Trends In Antibiotic Susceptibility Research Articles

Antibiotic susceptibility trends in bacterial isolates from wound infections

Pyogenic infections leading to pus formation are associated with various inflammatory mediators and the proliferation of microbial flora. Wound infections can be caused by both aerobic and anaerobic bacteria, viruses, fungi, or even protozoans. Timely treatment of infected patients is critical since untreated or poorly treated pyogenic infections can lead to mortality or severe complications. Successful treatment is defined by choosing the right antibiotic, which is hindered by the spreading of bacterial drug resistance. It is well documented that overuse of antimicrobials before and especially during the COVID-19 pandemic has resulted in the emergence of drug resistance among various microorganisms. Our study aimed to identify common etiological agents associated with wound infections and to evaluate their antibiotic resistance patterns. A cross-sectional study was conducted by analyzing the antibiograms of different aerobic bacteria isolated from wound samples of patients from the Palakkad District Hospital in Kerala, India, from 2017 through 2019. All variables, including age, sex, bacterial isolate, and antibiogram, were tabulated and the chi-square test was used for analysis. Out of the 1,269 bacterial isolates analyzed, the most common gram-negative strain was Escherichia coli (23%) followed by Pseudomonas aeruginosa (20%). Among the gram-positive isolates, Staphylococcus aureus was the most common (19%). We found only 15% of Staphylococcus aureus isolates were methicillin-resistant, against the national average of 41%. The most resistant strain in our study was Acinetobacter baumannii. Statistically significant changes in antibiotic resistance patterns were observed over the three years of the study period.

Effect of Age on the Etiology and Antibiotic Susceptibility Pattern of Infectious Endophthalmitis

ABSTRACT Purpose To review the etiology and antibiotic susceptibility patterns of infectious endophthalmitis over 11 years in different age groups Methods Microbiology records of culture-positive endophthalmitis cases from January 2011 and December 2021 were reviewed for the age groups 0–30, 31–60, and >60 years. Additionally, data was also analysed for trends in antibiotic susceptibility between different age groups. Results A total of 5590 patients were clinically diagnosed with endophthalmitis. Of these, 1316 (23.5%) patients were culture positive comprising of 1097 bacteria (83.3%) and 219 fungal (16.6%). Gram-positive bacteria predominated the culture-proven bacterial endophthalmitis group with 709 cases (62.6%). Streptococcus pneumoniae (9.3%) was the most prevalent organism in the age group between 0 and 30 years, while Staphylococcus epidermidis (6%) was the most prevalent organism in the age group of 31–60 years. In comparison, Pseudomonas aeruginosa (4.1%) was the most abundant organism in the age group >60 years. Interestingly, Aspergillus flavus (13.24%) was the predominant fungal pathogen in all age groups. There was an increasing trend in antibiotic resistance from younger to older age groups and this pattern was observed for almost all drugs tested except vancomycin and amikacin. Conclusion While infection can occur at any age, the etiology also seems to vary. This study helps us understand the demography of endophthalmitis along with choice of empirical antibiotics that would influence treatment outcomes. Although vancomycin currently holds good for the treatment for gram-positive infections, gram-negative infections calls for an immediate need for newer drugs or advanced treatment options.

Bacteriology and trends of antimicrobial resistance of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus in otitis media: A retrospective data analysis.

Otitis media (OM) has a high prevalence worldwide and the treatment is crucial because hearing loss in children can lead to growth disorders such as language development disorders. The aim of this study is to analyse the changes in bacterial strains and the trends of antibiotic susceptibility in otitis media with effusion (OME), chronic otitis media (COM) and cholesteatomatous otitis media (Chole OM). This retrospective study involved 2926 patients diagnosed with OME, COM, or Chole OM between January 2000 and December 2020. The clinical data were collected and analysed through chart review from May 2021 to July 2021. Two tertiary medical centres. The 2926 OM patients. An otorrhea sample was collected on the first day of their hospital visit. Middle ear fluid samples for bacterial culture and antibiotics susceptibility test were collected from patients during middle ear surgery, including ventilation tube insertion. In each type of OM, the distribution of bacterial strains in the 2000s and the 2010s was compared. In addition, changes in the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PA) and trends in their antibiotic susceptibility over the last 10 years were analysed. The most frequently detected bacterial strains in OME, COM and Chole OM over the study period were coagulase-negative Staphylococcus (CNS) (29.6%), MRSA (24.1%), and PA (20.1%). Compared to the 2000s, the proportion of non-typable Haemophilus influenzae in OME and MRSA in COM increased in the 2010s (27.4%-31.6% and 1.5%-29.5%, respectively). In total three types of OM, although there was no significant trend of change in detection rates of MRSA, PA, and multidrug resistant-P. aeruginosa (MDR-PA) during the last 10 years, resistance to the Quinolone class of MRSA and PA tended to increase (P < .05). The composition of bacterial strains in each types of OM has changed over the past 20 years. Additionally, the antibiotic resistance of MRSA and PA has increased in the last decade. Therefore, when using empirical antibiotics in necessary situations, it is necessary to change to an appropriate antibiotic through a bacterial culture test and antimicrobial susceptibility test.

Prevalence of Isolated Bacteria from Urinary Tracts and Antibiotic Resistance Trend in Peja Region, Kosovo

Background: Urinary tract infections are the most frequent bacterial infections, causing significant morbidity at a high cost of effectiveness. The main purpose of the research was to determine the prevalence and the resistance of gram-negative bacteria in urine samples in the Peja region. Methods and Results: This cohort longitudinal, prospective-retrospective study was conducted in the microbiological laboratories of the regional hospital in Peja and the Regional Centre of Public Health in Peja. The research includes all urine samples tested for gram-negative bacteria from 2018 to 2020. A total of 12,791 urine samples were analyzed in the study, of which 2316 (18.11%) were positive for the growth of gram-negative pathogenic strains, and 10,479 (81.89%) were negative. The most frequently isolated bacteria were E. coli (83.2%), followed by Proteus spp., Klebsiella spp., Acinetobacter spp., and Pseudomonas aeruginosa (5.18%, 4.79%, 2.42% and 2.37% respectively). From the data of our research, we can conclude that E. coli, Proteus spp, and Klebsiella spp. were the three commonly isolated microorganisms in the Peja region. A trend of increased resistance of E. coli to ampicillin was registered from 37.41% in 2018 to 65.58% in 2020; to tobramycin - from 3.68% in 2018 to 5.97% in 2020; to cefalexin from 29.41% in 2018 to 31.09% in 2020; to cefuroxime from 23.7% in 2018 to 28.99% in 2020; to cefotaxime from 21.32% in 2018 to 27.94% in 2020; ceftazidime from 18.84% in 2018 to 27.54% in 2020; to piperacillin from 28.73% in 2018 to 34.97% in 2020; to nitrofurantoin from 5.98% in 2018 to 8.21% in 2020; and to trimethoprim/sulfamethoxazole from 35.56% in 2018 to 42.77% in 2020. In the analyzed period, a trend of the increased resistance of Proteus spp. to ampicillin was registered from 31.43% in 2018 to 81.25% in 2020 and to imipenem from 4.76% in 2018 to 12% in 2020. The resistance rates of Klebsiella spp. strains isolated in 2020 (100% to ampicillin, 5% to amikacin, 38.46% to ofloxacin, 8.7% to imipenem, 33.33% to nitrofurantoin) were higher than those reported in 2018 (87.5%, 2.94%, 34.62%, 6.25%, and 28.21%, respectively). Conclusion: Data from this study can be used to control antibiotic susceptibility trends, create local antibiotic policies, and help clinicians in the rational choice of antibiotic therapy, thereby preventing indiscriminate antibiotic use.

Development of a multiyear pediatric antibiogram in Georgia identifies antibiotic resistance trends

Background: Antibiograms are used to monitor antibiotic resistance trends and help guide empiric antibiotic treatment. Community pediatricians may not have access to or be comfortable using children’s hospital antibiograms. Creating and disseminating a statewide pediatric antibiogram can help inform antibiotic stewardship efforts.Objective: To develop a pediatric-specific antibiogram for the state of Georgia. Methods: Annual pediatric antibiograms for the 5 children’s hospitals in Georgia from 2014 through 2021 were collected. All sites complied with the Clinical and Laboratory Standards Institute guidelines for antibiomicrobic breakpoints and antibiogram development. Antibiogram data were combined, and the most common bacteria were selected to incorporate into the statewide antibiogram: Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecalis, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, and Pseudomonas aeruginosa. Antibiogram data were reported as percentage susceptible and total number of isolates. Interhospital susceptibility differences were compared for methicillin-susceptible S. aureus (MSSA), methicillin-resistant S. aureus (MRSA), E. coli, and K. pneumoniae from 2018 through 2021. P &lt; .05 was considered significant. The combined antibiogram data from 2014 through 2021 were used to show antibiotic susceptibility trends over time. Results: The 2021 antibiogram is shown in the Table. For MSSA and MRSA, clindamycin susceptibility was 80% and 85%, respectively. K. pneumoniae susceptibility to amoxicillin-clavulanate was 91%. For E. coli, using urine-specific breakpoints, susceptibility to cefazolin was 89%. A few statistically significant differences in antibiotic susceptibility were detected between hospitals, but most were unlikely to be clinically relevant (all susceptibilities ≥90% or &lt; 80%). A notable exception was trimethoprim-sulfamethoxazole susceptibility for K. pneumoniae, which ranged from 74% to 98% in 2020 and from 74% to 86% in 2021. From 2014 to 2021, the percentage of MRSA decreased from 49% to 34%. Over the 8 years, susceptibility to ceftriaxone for E. coli ranged from 93% to 95% and from 90% to 95% for K. pneumoniae. Susceptibility to meropenem for E. coli and K. pneumoniae ranged from 99% to 100%. Conclusions: Antibiotic susceptibility for pediatric bacterial isolates in Georgia remained stable over time and supported the narrow-spectrum empiric antibiotic treatment recommended in national evidence-based guidelines for skin and soft-tissue infections, community-acquired pneumonia, and uncomplicated urinary tract infections. MRSA rates decreased over time and multidrug-resistant gram-negative bacilli were uncommon and remained stable.Disclosures: None

Vibrio cholerae in rural and urban Bangladesh, findings from hospital-based surveillance, 2000–2021

With more than 100,000 cases estimated each year, Bangladesh is one of the countries with the highest number of people at risk for cholera. Moreover, Bangladesh is formulating a countrywide cholera-control plan to satisfy the GTFCC (The Global Task Force on Cholera Control) Roadmap's goals. With a particular focus on cholera trends, variance in baseline and clinical characteristics of cholera cases, and trends in antibiotic susceptibility among clinical isolates of Vibrio cholerae, we used data from facility-based surveillance systems from icddr,b’s Dhaka, and Matlab Hospitals from years 2000 to 2021. Female patients comprised 3,553 (43%) in urban and 1,099 (51.6%) in rural sites. Of the cases and most patients 5,236 (63.7%) in urban and 1,208 (56.7%) in the rural site were aged 15 years and more. More than 50% of the families belonged to the poor and lower-middle-class; in 2009 (24.4%) were in urban and in 1,791 (84.2%) were in rural sites. In the urban site, 2,446 (30%) of households used untreated drinking water, and 702 (9%) of families disposed of waste in their courtyard. In the multiple logistic regression analysis, the risk of cholera has significantly increased due to waste disposal in the courtyard and the boiling of water has a protective effect against cholera. Rotavirus (9.7%) was the most prevalent co-pathogen among the under-5 children in both sites. In urban sites, the percentage of V. cholerae along with co-existing ETEC and Campylobacter is changing in the last 20 years; Campylobacter (8.36%) and Enterotoxigenic Escherichia coli (ETEC) (7.15%) were the second and third most prevalent co-pathogens. Shigella (1.64%) was the second most common co-pathogen in the rural site. Azithromycin susceptibility increased slowly from 265 (8%) in 2006–2010 to 1485 (47.8%) in 2016–2021, and erythromycin susceptibility dropped substantially over 20 years period from 2,155 (98.4%) to 21 (0.9%). Tetracycline susceptibility decreased in the urban site from 2051 (45.9%) to 186 (4.2%) and ciprofloxacin susceptibility decreased from 2,581 (31.6%) to 1,360 (16.6%) until 2015, then increased 1,009 (22.6%) and 1,490 (18.2%) in 2016–2021, respectively. Since 2016, doxycycline showed 902 (100%) susceptibility. Clinicians need access to up-to-date information on antimicrobial susceptibility for treating hospitalized patients. To achieve the WHO-backed objective of eliminating cholera by 2030, the health systems need to be put under a proper surveillance system that may help to improve water and sanitation practices and deploy oral cholera vaccines strategically.

Prevalence and antibiotics resistance of Ureaplasma species and Mycoplasma hominis in Hangzhou, China, from 2013 to 2019.

Ureaplasma spp. and Mycoplasma hominis, frequent colonizers in the lower urogenital tract, have been implicated in various infections, with antibiotic resistance growing and varying regionally. This study aims to investigate the prevalence and antibiotic resistance profiles of Ureaplasma spp. and M. hominis in outpatients in Hangzhou, China, from 2013 to 2019. A total of 135,263 outpatients were examined to determine the prevalence of Ureaplasma spp. and M. hominis, including 48,638 males and 86,625 females. Furthermore, trends in antibiotic susceptibility of Ureaplasma spp. and M. hominis during 1999–2019 were analyzed. The cultivation, identification, and antibiotic susceptibility of the bacteria (ofloxacin, ciprofloxacin, erythromycin, clarithromycin, azithromycin, josamycin, tetracycline, doxycycline, and pristinamycin) were determined using the Mycoplasma IST2 kit. Our study indicated that the overall prevalence of total Ureaplasma spp./M. hominis was 38.1% from 2013 to 2019. Ureaplasma spp. were the most frequently isolated species (overall prevalence, 31.3%), followed by Ureaplasma spp./M. hominis coinfection (6.0%) and single M. hominis infection (0.8%). The prevalence of Ureaplasma spp. and M. hominis was significantly higher in females than in males, and the highest positive rates of total Ureaplasma spp./M. hominis were observed in both female and male outpatients aged 14–20 years. During 2013–2019, josamycin, tetracycline, doxycycline, and pristinamycin maintained exceptionally high activity (overall resistance rates, <5%) against both Ureaplasma spp. and M. hominis, but ofloxacin and ciprofloxacin showed limited activity (overall resistance rates, >70%). During 1999–2019, the rates of resistance to ofloxacin and ciprofloxacin increased against both Ureaplasma spp. and M. hominis but decreased to erythromycin, clarithromycin, azithromycin, tetracycline, and doxycycline against Ureaplasma spp. In conclusion, our study demonstrates a high prevalence of Ureaplasma spp. compared to M. hominis and Ureaplasma spp./M. hominis, and their distribution was associated with sex and age. Josamycin, doxycycline, and tetracycline are promising antibiotics that have remarkable activity against Ureaplasma species and M. hominis.

Trends in Infectious Keratitis in Taiwan: An Update on Predisposing Factors, Microbiological and Antibiotic Susceptibility Patterns.

Infectious keratitis (IK) represents a major cause of corneal blindness. This study aims to investigate the demographics, risk factors, microbiological characteristics and antibiotic susceptibility patterns of IK in Taiwan over the past 15 years. A retrospective population-based study was conducted using the Chang Gung Research Database. Patients with IK were identified by diagnostic codes for corneal ulcer from 2004 to 2019. Of 7807 included subjects, 45.2% of patients had positive corneal cultures. The proportion of contact lens-related IK declined, while that of IK related to systemic diseases grew. The percentage of isolated gram-positive bacteria surpassed that of gram-negative bacteria in the 15-year period. The prevalence of Pseudomonas aeruginosa showed a decreasing trend (p = 0.004), whereas coagulase-negative Staphylococcus (CNS) and Propionibacterium species were increasingly detected (p < 0.001). Overall, the trend of antibiotic susceptibility of both gram-positive and gram-negative bacteria did not change throughout the study period. The susceptibility to the test antibiotics maintained over 90% in gram-negative isolates over 15 years. Vancomycin preserved 100% susceptibility to all gram-positive isolates. Since most tested antibiotics exhibited stable susceptibility over decades, this study reinforced that fluoroquinolones and fortified vancomycin continue to be good empiric therapies for treating bacterial keratitis in Taiwan.

A Tertiary Care Hospital's Observations on the Prevalence and Antibiotic Sensitivity of the Most Common Organisms Causing Urinary Tract Infections in Children

Objective: The purpose of this research was to evaluate the antibiotic resistance profile of urinary tract infection-causing bacteria and their prevalence among children presenting to a tertiary care hospital. Study Design: Cross-sectional/ Descriptive study Place and Duration: This study was carried out at Khyber Teaching Hospital, Peshawar from June, 2021 to May 2022. Methods: Total 112 suspected cases (children) of UTI with ages 6-months to 14 years were presented. After receiving parental agreement, we documented the children's age, gender, residence, and parental education level.It was decided to perform a urine dipstick test to check for nitrites and leucocytes, and then analyze the leucocytes and bacteria under the microscope. Antimicrobial resistance was tested using the modified Kirby-Bauer disc diffusion technique with a panel of antimicrobials.SPSS 20.0 was used to analyze all data. Results: Among 112 included cases, 58 (51.8%) were males and the rest were 54 (48.2%) female children. Frequency of leucocytes and nitrites by urine dipstick method was 30 (26.8%) and 12 (10%) but under the microscope, number of leucocytes were 15 (13.4%) and bacteria was 9 (8.03%). There were 65 (58.04%) gram positive and majority were females and 47 (41.96%) were gram negative cases. We found E.coli was the most prevalent microorganism found in 46 (70.8%) cases, 5 (7.7%) Klebsiella spp. and Pseudomonas spp. was 4 (6.2%). We found that microorganism were highly resistant (100%) to antibiotics ceftazidime, cefoperazone, ampicillin and ofloxacin while ciprofloxacin, cefuroxime and ceftriaxone showed high sensitivity. Conclusion: We observed that E.coli was the most frequent bacteria in UTI urine samples. Antimicrobial resistance in UTI-causing pathogens is worrying. It's crucial to monitor UTI-causing microbes' antibiotic susceptibility trends. Keywords:UTI, E.coli, Klebsiella spp., Resistance, Sensitivity

Antibiotic susceptibility patterns of viridans group streptococci isolates in the United States from 2010 to 2020.

BackgroundViridans group streptococci (VGS) are typically part of the commensal flora but can also cause severe invasive diseases such as infective endocarditis. There are limited data available showing antibiotic susceptibility over time for VGS.ObjectivesTo evaluate antibiotic susceptibility trends in VGS over time.Methods In vitro susceptibility patterns for 33 antibiotics were examined for Streptococcus mitis, Streptococcus oralis, and non-speciated VGS isolates from patients in Veterans Affairs (VA) Medical Centers in the United States between 2010 and 2020. Susceptibility determinations were made by the individual clinical microbiology laboratories and data were retrospectively collected from the VA Corporate Data Warehouse. Susceptibility trends were analysed using Poisson regression.ResultsA total of 14 981 VGS isolates were included of which 19.5%, 0.7% and 79.8% were S. mitis, S. oralis and non-speciated VGS isolates, respectively. Cumulative susceptibility rates across all years were similar between species for ceftriaxone (range: 96.0% to 100%), clindamycin (81.3% to 84.5%), and vancomycin (99.7% to 100%). For penicillin, susceptibility rates were 71.0%, 80.9% and 86.3% for S. mitis, S. oralis and non-speciated isolates, respectively. From 2010 to 2020, susceptibility of non-speciated VGS isolates decreased for erythromycin (P = 0.0674), penicillin (P = 0.0835), and tetracycline (P = 0.0994); though the decrease was only significant for clindamycin (P = 0.0033). For S. mitis, a significant susceptibility rate decrease was observed for erythromycin (P = 0.0112).ConclusionsSusceptibility rates for some clinically relevant antibiotics declined between 2010 and 2020. This worrisome trend highlights the need to improve antimicrobial stewardship efforts to limit unnecessary antibiotic use and preserve empirical treatment options.

Antimicrobial Susceptibility Pattern and Serotype Distribution of Streptococcus pneumoniae Isolates From a Hospital-Based Study in Chandigarh, North India.

Streptococcus pneumoniae (pneumococcus) causes significant infection-related morbidity and mortality worldwide. The genome plasticity of pneumococcus is an essential factor in antibiotic resistance, serotype switching, and the emergence of nonvaccine serotypes. Information regarding the serotype distribution as well as antimicrobial susceptibility in pneumococcus clinical isolates responsible for various infections in Northern India is limited. Here, we have explored the antibiotic resistance and serotype pattern associated with S. pneumoniae infections from both invasive and noninvasive sites of patients of all ages, visiting out-patient department of a tertiary care hospital (PGIMER, Chandigarh, India). This study was carried out on 68 S. pneumoniae isolates and the isolates exhibited the highest resistance (76.5%) to cotrimaxozole followed by resistance toward tetracycline (36.8%) and erythromycin (23.5%). All isolates showed vancomycin susceptibility and 86.8% of isolates showed sensitivity to chloramphenicol. Multidrug resistance was found in 32% (n=22) of the S. pneumoniae isolates showing resistance toward three different antibiotics. Serotype 19F was found to be the most prevalent serotype (39%) followed by serotypes 6A/B/C (19%) and 1 (12%). These data shed light on the latest trends in antibiotic susceptibility and prevalent serotype patterns of hospital-based S. pneumoniae isolates. This information can be helpful in designing future disease-preventive strategies.

Fluoroquinolones: With great power comes great risk.

Fluoroquinolones (FQs) are highly effective, well-tolerated, broad-spectrum antibiotics, making them desirable treatment options for infections. However, their adverse reactions as well as recent trends in antibiotic susceptibility must be considered. This article discusses the spectrum of activity and adverse reactions of FQs to guide nurses in caring for patients receiving this class of antibiotics.

Reported Cases of Urinary Tract Infections and the Susceptibility of Uropathogens from Hospitals in Northern Ghana.

As global studies report varying trends in antibiotic susceptibility of uropathogens, it is necessary to have current and constant information on the prevalence of urinary tract infections, the causative pathogens, and their susceptibility profiles, for effective management in specific geographical settings. This prospective cross-sectional study focused on the prevalence of urinary tract infections, etiological agents, and their antibiogram in a secondary and tertiary care hospital in Northern Ghana. Urine samples collected from 219 patients of all age groups were cultured on cysteine lactose electrolyte deficient agar. Pathogens were identified following standard microbiological methods, and their susceptibility to antibiotics was determined by the Kirby-Bauer disk diffusion method. Approximately 34% of the patients had significant bacteria, but the prevalence was slightly higher (P = .763) in the Tertiary care hospital (37.3%) than in the Secondary hospital (30.3%). Patients who were 60 years and above (27.0%) were commonly found with UTIs followed by the year group 20 to 29 years (20.3%). Although all the diagnoses had a positive relationship with urinary tract infection except Pyelonephritis, none of the underlying conditions was a significant (P > .05) predictor of urinary tract infection, with the odds ratio indicating that patients with hyperparathyroidism and dysuria had 2.606 times more likely increased risk or predictor of urinary tract infection. Ten different pathogens were identified, but Escherichia coli and Staphylococcus saprophyticus were frequently encountered. Gram-negative isolates generally showed more resistance. High resistance against ampicillin (100%), trimethoprim-sulfamethoxazole (88.5%), chloramphenicol (84.6%), augmentin (69.2%), ceftriaxone (69.2%), and ciprofloxacin (61.5%) were recorded. Amikacin was relatively effective against isolated pathogens. The high records of resistance among uropathogens and the occurrence of multidrug resistance (92%) reiterate the urgent call for rigorous surveillance of antimicrobial resistance among infectious pathogens in Ghana.

Microbiological profile and antibiotic susceptibility trends in orbital cellulitis in India: an analysis over 15 years

ABSTRACT Purpose To report the microbiologic profile and antibiotic susceptibility trends in orbital cellulitis. Methods Retrospective review of microbiology records of orbital cellulitis between 2005 and 2019. Orbital pus or conjunctival swab underwent culture for bacteria and fungi and antibiotic susceptibility testing for bacterial isolates. The microbiological profile and trends in antibiotic susceptibility were analyzed over the three study periods: 2005–2009, 2010–2014, and 2015–2019. Results Of the 203 patient samples, 189 (93%) were orbital pus samples, and 146 (72%) were culture positive. Organisms included bacteria (167/203, 82.3%), fungi (13/203, 6.4%), and mixed infection (25/203, 10.3%). Among bacteria, 79% were gram positive, with Staphylococcus aureus and Streptococcus species being commonest, and 21% were gram negative, with Pseudomonas aeruginosa and Enterobacteriaceae group being the commonest. Aspergillus flavus was the most common fungus isolated. Trend analysis revealed no change in the number of sterile cases and fungal cellulitis. Increase in gram positive bacteria was statistically significant (p = .0002) between 2005–2009 and 2015–2019. The increase in gram negative bacteria was statistically significant (p = .047) between all three time periods. Susceptibility patterns showed increasing trend of resistance to fluoroquinolones, that reached statistical significance for Ciprofloxacin, Moxifloxacin and Gatifloxacin (p < .05). Sterile sample was not found in any of the pediatric (0–16 years) cases (n = 55), compared to 28% in adults. Conclusion There was a significant rise in gram positive and negative orbital infections over the 15 year period, with increased resistance to fluoroquinolones. Fungal cellulitis and sterile samples showed a steady trend. Orbital aspirate provides accurate detection of the causative organism.

The impact of Nitrogen and Carbon Sources on the Biofilm Formation of Micrococcus luteus

This study is conducted to show the influence of different media on the extent and pattern of biofilm formation. Trends of newly emerging pathogens continue steadily. Micrococcus luteus is one of those emerging pathogens. Incidental isolations of this bacteria have been recorded from patients with urinary tract infection and/or immunocompromised conditions. Biofilm formation on the surfaces of wound drainage and urinary catheters has been reported to be the source of recurrence and colonization of the pathogen in those patients. The current study's approach assesses the role of nutrient availability on the patterns of attachment till detachment and dispersion of the biofilms. Different species of bacteria are used to correlate their biofilm formation trend. Micrococcus luteus was chosen in the study due to its emerging pathogenic potential. Validation of biofilm formation is provided by involving Proteus mirabilis; which is an ideal biofilm producer, in parallel with Micrococcus luteus throughout the entire experimental settings. The findings of this study confirm statistically significant differences in biofilm formation patterns when nutritionally different culture media have been utilized to resemble possible environments for the pathogen. Micrococcus luteus has been found to possess the highest potential to produce biofilm in peptone water media where it over paced Proteus mirabilis. Results of the study reveal that both availability and scarcity of carbon and nitrogen sources can influence both positively and negatively on the patterns of biofilm formation by different strains of bacteria and incubation time. Biofilm assessment is an inevitable technique for nosocomial infections due to the complications of antibiotic susceptibility trends that prolong the hospitalization process, which limits treatment capacity.

The role of bacterial colonization of ventilator circuit in development of ventilator associated pneumonia in ICU of Medical Center Hospital in Tripoli, Libya

Introduction: In mechanically ventilated patients, ventilator-associated pneumonia (VAP) is a major cause of prolonged hospitalization with increased morbidity and mortality. There is a lack of studies on the relationship between bacterial colonization of the ventilator circuit (VC) and VAP. This study aimed to investigate the role of bacterial colonization of VC in the development of VAP and identify antibiotic susceptibility trends for isolated strains. Methods: A prospective study of the bacterial culture has been performed between February 2021 to March 2021 on a total of 100 mechanically ventilated patients, (n =50) samples have been obtained from patient's lower respiratory tract (LRT) and (n =50) were taken from mechanical ventilator equipment VC. Paired samples of bacteria isolated from VC and LRT, where VC was colonized before LRT. Results: A total of 58 samples were cultured positively, while 42 specimens showed negative bacterial growth. However, there was no substantial difference in comparing between the bacterial colonization of the ventilator system and the patient samples. Most isolated organisms were gram-negative bacteria which were found in the ventilator circuit with 26 (68.4%), and 14 (70%) in patient’s LRT. Gram-positive was detected in 12 (31.6%) and 6 (30%) of the ventilator circuit, and patient's LRT, respectively. The predominant bacterial type was Acinetobacter baumannii organism at the VC with 10 (26.3%) and LRT at 4 (20%) followed by Klebsiella pneumoniae (8 (21.1%) in VC and 4 (20%) in LRT). Moreover, A. baumannii showed a full resistance to amoxicillin and the first generation of cephalosporins, while the other bacterial types were resistant to the most antibiotics used in this research. Conclusions: Bacterial colonization of ventilator circuit VC is a significant cause of VAP development in mechanically ventilated patients. Preventive strategies for the early detection and decontamination of contaminated VC can play a crucial role in ventilator-associated pneumonia prevention.

Global Landscape of Clostridioides Difficile Phylogeography, Antibiotic Susceptibility, and Toxin Polymorphisms by Post-Hoc Whole-Genome Sequencing from the MODIFY I/II Studies.

IntroductionClostridioides (Clostridium) difficile infection, the leading cause of healthcare-associated diarrhea, represents a significant burden on global healthcare systems. Despite being a global issue, information on C. difficile from a global perspective is lacking. The aim of this study is to model the global phylogeography of clinical C. difficile.MethodsUsing samples collected from the MODIFY I and II studies (NCT01241552, NCT01513239), we performed whole-genome sequencing of 1501 clinical isolates including 37 novel sequence types (STs), representing the largest worldwide collection to date.ResultsOur data showed ribotypes, multi-locus sequence typing clades, and whole-genome phylogeny were in good accordance. The clinical C. difficile genome was found to be more conserved than previously reported (61% core genes), and modest recombination rates of 1.4–5.0 were observed across clades. We observed a significant continent distribution preference among five C. difficile clades (Benjamini-Hochberg corrected Fisher’s exact test P < 0.01); moreover, weak association between geographic and genetic distance among ribotypes suggested sources beyond healthcare-related transmission. Markedly different trends of antibiotic susceptibility among lineages and regions were identified, and three novel mutations (in pyridoxamine 5′-phosphate oxidase family protein: Tyr130Ser, Tyr130Cys, and a promoter SNP) associated with metronidazole-reduced susceptibility were discovered on a nim-related gene and its promotor by genome-wide association study. Toxin gene polymorphisms were shown to vary within and between prevalent ribotypes, and novel severe mutations were found on the tcdC toxin regulator protein.ConclusionOur systematic characterization of a global set of clinical trial C. difficile isolates from infected individuals demonstrated the complexity of the genetic makeup of this pathogenic organism. The geographic variability of clades, variability in toxin genes, and mutations associated with antibiotic susceptibility indicate a highly complex interaction of C. difficile between host and environment. This dataset will provide a useful resource for validation of findings and future research of C. difficile.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40121-021-00426-6.

Trends in antibiotic susceptibility of enteric fever isolates among children attending a tertiary care hospital of Peshawar, KP

Introduction: The rising trend of multi-drug resistance in bacteria has also been documented in the organism Salmonella enterica causing Typhoid or Enteric Fevers, and cases of multidrug and extended drug resistance are on the rise. Determining the trends of antibiotic susceptibility provides an important therapeutic aid to the practicing clinician.Objective: To evaluate the ten-year trends in antibiotic susceptibilities of Salmonella typhi and Salmonella paratyphi isolated from blood cultures in the paediatric patients of a tertiary care hospital of Peshawar, Khyber Pakhtunkhwa, Pakistan.Materials &amp; Methods: A descriptive study was conducted in the department of Paediatrics, Rehman Medical Institute, Peshawar from June 2019 to May 2020 based on ten years retrospective data of children with positive blood culture for Salmonella spp. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY). The level of significance was set at p ≤0.05.&#x0D; Results: A total of 168 cases Salmonella enterica spp. were isolated over the 10-year study period, of which 97(64.88%) isolates were identified as Salmonella typhi and 71(42.26%) as Salmonella paratyphi A; 94(55.95%) patients were male and 74(44.04%) were female, with mean age of 4.76 ± 2.65 years (range 2 to 12 years); majority, 69(41.07%) of patients were of ages 5-8 years. S. typhi strains showed the highest sensitivity to Imipenem and Meropenem; the lowest sensitivity seen was to Ampicillin. Bacterial sensitivity to Ceftriaxone was 79.76% and to Ciprofloxacin 58.97%. In the S. typhi group, there were six (2.6%) cases of MDR typhoid and four (2.38%) cases of XDR typhoid which was only sensitive to Imipenem.&#x0D; Conclusion: Increased resistance to Ampicillin, Ciprofloxacin and Ceftriaxone was found, however complete sensitivity was found to Imipenem along with Meropenem.

Trends in Antibiotic Resistance Among Ocular Microorganisms in the United States From 2009 to 2018

Antibiotic resistance in ocular infections can affect treatment outcomes. Surveillance data on evolving antibacterial susceptibility patterns inform the treatment of such infections. To assess overall antibiotic resistance profiles and trends among bacterial isolates from ocular sources collected during 10 years. This cross-sectional study of longitudinal data from the ongoing, nationwide, prospective, laboratory-based surveillance study, the Antibiotic Resistance Monitoring in Ocular Microorganisms (ARMOR) study, included clinically relevant isolates of Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae cultured from patients with ocular infections at US centers from January 1, 2009, to December 31, 2018. Minimum inhibitory concentrations were determined for various combinations of antibiotics and species. Odds ratios (ORs) were determined for concurrent antibiotic resistance; analysis of variance and χ2 tests were used to evaluate resistance rates by patient age and geographic region; Cochran-Armitage tests identified changing antibiotic susceptibility trends over time. A total of 6091 isolates (2189 S aureus, 1765 CoNS, 590 S pneumoniae, 767 P aeruginosa, and 780 H influenzae) from 6091 patients were submitted by 88 sites. Overall, 765 S aureus (34.9%) and 871 CoNS (49.3%) isolates were methicillin resistant and more likely to be concurrently resistant to macrolides (azithromycin: S aureus: OR, 18.34 [95% CI, 13.64-24.67]; CoNS: OR, 4.59 [95% CI, 3.72-5.66]), fluoroquinolones (ciprofloxacin: S aureus: OR, 22.61 [95% CI, 17.96-28.47]; CoNS: OR, 9.73 [95% CI, 7.63-12.40]), and aminoglycosides (tobramycin: S aureus: OR, 18.29 [95% CI, 13.21-25.32]; CoNS: OR, 6.28 [95% CI, 4.61-8.56]) compared with methicillin-susceptible isolates (P < .001 for all). Multidrug resistance was observed among methicillin-resistant S aureus (577 [75.4%]) and CoNS (642 [73.7%]) isolates. Antibiotic resistance among S pneumoniae isolates was highest for azithromycin (214 [36.3%]), whereas P aeruginosa and H influenzae isolates showed low resistance overall. Differences in antibiotic resistance were found among isolates by patient age (S aureus: F = 28.07, P < .001; CoNS: F = 11.46, P < .001) and geographic region (S aureus: F = 8.03, P < .001; CoNS: F = 4.79, P = .003; S pneumoniae: F = 8.14, P < .001; P aeruginosa: F = 4.32, P = .005). Small changes in antibiotic resistance were noted over time (≤2.5% per year), with decreases in resistance to oxacillin/methicillin (oxacillin: -2.16%; 95% CI, -3.91% to -0.41%; P < .001) and other antibiotics among S aureus isolates, a decrease in ciprofloxacin resistance among CoNS (-1.38%; 95% CI, -2.24% to -0.52%; P < .001), and an increase in tobramycin resistance among CoNS (0.71%; 95% CI, -0.29% to 1.71%; P = .03). Besifloxacin retained consistently low minimum inhibitory concentrations. Antibiotic resistance may be prevalent among staphylococcal isolates, particularly among older patients. In this study, a few small differences in antibiotic resistance were observed by geographic region or longitudinally.

Moraxella catarrhalis: A Cause of Concern with Emerging Resistance and Presence of BRO Beta-Lactamase Gene-Report from a Tertiary Care Hospital in South India.

Background Found as a commensal in the upper respiratory tract, Gram-negative diplococcus Moraxella catarrhalis did not hold much importance as an infectious agent for long. The emergence of the first antibiotic-resistant strain of M. catarrhalis was noted in 1977 in Sweden. This has gradually spread worldwide over the years to more than 95% of the strains showing resistance to penicillin now. Penicillin resistance is mediated by the production of beta-lactamases encoded by bro-1 and bro-2 genes that code for beta-lactamases BRO-1 and BRO-2, respectively. The purpose of this study was to explore the trends of antibiotic resistance, the presence of bro genes, and clinical correlation of these findings with the rise in M. catarrhalis was noted in 1977 in Sweden. This has gradually spread worldwide over the years to more than 95% of the strains showing resistance to penicillin now. Penicillin resistance is mediated by the production of beta-lactamases encoded by bro-1 and bro-2 genes that code for beta-lactamases BRO-1 and BRO-2, respectively. The purpose of this study was to explore the trends of antibiotic resistance, the presence of bro genes, and clinical correlation of these findings with the rise in Methods Strains of M. catarrhalis was noted in 1977 in Sweden. This has gradually spread worldwide over the years to more than 95% of the strains showing resistance to penicillin now. Penicillin resistance is mediated by the production of beta-lactamases encoded by bro-1 and bro-2 genes that code for beta-lactamases BRO-1 and BRO-2, respectively. The purpose of this study was to explore the trends of antibiotic resistance, the presence of bro genes, and clinical correlation of these findings with the rise in Results Fourteen strains of M. catarrhalis was noted in 1977 in Sweden. This has gradually spread worldwide over the years to more than 95% of the strains showing resistance to penicillin now. Penicillin resistance is mediated by the production of beta-lactamases encoded by bro-1 and bro-2 genes that code for beta-lactamases BRO-1 and BRO-2, respectively. The purpose of this study was to explore the trends of antibiotic resistance, the presence of bro genes, and clinical correlation of these findings with the rise in Conclusion The increase in antibiotic resistance and beta-lactamase production in M. catarrhalis is a cause of concern. The emerging resistance pattern emphasises the need for an appropriate antibiotic stewardship program in clinical practice. Importance should be given to the monitoring of the trends of antibiotic susceptibility and their usage to prevent the emergence of outbreaks with resistant strains and treatment failures.M. catarrhalis was noted in 1977 in Sweden. This has gradually spread worldwide over the years to more than 95% of the strains showing resistance to penicillin now. Penicillin resistance is mediated by the production of beta-lactamases encoded by bro-1 and bro-2 genes that code for beta-lactamases BRO-1 and BRO-2, respectively. The purpose of this study was to explore the trends of antibiotic resistance, the presence of bro genes, and clinical correlation of these findings with the rise in