Timentin Research Articles

Investigating Urinary Pathogens and Their Antibiotic Resistance: A Cross-Sectional Urine Culture Study.

Urinary tract infections (UTIs) are among the most prevalent infectious diseases. Females are more affected than males. The primary culprit is Escherichia coli. Multiple research investigations have documented widespread antimicrobial resistance in uropathogens, sparking global concerns, especially regarding the rise of multidrug resistance (MDR). This cross-sectional study was conducted from December 2023 to March 2024. A non-probability purposive sampling technique was employed to select participants, and informed consent was obtained from them. Data were extracted from the culture and sensitivity reports of these patients. The collected data were meticulously entered into IBM SPSS Statistics for Windows, Version 21 (IBM Corp.,Armonk, NY). The findings were then presented using a blend of percentages and numerical figures, offering a clear and concise representation of the data. Our study of 313 participants showed a higher prevalence of UTIs in females (219, 70%) compared to males (94, 30%). E. coli and Citrobacter were the predominant pathogens, with E. coli and Citrobacter more common in females, while Enterobacter and Staphylococcus were more prevalent in males. Antibiogram analysis revealed sensitivities to specific drugs like nitrofurantoin and meropenem, while resistance was observed against others, including polymyxin B and ampicillin. These findings stress the need for tailored UTI treatment approaches. In conclusion, our research highlights a concerning trend of escalating antibiotic resistance among Pakistani patients with UTIs. Tobramycin B, ticarcillin-clavulanic acid, ampicillin, and clotrimazole exhibited the highest resistance rates, while imipenem, meropenem, nitrofurantoin, sulfonamides, and tigecycline demonstrated notable sensitivity. These findings emphasize the urgent need for the exploration of alternative treatment options to combat rising resistance levels effectively.

Biofilm generation and antibiotic resistant profile of extensive and multidrug resistant Pseudomonas aeruginosa from burn patients in Ahvaz: A cross-sectional study.

Multidrug and extensive drug-resistant Pseudomonas aeruginosa was extracted from burn patients referring to burn centers in southwest Iran so that biofilm generation and antibiotic resistance could be investigated. A specific primer was used to confirm all our considered 110 P. aeruginosa culture-positive reports on 345 burn patients. The resistance of P. aeruginosa to seven antibiotics and Colistin with minimum inhibitory concentration (MIC) was assessed. Biofilm formation was assessed by the phenotypic study of specimens under Congo red agar and microtiter plate assays. One hundred and 10 clinical P. aeruginosa isolates taken from burn wound infections were validated. Among P. aeruginosa isolates, Piperacillin, Ceftazidime, Maeropenem, Gentamycin, and Gatifloacin had the highest resistance to antibiotics, while Ticarcillin-Clavulanic acid and Ceftolozane-Tazobactam showed the least resistance. MICs were then evaluated via the E test. Seven isolates were resistant to colistin. Colistin reference MICs for multidrug-resistant P. aeruginosa prevalence was 38%, while it was 22% for extensively drug-resistant (XDR) P. aeruginosa. One P. aeruginosa was pandrug-resistant (PDR). Under Congo red agar test, 66 isolates (67%) formed biofilms and black colonies, whereas 44 isolates (50%) had red colonies. In MTP, 76% formed biofilm. 40%, 32%, 21% of the isolates were strong, moderate, and weak biofilm formers, respectively, while 43% did not form biofilms. The P. aeruginosa resistance to antimicrobial agents has largely challenged the control of the infection. Accordingly, a higher resistance occurred when the isolates were transferred to the patients. Less than 50% P. aeruginosa samples generated strong biofilms. Consequently, hygienic measurements are essential to inhibit P. aeruginosa transmission to hospitalized patients.

A Study of Genotypic Characterization of ESBL and MBL Genes of β-Lactamase Producing Pseudomonas aeruginosa in Various Clinical Samples

Pseudomonas aeruginosa, a Gram-negative bacterium, presents a substantial challenge in healthcare due to its adaptability and resistance. This study delves into its genotypic characteristics, focusing on ESBL and MBL genes. The prevalence of P. aeruginosa in nosocomial infections, the research aims to decipher resistance mechanisms crucial for tailored interventions. The study includes 170 non-repetitive clinical samples with protocols. Antibiotic susceptibility testing reveals diverse resistance patterns. Molecular detection of ESBL and MBL genes involves DNA isolation, PCR amplification, and gel electrophoresis. The study examined 170 P. aeruginosa samples, revealing gender-specific variations with 65.91% male and 34.09% female isolates. Antimicrobial testing displayed resistance in Ceftazidime (59%) and Ciprofloxacin (48%), while Ticarcillin-clavulanic acid showed promising sensitivity (58%). Molecular identification unveiled diverse resistance genes across sample types, emphasizing genetic complexity. The study underscores the urgency for targeted therapeutic interventions and novel antimicrobial strategies against P. aeruginosa infections. As antimicrobial resistance complexities persist, this research guides efforts toward a profound understanding of clinical interventions and strategic antimicrobial management.

Analysis of clinical characteristics of infections caused by Shewanella species

PurposeThe Shewanella genus is a rare pathogen of marine origin. In recent years, there has been a continuous increase in infection cases caused by this bacterium, and we have observed the uniqueness of infections caused by this microorganism. Materials and methodsThis study conducted a retrospective analysis of the medical history and laboratory examination data of patients infected with the Shewanella genus over the past decade. Additionally, it employed bioinformatics methods to analyze the relevant virulence factors and antibiotic resistance genes associated with the Shewanella genus. ResultsOver the past 10 years, we have isolated 51 cases of Shewanella, with 68.82% being Shewanella putrefaciens (35/51 cases) and 31.37% being Shewanella algae (16/51 cases). Infected individuals often had underlying diseases, with 39.22% (20/51) having malignant tumors and 25.49% (13/51) having liver and biliary system diseases primarily characterized by stones. The majority of patients, 62.74% (32/51), exhibited mixed infections, including one case with a combination of infections from three other types of bacteria and five cases with a combination of infections from two other types of bacteria. The identified microorganisms were commonly resistant to ticarcillin-clavulanic acid (23.5%), followed by cefoperazone-sulbactam (19.6%), ciprofloxacin (17.6%), and cefotaxime (17.6%). Bioinformatics analysis indicates that Shewanella can express bile hydrolysis regulators and fatty acid metabolism regulators that aid in adapting to the unique environment of the biliary tract. Additionally, it expresses abundant catalase, superoxide dismutase, and two-component signal transduction system proteins, which may be related to environmental adaptation. Shewanella also expresses various antibiotic resistance genes, including beta-lactamases and aminoglycoside modification enzymes. Iron carriers may be one of its important virulence factors. ConclusionsWe speculate that the Shewanella genus may exist as a specific colonizer in the human body, and under certain conditions, it may act as a pathogen, leading to biliary infections in the host.

Antibiotic Resistance of Uropathogenic Escherichia coli (UPEC) among Iranian Pediatrics: A Systematic Review and Meta-Analysis.

Uropathogenic Escherichia coli is a major cause of urinary tract infections (UTIs). This systematic review and meta-analysis was conducted to determine the prevalence of antibiotic-resistant uropathogenic E. coli among Iranian children with confirmed bacterial UTIs from 2012 to 2022. A systematic review was performed by searching PubMed, Scopus, Google Scholar, Web of Science, MagIran, Iranian Scientific Information Database, IranMedex, and Iranian Research Institute for Information Science and Technology. The antibiotic-specific pooled prevalence estimates were calculated by applying a random-effects model. Freeman-Tukey Double Arcsine transformation was applied. I-squared statistic, and Cochran's Q test were computed and meta-regression was conducted on latitude of sampling location. The literature search retrieved 2159 articles, among which 19 articles were included. The highest antibiotic resistance was related to doxycycline, ticarcillin-clavulanic acid, cefazolin, cefuroxime, and amoxycillin-clavulanic acid, 59%, 57%, 54%, 53%, and 52%, respectively. Meta-regression on the latitude was statistically significant for nitrofurantoin (P=0.05). Resistant uropathogenic Escherichia coli strains were observed in the majority of confirmed bacterial UTIs among Iranian children. The most effective antibiotics for uropathogens were colistin, meropenem, and imipenem.

Clinico-epidemiological Analysis of Stenotrophomonas Maltophilia Bacteraemia, its Associated Risk Factors and Outcome in Patients Admitted at a Tertiary Care Centre in Northern India- A Retrospective Cohort Study

Introduction: Stenotrophomonas maltophilia is a Gram-negative, motile, and glucose non fermenting bacterium commonly found in hospital settings. It poses a significant risk to immunocompromised individuals, often causing nosocomial infections. Aim: To identify the risk factors associated with Stenotrophomonas maltophilia bacteraemia and compare the factors influencing patient survival and mortality. Materials and Methods: Clinical and laboratory data from 39 cases of Stenotrophomonas bacteraemia encountered between July 2021 and July 2022 in the Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India, were analysed in the present retrospective study in August 2022. The study included all cultures positive for S. maltophilia bacteraemia, identified through Matrix-assisted Laser Desorption Ionisation Time- Of-Flight Mass Spectrometry (MALDI-TOF-MS). Antibiotic susceptibility testing was performed using the Kirby-Bauer disk diffusion method, following the Clinical and Laboratory Standards Institute (CLSI) guidelines. Statistical analysis and outcome assessment were conducted using Statistical Package for Social Sciences (SPSS) version 20.0. Results: Clinical data from all 39 bacteraemia patients were extracted from the hospital information system for analysis. The mean age of the patients included in the present study was 46.0±20.29 years, with a male predominance of 27 (69.23%). The most common risk factors associated with S. maltophilia bacteraemia were the presence of an indwelling catheter in 21/39 cases (53.8%) and co-existing pulmonary infections in 18/39 cases (46.2%). S. maltophilia isolates exhibited high susceptibility to Minocycline (94.87%), Ticarcillin-Clavulanic acid (87.18%), Levofloxacin (84.62%), and Cotrimoxazole (84.62%). The 30-day mortality rate was reported as 28.20% (11/39). Conclusion: S. maltophilia can cause various infections in immunocompromised patients. The appropriate use of empirical antibiotics and strict adherence to infection control measures can reduce hospital stays, as well as 14-day and 30- day mortality rates among affected patients.

Frequency of Fecal Carriage of ESBL Resistance Genes in Multidrug-Resistant Pseudomonas aeruginosa Isolates from Cancer Patients at Laquintinie Hospital, Douala, Littoral Region, Cameroon.

Background. Opportunistic infections are the second cause of death among cancer patients. This study aimed at determining the antimicrobial profile and the prevalence of extended-spectrum beta-lactamase (ESBL)-gene carriage of Pseudomonas aeruginosa isolates among cancer patients at the Douala Laquintinie Hospital, Littoral Region of Cameroon. Between October 2021 and March 2023, 507 study participants were recruited among whom 307 (60.55%) were cancer patients, compared to 200 (39.45%) noncancer patients. Fifty-eight P. aeruginosa isolates were isolated from fecal samples of forty-five cancer patients and thirteen noncancer patients using Cetrimide agar. The antimicrobial resistance profile of the isolates was determined using the Kirby-Bauer disk diffusion method. The polymerase chain reaction was used to detect the presence of extended-spectrum beta-lactamase genes among P. aeruginosa isolates. P. aeruginosa showed significant resistance rates in cancer patients compared to noncancer patients to imipenem, cefotaxime, and ceftazidime, piperacillin-tazobactam, ticarcillin-clavulanic acid, and ciprofloxacin. The multidrug resistance (MDR) rate was significantly (p < 0.05) higher in cancer patients than in noncancer patients. The frequency of beta-lactamase genes in the 58 ESBL-producing P. aeruginosa isolates was determined as 72.41% for bla TEM, 37.93% for bla OXA, 74.14% for blaCTX-M, and 44.83% for bla SHV genes. The study revealed an alarmingly high prevalence of fecal carriage of ESBL-producing P. aeruginosa with a high rate of MDR among cancer patients. It indicates that regular monitoring and surveillance of ESBL-producing P. aeruginosa among cancer patients are needed to improve the management of patients.

One year experience of Achromobacter bacteremia at a tertiary care hospital in Northern India.

Achromobacter is a Gram-negative, motile, obligate aerobic and non-fermentative bacterium. It is an emerging pathogen in the hospital environment as it is frequently found in various solutions. Information about the incidence and risk factors of Achromobacter bacteremia from India is limited. We conducted this study to identify the risk factors and underlying conditions predisposing to bacteremia by Achromobacter spp. and analyse the antibiotic resistance pattern of the isolates. We performed a retrospective observational study where automated blood cultures positive for Achromobacter spp. were assessed for clinical characteristics and antibiotic susceptibility patterns from January 2022 to December 2022 in the microbiology laboratory of a tertiary care centre in Northern India. A total of 14 cases (14/2435, 0.57 %) of Achromobacter spp. were identified from bloodstream infections in one year. The mean age of the patients was 37.59±23.17 years with a male predominance (8/14, 57.1 %). All patients were managed on intravenous antibiotics and intravenous access as peripheral line catheters and only 5(5/14, 35.7 %) patients were managed on central line catheters. The isolates were found highly susceptible to ticarcillin-clavulanic acid (14/14, 100.0 %) followed by fluoroquinolones (12/14, 85.72 %) and trimethoprim-sulphamethoxazole (12/14, 85.72 %). Only 57.14 % (8/14, 57.14 %) of the patients were susceptible to piperacillin-tazobactam. The all-cause 40 day mortality was observed in 35.7 % (5/14, 35.7 %) with two deaths that were directly attributable to sepsis. This study provides insight into the incidence of Achromobacter bacteremia at our centre and the necessary antibiotic therapy to combat it.

Exploring the antibiogram of soil isolates from an indian hospital precinct: link to antibiotic usage

ObjectiveHospitals serve as hotspots of antibiotic resistance. Despite several studies exploring antibiotic resistance in hospitals, none have explored the resistance profile of soil bacteria from a hospital precinct. This study examined and compared the antibiogram of the soil isolates from a hospital and its affiliated university precinct, to determine if antibiotic resistant bacteria were present closer to the hospital.Results120 soil samples were collected from JSS Hospital and JSS University in Mysore, India across three consecutive seasons (monsoon, winter and summer). 366 isolates were randomly selected from culture. Antibiotic susceptibility testing was performed on 128 isolates of Pseudomonas (n = 73), Acinetobacter (n = 30), Klebsiella species (n = 15) and Escherichia coli (n = 10). Pseudomonas species exhibited the highest antibiotic resistance. Ticarcillin-clavulanic acid, an extended-spectrum carboxypenicillin antibiotic used to treat moderate-to-severe infections, ranked highest amongst the antibiotics to whom these isolates were resistant (n = 51 out of 73, 69.9%). Moreover, 56.8% (n = 29) were from the hospital and 43.1% (n = 22) were from the university precinct, indicating antibiotic resistant bacteria were closer to the hospital setting. This study highlights the effect of antibiotic usage in hospitals and the influence of anthropogenic activities in the hospital on the dissemination of antibiotic resistance into hospital precinct soil.

Phylogenetic Analysis of Klebsiella pneumoniae Isolated from Nosocomial and Community Infection in Diyala, Iraq

Phylogenetic Analysis of Klebsiella pneumoniae Isolated from Nosocomial and Community Infection in Diyala, Iraq

Emerging Patterns in Antimicrobial Susceptibility Profiles of Pseudomonas SPP- Hospital Based Study

Background: There is an emerging trend of pseudomonas infections in immune-compromised patients, specifically in hospital settings. The flagship member of this family is Pseudomonas aeruginosa, which is a major infectious agent. This study assessed the distribution and susceptibility patterns of Pseudomonas species isolated from various specimens as a part of surveillance program, in order to devise antibiograms. Aim: To determine frequency &amp; antimicrobial sensitivities of Pseudomonas species in a tertiary care hospital from Lahore. Study design: Retrospective, descriptive, cross sectional study Place &amp; duration of study: Conducted in a tertiary care hospital in Lahore, from January 2021 to January 2022. Methods: Thirty two isolates of Pseudomonas species from different clinical specimens were isolated in microbiology section of a tertiary care hospital during a period of 13 months. MacConkey and blood agar were utilized for culturing of organisms. Gram staining, oxidase, and catalase testwere utilized for phenotypic characterization. Antibiotic susceptibility testing against anti-pseudomonal drugs was performed according to the Clinical and Laboratory Standards Institute guidelines (CLSI) 2021. Results: The inference drawn at the end of study was that, out of thirty two isolates of Pseudomonas species received and pus was the most common specimen (46.8%), followed by 18.75% from urine specimens. 62.5% of the pseudomonas species were obtained from male patients. The most affected age group was 40-60 years, followed by 1-20 years. The most sensitive options turned out to be Imipenem (65.6%) and Pipericillintazobactam (62.5%), followed by 59.3% sensitivity in Amikacin. The least sensitive options in the study isolates were Aztreonam (15.6%) and Ticarcillin clavulanic acid (25%). In 18% of pseudomonas species isolated from urine cultures, fosfomycin was 83.3%, whereas nitrofurantoin turned out to be 50% sensitive. Conclusions: The steadily rising resistance in Pseudomonas species againstavailable antibiotics optionsnecessitates their use inlife-threatening and hospital acquiredinfections. Keywords: Peudomonas, Flouroquinolones, Carbapenem

Study Some Virulence Factors of CO- agulase Positive Staphylococci and CO-agulase Negative Staphylococci Isolated from Different Parts of Human Body

This study included test production of some virulence factors that product from some species of Staphylococci: Co- agulase Positive Staphylococci (COPS) and Co-agulase Negative Staphylococci (CONS) that isolated from different parts of human body. (79%) of isolates was COPS while (21%) was CONS. All isolates showed production some virulence factors like (Protease, DNase, Lipase, Licithinase and Haemolysin) and the results were in COPS (64, 64, 55, 55 and 100)% respectively while all isolates of CONS were produced all this virulence factors except the licthinase . The results of all isolate were positive for oxidase test and negative for catalase test. From the results about (36.3%) of COPS produce white pigment and (63.6%) produced yellow pigment while all isolates of CONS was produced white pigment. Also the results showed that (86% and 71%) COPS isolates was produced haemolysine enzyme type (β and γ) while (14% and 29%) of CONS produced same enzyme type. Antibiotic susceptibility of all isolates were done,the results showed that all CONS isolates were Susceptible towards (Amikacin, Tobramycin, Tetraccline, Nitrofurantoin, Chloramphenicol and Clarithromycin) antibiotics but (33.3%) of CONS isolates were showed susceptible towards (Ampicillin, Amoxicillin, Cefdinir and Vancomycin) antibiotics. While in the COPS isolates showed low susceptibility rate towards (Vancomycin, Tetracycline Amikacin and Tobramycin) antibiotics and in different percentage (81.8, 54.5 and 90.9)% respectively while (42.8,36.3, 9, 18.1, and 45.5)% were susceptible to (Ampicillin, Cfidor, Pencillin, Amoxicillin, Ticarcillin-clavulanic acid, Tobramycin, Cephalothin, Erythromycin, Chloramphenicol and Clarithromycin) respectively.&#x0D; In conclusion, all isolates which have high resistance to antibiotics have low susceptible to same antibiotics

Phenotypic Detection of AmpC \(\beta\)-lactamase Producing Escherichia coli among Patients in Hospital Wards

Background and Objectives: AmpC β-lactamase producing Escherichia coli has emerged in hospital environments as an important health issue that is of a global health concern as drug-resistant pathogenic bacteria that has evolved into strains that are resistant to many classes of antibiotics. However, awareness of the prevalence of AmpC β-lactamase producing microorganisms such as E. coli could be very valuable for achieving more accurate epidemiological results, as well as controlling their spread in the different hospital wards.&#x0D; Methodology: A total of four hundred (400) clinical samples comprising of two hundred and seventy-nine (279) urine samples and one hundred and Twenty-one (121) wound samples were collected from patients in different ward at AE-FUTHA. The clinical samples were analyze using standard microbiological culture and identification of Escherichia coli. Detection of phenotypic AmpC β-lactamases production was performed using Cefoxitin-Cloxacillin Double-Disk Synergy Test (CC-DDST). Antibiotic susceptibility studies of AmpC β-lactamases producing Escherichia coli was determined using the Kirby–Bauer disk diffusion method and the results were construed using the Clinical Laboratory Standard Institute (CLSI) zone diameter breakpoints.&#x0D; Results: Phenotypic AmpC β-lactamases producing E. coli accounted overall prevalence rate of 94.1%. The frequency of AmpC β-lactamases producing E. coli in urine samples were 57(93.4%) comprising of high occurrence rate in Surgical ward 15(100%) followed by medical ward 24(88.9%) but also accounted for overall prevalence rate of 38(95.0%) in wound samples consisting of 9(100 %) from children ward and medical ward 10(100%) followed by Orthopedic ward 13(86.7%) with the least prevalence rate. The AmpC β-lactamases producing E. coli exhibited high percentage of resistance within the range of 50-100% against ceftriaxone, ceftazidime, cefepime, azetronam, Trimethoprim-Sulfamethoxazole Ticarcillin-clavulanic acid but were susceptible to ofloxacin 70.0%, Imipenem 83.3% and amikacin 100%.&#x0D; Conclusion: The findings of this study is a proof of the occurrence of AmpC β-lactamase producing Escherichia coli among patients admitted to hospital wards and there’s an urgent need for controlling and managing the development of MDR genotype strain. Moreover, to prevent the spread of resistance among AmpC β-lactamase producing Escherichia coli to other strains and improve the effectiveness of antibiotics, it is suggested to establish a precise schedule for antibiotic use in each region based on their antibiotic resistance pattern.

Impact the Antibiotic Resistance for Staphylococcus aureus in Hospitalized Cancer Patients in Erbil Governate, Iraq

Background: Infection is a continuous problem in cancer patient especially in developing countries. Multidrug-resistant Staphylococcus aureus is among the most frequent complication in immunocompromised cancer patients and poses the greatest risk to immunocompromised cancer patients.&#x0D; Objectives: Our study aimed to carry out a study on isolated Staphylococcus aureus from various clinical samples among cancer patients in Erbil city and analyze its epidemiology and antibiotics susceptibility pattern tests and multi-drug resistance.&#x0D; Materials and Methods: A total of 865 from 2016 until 2020 were isolated Staphylococcus aureus from 6 clinical samples (Urine, Sputum, Wound swab, Nasal swab, Bloodand, Stool) from patient attending Nanakaly Hospital and from both males and females. Only 100 cases had been identified as isolates of S. aureus which was identified by using macroscopical, microscopical, biochemical tests and Vitek 2 compact system. Also antibiotic susceptibility test were performed by Vitek 2 compact on 19 antibiotics.&#x0D; Results: Only 100 S. aureus isolates were isolated from 865 samples distributed according to their source of isolation in the cancer patient, urinary tract infection is the most our specimen followed by wound infection, respiratory tract infection, blood infection and gastrointestinal infection. Breast cancer is the most common in our study followed by Colon cancer and Multiple myeloma, with the percentage of females infected with S. aureus more than the males, with females being 74/865(8.5%) and males being 28/865(3.2%), after 2016 infections by S. aureus was increased in young and middle-aged people being 52/100(52%) in total, from 2016-2020 S. aureus infected patients with breast cancer was 47/100(47%), colon was 27/100(27%) and multiple myeloma was 26/100(26%). Although (Aztreoman, Ertapenem, Ticarcillin-clavulanic acid) can be considered effective for MDR strains for empirical antibiotic therapy in cancer patients. S. aureus isolates had resistance to more than six antibiotics.&#x0D; Conclusions: The study findings showed a significant distribution of MDR S. aureus which may increase the burden of healthcare-associated infections in cancer patients. Moreover, mechanisms of resistance should also be investigated for better characterization of the multi-drug resistance of S. aureus isolates.

Prevalence and Antibiogram Profile of Carbapenem-resistant Escherichia coli and Klebsiella pneumoniae among Patients with Urinary Tract Infection in Abakaliki, Nigeria

Background and Objectives: Carbapenem antibiotic are drug of last-resort from the treatment of bacterial infection, as a result of the prevalence and rapidly evolving enzymes from Carbapenem resistant bacteria such Escherichia coli and Klebsiella pneumoniae make urinary tract infection difficult, and in some cases impossible to treat in health care settings. With limited progress of new antibacterial drugs, the best approach is monitoring the prevalence and antibiogram profile of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae among patients with UTI in Abakaliki, Nigeria.&#x0D; Methodology: A non-repetitive, clean catch mid-stream urine was collected from five hundred (500) diagnosed UTI inpatient and outpatient. The samples were evaluated using routine microbiological protocol for isolation and identification of Escherichia coli and Klebsiella pneumoniae. Phenotypic screening of Carbapenem-resistant strains was performed using Modified Hodge Testing. Antibiogram studies of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae was performed using the Kirby–Bauer disk diffusion method and the results were interpreted using the Clinical Laboratory Standard Institute (CLSI) zone diameter breakpoints. Multiple antibiotic resistance index (MARI) was determined for MDR strain.&#x0D; Result: The prevalence of Escherichia coli and Klebsiella pneumoniae isolate accounted for 148(29.6 %) consisting of 95(54.3 %) and 53(16.3 %) from in-patients and out-patients. Escherichia coli accounted overall isolation rate of 112(22.4 %) comprising of high proportion among in-patient 82(46.9 %) over out-patient 30(9.2 %). The proportion of K. pneumoniae accounted for 36(7.2 %) with 13(7.4 %) and 23(7.1 %) recorded among in-patients and out-patients. Association between presence of Escherichia coli and Klebsiella pneumoniae isolates in clinical samples was statistically significant with patient’s population with p value &lt;0.05. Carbapenem-resistant Escherichia coli and Klebsiella pneumoniae accounted for 37(7.4 %) comprising of 24(13.7) and 13(4.0 %) among in-patients and out-patients respectively while carbapenem-susceptible Escherichia coli and Klebsiella pneumoniae accounted for overall detection rate of 111(22.2 %) consisting of 71(40.6 %) and 40(12.3 %) among in-patients and out-patients respectively. The isolates resistance rate to cephalosporins were relatively high i.e., Cefotaxime, Cefoxtin Ceftazidime, Ceftriaxone resistance was observed at 60-100% while amoxicillin/clavulanate, azetronam, tetracycline nitrofurantoin and Ticarcillin-clavulanic acid recorded 100 % with MDR index ranged from 0.5-0.8, but were 100 % and 85.0 % sensitive to ciprofloxacin and ofloxacin.&#x0D; Conclusion: These results strongly hypothesize that MDR bacteria, including Carbapenem-resistant isolate, have become common residents in various hospital environments, however with substantial evidence in this study, ciprofloxacin and ofloxacin as drugs of choice could be used for treatment of UTI. Therefore, its importance that good antibiogram evaluation of other drug classes beside fluoroquinoles reported in this study need to be establishes as baseline for empirical diagnosis, epidemiological surveillance, drug prescriptions and infection management.

Genetic Diversity, Distribution, and Genomic Characterization of Antibiotic Resistance and Virulence of Clinical Pseudomonas aeruginosa Strains in Kenya.

Pseudomonas aeruginosa is a leading cause of nosocomial infections worldwide. It can produce a range of debilitating infections, have a propensity for developing antimicrobial resistance, and present with a variety of potent virulence factors. This study investigated the sequence types (ST), phenotypic antimicrobial susceptibility profiles, and resistance and virulence genes among clinical isolates from urinary tract and skin and soft tissue infections. Fifty-six P. aeruginosa clinical isolates were obtained from six medical centers across five counties in Kenya between 2015 and 2020. Whole-genome sequencing (WGS) was performed to conduct genomic characterization, sequence typing, and phylogenetic analysis of the isolates. Results showed the presence of globally distributed high-risk clones (ST244 and ST357), local high-risk clones (ST2025, ST455, and ST233), and a novel multidrug-resistant (MDR) clone carrying virulence genes (ST3674). Furthermore, 31% of the study isolates were found to be MDR with phenotypic resistance to a variety of antibiotics, including piperacillin (79%), ticarcillin-clavulanic acid (57%), meropenem (34%), levofloxacin (70%), and cefepime (32%). Several resistance genes were identified, including carbapenemases VIM-6 (ST1203) and NDM-1 (ST357), fluoroquinolone genes, crpP, and qnrVCi, while 14 and 22 different chromosomal mutations were detected in the gyrA and parC genes, respectively. All isolates contained at least three virulence genes. Among the virulence genes identified, phzB1 was the most abundant (50/56, 89%). About 21% (12/56) of the isolates had the exoU+/exoS- genotype, while 73% (41/56) of the isolates had the exoS+/exoU- genotype. This study also discovered 12 novel lineages of P. aeruginosa, of which one (ST3674) demonstrated both extensive antimicrobial resistance and the highest number of virulence genes (236/242, 98%). Although most high-risk clones were detected in Nairobi County, high-risk and clones of interest were found throughout the country, indicating the local spread of global epidemic clones and the emergence of new strains. Thus, this study illustrates the urgent need for coordinated local, regional, and international antimicrobial resistance surveillance efforts.

Clinical and Microbiological Profile of Patients with Bloodstream Infections Caused by Burkholderia cepacia Complex.

Introduction Burkholderia cepacia complex (BCC) is an emerging pathogen causing nosocomial bloodstream infections (BSIs), and its treatment is challenging due to its multidrug resistance. In India, there is a dearth of data on BSIs caused by BCC, therefore, an updated study is required to know the clinical and microbiological profile of these patients. We aimed to study the clinical epidemiology and antibiotic susceptibility pattern of BCC isolated from blood samples in our hospital. Materials and Methods This observational study was conducted from January 2019 to December 2020 at a tertiary care center in northern India. All the blood cultures were done on an automated blood culture system. All BCC isolates of BSI were identified depending on their morphological properties and biochemical reactions, and underwent the matrix-assisted laser desorption ionization time-of-flight mass spectrometry system to confirm diagnosis. Antibiotic susceptibility testing was done as per Clinical Laboratory and Standards Institute guidelines. Results BCC was isolated from 30 BSI patients over a 2-year period. Sixty-six percent (20/30) of patients had cancer and a majority of them were undergoing chemotherapy. The most common predisposing factors were the use of steroids, immunosuppressive drugs, and chemotherapy (93.3%), central lines (83.3%), use of higher antibiotics (60%), and diabetes mellitus type 2 (60%). The most common species isolated were B. cepacia (64%) and B. cenocepacia (30%). Isolates showed highest sensitivity to minocycline (100%), ceftazidime (73.3%), and meropenem (70%) and the least to ticarcillin–clavulanate. Conclusion BCC is an emerging pathogen causing BSIs, especially in malignancy patients. Minocycline can be a good choice for these bacteria.

Prevalence, risk factors and emergence of extended-spectrum β-lactamase producing-, carbapenem- and colistin-resistant Enterobacterales isolated from wild boar (Sus scrofa) in Tunisia

Antimicrobial resistance (AMR) is recognized as an emerging and growing public health problem worldwide. In Tunisia, knowledge is still limited to domestic animals and humans, and only few data are available regarding the role of wildlife. This research determined the antibiotic susceptibility profiles of Beta-lactamase producing Gram-negative bacteria isolated from the faeces of 110 wild boars (Sus scrofa) in northern Tunisia. Fecal samples, obtained post mortem from boar carcasses, were cultured on MacConkey agar and MacConkey agar containing 2 mg/L of cefotaxime. A total of 102 Enterobacterales isolates were identified from 94(85%) fecal samples. Escherichia coli (56, 54%), Citrobacter freundii (14, 13%), Klebsiella oxytoca (11, 10%), and Klebsiella pneumoniae (7, 6%) were the most predominantly identified Enterobacterales. However, Pantoea spp. (4, 4%), Enterobacter spp. (3,3%), Enterobacter cloacae (1, 1%), Enterobacter gergoviae (2, 2%), Proteus mirabilis (2, 2%), Yersinia sp. (1, 1%), and Citrobacter diversus (1, 1%) were rarely identified. Antimicrobial susceptibility tests revealed that 55% (57/102) of the identified strains were multidrug resistant (MDR). A total of 30% (31/102) of the tested isolates were recognized as Extended Spectrum β-Lactamase (ESBL)-producing strains and blaCTX-M-G1, blaTEM, blaSHV β-lactamases were the main encoding genes revealed. Furthermore, identified isolates showed a high level of AMR, especially for amoxicillin-clavulanic acid (77.67%), ticarcillin-clavulanic acid (71.85%), streptomycin (76.69%), amoxicillin (75.73%), and cephalotin (74.76%). Alarming levels of resistance to colistin (2.9%) and ertapenem (9.7%) were revealed and confirmed by the detection of mcr-1, and blaIMP and blaVIM genes, respectively. Various phenotypes of AMR were obtained in this study highlighting the important role of wild boars as hosts and even carriers for several resistant Enterobacterales isolates. This may represents a focal risk factor allowing the transmission of these strains between domestic, wild animals, environment and humans.

Prevalence of Salmonella typhi in among febrile patients in a tertiary care hospital of South West Rajasthan.

ABSTRACTBackground:Salmonella enterica, serotype typhi, remains the predominant Salmonella species causing enteric fever in India. The mode of Salmonella typhi transmission is considered to be predominantly vehicle-borne through contaminated water or food. In India, the incidence of Salmonella typhi occurs between the months of April and June (dry season) followed by July and September (monsoon season). Typhoid fever may be difficult to distinguish clinically from other febrile illnesses and if left untreated, intestinal, neuropsychiatric, and other complications develop in some patients.Objective:The aim of this study was to determine the prevalence of S. typhi in bloodstream infections and its antimicrobial susceptibility pattern among patients with febrile illness.Methodology:Febrile patients admitted in the hospital who were prescribed blood culture tests and whose samples were sent to microbiology laboratory were included in the study. All blood samples (average 5 mL for adults and 2–3 mL for pediatric age group) were immediately inoculated into Bac-T ALERT aerobic blood culture bottles containing sodium polyethanol sulfonate as an anticoagulant (0.025%). If growth was isolated, isolated colony characteristics of growth and Gram stain were assessed. On Gram staining, typical nonlactose fermenting Gram negative bacilli were further subjected to species identification and detection of antimicrobial susceptibility pattern on the VITEK2.Results:In this study period, a total of 511 blood culture (paired) samples were processed, out of which 47 isolates of Salmonella were obtained. Among these isolates, 33 (70.23%) were from males, and 14 (29.77%) were from females. Amongst these, 35 (74.4%) patients were from rural, 8 (17%) were from subrural, and 4 (8.5%) were from urban areas. Out of the total 47 isolates of Salmonella, 42 (89.36%) were Salmonella typhi, 2 (4.25%) were Salmonella paratyphi A and B each, and 1 (2.12%) was Salmonella enterica. Antimicrobial susceptibility pattern of Salmonella isolates revealed that all the isolates of Salmonella species were highly susceptible (95%–100%) to third generation cephalosporins (ceftazidime, ceftriaxone, cefepime, cefoperazone-sulbactam) and other higher antibiotics such as betalactamase inhibitors – piperacillin tazobactam (95%–100%) and Ticarcillin–clavulanic acid (100%). They were also highly susceptible (100%) to carbapenams (imipenem, merpenem, doripenem, and ertapenem) but showed a fairly decreased susceptibility was towards nalidixic acid with 15% for Salmonella typhi and 50% for other Salmonella isolates.Conclusion:Surging drug-resistant Salmonella enterica cases, the level of resistance was not as high as predicted in our study population. Multidrug-resistant (MDR) trends may vary; therefore, drug susceptibility testing side-by-side to empirical therapy is mandatory, especially in developing countries where there is a practice of self-medication.

Biofilm Formation and Inhibitory Effect of Essential Oils in Multidrug-Resistant Pseudomonas aeruginosa

Biofilm formation is a major concern in medicine, as well as in the food industry. Some infections related to bacterial biofilms such as Pseudomonas aeruginosa are a real public health challenge. This study aimed to show the activity of essential oils on P. aeruginosa biofilm formation. Pseudomonas aeruginosa isolates consisting of animal (100), environmental (20) and clinical strains (42) were identified by PCR and sequenced. Biofilm formation was assessed by the microplate method. Antibiotic susceptibility testing was performed by using Kirby–Bauer disc-diffusion method. The average biofilm formation percentages vary from 1.2 to 2.1 in 24h and from 2.3 to 3.2 in 48h. The median biofilm formation value was higher in environmental strains (1.4 ± 0.2) than in clinical (1.2 ± 0.4) and animal (1.1 ± 0.4). In decreasing order of importance, the essential oils of Mentha piperita (90 ± 5.12% at 100%), Eucalyptus globulus (34 ± 0.08% at 100%) and Lavandula angustifolia (12 ± 0.71% to 100%) showed distinct inhibitory effects on biofilm formation (p &lt;0.05). The rate of resistance of P. aeruginosa to the antibiotics imipenem, ceftazidime, cefepime, fosfomycin and colistin varied from 12.7% to 48.4% in the biofilm status while that of plankton cells ranged from 2.3% to 15.0%. Moreover, resistance to ticarcillin, ticarcillin clavulanic acid, piperacillin and ciprofloxacin ranged from 56.4% to 83.1% in biofilm and from 29.4% to 51.4% in planktonic cells. In general, biofilm is more resistant to different antibiotics than free cells. The tested essential oils could be an effective natural control against microbial biofilm formation.