Antimicrobial resistance pattern of enterococcus species among clinical isolates in Iran: A systematic review and meta-analysis.

Carboxylated graphene quantum dots as a nano-delivery system for insoluble curcumin in antimicrobial photodynamic therapy.

Antibiotic-resistant microbes represent a growing problem for modern medicine and public health. Projections indicate that deaths from such infections could reach 10 million per year by 2050. Healthcare associated infections (HAI) are among the most significant causes of mortality and morbidity in hospitals, impacting millions of patients globally. The emergence of HAI is associated with resistance to antimicrobials, rapidly worsening the patient’s condition. Antimicrobial resistance determines unresponsiveness to treatment, which can ultimately lead to severe complications such as sepsis and shock. It is estimated that one in every ten patients are susceptible to infection during their stay in hospital, with the microorganism responsible for the infection frequently proving resistant to antibiotics. Among the latter, CRE (carbapenem-resistant Enterobacteriaceae), CRAB (carbapenem-resistant Acinetobacter baumannii), CRPA (carbapenem-resistant Pseudomonas aeruginosa), vancomycin-resistant Enterococcus spp. and methicillin-resistant Staphylococcus aureus (MRSA), commonly referred to as ‘superbugs’, are a major cause of HAIs. The aim of the present study is to provide a comprehensive overview of the global epidemiology of healthcare-associated infections, with particular emphasis on their incidence, distribution over time, and correlation with the socioeconomic status of different countries. Furthermore, the review aims to evaluate the effectiveness of current preventive strategies in reducing the incidence and mortality associated with HAIs.

Vancomycin-resistant Enterococcus (VRE) has demonstrated increasing global prevalence in recent years. Clinical detection currently relies on phenotypic methods including agar screening, minimum inhibitory concentration (MIC) testing, Kirby-Bauer disk diffusion, and Etest. In addition, molecular approaches such as polymerase chain reaction (PCR) and quantitative PCR (qPCR) can be applied for VRE identification. Nevertheless, these methods cannot achieve point-of-care detection (POCT). Thus, novel rapid diagnostic platforms have become urgently needed for curbing VRE transmission and containing nosocomial outbreaks. Recombinase polymerase amplification (RPA) and lateral flow strips (LFS) are effective tools for achieving rapid POCT. In this study, RPA was combined with LFS to establish a fast, sensitive, and specific detection method. This study established a multiplex RPA-LFS (mRPA-LFS) that delivers results within 30-40 min, with detection limits of 102 copies/μl for vanA, vanB, and vanM. Notably, the assay demonstrated high specificity without cross-reactivity to common bacterial/fungal pathogens, and showed 100% concordance with conventional PCR in 30 clinical samples. In this study, a rapid detection assay for vanA, vanB, and vanM genes in VRE was developed using mRPA-LFS technology. Characterized by high sensitivity, specificity, operational simplicity, and cost-effectiveness, this method is suitable for on-site detection.

Multimodal diagnosis and management of prosthetic valve endocarditis: A decade of experience at a tertiary center.

Italy reports some of the highest antimicrobial resistance (AMR) rates in Europe. This necessitates multiple interventions among which improved surveillance is a key to solutions. Statistical Process Control (SPC) methods may help distinguishing between natural variability and significant regional trends. We applied specifically tailored SPC methods, namely funnel plots, Z-score charts, and chi-squared control charts to the AMR data from the AR-ISS surveillance system (2015-2023), focusing on bloodstream infections. Specifically, we analysed regional and temporal trends of carbapenem-resistant Klebsiella pneumoniae (CRKP), third-generation cephalosporin-resistant Escherichia coli (3GCephRE), carbapenem-resistant Acinetobacter spp. (CRAS), carbapenem-resistant Pseudomonas aeruginosa (CRPA), vancomycin-resistant Enterococcus faecium (VRE-faecium), and Staphylococcus aureus methicillin-resistant (MRSA). VRE- faecium showed a persistent increase at the national level, while other pathogens exhibited marked regional variability. Funnel plots identified significant outliers, particularly for CRAS and CRKP, with peaks in 2020-2021. These trends align with increased antibiotic use during the COVID-19 pandemic. The chi-squared control chart highlighted widening interregional disparities, possibly indicating an uneven distribution of AMR containment efforts across Italy. SPC methods can help highlighting significant deviations and interregional disparities in AMR trends across Italy. The identification of specific outliers suggests these tools can complement traditional surveillance approaches by flagging patterns that may warrant further investigation, supporting targeted public health interventions, especially where regional differences are pronounced.

Background/Objectives: The right diagnostic tests, for the right patient, at the right time, are key to optimising antimicrobial use (AMU) and preventing antimicrobial resistance (AMR). This study evaluated diagnostic stewardship trends and AMR patterns in Zambian surveillance sentinel sites from 2020 to 2024. Methods: This descriptive, retrospective study analysed routine laboratory data from January 2020 to December 2024 at seven designated AMR surveillance sentinel sites across Zambia. Data on clinical specimens submitted for antimicrobial susceptibility testing were extracted from WHONET and analysed by year, specimen type, and antimicrobial susceptibility profile. Results: A total of 184,788 bacteriology specimens were processed over five years. Urine was the most frequently collected specimen, peaking above 20,000 in 2024. Escherichia coli was the most commonly isolated organism among 15 priority pathogens, comprising 25.9% of the 30,013 isolates. Though a statistically significant increasing trend in total organism isolations was observed annually, only Shigella sp. demonstrated a substantial increase in non-susceptibility to azithromycin (p = 0.027). High resistance was observed with doxycycline, azithromycin, clindamycin, trimethoprim/sulfamethoxazole, ciprofloxacin, and rifampicin, exhibiting resistance ranging from 50% to 80%. Critical AMR alerts included 65% for Vancomycin-Resistant Enterococcus (VRE), 72% for linezolid, and 44% for carbapenems, and possible ESBL-producing Enterobacterales showing the highest overall resistance at 35%, across sentinel sites. Conclusions: Zambia faces a concerning and significant increase in AMR, with high resistance prevalence across commonly used antibiotics. Critical resistance alerts for VRE, linezolid, carbapenems, and possible ESBL-producing Enterobacterales underscore an urgent need for robust antimicrobial stewardship and continuous diagnostic surveillance.

In LA County, contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus require 7.3 million gowns annually generating 506 tons of plastic waste and 1.73 million kilograms of carbon dioxide equivalents, which cause the loss of 4.07 disability-adjusted life-years. Unintended consequences of gown use necessitates exploration of infection prevention alternatives.

Vancomycin-resistant enterococci (VRE) have emerged as a significant increasingly become an public health concern over past few decades due to their association with serious multidrug-resistant (MDR) infections. This study utilized whole genome sequencing (WGS) to perform molecular characterization of three VRE isolates previously recovered from two cats and one dog. The genomic DNA of the isolates was extracted and sequencing was performed using the Illumina Novaseq platform. The genomes of Enterococcus faecium HMKU_VREfm_Dog12, Enterococcus faecium HMKU_VREfm_Cat95 and Enterococcus faecium HMKU_VREfm_Cat103 consisted of 2707111 bp, 2715129 bp, and 2664256 bp, respectively with GC content of 37.95%, 38.03% and 38.01%, respectively. Multidrug antimicrobial resistance genes conferring resistance to aminoglycosides (aac(6’)-aph(2’) and ant(6)-Ia), lincosamides (lnu(B) and lsa(E)), macrolides (erm(A), erm(B), msr(A), msr(C), and msr(B)), trimethoprim (dfrG) and tetracyclines (tet(L) and tet(M)) were identified. The sequence type (ST) of each isolate was determined using the Enterococcus PubMLST database. The isolates were found to belong to different STs (ST2248 in VREfm_Dog12, ST43 in VREfm_Cat95, and ST284 in VREfm_Cat103). The isolates carried only efaAfm (adhesion-associated protein) as virulence gene. To the best of the authors’ knowledge, this study is the first to provide insights into genetic diversity of VREfm strains isolated from dogs and cats using whole genome sequencing analysis in Turkey. The findings underscore the importance of genomic surveillance in monitoring the dissemination of MDR VREfm in pet animals.

Antimicrobial resistance remains a critical global health threat, driving the urgent need for novel therapeutic agents. Cannabinoids, bioactive secondary metabolites derived from Cannabis sativa, have gained attention for their promising antimicrobial properties. This review presents the latest advances in the antimicrobial properties of cannabinoids, emphasizing their activity against multidrug-resistant pathogens, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecium, and selected Gram-negative bacteria. We summarize their antibacterial and antifungal effects, along with insights into structure-activity relationships that reveal the critical roles of functional groups such as the resorcinol moiety and alkyl side chain. Mechanistic studies suggest that membrane disruption, metabolic interference, and reactive oxygen species generation contribute to their antimicrobial action. Moreover, we summarize the synergistic potential of cannabinoids when used in combination with conventional antibiotics, highlighting both promising outcomes and notable limitations. Despite these advances, challenges such as poor solubility, limited in vivo data, and regulatory barriers persist. Addressing these gaps through focused medicinal chemistry and translational research will be essential to harness the full potential of cannabinoids as next-generation antimicrobial agents.

Infections with antimicrobial resistant pathogens are a major threat to human health. Inhibitors of the replicative polymerase PolC are a promising novel class of antimicrobials against Gram-positive pathogens, but the structural basis for their activity remains unknown. The first-in-class PolC-targeting antimicrobial, ibezapolstat, is a guanine analogue in late-stage clinical development for the treatment of Clostridioides difficile infections, and related inhibitors are being developed for systemic treatment of infections with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Here, we present the cryo-electron microscopy structures of Enterococcus faecium PolC bound to DNA and in complex with ibezapolstat or the previously-undescribed inhibitor ACX-801. Both inhibitors form base-pairing interactions with the DNA in the active site, thereby competing with incoming dGTP nucleotides. We identify a crucial susceptibility determinant in PolC that is conserved in other organisms, such as C. difficile. This is explained by an unusual non-planar conformation of the inhibitors that induce a binding pocket in PolC. By combining structural, biochemical, bioinformatic and genetic analyses, this work lays the foundation for the rational development of an innovative class of antimicrobials against Gram-positive priority pathogens.

Genomic surveillance of vancomycin-resistant Enterococcus faecium: a study on Resistome, Plasmidome, and mobilome profiling.

Infections caused by antimicrobial-resistant bacteria represent a significant global health crisis that continues to worsen, creating an urgent need for alternative treatment and prevention strategies. A major source of drug-resistant bacteria is the human gut. The gut microbiota consists of bacteria that are frequently exposed to antibiotics, leading to selective pressure that promotes the development of resistant strains such as carbapenem-resistant Enterobacterales (CRE) and vancomycin-resistant enterococci (VRE). These drug-resistant bacteria can spread from the gut to other body sites, leading to hard-to-treat and potentially life-threatening infections such as bacteremia, surgical site infections, and urinary tract infections. Targeting the gut reservoir is essential in the fight against antimicrobial resistance. In this review, we focus on emerging non-antibiotic strategies aimed at eliminating drug resistant bacteria from the gut before they cause invasive infections, with particular emphasis on clinical evidence. Approaches discussed include fecal microbiota transplantation, bacteriophage therapy, antimicrobial peptides, probiotics, and dietary interventions. Optimizing these strategies, while continuing to explore newer approaches, will be essential to combat the growing threat of drug-resistant infections.

Aim Periprosthetic infections caused by vancomycin-resistant pathogens, such as vancomycin-resistant Enterococcus faecalis (VRE), represent a major clinical challenge. Daptomycin can be incorporated into polymethyl methacrylate (PMMA) cement spacers. This study aimed to utilize the in vivo Galleria mellonella larvae implant infection model to determine the optimal dosage of daptomycin in different PMMA cements and evaluate its efficacy. Method Daptomycin (1 g or 2 g) was added to different PMMA cements (Cement 1 containing 1 g tobramycin; Cement 2 containing 0.5 g gentamicin), to produce bone cement implants. Control groups included non-loaded Cement 1 and Cement 2, as well as Reference 1 and Reference 2, without antibiotics. The test specimens were implanted into larvae of the greater wax moth ( G. mellonella ), followed by infection with 250 CFU of VRE DSM13591 after 1 hour. The survival of the larvae was monitored over time, and bacterial numbers in the larval tissue and on the implant surface were determined after 24h. These experiments were completed with in vitro proliferation assay and inhibition zone testing. Mechanical stability was measured according to ISO 5833 and DIN 53435. Results Survival and bacterial burden analysis demonstrated that the addition of 1 g or 2 g of daptomycin was effective in preventing VRE infections. There were significantly improved larval survival and reduced bacterial numbers in both the larval tissue and on the implant surface. In contrast, Cement 1 and Cement 2 alone did not enhance larval survival and showed outcomes comparable to the antibiotic-free control groups. The addition of daptomycin was found to be effective in inhibiting bacterial growth when compared to the references, with the largest inhibition observed for Cement 2 (2 g daptomycin). On day 42, sufficient bacterial growth inhibition was observed only with the addition of 2 g daptomycin. These results correlate with those from the proliferation assay. Adding more than 1.5 g daptomycin resulted in a reduction of mechanical strength, with Cement 1 no longer meeting the ISO standard for four-point bending strength. Conclusions The incorporation of daptomycin into ALBC successfully prevented VRE infections in an in vivo model. These findings emphasize the potential of the G. mellonella implant infection model as a valuable tool for evaluating the efficacy of ALBC against multidrug-resistant bacteria, thereby accelerating pre-clinical research and advancing strategies to combat PJI. We observed differences in mechanical stability and antimicrobial efficacy between daptomycin-loaded Simplex Tobramycin and Palacos R+G with increased stability and bacterial growth reduction for the latter one.

Antibiotic-exposure guided prevalence screening for vancomycin-resistant Enterococcus: better value for hospitals.

With antimicrobial resistance (AMR) posing a major global threat, largely driven by antibiotic overuse, the search for alternative antimicrobial strategies has become increasingly urgent. Bacteriocins, due to their specificity and limited impact on host microbiota, are gaining attention as viable substitutes. Here, we report the identification and characterization of a novel bacteriocin produced by Staphylococcus saprophyticus P1CEA4, a strain isolated from meat-producing pigs. This strain exhibited potent direct and extracellular antimicrobial activity. Whole-genome sequencing (WGS) enabled the identification of multiple gene clusters encoding putative bacteriocins and secondary metabolites. Among them, a gene encoding a novel leaderless bacteriocin was functionally validated through in vitro cell-free protein synthesis (IV-CFPS) and purification from the cell-free supernatant. The bacteriocin, named saprophyticin S (SapS), is a 51-amino-acid, highly cationic peptide (pI 10.08) with a mass range of 6047.8-6110.5 Da, due to N-terminal formylation and oxidation states. Structurally, it resembles other class IIc saposin-like bacteriocins such as epidermicin NI01 and aureocin A53. SapS displayed broad antimicrobial activity against pathogenic species of clinical, veterinary, and food safety relevance, including vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). SapS was inactive against Gram-negative strains on its own, but displayed synergy with microcins and colicins against Escherichia coli.

Background and Objectives: Changes in the incidence of healthcare-associated infections (HAIs) during the coronavirus disease 2019 (COVID-19) pandemic and during periods with fewer or more COVID-19 cases have been inconclusively studied. Compared with 2015, in 2019, the abundances of the microorganisms Klebsiella pneumoniae and Enterococcus faecium increased in intensive care units (ICUs) in Taiwan. The trend in the incidence of HAIs in ICUs in Taiwan during the emergence of new infectious diseases is worth studying. Materials and Methods: We surveyed the incidence densities of different types of HAIs, device-associated HAIs, pathogens, and antimicrobial resistance in a dataset from the Taiwan Healthcare-associated Infection and Antimicrobial Resistance Surveillance System from 2015 to 2022. The change in incidence density trends was evaluated via Poisson regression, and the change in proportion trends was checked via the Mantel–Haenszel chi-square test. Results: The incidence of HAIs decreased from 5.7 to 5.17 episodes per 1000 person-days from the pre-COVID-19 period to the post-COVID-19 period. The incidences of healthcare-acquired pneumonia (HAP), device-associated HAIs decreased. However, the incidences of bloodstream infections (BSIs) increased. The percentages of patients with Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii infections significantly decreased. The percentage of patients with methicillin-resistant Staphylococcus aureus (MRSA) infection decreased, but that of patients with carbapenem-resistant K. pneumoniae (CRKP), carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa, and vancomycin-resistant Enterococcus faecium infections increased. The antimicrobial consumption related to CRKP increased and MRSA decreased. Conclusions: Overall, HAIs, HAP, and VAP decreased in incidence after the COVID-19 pandemic. These results revealed decreases in MRSA infection incidence under infection control protocols with more antimicrobial use. However, the proportion of CRKP among HAIs increased with broad-spectrum antimicrobial agent use. Based on the recent incidence of HAIs in ICUs, the quality of infection control in medical units can be enhanced to decrease HAI incidence.

Origin and transmission of carbapenemase-producing Enterobacterales and vancomycin-resistant enterococci in hospitalized patients: a genomic and epidemiological analysis.

Bacterial epidemiology and antibiotic resistance rates in male urinary tract infections in France, 2019-2023.

Assessing healthcare workers as potential stool donors for faecal microbiota transplantation: a cross-sectional study of antimicrobial-resistant gut bacteria and enteropathogenic micro-organisms.