Antimicrobial Resistance Trends Research Articles

Emerging trends in antimicrobial resistance in bloodstream infections: multicentric longitudinal study in India (2017–2022)

BackgroundAntimicrobial resistance (AMR) has escalated to pandemic levels, posing a significant global health threat. This study examines the patterns and trends of AMR in Bloodstream Infections (BSIs) across India, aiming to inform better surveillance and intervention strategies. MethodsSix-year data from 21 tertiary care centers in the Indian Council of Medical Research's AMR Surveillance Network (IAMRSN) were retrospectively analyzed to estimate cluster-robust trends in resistance. Time-series analysis was used to discern lead/lag relationships between antibiotic pairs and the directional influence of resistance in community and hospital-acquired BSIs(CA/HA BSIs). A data-driven Bayesian network ensemble averaged over 301 bootstrap samples was modelled to uncover systemic associations between AMR and Sustainable Development Goals (SDGs). FindingsOur findings indicate significant (p<0.001) monthly increases in Imipenem and Meropenem resistance for Klebsiella, E. coli, and Acinetobacter BSIs. Importantly, Carbapenem resistance in HA-BSIs preceded that in CA-BSIs for Klebsiella and Acinetobacter (p<0.05). At a national level, Cefotaxime resistance emerged as a potential early indicator for emerging Carbapenem resistance, proposing a novel surveillance marker. In Klebsiella BSIs, states with higher achievement of SDG3 goals showed lower Imipenem resistance. A model-based AMR scorecard is introduced for focused interventions and continuous monitoring. InterpretationThe identified spatiotemporal trends and drug resistance associations offer critical insights for AMR surveillance aligning with WHO GLASS standards.The escalation of carbapenem resistance in BSIs demands vigilant monitoring and may be crucial for achieving SDGs by 2030. Implementing the proposed framework for data-driven evidence can help nations achieve proactive AMR surveillance. FundingNo specific funding was received for this analysis.

Antimicrobial resistance among common bacterial pathogens in Indonesia: a systematic review

The WHO Global Antimicrobial Resistance Surveillance System (GLASS) aims to describe antimicrobial resistance (AMR) patterns and trends in common bacterial pathogens, but data remain limited in many low and middle-income countries including Indonesia. We systematically searched Embase, PubMed and Global Health Database and three Indonesian databases for original peer-reviewed articles in English and Indonesian, published between January 1, 2000 and May 25, 2023, that reported antimicrobial susceptibility for the 12 GLASS target pathogens from human samples. Pooled AMR prevalence estimates were calculated for relevant pathogen-antimicrobial combinations accounting for the sampling weights of the studies (PROSPERO: CRD42019155379). Of 2182 search hits, we included 102 papers, comprising 19,517 bacterial isolates from hospitals (13,647) and communities (5870). In hospital settings, 21.6% of Klebsiella pneumoniae isolates, 18.3% of Escherichia coli isolates, 35.8% of Pseudomonas aeruginosa isolates and 70.7% of Acinetobacter baumannii isolates were carbapenem-resistant; 29.9% of Streptococcus pneumoniae isolates were penicillin-resistant; and 22.2% of Staphylococcus aureus isolates were methicillin-resistant. Hospital prevalence of carbapenem-resistant K.pneumoniae and E.coli, and penicillin-resistant S.pneumoniae increased over time. In communities, 28.3% of K.pneumoniae isolates and15.7% of E.coli isolates were carbapenem-resistant, 23.9% of S.pneumoniae isolates were penicillin-resistant, and 11.1% of S.aureus isolates were methicillin-resistant. Data were limited for the other pathogens. AMR prevalence estimates were high for critical gram-negative bacteria. However, data were insufficient to draw robust conclusions about the full contemporary AMR situation in Indonesia. Implementation of national AMR surveillance is a priority to address these gaps and inform context-specific interventions. Wellcome Africa Asia Programme Vietnam.

In vitro activity of ceftolozane/tazobactam against Gram-negative bacilli isolated from pediatric patients: results from the Study for Monitoring Antimicrobial Resistance Trends (SMART) 2017-2021, China

ObjectivesCeftolozane-tazobactam (C/T) is a combination of a cephalosporin and a β-lactamase inhibitor with activity against Gram-negative bacilli (GNB). The study aims were to evaluate the activity of C/T in vitro vs. comparators against clinical GNB isolated from Chinese pediatric patients. MethodsFrom 2017-2021, 660 GNB isolates were collected from 20 hospitals across China. The minimum inhibitory concentrations were tested using a Trek Diagnostic System (Thermo Fisher Scientific). Susceptibility was determined by CLSI broth microdilution and the results were interpreted according to CLSI M100 (2021) breakpoints. ResultsGNB isolates were obtained from pediatric patients < 18 years old, mainly from the bloodstream (n=146), intraperitoneal cavity (n=138), lower respiratory (n=278) and urinary tract (n=96). Overall, C/T was active against 76.6% of 436 Enterobacterales, with a descending susceptibility rate of 100.0% to S. marcescens, 92.2% to E. coli, 83.3% to K. oxytoca, 66.7% to K. aerogenes, 66.7% to P. mirabilis, 58.6% to K. pneumoniae and 57.1% to E. cloacae. The susceptibility of P. aeruginosa to C/T was 89.4%, which was the highest among the β-lactams and was second only to amikacin (92.9%). Isolates of respiratory tract infection (RTI) derived P. aeruginosa were highly susceptible (93.8%) to C/T, while < 75% of isolates of RTI derived P. aeruginosa were susceptible to the other β-lactams tested, except for ceftazidime-avibactam (91.2%). ConclusionGNBs collected from pediatric patients in China showed a high susceptibility to C/T making this drug combination an effective choice for treating the pediatric population, especially those infected with P. aeruginosa.

Hand Washing Practices and Antibiotic Susceptibility of Palmar Bacterial Flora in a Tertiary Education Institution in Nigeria

Introduction: Hand hygiene is one of the most effective and inexpensive means of preventing the spread of communicable diseases. Rates of handwashing worldwide are low, and poor handwashing practices in universities remain a public health challenge. Objective: The objective of this study was to examine the practice of handwashing, the microbial communities, and the susceptibility pattern of micro-organisms isolated from the palms of students of the Obafemi Awolowo University in Ile-Ife, Osun, Nigeria. Methods: A combination of qualitative and quantitative methods was used to retrieve data. A self-administered questionnaire was utilised to gather socio-demographic characteristics and the practice scale of handwashing from the respondents. Isolation and identification were carried out by culture-based surveys and biochemical tests. Disk diffusion was used to determine susceptibility. Results: The majority of respondents were between ages 21–25 years, with 54.3% of them being female. About half of individuals never used an alcohol-based hand sanitiser, while only 4.9% of respondents admitted to always using soap to wash their hands. Presumptive identification of the organisms showed 38.1% of organisms as Staphylococcus epidermidis and 17.58% as Micrococcus spp. None of the antibiotics showed total efficacy. The resistance to chloramphenicol was low, and &lt;50% of the isolates showed resistance to tetracycline, novobiocin, and sulphonamide. Resistance to nalidixic acid was seen in 58.4% of organisms tested, and 77.75% were susceptible to tetracycline. Conclusion: Instances of improper hand hygiene were high, and this may increase the spread of micro-organisms through hand carriage. High resistance to the antibiotics tested was prevalent. Local trends of antimicrobial resistance must be robustly studied and proper interventions developed.

Development of silver-doped copper oxide and chitosan nanocomposites for enhanced antimicrobial activities.

Antimicrobial resistance (AMR) has emerged as a significant and pressing public health concern, posing serious challenges to effectively preventing and treating persistent diseases. Despite various efforts made in recent years to address this problem, the global trends of AMR continue to escalate without any indication of decline. As AMR is well-known for antibiotics, developing new materials such as metal containing compounds with different mechanisms of action is crucial to effectively address this challenge. Copper, silver, and chitosan in various forms have demonstrated significant biological activities and hold promise for applications in medicine and biotechnology. Exploring the biological properties of these nanoparticles is essential for innovative therapeutic approaches in treating bacterial and fungal infections, cancer, and other diseases. To this end, the present study aimed to synthesize silver@copper oxide (Ag@CuO) nanoparticles and its chitosan nanocomposite (Chi-Ag@CuO) to investigate their antimicrobial efficacy. Various established spectroscopic and microscopic methods were employed for characterization purposes, encompassing scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDX), X-ray diffraction (XRD), and Fourier transform infrared spectroscopy (FTIR). Subsequently, the antimicrobial activity of the nanoparticles was assessed through MIC (minimum inhibitory concentration), MBC (minimum bactericidal concentration), and well-disk diffusion assays against Pseudomonas aeruginosa, Acinetobacter baumannii Staphylococcus aureus, Staphylococcus epidermidis, and Candida albicans. The size of the CuO-NPs, Ag@CuO, and Chi-Ag@CuO NPs was found to be 70-120 nm with a spherical shape and an almost uniform distribution. The nanocomposites were found to possess a minimum inhibitory concentration (MIC) of 5 μg/mL and a minimum bactericidal concentration (MBC) of 250 μg/mL. Moreover, these nanocomposites generated varying clear inhibition zones, with diameters ranging from a minimum of 9±0.5 mm to a maximum of 25±0.5 mm. Consequently, it is evident that the amalgamation of copper-silver-chitosan nanoparticles has exhibited noteworthy antimicrobial properties in the controlled laboratory environment, surpassing the performance of other types of nanoparticles.

Antimicrobial Resistance Patterns of Common Gram-Negative Microorganisms Isolated from Patients with Lower Respiratory Tract Infections in a Teaching Hospital in Vietnam.

This cross-sectional study investigated the antimicrobial resistance (AMR) patterns of gram-negative pathogens isolated from 4,789 hospitalized patients with lower respiratory tract infections (LRTIs). Of the collected specimens, 1,325 (27.7%) tested positive for gram-negative bacteria. Acinetobacter baumannii (38.6%), Pseudomonas aeruginosa (33.5%), Klebsiella pneumoniae (18.7%), Escherichia coli (5.6%), and Klebsiella aerogenes (3.5%) were the most prevalent isolates. AMR analysis revealed high resistance rates (79.9%-100%) of A. baumannii isolates to multiple classes of antibiotics except amikacin, trimethoprim/sulfamethoxazole, and colistin. P. aeruginosa displayed low resistance to colistin (< 10%) but high resistance to other antibiotics. K. pneumoniae displayed high resistance rates of 90.0%-100.0% to most penicillins, whereas resistance rates were notably lower for colistin (7.1%) and amikacin (16.7%). K. aerogenes exhibited high resistance to various antibiotics and sensitivity to amikacin (95.1%), ampicillin (100.0%), and colistin (100.0%). E. coli isolates exhibited resistance to ampicillin (96.9%) and maximum sensitivity to several antibiotics. Our study identified significant AMR trends and highlighted the prevalence of multidrug-resistant strains (93.6% for K. aerogenes and 69.1%-92.4% for other isolates). These findings emphasize the urgent need for appropriate antibiotic management practices to combat AMR in gram-negative pathogens associated with LRTIs.

Antimicrobial resistance trends among Klebsiella pneumoniae associated with urinary tract infections in Crete, Greece, 2017-2022.

Klebsiella pneumoniae is one of the most prevalent bacteria causing urinary tract infections (UTIs). Its increasing resistance to a wide array of antibiotics limits available treatment options. This study investigated the characteristics and trends of antimicrobial resistance in K. pneumoniae isolated from UTIs in Crete, Greece, during 2017 and 2022. Among the 11,946 Enterobacteriaceae isolated from urine specimens, a total of 1,771 K. pneumoniae isolates were identified (14.8%), with an isolation frequency secondary to Escherichia coli (66.3%). K. pneumoniae isolates increased over the years, with a peak in the year 2022. Higher resistance rates were detected in ciprofloxacin (41%), trimethoprim/sulfamethoxazole (TMP/SMX) (38.1%) and nitrofurantoin (33.9%). Resistance to ciprofloxacin, amoxicillin/clavulanic acid, tigecycline, and TMP/SMX significantly increased from 33.7%, 24%, 6%, and 33.1%, respectively, over the years 2017-2019, to 47.8%, 34.2%, 14.3% and 42.8%, respectively, over the period 2020-2022. ESBL production and carbapenem resistance were decreased by 2.2% and 3.7%, respectively, over the two three-year periods (2017-2019 and 2020-2022). Among the 278 carbapenem-resistant K.pneumoniae (CRKP) isolates, 164 (59%), 66 (23.7%), 18 (6.5%) and 16 (5.8%) were positive for KPC, NDM, VIM and OXA-48 enzymes, respectively. Only 14 (5%) isolates harboured two carbapenemase genes, namely 10 (3.6%) both blaNDM and blaVIM, and 4 (1.4%) both blaKPC and blaNDM. Females, inpatients and the elderly were more frequently affected by CRKP. The frequency of multidrug-resistant (MDR) and extensively drug-resistant (XDR) isolates were 32.6% and 7.7%, respectively. Continuous surveillance of local microbial prevalence and monitoring of antimicrobial resistance patterns provide critical information to guide the empiric therapy for UTIs and control the spread of MDR bacteria.

Trend of distribution and antimicrobial resistance in uropathogens in China from the CHINET antimicrobial resistance surveillance program, a 7-year retrospective study

Trend of distribution and antimicrobial resistance in uropathogens in China from the CHINET antimicrobial resistance surveillance program, a 7-year retrospective study

A five-year retrospective antibiogram review in the paediatric burns unit at a tertiary South African Hospital

BackgroundThere is a global concern regarding increasing colonization and/or infection of paediatric burns patients with multi-drug-resistant organisms, especially in Africa. Surveillance of antimicrobial resistant patterns enables clinicians to opt for the most appropriate empiric antimicrobial agent according to the unit’s susceptibility profile. ObjectiveThis study sought to compile unit-specific antibiograms comparing the organism prevalence and their antimicrobial resistance trends in the paediatric burns unit, Chris Hani Baragwanath Academic Hospital (CHBAH) from January 2015 to December 2019. MethodsA retrospective, laboratory-based review was conducted of bacterial and fungal isolates including antimicrobial susceptibility testing (AST) data from blood cultures and tissue samples. Enterobacterales, non-fermenters, gram-positive organisms, and yeasts were analysed as a percentage of total positive blood cultures comparing 2015–2017 to 2018–2019 data. Analysis of antimicrobial resistance trends was performed for extended-spectrum beta-lactamases (ESBLs), carbapenem-resistant Enterobacterales (CRE), extensively-drug-resistant (XDR) Acinetobacter baumannii, and meticillin-resistant Staphylococcus aureus (MRSA) for the years 2015, 2017, and 2019. ResultsA total of 1243 blood culture isolates were studied with A.baumannii (208/1243;17 %), coagulase negative staphylococci (141/1243; 11 %) and Candida auris (53/1243; 4 %) representing the predominant gram-negative bacteria, gram-positive bacteria, and yeast, respectively. A significant decrease in ESBLs (p = 0.00) was noted with a rise in CREs (p = 0.00) during the study period. Majority of the A. baumannii were XDR (≥77 %) despite an appreciable decrease. A notable decrease in MRSA (p = 0.00) isolates was observed. Pseudomonas aeruginosa (72/275; 26 %) was the leading organism recovered from a total of 275 tissue isolates. ConclusionThe results of this study encourage review of the current antimicrobial choices in the unit for empiric antibacterial cover. Due to the low numbers of yeasts, we cannot comment on the institution of early antifungal strategies. We support reinforced infection prevention and control practices as well as antimicrobial stewardship initiatives.

Investigating the feasibility and potential of combining industry AMR monitoring systems: a comparison with WHO GLASS

Background Efforts to estimate the global burden of antimicrobial resistance (AMR) have highlighted gaps in existing surveillance systems. Data gathered from hospital networks globally by pharmaceutical industries to monitor antibiotic efficacy in different bacteria represent an additional source to track the temporal evolution of AMR. Here, we analysed available industry monitoring systems to assess to which extent combining them could help fill the gaps in our current understanding of AMR levels and trends. Methods We analysed six industry monitoring systems (ATLAS, GEARS, SIDERO-WT, KEYSTONE, DREAM, and SOAR) obtained from the Vivli platform and reviewed their respective isolates collection and analysis protocols. Using the R software, we designed a pipeline to harmonise and combine these into a single dataset. We assessed the reliability of resistance estimates from these sources by comparing the combined dataset to the publicly available subset of WHO GLASS for shared bacteria-antibiotic-country-year combinations. Results Combined, the industry monitoring systems cover 18 years (4 years for GLASS), 85 countries (71), 412 bacterial species (8), and 75 antibiotics (25). Although all industry systems followed a similar centralised testing approach, the criteria for isolate collection were unclear (patients selection, associated sampling periods…). For E.coli, K. pneumoniae and S. aureus, at least 65% of comparable resistance proportions were within 0.1 of the corresponding estimate in GLASS. We did not identify systemic bias towards resistance in industry systems compared to GLASS. Conclusions Combining industry monitoring systems can substantially strengthen our knowledge of global AMR burden across bacterial species and countries. High agreement values for available comparisons with GLASS suggest that data for other bacteria-antibiotic-country-year combinations only present in industry systems could complement GLASS, particularly for Priority Pathogens currently not covered. This valuable information on resistance levels could help clinicians and stakeholders prioritize testing and select appropriate antibiotics in settings with limited surveillance data.

Genome analysis of an extensively drug resistant Pseudomonas aeruginosa ST1791 from a patient in China hospitalized for severe pneumonia

The emergence and outbreak of carbapenem-resistant Pseudomonas aeruginosa (CRPA) are a major global public threat. we aimed to characterize the genome of drug-resistant and virulent genes in an extremely drug-resistant Pseudomonas aeruginosa strain to understand its antimicrobial resistance trends and pathogenicity. An XDR Pseudomonas aeruginosa strain was isolated in China from a patient with severe pneumonia. Antimicrobial susceptibility testing, genome sequencing and phylogenetic analysis was performed. Predictions were fulfilled using curated bioinformatics tools. The assembly of the strain (CRPA190) comprised 76 contigs with a total length of 7 009 318 bp. CRPA190 belongs to sequence type 1791 (ST1791) and the O11 serogroup. Nine prophage regions, three CRISPR arrays, and two Cas clusters were identified. However, no plasmids were predicted. Antibiotic susceptibility tests showed that CRPA190 was resistant to all the tested antibiotics, including carbapenem, polymyxin B and ceftazidime-avibactam. Forty antimicrobial resistance genes were predicted in CRPA190, including several carbapenemase genes such as blaPDC-142, blaPME-1, blaNDM-1 and blaOXA-902. The isolate was predicted to be pathogenic and possess strong biofilm-forming ability. It harbors virulence genes that are associated with an arsenal of virulence determinants involved in adherence, motility, exotoxins, exoenzymes, immune modulation, biofilms, nutritional/metabolic factors and effector delivery systems. These findings enhance our understanding of the resistance and pathogenicity of the ST1791 Pseudomonas aeruginosa strain which is unique in China and provide a broader perspective on the global epidemiological landscape, suggesting the emergence of P. aeruginosa ST1971, which requires control measures to limit its dissemination.

Epidemiological trends in serotypes distribution and antimicrobial resistance in Salmonella from humans in Taiwan, 2004-2022

ObjectivesSalmonella, a zoonotic pathogen, significantly impacts global human health. Understanding its serotype distribution and antimicrobial resistance is crucial for effective control measures and medical interventions. MethodsWe collected Salmonella isolates and demographic data from Taiwanese hospitals between 2004 and 2022, analyzing their serotypes and antimicrobial susceptibility. ResultsAmong 40,595 isolates, salmonellosis predominated in children aged 0-4 (61.2%) years and among males (55.2%). Males also showed higher rates of extraintestinal infections (18.1% vs 16.0%, P <0.001), particularly, in the ≥65 years age group (52.4%). The top five serovars were S. Enteritidis (32.8%), S. Typhimurium (21.7%), S. Newport (6.2%), S. Stanley (4.7%), and S. Anatum (4.0%). Notably, S. Enteritidis prevalence increased from 23.9% (2004-2005) to 43.6% (2021-2022). Antimicrobial resistance was high, with a 51.6% multidrug resistance (MDR) rate. Disturbingly, MDR rates exceeded 90% in serovars Albany, Schwarzengrund, Choleraesuis, and Goldcoast. Resistance to key therapeutic agents, azithromycin, cefotaxime, and ciprofloxacin, exhibited concerning upward trends, and the surge in cefotaxime and ciprofloxacin resistance was closely linked to the emergence and spread of MDR S. Anatum and S. Goldcoast clones. ConclusionsPrioritizing control measures against S. Enteritidis and closely monitoring the prevalence and spread of MDR clones are imperative to mitigate Salmonella infections in Taiwan.

Epidemiology and antimicrobial resistance patterns of bacterial meningitis among hospitalized patients at a tertiary care hospital in Saudi Arabia: a six-year retrospective study.

Bacterial meningitis poses significant medical challenges due to its acute inflammatory nature and potential for severe neurological complications, emphasizing the need for prompt diagnosis and treatment. Limited data exists on its epidemiology and antimicrobial resistance trends among hospitalized patients in Saudi Arabia. This study aimed to investigate these factors at a tertiary care hospital over six years. A retrospective analysis was conducted on cerebrospinal fluid samples results from 222 bacterial meningitis cases among hospitalized patients between 2018 and 2023. Demographic, clinical, microbiological data, and antibiotic susceptibility patterns were collected and analyzed. Pseudomonas aeruginosa (43%) was the predominant pathogen isolated. Neonates (16%) and children (47%) were most affected population. Nosocomial meningitis accounted for 92% of cases, mainly in the intensive care settings (50.45%). Extended-spectrum beta-lactamase was the leading resistance pattern (12.2%). Seasonal variation was observed, with a peak incidence in October-November. The study highlights the substantial burden of bacterial meningitis among hospitalized patients, especially among high-risk groups. Emerging antimicrobial resistance emphasizes the need for optimized surveillance and stewardship. Future prospective research employing molecular techniques across multiple centers in the country is warranted to enhance understanding and guide public health strategies in Saudi Arabia.

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.

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.

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.

Antimicrobial Susceptibility Pattern of Uropathogens Isolated at a Private Hospital in Khulna, Bangladesh

Background &amp; objectives: Urinary tract infection (UTI) is one of the most common infectious diseases affecting all age &amp; sex groups, causing significant morbidity &amp; mortality with a substantial economic burden. Due to the irrational empiric use of antibiotics, resistance is increasing at an alarming rate. Bacteria causing UTIs &amp; their antimicrobial susceptibility pattern varies among different areas &amp; changes frequently over time. This study aimed to identify microorganisms causing UTI at a private hospital in the southern part of Bangladesh &amp; to determine their sensitivity pattern towards commonly used antibiotics. Methods: A cross-sectional study was conducted in the clinical pathology &amp; microbiology laboratory at Islami Bank Hospital (IBH), Khulna during the period of January’2021 to July’2021. Clean catch midstream urine samples (MSU) from 221 clinically suspected UTI cases of all age &amp; sex groups were included in the study. Uropathogens were isolated &amp; identified by standard microbiological techniques &amp; susceptibility was determined by Kirby Kirby-Bauer disc diffusion method. Results: Among 221 suspected UTI cases, 108 (48.8%) were positive for urine culture, of which 103 (95.37%) showed antimicrobial growth. The majority 75 (69.4%) of the culture-positive cases were female. E. coli 50(44.24%) was the most predominant bacterial isolate, followed by Klebsiella 18(15.92%) &amp; Enterococcus 16(14.15%). All Isolated gram-positive cocci (GPC) showed very high sensitivity to Vancomycin (83.3% to 100%), Linezolid (87.5% to 100%) &amp; moderate sensitivity to Meropenem (66.7% to 75%). However, they showed relatively lower sensitivity to Ciprofloxacin, Doxycycline, Gentamicin, and Amoxiclav &amp; very poor sensitivity to Nitrofurantoin (31.3% to 50% only). Levofloxacin had relatively better sensitivity against GPC (S. aureus- 83.3% &amp; CONS- 75%), except Enterococcus. All gram-negative bacilli (GNB) showed a very good sensitivity towards Amikacin &amp; Meropenem, ranging from 77.8% to 100%. E. coli &amp; Pseudomonas were highly sensitive to Piperacillin-Tazobactam (90% &amp; 88.9% respectively). GNB were poorly sensitive to commonly used 3rd generation cephalosporins, Azithromycin, Amoxiclav &amp; Ciprofloxacin. Except for Pseudomonas &amp; Klebsiella, Levofloxacin showed relatively good sensitivity against other GNB. Nitrofurantoin showed lower sensitivity against GNB, except for Pseudomonas (66.7%) &amp; Enterobacter (75%). Conclusion: E. coli remains the most predominant uropathogen. Vancomycin, linezolid, Levofloxacin &amp; Meropenem were very effective against GPC whereas Amikacin, Piperacillin- tazobactam &amp; Meropenem showed good responses against GNB. Empiric antibiotics must be selected based on the current antibiogram of uropathogens in a particular area to prevent the increasing trends of antimicrobial resistance. Mediscope 2024;11(1): 01-12

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.

Retrospective analysis of pediatric sepsis and the burden of antimicrobial resistance in Duhok, Kurdistan Region of Iraq.

Introduction: Sepsis is a life-threatening complication in pediatric patients. This study primarily aimed to investigate sepsis-causing bacteria and their antimicrobial resistance profile and check the change in the antimicrobial resistance trend for some selected bacteria. In addition, we evaluated the incidence of sepsis, the related mortality rate, and the effectiveness and outcome of the treatment regimes in sepsis pediatric patients. Methods: A retrospective analysis was conducted on 4-year data (2018-2021) collected from three intensive care units at the Hevi Pediatric Teaching Hospital. Sepsis screening involved clinical detection and confirmation by blood culture. Results: A total of 520 out of 1,098 (47.35%) blood samples showed positive microbial growth. A decrease in sepsis rate was observed during the COVID-19 pandemic. Coagulase-negative Staphylococci (CoNS) and Klebsiella pneumonia were the most commonly isolated bacteria. A notable variation in the antimicrobial resistance trend was observed among sepsis-causing bacteria. The empirical sepsis treatment recommended by the WHO was ineffective, as certain bacteria exhibited 100% resistance to every antibiotic tested. The mortality rate significantly increased from 1.3% in 2018 to 16.5% in 2021. Discussion: The antimicrobial resistance profile of sepsis causing bacteria is of concerns, indicating a potentially serious situation. Thus, to avoid treatment failure, the monitoring of antimicrobial resistance in pediatric patients is essential.