Susceptibility Profile Of Isolates Research Articles

Survey for Carbapenem Resistant Klebsiella Pneumoniae among Patients Attending Aminu Kano Teaching Hospital, Kano, Nigeria

Carbapenem resistant Klebsiella pneumoniae is becoming a more significant pathogen because of the grave clinical risk it poses which affects patient’s treatment outcome. This study aimed to survey for carbapenem resistant Klebsiella pneumoniae (CRKP) among patients attending Aminu Kano Teaching Hospital, Kano State, Nigeria. A total of 600 clinical samples including urine, sputum and swabs were collected and screened. Klebsiella pneumoniae were isolated and confirmed using culture, microscopy and biochemical test according to standard microbiological techniques. Phenotypic carbapenem resistant and carbapenemase production were detected using meropenem discs diffusion method and modified Hodge test respectively. Genotypic carbapenemase productions were confirmed by detecting the presence of blaKPC genes using PCR and Gel electrophoresis. Antibiotics susceptibility profiles of the CRKP isolates were evaluated using disc diffusion method and interpreted using CLSI protocols. The study revealed the incidence of Klebsiella pneumoniae infection as 14% with the highest occurrence in sputum (18%) and the lowest in swab (10%). Of the total number of isolated K. pneumoniae, 14.3% were found to be carbapenem resistant. Up to 75% of CRKP isolates were found to produce carbapenamase and harbor blaKPC genes. Antibiotic susceptibility profile of these isolates revealed colistin and tigecycline as the most active antibiotics in vitro (92%).The isolates were found to be generally resistant to cefepime, ceftriaxone, cefuroxime, cotrimoxazole and ciproflaxin (100%). Up to 8% of the isolates were sensitive to Gentamicin and Nalidixic acid, 25% to Nitrofurantoin, 50% to Minocycline and 17% to Amikacin. This study verifies the existence of carbapenem resistant Klebsiella pneumoniae isolates that are highly resistant to other antibiotics in patients attending AKTH Kano which is an indication of increase in drug resistance. This requires the need for newer tactics in infection control to prevent the spread of carbapenem resistant isolates.

Species distribution and antifungal susceptibility profiles of yeasts isolated from onychomycosis: a cross-sectional study with insights into emerging species.

Candida onychomycosis is a common fungal infection affecting the nails, primarily caused by Candida (C.) species. Regarding the increasing trend of Candida onychomycosis and the antifungal resistant phenomenon in recent years, this study aims to evaluate the epidemiological characteristics of Candida onychomycosis, the distribution of emerging species, and the antifungal susceptibility profiles of isolates. Onychomycosis caused by yeast species was confirmed through direct examination and culture of nail scraping among all individuals suspected to have onychomycosis and referred to a medical mycology laboratory between June 2019 and March 2022. Species of yeast isolates were identified using the multiplex PCR and PCR-RFLP methods. The antifungal susceptibility of isolates to common antifungal agents and imidazole drugs was evaluated according to the M-27-A3 CLSI protocol. Among 101 yeast strains isolated from onychomycosis, Candida parapsilosis complex (50.49%) was the most common species, followed by C. albicans (20.79%) and C. tropicalis (10.89%). Rare species of yeasts such as C. guilliermondii and Saccharomyces cerevisiae were also identified by molecular methods. Results obtained from antifungal susceptibility testing showed significant differences in MIC values of isoconazole, fenticonazole, and sertaconazole among different species. Overall, a fluconazole-resistant rate of 3% was found among Candida species. Moreover, there was a statistically significant difference in MICs of fenticonazole and clotrimazole between the two most prevalent causative species, C. parapsilosis complex and C. albicans. Correct identification of the causative agents of onychomycosis and performing susceptibility testing could be helpful in choosing the most appropriate antifungal therapy.

COVID-19-associated pulmonary aspergillosis (CAPA): identification of Aspergillus species and determination of antifungal susceptibility profiles.

Among the co-infectious agents in COVID-19 patients, Aspergillus species cause invasive pulmonary aspergillosis (IPA). IPA is difficult to diagnose and is associated with high morbidity and mortality. This study is aimed at identifying Aspergillus spp. from sputum and tracheal aspirate (TA) samples of COVID-19 patients and at determining their antifungal susceptibility profiles. A total of 50 patients with COVID-19 hospitalized in their intensive care units (ICU) were included in the study. Identification of Aspergillus isolates was performed by phenotypic and molecular methods. ECMM/ISHAM consensus criteria were used for IPA case definitions. The antifungal susceptibility profiles of isolates were determined by the microdilution method. Aspergillus spp. was detected in 35 (70%) of the clinical samples. Among the Aspergillus spp., 20 (57.1%) A. fumigatus, six (17.1%) A. flavus, four (11.4%) A. niger, three (8.6%) A. terreus, and two (5.7%) A. welwitschiae were identified. In general, Aspergillus isolates were susceptible to the tested antifungal agents. In the study, nine patients were diagnosed with possible IPA, 11 patients were diagnosed with probable IPA, and 15 patients were diagnosed with Aspergillus colonization according to the used algorithms. Serum galactomannan antigen positivity was found in 11 of the patients diagnosed with IPA. Our results provide data on the incidence of IPA, identification of Aspergillus spp., and its susceptibility profiles in critically ill COVID-19 patients. Prospective studies are needed for a faster diagnosis or antifungal prophylaxis to manage the poor prognosis of IPA and reduce the risk of mortality.

Analysis of diversity and antibiotic susceptibility profile of bacterial strains isolated from freshwater canal of Lahore, Pakistan

The key objective of current study was to analyse the bacterial diversity of canal water of Lahore, Pakistan. Members of Enterobacteriaceae were targeted that may pose serious health issues to human health. Total 50 bacterial strains were isolated by using Eosin Methylene Blue agar and MacConkey agar. The 16S rRNA gene sequencing of 30 strains confirmed the final taxonomic status of bacterial strains. The results manifested that strains belong to genera of Enterobacter, Escherichia, Klebsiella, Pseudomonas, Acinetobacter, Aeromonas and Vogesella. Antibiotic susceptibility profile of isolates was evaluated against 13 different antibiotics. E. coli SCE-1 showed highest resistant against majority of the antibiotics. Whereas all strains were sensitive to Amikacin (30 µg). Aeromonas hydrophila SD-6 exhibited highest sensitivity against all antibiotics except ampicillin (10 µg) and amoxicillin (25 µg). None of the bacterial strain was completely resistant or susceptible to all antibiotics. Except E. coli all strains were sensitive to Amikacin (30 µg), Gentamycin (30 µg) and Norfloxacin (10 µg). Most of the strains showed intermediate and resistant antibiotic profile towards Nitrofurantoin (300 µg). Latex agglutination test was performed for the screening of E. coli O157 that showed negative results for this serotype. The detection of potential human pathogens like E. coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and A. hydrphila in canal water indicates that it is not suitable for domestic purposes, recreational activities, and irrigation

Species Distribution and Antifungal Susceptibilities of Aspergillus Section Terrei Isolates in Clinical Samples from the United States and Description of Aspergillus pseudoalabamensis sp. nov.

Aspergillus section Terrei consists of numerous cryptic species in addition to A. terreus sensu stricto. The treatment of invasive infections caused by these fungi may pose a unique challenge prior to diagnosis and species identification, in that they are often clinically resistant to amphotericin B, with poor outcomes and low survival rates in patients treated with this polyene. Data on the species distributions and susceptibility profiles of isolates within section Terrei from the United States (U.S.) are limited. Here, we report the species distributions and susceptibility profiles for amphotericin B, isavuconazole, itraconazole, posaconazole, voriconazole, and micafungin against 278 clinical isolates of this section from institutions across the U.S. collected over a 52-month period. Species identification was performed by DNA sequence analysis and phenotypic characterization. Susceptibility testing was performed using the CLSI broth microdilution method. The majority of isolates were identified as Aspergillus terreus sensu stricto (69.8%), although several other cryptic species were also identified. Most were cultured from specimens collected from the respiratory tract. Posaconazole demonstrated the most potent activity of the azoles (MIC range ≤ 0.03-1 mg/L), followed by itraconazole (≤0.03-2 mg/L), voriconazole, and isavuconazole (0.125-8 mg/L for each). Amphotericin B demonstrated reduced in vitro susceptibility against this section (MIC range 0.25-8 mg/L), although this appeared to be species-dependent. A new species within this section, A. pseudoalabamensis, is also described. Our results, which are specific to the U.S., are similar to previous surveillance studies of the Aspergillus section Terrei.

Prevalence of COVID Associated Mucormycosis with Antifungal Susceptibility Profiles of Isolates in a Tertiary Care Hospital

Mucormycosis is an angioinvasive opportunistic fungal infection, but these have become emerging pathogens, especially in conditions with underlying predisposing risk factors in a favourable setting. With the exponential rise in COVID-19 cases, there was an increase in the number of mucormycosis cases among them. The global prevalence rate of mucormycosis in COVID-19 globally varies from 0.005 to 1.7 per million population and in India, it is approximately 0.14 cases/1000. The objective of this study is to detect the prevalence of mucormycosis with the antifungal susceptibility pattern among COVID-19 patients admitted in our hospital. A total of 347 COVID-19 and post-COVID-19 patients with symptoms suggestive of mucormycosis were included in this study. Nasal scrapings, debrided necrotic tissue, unhealthy tissue bits and biopsy tissues taken through FESS were processed for mycological examination under sterile conditions. Among the total 347 samples processed, 87(25%) were positive for fungal culture. Among the culture positves 7.8% (25) belong to mucorales. Among the total 87 fungal isolates, the majority of organism isolated was Aspergillus sp(68%), followed by Rhizopus sp (18%). Rhizopus/Aspergillus sp (5%), Mucor species (5%), Rhizomucor sp (2%), Mucor/Aspergillus sp(1%), Curvularia sp (1%) were the other fungi isolated. All the strains of Mucorales were sensitive to Posaconazole and one strain showed resistance to amphotericin B with MIC 8 µg/ml by microbroth dilution method based on CLSI M27 guidelines for Amphotericin B, and Posaconazole.

1196. Environmental Contamination of Rooms of Patients Harboring Multidrug-Resistant Organisms

Abstract Background Healthcare environmental contamination by patients harboring multidrug-resistant organism (MDROs) is an important source of hospital MDRO transmission. We aimed to determine the MDRO contamination and bioburden of surfaces within hospital rooms of patients with positive MDRO clinical cultures. Methods Patients with positive clinical cultures of MDROs (carbapenem resistant Acinetobacter baumannii [CRAB], carbapenem resistant Pseudomonas aeruginosa [CRPA], extended spectrum cephalosporin and carbapenem resistant Enterobacterales [ESCRE, CRE] and vancomycin resistant Enterococcus [VRE]) were identified through daily screening of clinical microbiology results. Patient peri-rectal, inguinal, and wound sampling was performed. E-swab and environmental sampling of room surface composites was performed using environmental sponge wipes. Composite 1 included the TV remote, telephone, call button and bed rails. Composite 2 included the room door handle, IV pole and overbed table. Composite 3 included toileting surfaces. Each composite surface area was no more than 350mm3 each. Sponge wipes were expressed in phosphate-buffered saline containing 0.1% Tween 20 using a stomacher. The eluate was concentrated removed leaving ∼ 5mL, and remaining resuspended by vortex. Undiluted suspension was plated on selective MDRO medias and broth. Microbial burden was calculated by summing composites bioburdens. Samples that were only broth positive were given a value of 1 CFU. Table 1.Demographic and Clinical Characteristics of Multidrug-resistant Organisms Positive Patients (n=5)Abbreviation: CRAB: carbapenem-resistant Acinetobacter baumanii, CRPA: carbapenem-resistant Pseudomonas aeruginosa, ESCRE: extended spectrum cephalosporin-resistant Enterobacterales, ESLD: end-stage liver disease, IBD: inflammatory bowel diseases, HTN: hypertension, MDRO: multidrug resistant organism, TBI: traumatic brain injury, VRE: vancomycin resistant enterococcus1- Immunosuppressed defined as solid organ transplant, bone marrow transplant within 12 months, chemotherapy within 6 months, HIV and CD4 <200, any immunomodulatory agent within the past 30 days, at least 10 mg of corticosteroid for >14 daysTable 2.Multidrug-resistant Organism Environmental Contamination and Bioburden of Patients and Environmental CompositesAbbreviation: CRAB: carbapenem-resistant Acinetobacter baumannii, CRPA: carbapenem-resistant Pseudomonas aeruginosa, ESCRE: extended spectrum cephalosporin-resistant Enterobacterales, VRE: vancomycin resistant Enterococcus, ND: not done, NG: no growth, N/A; not applicable1Patient Swab P1: peri-rectal, P2: wound or tracheostomy, P3: inguinal2Environmental Swab C1: TV remote, telephone, call button and bed rails; Composite 2 room door handle, IV pole and overbed table; Composite 3: toileting surfaces Results Five patients were included with target MDROs (1 CRAB, 1 CRPA, 2 ESCRE, 1 VRE). Demographic, clinical, and microbiological characteristics are summarized in Table 1. The same MDRO was detected in the environment of 60% (3/5) patients. Additional MDROs other than the clinical culture were cultured from patient and composite sites swabs (Table 2). Antibiotic susceptibility data confirmed similarity between patient and environmental isolates and identified additional MDROs present (Table 3,4). Additional patient enrollment and WGS isolates from clinical culture, patient and environmental isolates is ongoing. Table 3.Antimicrobial Susceptibility Profile of Isolates from Patients with Concordant Clinical and Environmental MDROsAbbreviation: CRAB: carbapenem-resistant Acinetobacter baumannii, ESCRE: extended spectrum cephalosporin-resistant Enterobacterales, MIC: minimum inhibitory concentration, N/A; not applicableTable 4.Antimicrobial Susceptibility Profile of Concordant Clinical and Environmental MDROsAbbreviation: CRAB: carbapenem-resistant Acinetobacter baumannii, MIC: minimum inhibitory concentration, N/A; not applicable, VRE: vancomycin resistant enterococcus Conclusion Concordance of clinical isolates with environmental isolates suggest that decolonization interventions could reduce environmental bioburden Disclosures All Authors: No reported disclosures.

Bacteriological load and antibiotic susceptibility patterns of bacterial isolates from aquatic resources harvested from Okwan Obolo estuary, Akwa Ibom State

This study was conducted to determine bacteriological load and antibiotic susceptibility profile of isolates from aquatic resources harvested from Okwan Obolo estuary, Akwa Ibom state, using standard microbiological techniques. The aquatic resources used were the fresh land crab (Gecarinus quadratus), Pallid Ghost crab (Ocypode pallidulla) and fishes (Sadinella maderensis) samples. The bacterial load of each sample was determined using serial dilution and pour plating techniques. Antibiotic sensitivity test was conducted using Kirby-Bauer Agar-disc diffusion method. The results indicated the highest mean of total heterotrophic bacterial counts(THBC), total Vibrio count (TVC), total coliform count (TCC) and total fecal coliform count(TFCC) ranges of 1.15 x105 CFU/g, 4.9x105 CFU/g 6.9 x105 CFU/g, 5.25 x105 CFU/g for Gecarinus quadratus 1, 1.16 x105 CFU/g, 4.4 x105 CFU/g, 6.5 x105 CFU/g, 5.75 x105 CFU/g for Ocypode pallidulla 1. Mean bacterial load from different anatomical sites of Sadinella maderensis ranged from 4.1 x 105 CFU/g, 1.6 x 105 CFU/g, 3.3 x 105 CFU/g and 2.6x 105 CFU/g for Sadinella maderensis1, 4.4 x 105 CFU/g, 2.6x 105 CFU/g, 2.8x 105 CFU/g, 2.0 x 105 CFU/g for Sadinella maderensis2 respectively. The isolates recovered were Vibrio parahaemolyticus, Vibrio vulnificus, Escherichia coli, Enterococcus spp, Staphylococcus aureus, Salmonella spp, Micrococcus spp, Coagulase- negative Staphylococcus (CON Staphylococcus), Bacillus spp, Enterobacter spp, Pseudomonas spp and Proteus species. However, guts samples had the highest number of bacterial loads and isolates. Staphylococcus aureus had the highest percentage of occurrence (14.1%), closely followed by Escherichia coli and Micrococcus spp (12.5%) respectively. All the isolates recorded 100% sensitivity to amoxicillin-clavulanic antibiotics. CON Staphylococcus and Proteus spp recorded 100% sensitivity to all drugs tested while Escherichia coli recorded 100% to imipenem, gentamicin, ceftriazole and amoxicillin-clauvalanic antibiotics respectively. Proper cooking of aquatic resources is encouraged, and good water quality should be maintained in the estuary.

Phenotypic characterization, detection of virulence factors, and antibacterial susceptibility profile of clinical isolates of Klebsiella pneumoniae

Klebsiella pneumoniae has been one of the most occurring bacteria in clinical samples causing community-acquired and nosocomial infections. It has been developing resistance to most antimicrobial agents. These have increased the pathogenicity and the chance for the evolvement of more invasive K. pneumoniae. The study was aimed at the identification and detection of Klebsiella pneumoniae from clinical samples. Some selected virulence factors were detected and the antibacterial susceptibility profile of the isolates was conducted. The incubation period, infective dose, and mortality rate of K.pneumoniae were measured using Baggs albino rats (BALB/c) strain. The isolation and identification of 56 Klebsiella pneumoniae from 223 clinical samples were made. Out of 56 K. pneumoniae isolates, all manifested mucoid phenotype, 44(78.6%) capsule antigen and 13(23.2%) Siderophore. The antimicrobial test conducted identified Zinacef 51(91.1%), Rocephin 50 (89.3%), and Ampiclox 50 (91.1%) as the most resistant. Ciprofloxacin 49 (87.5%), chloramphenicol 35(62.5%), Gentamycin 32(57.1%), and Amoxicillin 28 (50%) were the most susceptible to Klebsiella pneumoniae. The mouse lethality test shows that K. pneumoniae hypermucoviscous strain can cause 41.7% lethality and 66.7% mortality in Baggs Albino rats. Meanwhile an infection dose 105cfu/ml, 107cfu/ml and 109cfu/ml produced an incubation period of 9 days, 7days and 5days. The chi-square test shows no significant association between the isolate and the gender of the patients, but there is a significant association between the samples and isolates identified p <0.05. Likewise, the association between mucoid phenotype, capsule antigen, siderophore, and the type of infection is significant (p<0.05). It is finally concluded that K. pneumoniae is the second most prevailing bacterium causing community-acquired infection the resistant pattern recorded identified the test bacteria as a multidrug-resistant strain and manifestation of the virulent factor depends on the type and site of infection caused by the K. pneumoniae.

A longitudinal study of Candida bloodstream infections in a Japanese university hospital: species distribution, drug susceptibility, clinical features, and mortality predictors.

We aimed to detect possible changes in Candida species distribution over time and to know the antifungal susceptibility profile of isolates obtained from patients with bloodstream infection (BSI) due to this pathogen. Risk factors associated with 30-day mortality were also assessed. We conducted a retrospective cohort study of patients diagnosed with Candida BSI at a Japanese university hospital from 2013 to 2021. The change in the distribution pattern of the Candida spp. isolated was examined by considering three successive sub-periods of 3years each. Risk factors for 30-day mortality were determined using Cox regression analysis. In the entire study period, Candida albicans was the most frequent species (46.7%), followed by Candida glabrata (21.5%) and Candida parapsilosis (18.7%). There was no change in Candida species distribution comparing the three sub-periods analyzed. All isolates were susceptible to micafungin, and most were susceptible to fluconazole, except for C. glabrata. No isolates were resistant to amphotericin B or voriconazole. The overall 30-day mortality was 40.2%. Univariate analysis revealed an association between 30-day mortality and central venous catheter (CVC) removal at any time, high Pitt bacteremia score (PBS), and high Charlson comorbidity index (CCI). Multivariate Cox analysis found that high PBS was the only independent predictor of 30-day mortality; subsequent multivariate Cox regression demonstrated that early CVC removal significantly reduced 30-day mortality. Candida species distribution and antifungal susceptibility profile in our hospital remained similar from 2013 to 2021. Early CVC removal may improve candidemia outcomes.

The impact of COVID-19 on antimicrobial prescription and drug resistance in fungi and bacteria.

Secondary infections are one of the complications in COVID-19 patients. We aimed to analyze the antimicrobial prescriptions and their influence on drug resistance in fungi and bacteria isolated from severely ill COVID-19 patients. Seventy-nine severely ill COVID-19 hospitalized patients with secondary bacterial or fungal infections were included. We analyzed the prescribed antimicrobial regimen for these patients and the resistance profiles of bacterial and fungal isolates. In addition, the association between drug resistance and patients’ outcome was analyzed using correlation tests. The most prescribed antibacterial were ceftriaxone (90.7% of patients), vancomycin (86.0%), polymyxin B (74.4%), azithromycin (69.8%), and meropenem (67.4%). Micafungin and fluconazole were used by 22.2 and 11.1% of patients, respectively. Multidrug-resistant (MDR) infections were a common complication in severely ill COVID-19 patients in our cohort since resistant bacteria strains were isolated from 76.7% of the patients. Oxacillin resistance was observed in most Gram-positive bacteria, whereas carbapenem and cephalosporin resistance was detected in most Gram-negative strains. Azole resistance was identified among C. glabrata and C. tropicalis isolates. Patients who used more antimicrobials stayed hospitalized longer than the others. The patient’s age and the number of antibacterial agents used were associated with the resistance phenotype. The susceptibility profile of isolates obtained from severely ill COVID-19 patients highlighted the importance of taking microbial resistance into account when managing these patients. The continuous surveillance of resistant/MDR infection and the rational use of antimicrobials are of utmost importance, especially for long-term hospitalized patients with COVID-19.

Bacteriological quality and antimicrobial susceptibility profiles of isolates of ready-to-eat raw minced meat from hotels and restaurants in Arba Minch, Ethiopia.

In Ethiopia, the bacteriological quality of ready-to-eat raw meat is of a great public health concern as it can serve as a source of meat-borne pathogens and worsen the transmission of antimicrobial resistant bacteria, and hence this cross-sectional study, done on 257 meat samples (ie., 169 beef, 50 mutton and 38 chevon) from randomly selected hotels and restaurants (n = 52). Approximately 25 gm of meat samples were taken bi-weekly and subjected to quantitative and qualitative analyses; antimicrobial susceptibility tests were done as per the Kirby-Bauer disk diffusion method. It was found that 13.2 (n = 34), 17.5 (n = 45) and 21.8% (n = 56) samples exceeded the permissible limit for total viable and coliform and S. aureus counts, respectively. At the same time, 24.9% (n = 64) surpassed the bacteriological limit permissible for consumption. Overall, 36.6% (n = 94) of samples were extrapolated as unsatisfactory for consumption due to high bacterial load and or the presence of pathogens. Five different bacterial spp. such as E. coli 65% (n = 167), S. aureus 59% (n = 152), Salmonella spp. 28.4% (n = 73), Campylobacter spp. 14.4% (n = 37) and Shigella spp. 4.3% (n = 11) were isolated in varied proportions. Alarmingly, 60% (n = 264) of the isolates were multi-drug resistant and 51% of S. aureus were found to be MRSA.

Impact of COVID-19 on the antifungal susceptibility profiles of isolates collected in a global surveillance program that monitors invasive fungal infections.

Studies demonstrated the impact of the COVID-19 pandemic in the prevalence and susceptibility profiles of bacterial and fungal organisms. We analyzed 4821 invasive fungal isolates collected during 2018, 2019, and 2020 in 48 hospitals worldwide to evaluate the impact of this event in the occurrence and susceptibility rates of common fungal species. Isolates were tested using the CLSI broth microdilution method. While the percentage of total isolates that were C. glabrata (n = 710 isolates) or C. krusei (n = 112) slightly increased in 2020, the percentage for C. parapsilosis (n = 542), A. fumigatus (n = 416), and C. lusitaniae (n = 84) significantly decreased (P < .05). Fluconazole resistance in C. glabrata decreased from 5.8% in 2018–2019 to 2.0% in 2020, mainly due to fewer hospitals in the US having these isolates (5 vs. 1 hospital). Conversely, higher fluconazole-resistance rates were noted for C. parapsilosis (13.9 vs. 9.8%) and C. tropicalis (3.5 vs. 0.7%; P < .05) during 2020. Voriconazole resistance also increased for these species. Echinocandin resistance was unchanged among Candida spp. Voriconazole susceptibility rates in A. fumigatus were similar in these two periods (91.7% in 2018 and 2019 vs. 93.0% in 2020). Changes were also noticed in the organisms with smaller numbers of collected isolates. We observed variations in the occurrence of organisms submitted to a global surveillance and the susceptibility patterns for some organism-antifungal combinations. As the COVID-19 pandemic is still ongoing, the impact of this event must continue to be monitored to guide treatment of patients affected by bacterial and fungal infections.Lay SummarySecondary infections were documented in COVID-19 patients. We compared the prevalence of invasive fungal isolates consecutively collected in 48 worldwide hospitals and their susceptibility patterns between 2020, the year of the global COVID-19 pandemic, and the two prior years.

Three-year evaluation of the nosocomial infections in pediatrics: bacterial and fungal profile and antimicrobial resistance pattern

BackgroundNosocomial infections (NIs) could lead to considerably higher mortality rates, length of the hospital stays and costs, and represent a serious public health concern worldwide. Besides, the unreasonable use of antibiotics could lead to get resistant to different antibiotics and create limited therapeutic options, increased risks of treatment failure and poor patient management. The current study aimed to evaluate the prevalence and antimicrobial susceptibility of NIs in an Iranian referral pediatrics hospital during 3 years.MethodsDuring the 3-year period, all electronic medical records of nosocomial infection episodes in hospitalized patients were retrospectively reviewed. The bacterial and fungal profile and antimicrobial susceptibility profiles of isolates recovered from different samples of patients with NIs were determined.ResultsIn this study, a total of 718 patients with NIs was found, among which 61.3% were male (N = 440). The median age of the patients was 2.5 years (IQR: 1 month to 3 years). Klebsiella pneumonia and Candida spp. isolates were the most prevalent microorganisms (N = 125, 17.4%, N = 121, 16.9%, respectively), followed by Pseudomonas aeruginosa (N = 72, 10%) and Coagulase-negative Staphylococci (CoNS) (N = 69, 9.6%). Pseudomonas aeroginusa strains showed high sensitivity to the studied antibiotics. Acinetobacter baumannii strains displayed more than 90% resistance to the almost all antibiotics. All of the tested isolates of S. maltophilia were susceptible to Trimethoprim−sulfamethoxazole (100%) and showed high susceptibility rate to ciprofloxacin (96.4%). Vancomycin resistance was not reported in S. aureus isolates, while 64% of Enterococcus spp. was resistant to vancomycin. The rates of methicillin resistance for S. aureus and CoNS isolates were 45.5% and 85.7%, respectively.ConclusionsHigh frequency of antimicrobial resistance to the commonly tested antibiotics is a concerning alarm. Therefore, effective infection control programs and rational antibiotic use policies should be established promptly.

Isolation, toxinotyping and antimicrobial susceptibility testing of Clostridium perfringens isolated from Pakistan poultry

Background and objectivesClostridium perfringens is a causative agent of enteric infections in animals including poultry by producing twenty different types of toxins. A single strain produces only a subset of these toxins, which form the basis of its classification into seven toxinotypes (A-G). C. perfringens toxinotype A is a widespread cause of necrotic enteritis (NE) in poultry. The current study was conducted to determine the prevalence of different toxins and antimicrobial susceptibility of C. perfringens isolated from Pakistan NE affected poultry. MethodsA total of 134 intestinal samples of the diseased birds were collected postmortem and processed for isolation of C. perfringens using tryptose sulphite cycloserine (TSC) agar supplemented with d-cycloserine. Isolates were confirmed by Gram's staining, biochemical and molecular analyses. Toxinotyping was performed by multiplex PCR. Antimicrobial susceptibility profile of isolates was performed by Kirby Bauer disc diffusion method. ResultsA total of 34 strains of C. perfringens were isolated from 134 samples with prevalence rate of 25.37%. All the isolated strains were toxinotype A, as they were positive for alpha toxin (CPA) and negative for other tested toxins such as beta (CPB), epsilon (ETX), iota (ITX), enterotoxin (CPE), toxin perfringens large (TpeL) and necrotic B-like toxin (NetB). Interestingly, all the isolated strains of C. perfringens were multidrug resistant. The highest resistance was observed against Neomycin, Trimethoprim, Tetracycline and Lincomycin which are routinely used at Pakistan poultry production. ConclusionC. perfringens toxinotype A is prevalent in Pakistan poultry. Incidence of C. perfringens with prevalence rate of 25.37% can pose serious threat to Pakistan's poultry industry given that all the isolated strains were multidrug resistant. Our findings highlight the need for new antibiotics and antibiotic alternatives to overcome multidrug resistance.

Group B Streptococci Vaginal-Recto Colonization, Vertical Transmission to Newborns, Antimicrobial Susceptibility Profile and Associated Factors in Selected Health Facilities of Bahir Dar City: A Cross-Sectional Study.

BackgroundGroup B streptococci (GBS) is an important pathogen involved in stillbirths, neonatal deaths and neurological defects, and the occurrence of multi-drug resistance (MDR) is an alarming issue. This study determined the prevalence of GBS colonization in pregnant women and newborns, the proportion of vertical transmission, antimicrobial susceptibility profiles of isolates, and the factors associated with colonization and vertical transmission.MethodsA cross-sectional study was conducted from March 1, 2021 to June 30, 2021, at selected health facilities of Bahir Dar city. Vaginal-recto swabs from 292 pregnant women and pooled ear, nasal and umbilical swabs from 292 newborns were collected. GBS were identified following standard microbiological protocols. Antimicrobial susceptibility testing was performed using modified Kirby–Bauer disk diffusion method and interpreted by the accepted 2020 CLSI M100 guidelines. Logistic regression analysis was computed.ResultsOverall, 54 (18.5%) of pregnant women and 22 (7.5%) of newborns had GBS colonization. The proportion of GBS vertical transmission was 22 (40.7%). Group B Streptococcus isolates scored susceptibility to penicillin, ampicillin and vancomycin with 88.9%, 90.7%, and 96.3% for pregnant women and 86.4%, 90.9% and 95.9% for newborns, respectively. A high percentage of non-susceptibility was found for clindamycin and erythromycin with 33.3% and 25.9% for pregnant women and 31.8% and 22.7% from newborns, respectively. Besides, 19 (35.2%) GBS from pregnant women and 8 (36.4%) from newborns were MDR. Group B streptococci colonization was significantly associated with delivery before 37th week of gestation (AOR=2.77, 95% CI 1.14–6.68) and history of stillbirth (AOR=3.13, 95% CI 1.13–8.70).ConclusionPregnant women vaginal-recto GBS colonization and transmission to newborns connected with MDR are a matter of concerns. Although non-susceptible GBS isolates are obtained, penicillin and vancomycin are relatively effective. The use of clindamycin, erythromycin and ceftriaxone should be guided by antimicrobial susceptibility testing. Genetic analysis is recommended to exactly identify the epidemiology of GBS strains, vertical transmission and antimicrobial resistance at the country level.

Evaluation of Identification and Susceptibility for Candida Spp. Isolated Directly from Positive Blood Culture Bottles

Determination of the susceptibility profile of isolates of Candida from blood culture bottles is extremely important for correctly guiding patient pharmacotherapy. The aim of this study was to compare the results of analysis of Candida isolated directly from blood culture bottles by the VITEK MS MALDI-TOF identification system and the fluconazole disk diffusion assay with those of standard identification methods. Testing directly from the bottle allowed results 24 to 48 hours quicker than the standard method. There was a categorical agreement of 51.64% (47 of 91 samples) between the results of analysis directly from the bottle and analysis by the standard method. Regarding species identification, there was 96.15% agreement for Candida parapsilosis (25 of 26 samples). Categorical agreement between the rapid and standard disk diffusion methods was 95%, and the agreement between the rapid disk diffusion method and the broth microdilution method was 97%. Only minor errors in the rapid method were observed: 3 (5%) in the standard disk diffusion method and 2 (3%) in the broth microdilution method. Our study concluded that the rapid disk diffusion method for fluconazole is a fast, easy, reproducible, and consistent method. Its timely implementation for testing antifungal agents in the clinical microbiology laboratory can help reduce profile release times, thus helping to determine the most appropriate antifungal treatment.

Comparison of clinical and biological characteristics of HIV-infected patients presenting Cryptococcus neoformans versus C. curvatus/C. laurentii meningitis

BackgroundCryptococcal meningitis is mainly caused by Cryptococcus neoformans/C. gattii complex. We compared the clinical, biological, and antifungal susceptibility profiles of isolates from HIV-Infected Patients (HIVIP) with C. neoformans (Cn) versus C. curvatus/C. laurentii (Cc/Cl) meningitis.MethodsComparative analytical study were conducted. Apart from patients’ clinical data, the following analysis were performed and the results were compared in both groups: biochemical examination, cryptococcal antigen test, India ink staining, and culture on Cerebral Spinal Fluid (CSF), strains identification by mass spectrometry, ITS sequencing, PCR serotyping and antifungal susceptibility. The main outcome variable was the “species of Cryptococcus identified”, which was compared to other variables of the same type using the Pearson Chi-square test or the Fisher exact test.ResultsA total of 23 (79.3%) Cn meningitis cases versus 6 (20.7%) Cc/Cl meningitis were retained.Cn meningitis was more frequently associated with headache (100% vs 50%, p = 0.005) than Cc/Cl meningitis and meningeal signs were more frequent in Cn infected patients. Biologically, hypoglycorrhachia and low CD4 count were more observed in Cn group (90% vs 20% of patients, p = 0.01; 45.6 vs 129.8 cells/µL, p = 0.02, respectively). A higher proportion of Cn strains (91.3%) showed a low Minimum Inhibitory Concentration (MIC) (< 8 mg/L) for fluconazole compared to Cc/Cl strains (66.7%). Also, Cc/Cl strains resistant to 5-flucytosine and amphotericin B were found in 16.7% of cases for each of the two antifungal agents. Cryptococcus detection by routine analysis (India ink, culture, and antigens) was better for Cn samples than Cc/Cl. Except ITS sequencing, which identified all strains of both groups, mass spectrometry and serotyping PCR identified Cn strains better than Cc/Cl (100% vs 80%, p = 0.1; 100% vs 0%, p < 0.0001, respectively). After treatment with amphotericin B, 5-flucytosine, and fluconazole in both groups, the outcome was similar.ConclusionsClinical presentation of Cn meningitis is certainly more severe than that of Cc/Cl meningitis, but Cc/Cl infection should be considered in the management of HIVIP with meningeal syndrome because of the diagnostic difficulty and the high MICs of antifungal agents required for the treatment of meningitis due to these cryptococcal species.

Bacteriological and antimicrobial susceptibility profile of isolates in pleural fluid samples in a tertiary care hospital of North India

Bacteriological and antimicrobial susceptibility profile of isolates in pleural fluid samples in a tertiary care hospital of North India

Prevalence, serotype and antibiotic susceptibility of Group B Streptococcus isolated from pregnant women in Jakarta, Indonesia.

Group B Streptococcus (GBS) is a bacterial pathogen which is a leading cause of neonatal infection. Currently, there are limited GBS data available from the Indonesian population. In this study, GBS colonization, serotype distribution and antimicrobial susceptibility profile of isolates were investigated among pregnant women in Jakarta, Indonesia. Demographics data, clinical characteristics and vaginal swabs were collected from 177 pregnant women (mean aged: 28.7 years old) at 29-40 weeks of gestation. Bacterial culture identification tests and latex agglutination were performed for GBS. Serotyping was done by conventional multiplex PCR and antibiotic susceptibility testing by broth microdilution. GBS colonization was found in 53 (30%) pregnant women. Serotype II was the most common serotype (30%) followed by serotype III (23%), Ia and IV (13% each), VI (8%), Ib and V (6% each), and one non-typeable strain. All isolates were susceptible to vancomycin, penicillin, ampicillin, cefotaxime, daptomycin and linezolid. The majority of GBS were resistant to tetracycline (89%) followed by clindamycin (21%), erythromycin (19%), and levofloxacin (6%). The serotype III was more resistant to erythromycin, clindamycin, and levofloxacin and these isolates were more likely to be multidrug resistant (6 out of 10) compared to other serotypes. This report provides demographics of GBS colonization and isolate characterization in pregnant women in Indonesia. The results may facilitate preventive strategies to reduce neonatal GBS infection and improve its treatment.