trimethoprim (64.4%). In addition, 56% were multidrug-resistant (MDR) exhibiting 20 different phenotypes with CN-P-SXT-TE-AMP-FOX (15.6%) being the majority. Notwithstanding, S. aureus isolates showed high sensitivity to nitrofurantoin (93.3%) and ofloxacin (91.1%).Conclusion: This study established an increasing resistance of S. aureus to different classes of antibiotics which emphasize the need for constant surveillance to monitor antimicrobial resistance trends. Routine screening for BL-PSA and MRSA among uropathogenic S. aureus is also advocated in order to reduce the development and spread of MDR isolates.

Epidemiology and antimicrobial susceptibility profiles of Enterobacterales causing bloodstream infections before and during COVID-19 pandemic: Results of the Study for Monitoring Antimicrobial Resistance Trends (SMART) in Taiwan, 2018–2021

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic has contributed to the spread of antimicrobial resistance, including carbapenem-resistant Enterobacterales. MethodsThis study utilized data from the Study for Monitoring Antimicrobial Resistance Trends (SMART) surveillance program in Taiwan. Enterobacterales from patients with bloodstream infections (BSIs) were collected and subjected to antimicrobial susceptibility testing and β-lactamase gene detection using a multiplex PCR assay. Statistical analysis was conducted to compare susceptibility rates and resistance genes between time periods before (2018–2019) and during the COVID-19 pandemic (2020–2021). ResultsA total of 1231 Enterobacterales isolates were collected, predominantly Escherichia coli (55.6%) and Klebsiella pneumoniae (29.2%). The proportion of nosocomial BSIs increased during the COVID-19 pandemic (55.5% vs. 61.7%, p < 0.05). Overall, susceptibility rates for most antimicrobial agents decreased, with Enterobacterales from nosocomial BSIs showing significantly lower susceptibility rates than those from community-acquired BSIs. Among 123 Enterobacterales isolates that underwent molecular resistance mechanism detection, ESBL, AmpC β-lactamase, and carbapenemase genes were detected in 43.1%, 48.8% and 16.3% of the tested isolates, respectively. The prevalence of carbapenemase genes among carbapenem-resistant Enterobacterales increased during the pandemic, although the difference was not statistically significant. Two novel β-lactamase inhibitor combinations, imipenem-relebactam and meropenem-vaborbactam, preserved good efficacy against Enterobacterales. However, imipenem-relebactam showed lower in vitro activity against imipenem-non-susceptible Enterobacterales than that of meropenem-vaborbactam. ConclusionsThe COVID-19 pandemic appears to be associated with a general decrease in antimicrobial susceptibility rates among Enterobacterales causing BSIs in Taiwan. Continuous surveillance is crucial to monitor antimicrobial resistance during the pandemic and in the future.

Antimicrobial resistance of Pseudomonas aeruginosa: navigating clinical impacts, current resistance trends, and innovations in breaking therapies.

Pseudomonas aeruginosa, a Gram-negative bacterium, is recognized for its adaptability and opportunistic nature. It poses a substantial challenge in clinical settings due to its complicated antibiotic resistance mechanisms, biofilm formation, and capacity for persistent infections in both animal and human hosts. Recent studies revealed a potential zoonotic transmission of P. aeruginosa between animals, the environment, and human populations which highlights awareness of this microbe. Implementation of the One Health approach, which underscores the connection between human, animal, and environmental health, we aim to offer a comprehensive perspective on the current landscape of P. aeruginosa management. This review presents innovative strategies designed to counteract P. aeruginosa infections. Traditional antibiotics, while effective in many cases, are increasingly compromised by the development of multidrug-resistant strains. Non-antibiotic avenues, such as quorum sensing inhibition, phage therapy, and nanoparticle-based treatments, are emerging as promising alternatives. However, their clinical application encounters obstacles like cost, side effects, and safety concerns. Effectively addressing P. aeruginosa infections necessitates persistent research efforts, advancements in clinical development, and a comprehension of host-pathogen interactions to deal with this resilient pathogen.

Comparison of methods proposed for monitoring cefotaxime-resistant Escherichia coli in the water environment.

Escherichia coli is a promising subject for globally coordinated surveillance of antimicrobial resistance (AMR) in water environments due to its clinical relevance and widespread use as an indicator of fecal contamination. Cefotaxime-resistant E. coli was recently evaluated favorably for this purpose by the World Health Organization TriCycle Protocol, which specifies tryptone bile x-glucuronide (TBX) medium and incubation at 35°C. We assessed comparability with the U.S. Environmental Protection Agency-approved method for E. coli quantification, which uses membrane-thermotolerant E. coli (mTEC) agar and incubation at 44.5°C, in terms of recovery of E. coli and cefotaxime-resistant E. coli from wastewater influent and surface waters. Total E. coli concentrations in wastewater influent were 106-108 CFU/100 mL, while cefotaxime-resistant E. coli were ~100-fold lower. Total E. coli in surface waters were ~102 CFU/100 mL, and cefotaxime-resistant isolates were near the limit of detection (0.4 CFU/100 mL). Total and putative cefotaxime-resistant E. coli concentrations did not differ significantly between media or by incubation method; however, colonies isolated on mTEC were more frequently confirmed to species (97.1%) compared to those from TBX (92.5%). Incubation in a water bath at 44.5°C significantly decreased non-specific background growth and improved confirmation frequency on both media (97.4%) compared to incubation at 35°C (92.3%). This study helps to advance globally coordinated AMR in water environments and suggests that the TriCycle Protocol is adaptable to other standard methods that may be required in different locales, while also offering a means to improve specificity by decreasing the frequency of false-positive identification of cefotaxime-resistant E. coli by modifying incubation conditions.IMPORTANCEAs antibiotic-resistant bacteria in water environments are increasingly recognized as contributors to the global antibiotic resistance crisis, the need for a monitoring subject that captures antibiotic resistance trends on a global scale increases. The World Health Organization TriCycle Protocol proposes the use of cefotaxime-resistant Escherichia coli isolated on tryptone bile x-glucuronide agar. The U.S. Environmental Protection Agency (USEPA) criteria for safe recreational waters also use E. coli as an indicator but specify the use of mTEC agar at a higher incubation temperature (44.5°C vs 35°C). We assessed the comparability of these methods for isolating total and cefotaxime-resistant E. coli, finding overall good agreement and performance, but significantly higher specificity toward E. coli selection with the use of the USEPA incubation protocol and mTEC agar. This study is the first to directly compare these methods and provides evidence that the methods may be used interchangeably for global surveillance of antibiotic resistance in the environment.

Evolutionary trends in antifungal resistance: a meta-analysis.

A kingdom-wide the largest set of published wild-type antifungal data comparison were analyzed. Trends in resistance in taxonomic groups (monophyletic clades) can be compared with the phylogeny of the fungal kingdom, eventual relationships between fungus-drug interaction and evolution can be described.

Multi-Drug Resistant Gonorrhea: An Emerging Global Threat

&amp;lt;i&amp;gt;Neisseria gonorrhoeae&amp;lt;/i&amp;gt; is the bacterial culprit behind gonorrhea, a highly prevalent sexually transmitted infection (STI) found worldwide. Despite over 1 million daily cases, many infections are asymptomatic, contributing to its widespread transmission. The emergence of multidrug-resistant strains poses a significant challenge to public health, limiting treatment options and increasing the risk of complications. Key aspects covered include the bacterium&amp;apos;s transmission dynamics, pathogenesis, clinical manifestations, laboratory diagnosis methods, and epidemiology. Transmission primarily occurs through sexual contact, with the bacterium thriving on mucous membranes in various parts of the body. Clinical presentations range from urethritis and cervicitis to more severe complications such as pelvic inflammatory disease and disseminated gonococcal infection. Laboratory diagnosis relies on culture, nucleic acid amplification tests (NAATs), and Gram staining, with NAATs offering high sensitivity. However, antimicrobial susceptibility testing is essential to guide treatment decisions, given the rapid emergence of resistance. Gonorrhea&amp;apos;s epidemiology varies globally, with higher prevalence rates in low- and middle-income countries. Surveillance programs play a crucial role in monitoring antimicrobial resistance trends and informing treatment guidelines. The economic burden of gonorrhea is substantial, with potential increases in medical expenses and the challenge of managing outbreaks. Despite these challenges, there is hope for the development of new treatments and vaccines. Promising candidates such as zoliflodacin and solithromycin have shown efficacy in clinical trials, while vaccine development faces obstacles due to the bacterium&amp;apos;s antigenic variation. The paper provides a comprehensive overview of &amp;lt;i&amp;gt;N. gonorrhoeae,&amp;lt;/i&amp;gt; covering its basic features, transmission, pathogenesis, clinical presentation, laboratory diagnosis, epidemiology, challenges of drug-resistant gonorrhea, and prospects for the development of new treatments and vaccines. The paper underscores the urgent need for continued research, surveillance, and development of effective strategies to combat drug-resistant gonorrhea. Investment in new treatments and vaccines is crucial to mitigate the spread of the infection and its associated complications.

Trends of pre-treatment drug resistance in antiretroviral-naïve people with HIV-1 in the era of second-generation integrase strand-transfer inhibitors in Taiwan.

Monitoring the trends of pre-treatment drug resistance (PDR) and resistance-associated mutations (RAMs) among antiretroviral-naïve people with HIV (PWH) is important for the implementation of HIV treatment and control programmes. We analysed the trends of HIV-1 PDR after the introduction of second-generation integrase strand-transfer inhibitors (INSTIs) in 2016 in Taiwan, when single-tablet regimens of non-nucleoside reverse-transcriptase inhibitor (NNRTI-) and INSTI-based antiretroviral therapy became the preferred treatments. In this multicentre study, we included newly diagnosed, antiretroviral-naïve PWH who underwent tests for RAMs between 2016 and 2022. Pre-treatment genotypic resistance testing was performed, along with HIV-1 subtyping and determinations of plasma HIV RNA load and CD4 lymphocyte counts. RAMs were analysed using the Stanford University HIV Drug Resistance Database and only RAMs conferring at least low-level resistance were included. From 2016 to 2022, pre-treatment blood samples from 3001 newly diagnosed PWH, which constituted 24.3% of newly diagnosed PWH in Taiwan during the study period, were tested. Of the PWH with analysable gene sequences, the HIV-1 PDR prevalence to NNRTIs, nucleoside reverse-transcriptase inhibitors (NRTIs), first- and second-generation INSTIs and PIs was 10.0%, 2.1%, 2.5%, 0.6% and 0.4%, respectively. While the trends of PDR remained stable for NRTIs, INSTIs and PIs, there was a significantly increasing trend of PDR to NNRTIs from 6.0% in 2016% to 13.1% in 2022 (P = 0.001). After the introduction of second-generation INSTIs in Taiwan, the trends of HIV-1 PDR to NRTIs and INSTIs remained low. Furthermore, there was no significant decrease of the prevalence of PDR toward NNRTIs between 2016 and 2022.

Tekrarlayan idrar yolu enfeksiyonlarında etiyolojik paternler ve antibiyotik direnci: Retrospektif bir analiz

Amaç: Bu çalışma, tekrarlayan idrar yolu enfeksiyonlarının (rUTİ'ler) etiyolojisini ve rekürrensle ilişkili faktörleri retrospektif olarak analiz etmeyi amaçlamaktadır. Escherichia coli, UTİ'lerde yaygın bir patojen olmakla birlikte, artan antibiyotik direnci büyük bir endişe kaynağıdır. Çalışma, rUTİ'lerde E. coli'nin prevalansını ve antibiyotik direnç modellerini değerlendirirken, bu enfeksiyonların nedenlerini ve tekrarlanma ile ilişkili faktörleri de incelemektedir.&#x0D; Gereç ve Yöntemler: 2020 ve 2023 yılları arasında Özel Kızılay Kağıthane Hastanesinde yürütülen bu retrospektif kohort çalışması, rUTİ tanısı almış 265 hastayı içermektedir. Veriler, demografik bilgileri, klinik geçmişi, üropatojenleri ve antibiyotik direnç modellerini kapsayarak, bu popülasyonda etyoloji ve direnç trendleri hakkında içgörüler sunmaktadır.&#x0D; Sonuçlar: Escherichia coli, rUTİ vakalarının %70.6'sında başlıca üropatojen olarak ortaya çıkmış, önemli bir oranı kotrimoksazol (%54.5) ve florokinolonlara (%46.5) karşı direnç göstermiştir. Çalışma, çoğunlukla kadın hastaları (%79.2) kapsamış, cinsel aktivitenin bu hastaların %60'ında önemli bir risk faktörü olduğu belirtilmiştir. Ayrıca, hastaların %40'ı orta ila şiddetli semptomlar bildirerek, bu durumun yaşam kalitesi üzerindeki etkisini vurgulamıştır.&#x0D; Sonuç: Bu çalışma, özellikle Escherichia coli izolatlarında artan antibiyotik direnci bağlamında rUTİ'lerin meydan okumasını ele almanın aciliyetini vurgulamaktadır. Hastaların demografik özelliklerini ve risk faktörlerini rUTİ yönetiminde göz önünde bulundurmanın önemini vurgulamaktadır. rUTİ'lerin bireyler ve sağlık sistemleri üzerindeki yükünü hafifletmek için etkili terapötik ve önleyici stratejiler geliştirmek amacıyla gelecekte yapılacak prospektif çalışmalar da dahil olmak üzere, gelecekteki araştırmalar hayati önem taşımaktadır.

Frequency of drug-resistant bacterial isolates among pregnant women with UTI in maternity and children’s hospital, Bisha, Saudi Arabia

Urinary tract infections (UTIs) are one of the most prevalent bacterial infections affecting humans, with a higher incidence among women. Pregnant women are at an increased risk of developing UTIs, which can have detrimental consequences for both the mother and fetus. UTIs can be caused by various bacteria, and the prevalence of drug-resistant UTIs in maternity and children’s hospitals is a cause for concern due to the potential for severe complications if left untreated. The primary objective of the current study was to determine the distribution of UTI-causing bacteria and investigate the antibiotic sensitivity patterns of isolated cultures obtained from pregnant women with UTIs at the Maternity and Children’s Hospital, Bisha, Saudi Arabia. This cross-sectional study was conducted from October 2021 to October 2023, involving the analysis of urine samples collected from 321 participants who acquired UTIs during pregnancy. Using biochemical tests and standard cultures, the urine samples were examined for pathogenic bacteria and their anti-microbial sensitivity patterns. The study analyzed susceptibility results according to the Clinical Laboratory Standards Institute guidelines (M100, 28th Edition, 2018). Bacterial strains demonstrating resistance to three or more antibiotics were classified as multidrug-resistant (MDR). This study revealed the distribution of UTI-causing bacteria to be as follows: Escherichia coli, 57.01%; Klebsiella pneumoniae, 24.61%; Pseudomonas aeruginosa, 4.36%; Proteus mirabilis and Enterobacter cloacae, 3.74%; Streptococcus agalactiae, 3.11%; Enterococcus faecalis, 2.18%; and Staphylococcus aureus, 1.24%. Antimicrobial susceptibility testing varied among gram-positive and gram-negative bacteria. Gentamicin demonstrated the highest sensitivity among both gram-positive and gram-negative bacteria; piperacillin-tazobactam was the second most effective drug against gram-negative bacteria. The bacterial isolates showed varying susceptibility to different antibiotics, with Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa being mainly sensitive to gentamicin, piperacillin-tazobactam, and ciprofloxacin, respectively. The strategies for reducing the risk of UTIs need to be improved to limit the spread of MDR bacteria. These strategies may include promoting hygienic practices and administering appropriate antibiotics to prevent the emergence and spread of drug-resistant bacteria. Further research is required to monitor the trends in antibiotic resistance among UTI-causing bacteria and develop effective strategies for managing this public health menace.

Antimicrobial resistance trends in clinical Escherichia coli and Klebsiella pneumoniae in Ethiopia.

Clinicians rely on local antimicrobial resistance pattern data to guide empiric treatment for seriously ill patients when culture and antimicrobial susceptibility testing results are not immediately available. This study aimed to analyse 5-year trends in antimicrobial resistance profiles of Escherichia coli and Klebsiella pneumoniae isolates. Bacteriology reports from 2017 to 2021 at the Ethiopian Public Health Institute were analysed retrospectively. Isolates were identified using either the VITEK 2 Compact system, the BD Phoenix M50 instrument, or conventional biochemical tests. Antimicrobial susceptibility testing was conducted using either the Kirby-Bauer disk diffusion method or the VITEK 2 Compact system and BD Phoenix M50 systems available at the time of testing. The Cochran Armitage trend test was employed to test the significance of antimicrobial resistance trends over time. P-values less than 0.05 were considered statistically significant. Of the 5382 bacteriology reports examined, 458 (9%) were on E. coli and 266 (5%) were on K. pneumoniae. Both K. pneumoniae (88%) and E. coli (65%) demonstrated high resistance to extended-spectrum cephalosporins. However, both K. pneumoniae (14%) and E. coli (5%) showed lower rates of resistance to carbapenems compared to other antimicrobials. In K. pneumoniae, resistance to carbapenems (from 0% to 38%; p < 0.001) and ciprofloxacin (from 41% to 90%; p < 0.001) increased significantly between 2017 and 2021. Both organisms showed very high resistance to broad-spectrum antibiotics. Additionally, K. pneumoniae demonstrated a statistically significant rise in ciprofloxacin and carbapenem resistance. This study emphasises the significance of regular reporting of local antimicrobial resistance patterns as this information can guide appropriate empiric therapy and efforts to address antimicrobial resistance issues.

Epidemiology of Escherichia coli bloodstream infection antimicrobial resistance trends across South West England during the first 2 years of the coronavirus disease 2019 pandemic response

ObjectivesBetween 2016 and 2019, the proportion of Escherichia coli bloodstream infection (BSI) with resistance to at least one antibiotic increased nationally. Public health interventions implemented in response to the COVID-19 pandemic changed population contact patterns and healthcare systems, with consequent effects on epidemiological trends of numerous pathogens. We investigated the impact of COVID-19 restrictions on epidemiological trends of E. coli BSI antimicrobial resistance (AMR) across South West England. MethodsWe undertook a retrospective ecological analysis utilizing routine surveillance data of E. coli BSI cases reported to the UK Health Security Agency between 2016 and 2021. We analysed AMR trends for antimicrobial agents including amoxicillin–clavulanate, ciprofloxacin, piperacillin–tazobactam, gentamicin, third-generation cephalosporins and carbapenems before and after the implementation of COVID-19 restrictions (23 March 2020) using Bayesian segmented regression. ResultsWe identified 19 055 cases. A total of 50.2% were male. Median age was 76 (interquartile range, 65–85 years). Piperacillin–tazobactam (–2.90% [95% highest density interval {HDI} –4.51%, –0.48%]) and ciprofloxacin (–2.40% [95% HDI –4.35%, 0.48%]) resistance demonstrated immediate step changes at the implementation of COVID-19 restrictions. Gentamicin (odds ratio [OR] 0.92 [95% HDI 0.76, 1.12]) and third-generation cephalosporins (OR 0.95 [95% HDI 0.80, 1.14]) exhibited decreasing annual resistance trends after the implementation of COVID-19 restrictions, with moderate evidence for a lower OR after restrictions as compared to the period before (gentamicin Bayes Factor = 5.10, third-generation cephalosporins Bayes Factor = 6.67). DiscussionCOVID-19 restrictions led to abrupt and longer term changes to E.coli BSI AMR. The immediate effects suggest altered transmission, whereas changes to resistant E. coli reservoirs may explain trend effects.

Impact of antibiotic treatment duration on community-acquired pneumonia in children: a systematic review

The treatment of pediatric community-acquired pneumonia (CAP) with antibiotics is important due to its substantial global health impact. To support clinical practice and antibiotic stewardship, this narrative review investigates the effects of the length of antibiotic therapy on the outcomes of childhood CAP. A thorough search of PubMed, Scopus, and Google Scholar produced English articles published in the last ten years (2019–2024) and looked at the connection between the length of antibiotic therapy and the outcomes of community-associated pneumonia in children. There is increasing evidence to support the similarity of shorter and longer antibiotic regimens for treating juvenile community-acquired pneumonia. Research continuously shows that shorter periods of antibiotic therapy—usually five days—produce similar clinical results as lengthier regimens that last seven to 10 days. Furthermore, emphasis is placed on tailored treatment plans that take into account the child's age, the severity of the symptoms, and regional trends of antibiotic resistance. The included studies, albeit observational and retrospective, provide important insights into the safety, effectiveness, and consequences of various antibiotic regimens in the therapy of pediatric CAP. This review emphasizes the significance of evidence-based strategies to maximize antibiotic treatment for pediatric CAP, while also noting research limitations. More research is required to enhance treatment methods and results for kids with CAP. This includes carefully planned randomized controlled trials and integrated diagnostic tools.

Leveraging Large Data, Statistics, and Machine Learning to Predict the Emergence of Resistant E. coli Infections.

Drug-resistant Gram-negative bacterial infections, on average, increase the length of stay (LOS) in U.S. hospitals by 5 days, translating to approximately $15,000 per patient. We used statistical and machine-learning models to explore the relationship between antibiotic usage and antibiotic resistance over time and to predict the clinical and financial costs associated with resistant E. coli infections. We acquired data on antibiotic utilization and the resistance/sensitivity of 4776 microbial cultures at a Kaiser Permanente facility from April 2013 to December 2019. The ARIMA (autoregressive integrated moving average), neural networks, and random forest time series algorithms were employed to model antibiotic resistance trends. The models' performance was evaluated using mean absolute error (MAE) and root mean squared error (RMSE). The best performing model was then used to predict antibiotic resistance rates for the year 2020. The ARIMA model with cefazolin, followed by the one with cephalexin, provided the lowest RMSE and MAE values without signs of overfitting across training and test datasets. The study showed that reducing cefazolin usage could decrease the rate of resistant E. coli infections. Although piperacillin/tazobactam did not perform as well as cefazolin in our time series models, it performed reasonably well and, due to its broad spectrum, might be a practical target for interventions in antimicrobial stewardship programs (ASPs), at least for this particular facility. While a more generalized model could be developed with data from multiple facilities, this study acts as a framework for ASP clinicians to adopt statistical and machine-learning approaches, using region-specific data to make effective interventions.