Perception of doctors at Elobied teaching hospital toward antibiotics resistance as a health threat

Background: Resistance to antibiotics has increased dramatically over the past few years and has now reached a level that places future patients in real danger. Several factors contribute to this problem, some of them are health workers related and others are community related. This study aimed to assess the awareness of doctors in Elobeid hospital, North Kordofan state, Sudan about the problem, its causes, and its possible preventive measures. Methods: This descriptive, questionnaire-based study was conducted in Elobeid teaching hospital between 2020, February 27 and March 13. The study involved 50 doctors in the internal medicine department. Results: Out of the 50 doctors involved, 49 (98%) agreed that antibiotics resistance is a big progressive health threat in Sudan; 86% of the participants think that selfmedication is the leading cause of antibiotic resistance; and 98% believe that providing good quality culture and sensitivity service in hospitals and health centers is the most effective preventive measure. Regarding education about antibiotics as a part of academic activities in the unit during the last year, 36% of the participants received zero sessions, 68% received 1­5 sessions, and 12% received more than 5 sessions. The assessment of doctor's adherence to the Sudan Standard Treatment Guideline revealed that 28/50 participants (56%) did not see it or hear about it, 17/50 participants (34%) know it but don't comply, and only 5/50 participants (10%) know it and comply with it. Conclusion: Participants show a good awareness about the significance of antibiotics resistance as a health threat, a good awareness about the main causes and the possible preventive measures, a low to moderate frequency of education on antibiotics, and a very poor adherence to the Sudan Standard Treatment Guidelines.

Pseudomonas aeruginosa associated pulmonary infections and in vitro amplification virulent rhamnolipid (rhlR) gene / Infecções pulmonares associadas a Pseudomonas aeruginosa e gene ramnolipídeo virulento (rhlR) da amplificação in vitro

Background: Pseudomonas aeruginosa is a common opportunistic pathogenic bacterium with the ability to develop a strong communication pathway by quorum sensing system and different virulent factors. Among the various important secretions of P. aeruginosa rhamnolipid is important biological detergent, believed to be involved in the development of the biofilm and intercellular communication. It readily dissolves the lung surfactants that are then easily catalyzed by the phospholipases and in this way is involved in the acute pulmonary infection. Objective: research work was designed to investigate virulence and gene associated with virulence in P. aeruginosa responsible for pulmonary infections. Methods: In current study polymerase chain reaction (PCR) was used for the detection of the rhlR (rhamnolipid encoding) gene of isolated strains. A number of assays were performed that ensured its virulent behavior. Disc diffusion method was used to check its antibiotic resistance. Isolated strains were resistant to a number of antibiotics applied. Result: It was found that males are more prone to respiratory infections as compared to females. Male members with age of 44-58 and 59-73 are at a higher risk, while females with age of 44-58 are also at a risk of pulmonary infections. Antibiotic resistance was observed by measuringzone of inhibition in strains GCU-SG-M4, GCU-SG-M3, GCU-SG-M5, GCU-SG-M2, GCU-SG-M1 and GCU-SG-M6. GCU-SG-M2 was resistant to fluconazole (FLU), clarithromycin (CLR), cefixime (CFM) and Penicillin (P10). No zone of inhibition was observed. But it showed unusual diffused zone around the Ak and MEM antibiotic discs. rhl R gene and 16s rRNA gene were characterized and analyzed. Conclusion: Findings from current study would help[...].

Antecedentes: Pseudomonas aeruginosa é uma bactéria patogênica oportunista comum, com a capacidade de desenvolver uma forte via de comunicação pelo sistema de detecção de quorum e diferentes fatores virulentos. Entre as várias secreções importantes de P. aeruginosa rhamnolipid, há um importante detergente biológico, que se acredita estar envolvido no desenvolvimento do biofilme e na comunicação intercelular. Dissolve rapidamente os surfactantes pulmonares que são facilmente catalisados pelas fosfolipases e, dessa maneira, estão envolvidos na infecção pulmonar aguda. Objetivo: O trabalho de pesquisa foi desenhado para investigar a virulência e o gene associado à virulência em P. aeruginosa responsável por infecções pulmonares. Métodos: No presente estudo, a reação em cadeia da polimerase (PCR) foi utilizada para a detecção do gene rhlR (codificação ramnolipídeo) de cepas isoladas. Foram realizados vários ensaios que garantiram seu comportamento virulento. O método de difusão em disco foi utilizado para verificar sua resistência a antibióticos. As estirpes isoladas foram resistentes a vários antibióticos aplicados. Resultado: Verificou-se que os homens são mais propensos a infecções respiratórias em comparação às mulheres. Membros do sexo masculino com idade entre 44 e 58 e 59 e 73 anos correm maior risco, enquanto mulheres com idade entre 44 e 58 anos também correm risco de infecções pulmonares. A resistência aos antibióticos foi observada medindo a zona de inibição nas cepas GCU-SG-M4, GCU-SG-M3, GCU-SG-M5, GCU-SG-M2, GCU-SG-M1 e GCU-SG-M6. O GCU-SG-M2 foi resistente ao fluconazol (FLU), claritromicina (CLR), cefixima (CFM) e penicilina (P10). Nenhuma zona de inibição foi observada. Mas se notou uma zona difusa incomum ao redor dos discos antibióticos Ak e MEM. Os genes rhl R e 16s rRNA foram caracterizados e analisados. Conclusão: As conclusões do presente estudo ajudariam a aumentar a conscientização sobre a resistência a antibióticos de, [...].

Pseudomonas aeruginosa associated pulmonary infections and in vitro amplification virulent rhamnolipid (rhlR) gene

Abstract Background Pseudomonas aeruginosa is a common opportunistic pathogenic bacterium with the ability to develop a strong communication pathway by quorum sensing system and different virulent factors. Among the various important secretions of P. aeruginosa rhamnolipid is important biological detergent, believed to be involved in the development of the biofilm and intercellular communication. It readily dissolves the lung surfactants that are then easily catalyzed by the phospholipases and in this way is involved in the acute pulmonary infection. Objective research work was designed to investigate virulence and gene associated with virulence in P. aeruginosa responsible for pulmonary infections. Methods In current study polymerase chain reaction (PCR) was used for the detection of the rhlR (rhamnolipid encoding) gene of isolated strains. A number of assays were performed that ensured its virulent behavior. Disc diffusion method was used to check its antibiotic resistance. Isolated strains were resistant to a number of antibiotics applied. Result It was found that males are more prone to respiratory infections as compared to females. Male members with age of 44-58 and 59-73 are at a higher risk, while females with age of 44-58 are also at a risk of pulmonary infections. Antibiotic resistance was observed by measuring zone of inhibition in strains GCU-SG-M4, GCU-SG-M3, GCU-SG-M5, GCU-SG-M2, GCU-SG-M1 and GCU-SG-M6. GCU-SG-M2 was resistant to fluconazole (FLU), clarithromycin (CLR), cefixime (CFM) and Penicillin (P10). No zone of inhibition was observed. But it showed unusual diffused zone around the Ak and MEM antibiotic discs. rhl R gene and 16s rRNA gene were characterized and analyzed. Conclusion Findings from current study would help in raising awareness about antibiotic resistance of P. aeruginosa, and also the sequence of rhl R gene can be used as the diagnostic marker sequence to identify the virulent rhl R gene sequence from the samples when isolated from sputum of Pneumonia patients.

Resumo Antecedentes Pseudomonas aeruginosa é uma bactéria patogênica oportunista comum, com a capacidade de desenvolver uma forte via de comunicação pelo sistema de detecção de quorum e diferentes fatores virulentos. Entre as várias secreções importantes de P. aeruginosa rhamnolipid, há um importante detergente biológico, que se acredita estar envolvido no desenvolvimento do biofilme e na comunicação intercelular. Dissolve rapidamente os surfactantes pulmonares que são facilmente catalisados pelas fosfolipases e, dessa maneira, estão envolvidos na infecção pulmonar aguda. Objetivo O trabalho de pesquisa foi desenhado para investigar a virulência e o gene associado à virulência em P. aeruginosa responsável por infecções pulmonares. Métodos No presente estudo, a reação em cadeia da polimerase (PCR) foi utilizada para a detecção do gene rhlR (codificação ramnolipídeo) de cepas isoladas. Foram realizados vários ensaios que garantiram seu comportamento virulento. O método de difusão em disco foi utilizado para verificar sua resistência a antibióticos. As estirpes isoladas foram resistentes a vários antibióticos aplicados. Resultado Verificou-se que os homens são mais propensos a infecções respiratórias em comparação às mulheres. Membros do sexo masculino com idade entre 44 e 58 e 59 e 73 anos correm maior risco, enquanto mulheres com idade entre 44 e 58 anos também correm risco de infecções pulmonares. A resistência aos antibióticos foi observada medindo a zona de inibição nas cepas GCU-SG-M4, GCU-SG-M3, GCU-SG-M5, GCU-SG-M2, GCU-SG-M1 e GCU-SG-M6. O GCU-SG-M2 foi resistente ao fluconazol (FLU), claritromicina (CLR), cefixima (CFM) e penicilina (P10). Nenhuma zona de inibição foi observada. Mas se notou uma zona difusa incomum ao redor dos discos antibióticos Ak e MEM. Os genes rhl R e 16s rRNA foram caracterizados e analisados. Conclusão As conclusões do presente estudo ajudariam a aumentar a conscientização sobre a resistência a antibióticos de P. aeruginosa e, também, a sequência do gene rhl R pode ser usada como sequência de diagnóstico para identificar a sequência virulenta do gene rhl R das amostras quando isoladas do escarro de pacientes com pneumonia.

Pseudomonas aeruginosa associated pulmonary infections and in vitro amplification virulent rhamnolipid (rhlR) gene / Infecções pulmonares associadas a Pseudomonas aeruginosa e gene ramnolipídeo virulento (rhlR) da amplificação in vitro

Background: Pseudomonas aeruginosa is a common opportunistic pathogenic bacterium with the ability to develop a strong communication pathway by quorum sensing system and different virulent factors. Among the various important secretions of P. aeruginosa rhamnolipid is important biological detergent, believed to be involved in the development of the biofilm and intercellular communication. It readily dissolves the lung surfactants that are then easily catalyzed by the phospholipases and in this way is involved in the acute pulmonary infection. Objective: research work was designed to investigate virulence and gene associated with virulence in P. aeruginosa responsible for pulmonary infections. Methods: In current study polymerase chain reaction (PCR) was used for the detection of the rhlR (rhamnolipid encoding) gene of isolated strains. A number of assays were performed that ensured its virulent behavior. Disc diffusion method was used to check its antibiotic resistance. Isolated strains were resistant to a number of antibiotics applied. Result: It was found that males are more prone to respiratory infections as compared to females. Male members with age of 44-58 and 59-73 are at a higher risk, while females with age of 44-58 are also at a risk of pulmonary infections. Antibiotic resistance was observed by measuring zone of inhibition in strains GCU-SG-M4, GCU-SG-M3, GCU-SG-M5, GCU-SG-M2, GCU-SG-M1 and GCU-SG-M6. GCU-SG-M2 was resistant to fluconazole (FLU), clarithromycin (CLR), cefixime (CFM) and Penicillin (P10). No zone of inhibition was observed. But it showed unusual diffused zone around the Ak and MEM antibiotic discs. rhl R gene and 16s rRNA gene were characterized and analyzed. Conclusion: Findings from current study would help in raising awareness about antibiotic resistance of P. aeruginosa, and also the sequence of rhl R gene can be used as the diagnostic marker sequence to identify the virulent rhl R gene sequence from the samples when isolated from sputum of Pneumonia patients.

Antecedentes: Pseudomonas aeruginosa é uma bactéria patogênica oportunista comum, com a capacidade de desenvolver uma forte via de comunicação pelo sistema de detecção de quorum e diferentes fatores virulentos. Entre as várias secreções importantes de P. aeruginosa rhamnolipid, há um importante detergente biológico, que se acredita estar envolvido no desenvolvimento do biofilme e na comunicação intercelular. Dissolve rapidamente os surfactantes pulmonares que são facilmente catalisados pelas fosfolipases e, dessa maneira, estão envolvidos na infecção pulmonar aguda. Objetivo: O trabalho de pesquisa foi desenhado para investigar a virulência e o gene associado à virulência em P. aeruginosa responsável por infecções pulmonares. Métodos: No presente estudo, a reação em cadeia da polimerase (PCR) foi utilizada para a detecção do gene rhlR (codificação ramnolipídeo) de cepas isoladas. Foram realizados vários ensaios que garantiram seu comportamento virulento. O método de difusão em disco foi utilizado para verificar sua resistência a antibióticos. As estirpes isoladas foram resistentes a vários antibióticos aplicados. Resultado: Verificou-se que os homens são mais propensos a infecções respiratórias em comparação às mulheres. Membros do sexo masculino com idade entre 44 e 58 e 59 e 73 anos correm maior risco, enquanto mulheres com idade entre 44 e 58 anos também correm risco de infecções pulmonares. A resistência aos antibióticos foi observada medindo a zona de inibição nas cepas GCU-SG-M4, GCU-SG-M3, GCU-SG-M5, GCUSG-M2, GCU-SG-M1 e GCU-SG-M6. O GCU-SG-M2 foi resistente ao fluconazol (FLU), claritromicina (CLR), cefixima (CFM) e penicilina (P10). Nenhuma zona de inibição foi observada. Mas se notou uma zona difusa incomum ao redor dos discos antibióticos Ak e MEM. Os genes rhl R e 16s rRNA foram caracterizados e analisados. Conclusão: As conclusões do presente estudo ajudariam a aumentar a conscientização sobre a resistência a antibióticos de P. aeruginosa e, também, a sequência do gene rhl R pode ser usada como sequência de diagnóstico para identificar a sequência virulenta do gene rhl R das amostras quando isoladas do escarro de pacientes com pneumonia.

Prevalence of antibiotic resistance and virulent factors in nosocomial clinical isolates of Pseudomonas aeruginosa from Panamá

ABSTRACT Background: Pseudomonas aeruginosa is an important causative agent of nosocomial infections. As pathogen, P. aeruginosa is of increasing clinical importance due to its ability to develop high-level multidrug resistance (MDR). Methods: The aim of the present study was to better understand the intrinsic virulence of circulating strains of Pseudomonas aeruginosa, by surveying and characterizing the antibiotic resistance profiles and prevalence of virulence factors in 51 clinical isolates of P. aeruginosa obtained from children admitted to Hospital del Niño-Panamá during the period of October 2016 until March 2017. Antimicrobial susceptibilities were assessed by determining the minimum inhibitory concentration for 12 antibiotics against P. aeruginosa clinical isolates using the VITEK system (https://www.biomerieux.com). Additionally, all isolates were examined by Polymerase Chain Reaction (PCR) for the presence of components of the MexAB-OprM efflux pump system (mexABR) and pyoverdine receptor genes and betalactamases resistance genes (ESBL) using gene-specific primers. Results: A total of 51 pyoverdine producing clinical isolates were analyzed, all of which expressed resistance genes such as genes of the MexAB-OprM efflux pump system (mexABR) and pyoverdine receptor genes (fpvA). Out of 51 MDR isolates, 22 were ESBL producers. The most common ESBL gene was blaTEM expressed by 43% of the isolates. The isolates tested in this study showed increased resistance to antibiotics in the following categories: (i) penicillins (ampicillin (69%), piperacillin (22%); (ii) pyrimethamines (trimethoprim, 65%); (iii) nitrofurans (nitrofurantoin, 63%), and (iv) third-generation cephalosporin cefotaxime (53%). These results underscore a high prevalence of MDR amongst clinical isolates from Panama. Conclusions: The present study indicates that prevalence of BlaTEM-carrying strains is increasing with subsequent multidrug resistance in Panamá and as well reported worldwide. The virulent factors identified in this study provide valuable information regarding the prevalence of resistance genes and their potential impact on treatments that exploit the unique physiology of the pathogen. To prevent further spread of MDR, the proportions of resistant strains of Pseudomonas aeruginosa should be constantly evaluated on healthcare institutions of Panamá. More importantly, this information can be used to better understand the evolution and dissemination of strains hoping to prevent the development of resistance in Pseudomonas aeruginosa. Future studies quantifying the expression of these virulent genes will emphasize on the acquisition of multidrug resistance.

Epidemiología molecular de Klebsiella pneumoniae resistentes a los antibióticos betalactámicos aislados de centros asistenciales del estado Aragua-Venezuela / Molecular epidemiology of Klebsiella pneumoniae resistant to beta-lactams antibiotics isolated from health centers of Aragua State-Venezuela

La resistencia de K. pneumoniae a los antibióticos ß-lactámicos es un problema de salud pública. El objetivo fue caracterizar por epidemiología molecular aislados de K. pneumoniae resistentes a los antibióticos ß-lactámicos en cuatro Centros Asistenciales del Estado Aragua y establecer asociaciones entre los genotipos con la resistencia y las variables epidemiológicas. Se procesaron 72 cepas de K. pneumoniae y su resistencia a ß-lactámicos se realizó según las directrices del CLSI. Para la detección fenotípica de ß-lactamasa de Espectro Extendido (BLEE) se usó la sinergia de doble disco, mientras que para detectar metalobetalactamasa (MBLs), carbapemenasas (KPC) y AmpC inducible se utilizaron las combinaciones de discos de EDTA/imipenem/meropenem, ácido fenilborónico/meropenem/imipenem y piperacilina tazobactam/ceftazidima/Imipenem/cefoxitin respectivamente. La tipificación molecular se realizó por la reacción en cadena de la polimerasa de las secuencias repetitivas extragénicas palindrómicas. Solo 35 cepas (48,6%) fueron resistentes a todos los ß-lactámicos. El 34,29%; 31,43% y 31,43% resultaron ser productoras de BLEE, KPC y MBLs respectivamente, y 2,86% AmpC inducible. Se identificaron siete genotipos, donde el tipo B agrupó 23 cepas idénticas que se diseminan clonalmente. Se encontró una relación estadísticamente significativa entre el genotipo, la edad y el género. En conclusión, K. pneumoniae es altamente resistente a los antibióticos ß-lactámicos

K. pneumoniae resistance to ß-lactam antibiotics is a public health problem. The objective was to characterize by molecular epidemiology isolates of K. pneumoniae resistant to ß-lactams in four Health Centers of the Aragua State and establish the association between genotypes with resistance and epidemiological variables. 72 strains of K. pneumoniae were processed and their resistance to ß-lactams was performed according to the CLSI guidelines. Double disc synergy was used for phenotypic detection of Extended Spectrum ß-lactamase or ESBL. Combinations of EDTA/imipenem/meropenem; phenylboronic acid/meropenem/imipenem and piperacillin tazobactam/ ceftazidime/Imipenem/cefoxitin were used to detect metallo-beta-lactamase or MBLs, carbapenemases (KPC) and inducible AmpC respectively. Molecular typing was performed by polymerase chain reaction of palindromic extragenic repetitive sequences. Only 35 strains (48.6%) were resistant to all ß-lactams. 34.29%; 31.43% and 31.43% turned out to be ESBL, KPC and MBLs respectively, and 2.86% inducible AmpC. Seven genotypes were identified, where type B grouped 23 genetically identical strains and clonally spreaded. A statistically significant relationship was found between genotype, age and gender. In conclusion, K. pneumoniae is highly resistant to ß-lactams

Molecular detection of chloramphenicol-florfenicol resistance (cfr) genes among linezolid resistant MRSA isolates in Sokoto State, Nigeria / Detecção molecular de genes de resistência ao cloranfenicol-florfenicol (cfr) entre isolados de MRSA resistentes a linezolida no estado de Sokoto, Nigéria

Objective: we investigated previous literatures for documentation of the trend in Sokoto, Nigeria and found none. We deemed it fit to determine the frequency of linezolid resistance mediated by cfr gene among MRSA isolates from Sokoto State-owned hospitals. Methods: Bacterial species identification was carried out with Microgen™ Staph-ID System kit (Microgen, Surrey, UK). Disc agar diffusion method (Modified Kirby-Bauer's) following Clinical and Laboratory Standards Institute (CLSI 2018) guidelines was used in antimicrobial susceptibility testing. The results were interpreted and managed using WHONET 5.6 software (WHO, Switzerland). Oxacillin resistant screening agar base (ORSAB) culture was used to determine phenotypic methicillin resistance. Polymerase chain reaction (PCR) was carried out to determine the presence of cfr-gene. Results: A total of 81 S. aureus isolates were phenotypically identified. Of this number, 46.91% (38/81) were MRSA; Healthcare workers (39.5%), Outpatient (28.9%), In patient (21%), Security men and Cleaners (5.3% each). Importantly linezolid resistance rate among the MRSA isolates was 44.7%. Analysis of antimicrobial susceptibility profile also showed a multiple antibiotics resistance burden of MDR (5.9%), possible XDR (47.1%), XDR (41.1%) and PDR (5.9%) amongst LR-MRSA. About 52.9% (9/17) of LR-MRSA harbored the cfr gene. Conclusions: This is the first report to document cfr gene in LR-MRSA strains in Sokoto. The cfr gene was found among the studied LR-MRSA strains and if cfr-mediated linezolid resistance is not properly checked, its phenotypic expression may result in an outbreak of multiple antibiotic resistant strains.

Objetivo: avaliar a incidência de resistência linezolida cfr-mediada entre os isolados de MRSA dos hospitais do Estado de Sokoto. Métodos: A identificação das espécies bacterianas foi realizada com Microgen™ Staph-ID System kit (Microgen, Surrey, UK). Método de difusão em ágar de disco (Kirby-Bauer modificado) seguindo as diretrizes do Clinical and Laboratory Standards Institute (CLSI 2018). O resultado foi interpretado e gerido com WHONET 5.6 (OMS, Suíça) software. A cultura ORSAB (Oxacillin resistant screening agar) foi utilizada para determinar a resistência fenotípica à meticilina. A PCR foi realizada para determinar a presença de cfr-gene. Resultados: um total de 81 isolados de S. aureus foi identificada fenotipicamente. Desse número, 46,91% (38/81) eram de MRSA; Profissionais de saúde (39,5%), Ambulatoriais (28,9%), Em paciente (21%), Homens de segurança e Limpadores (5,3% cada). A taxa de resistência linezolida entre os isolados de MRSA foi de 44,7%. A análise do perfil de sensibilidade antimicrobiana também mostrou uma carga de resistência a antibióticos múltiplos de MDR (5,9%), possível XDR (47,1%), XDR (41,1%) e PDR (5,9%) entre LR-MRSA. Um total de, 52,9% (9/17) da LR-MRSA abrigava o gene cfr. Conclusões: Este é o primeiro relatório a documentar o cfr-gen nas estirpes LR-MRSA em Sokoto. O gene cfr está presente entre as cepas estudadas de LR-MRSA, e se a resistência cfr-mediated linezolida não for adequadamente verificada, sua expressão fenotípica pode resultar em um surto de múltiplas cepas resistentes a antibióticos.

Analysis of Distribution and Drug Resistance of Clinical Bacterial Strains Isolated from Children Patients in Our Hospital during 2014-2019 / 中国药房

OBJECTIVE：To pro vide reference for rational use of antibiotics in pediatric department. METHODS ：Clinical bacterial strains isolated from children outpatients and inpatients were collected from West China Guang ’an Hospital of Sichuan University（called“our hospital ”for short ）during Jan. 2014 to Jun. 2019. Distribution and drug resistance of bacteria were analyzed retrospectively. RESULTS ：During 2014-2019，total of 4 692 strains were detected ，accounting for 29.56％ of total ；those were mainly from sputum （3 749 strains，79.90％），blood（203 strains，4.33％）and secretion （137 strains，2.92％）specimen. Among them ，1 488 strains of Gram-positive bacteria （31.71％）were mainly Streptococcus pneumoniae （711 strains，15.15％） and Staphylococcus aureus （574 strains，12.23％）；3 204 strains of Gram-negative bacteria （68.29％）were mainly 2 466 strains of Haemophilus influenza （52.56％）. Totally 172 strains of methicillin-resistant S. aureus and 1 517 strains of β-lactamase producing H. influenzae were detected ；the detection rates were 29.97％ and 61.52％ ，respectively. Resistance rates of H. influenza to ampicillin，cefaclor and cefuroxime were higher than 50％，and the overall trend was on the rise ，resistance rates of cefotaxime ， rifampin and ofloxacin were all lower than 6％. Resistance rates of S. pneumoniae to erythromycin and tetracycline were more than 70％，and the resistance rate to erythromycin was increasing year by year. Resistance rates of S. pneumoniae to β-lactams and quinolones were generally lower than 20％. No resistant strains of linezolid and vancomycin were found. Resistance rate of S. aureus to penicillin G was more than 90％. S. aureus was relarively sensitive to aminoglycosides ，macrolides and tetracyclines ；no furantoin，linezolid and vancomycin-resistant strains were found. CONCLUSIONS ：Gram-negative bacteria are the main pathogens isolated from children in our hospital ，and most of them are H. influenza e，S. pneumon iae and other caustic bacteria. The detection rate of drug-resistant and enzyme producing strains is high ， and the resistance rate of several pathogens to commonly used 0826-2600251。E-mail：wenxiaozheng269@sina.com antibiotics is increasing year by year. Drug resistance is severe. In order to delay the emergence and spread of drug-resistant pathogens in real time and further standardize the use of pediatric antibiotics.

Microbial Assessment of In-door Air and Equipment Used in Banks within Ekiti State University, Ado-Ekiti, Ekiti State, Nigeria

Banking activities which involve the use of counting machines, Automated teller machines, and exchange of naira notes play potential roles in the spread of infectious microorganisms. This study aimed at determining the microbial status of banks within Ekiti State University campus. A total of 96 samples were collected from six different banks’ in–door air, ATM, counting tables and Money counting machines in Ekiti State University campus. The samples were collected both in the morning and afternoon. Bacteria and fungi were isolated from the samples using serial dilution and pour plating methods. The isolates were identified based on morphological and biochemical characterization. Susceptibility pattern of the isolates to different classes of antibiotics (Penicillins, Quinolones, Macrolides, Aminoglycosides, Fluoroquinolones and Sulfonamides) were determined using agar disc diffusion method. There was significant difference (p<0.05) in bacteria counts on all the equipment analyzed in all the banks except Heritage bank. Analysis of variance also revealed significant difference in the bacteria counts from the banks in the morning and in the afternoon (p<0.05). Bacteria and fungi isolated from the samples belonged to the genera Staphylococcus, Streptococcus, Enterobacter, Klebsiella, Escherichia Serratia, Pseudomonas, Proteus Bacilllus, Aspergillus, Alternaria, Mucor and Fusarium where bacteria group dominated with 65% while their fungal counterparts were 35% of the total isolates. Escherichia coli had the highest percentage occurrence of 18.6%, followed by Staphylococcus aureus (15.2%) while Proteus sp. had the lowest occurrence (1%). The isolates exhibited resistance to Augmentin (100%), Erythromycin (100%), Amoxycillin (96%), Cotrimoxazole (96%), Chloramphenicol (86%), Streptomycin (72%) and Gentamycin (58%) while their growths were inhibited by Ciprofloxacin, Ofloxacin, Prefloxacin and Septrin. Plasmid analysis of the resistant strains showed that the isolates lack plasmids. The presence of potential pathogens in the banks and multiple antibiotic resistance displayed by the isolates constitutes risk to the public health. Hence, measures such as thorough hand washing with soap and hand sanitization after using the bank and its facilities should be emphasized.

Bibliometric analysis of recent research on multidrug and antibiotics resistance (2017–2018)

Antibiotic resistance is considered, nowadays, as a severe public health problem. In February 2017, the World HealthOrganization (WHO) reported the global priority list of antibiotic-resistant bacteria as a guide for further researchon the field. This contribution presents a bibliometric overview of global research on multidrug and antibioticsresistance. Research articles indexed between 2017 and 2018 on the Scopus database were filtered according to asystematic search strategy and a total of 2,362 records were retrieved. A significative number of studies were foundto be focused on four pathogenic bacteria: Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, andKlebsiella pneumoniae, which were also included in the critical priority level according to the WHO. The results ofthis study indicate that the United States, China, and India were the most productive countries regarding the numberof publications. Furthermore, publications from the United States, Germany, and the United Kingdom had the highestimpact based on the ratio of the number of citations and the number of publications. Nevertheless, when productivitywas stratified by the number of publications and the number of citations based on the gross domestic product, Iranranked first. This bibliometric approach showed that most of multidrug- and antibiotics-resistance studies focused onthe so-called critical bacteria according to the WHO but less on those bacteria catalogued as high and medium priority

Carriage prevalence and drug resistance profile of MRSA and MSSA strains isolated from newborns / 中华疾病控制杂志

Objective To determine the carriage prevalence and antibiotics resistance profile of methicillin-resistant staphylococcus aureus(MRSA) and methicillin-sensitive staphylococcus aureus(MSSA) strains isolated from newborns. Methods A cross-sectional study was conducted in two hospitals in Shenzhen from August to November 2015. Cotton swab samples were collected from 1834 newborns. Staphylococcus aureus was identified by general laboratory tests, and antimicrobial-susceptibility profiles was tested. Results In total, 3.27% (60/1 834) Staphylococcus aureus (SA) strains were isolated, including 0.82% (15/1 834) MRSA and 2.45% (45/1 834) MSSA. Most MRSA and MSSA strains were resistant to penicillin and erythromycin but less than 10% strains resistant to linezolid. Drugs resistance rates of MRSA to erythromycin, moxifloxacin and clindamycin were all higher than that of MSSA (all P<0.05). The multidrug-resistant risk of MRSA (80.00%) was 12.36 times higher than that of MSSA (24.44%). Conclusions Multidrug-resistant SA especially MRSA strains isolated from newborns had the higher prevalence, the drugs resistance rate of MRSA strains was more serious than that of MSSA.

Manejo de las infecciones urinarias en la consulta ambulatoria: de las guías a la práctica clínica / Management of urinary tract infections in the outpatient clinic: from the guides to clinical practice

La infección del tracto urinario constituye el segundo proceso infeccioso más frecuente en el ser humano. Existen controversias respecto a la conducta en casos de bacteriuria asintomática, cistitis aguda no complicada, pielonefritis aguda y manejo de pacientes cateterizados. Objetivo: Con este estudio descriptivo basado en la realización de una encuesta pretendemos comparar el manejo de las infecciones urinarias en la consulta ambulatoria con respecto a las recomendaciones de las guías internacionales. Materiales y Métodos: Se realizó un estudio descriptivo basado en una encuesta compuesta de 15 preguntas de selección múltiple basadas en las guías internacionales dirigida a médicos de familia y de atención primaria de la salud (APS). El análisis estadístico de los datos fue realizado con el programa Microsoft Excel 2003®. Las frecuencias fueron expresadas como porcentajes y los datos cuantitativos como media, mediana y moda. Discusión y Resultados: Existe discordancia en el manejo ambulatorio de las infecciones urinarias de los profesionales encuestados en relación a lo establecido en las guías internacionales. El 48,4% de los médicos utiliza la ciprofloxacina como antibiótico de primera línea para la cistitis aguda no complicada; el 50,8% indica el tratamiento antibiótico durante 6 a 10 días. Con respecto a la resistencia de los uropatógenos, solo el 10% conoce como se encuentra la misma en sus centros hospitalarios. En cuanto al tratamiento de la pielonefritis aguda, el 57% considera necesario el tratamiento parenteral en todos los casos.

The infection of the urinary tract constitutes the second most frequent infectious process in the human being. Controversies exist regarding behavior in cases of asymptomatic bacteriuria, uncomplicated acute cystitis, acute pyelonephritis and management of catheterized patients. Objective: With this descriptive study based on the conduct of a survey, we intend to compare the management of urinary tract infections in the outpatient clinic with respect to the recommendations of international guidelines. Material and method: A descriptive study was conducted based on a survey composed of 15 multiple-choice questions based on international guidelines for family doctors and primary health care (PHC). The statistical analysis of the data was performed with the Microsoft Excel 2003® program. The frequencies were expressed as percentages and the quantitative data such as mean, median and fashion. Discussion and Results: There is disagreement in the ambulatory management of urinary tract infections of the professionals surveyed in relation to what is established in the international guidelines.48.4% of doctors use ciprofloxacin as a first-line antibiotic for uncomplicated acute cystitis; 50.8% indicate antibiotic treatment for 6 to 10 days. With respect to the resistance of uropathogens, only 10% know how it is in their hospital centers. Regarding the treatment of acute pyelonephritis, 57% considered parenteral treatment necessary in all cases.

Efficacy of conventional pharmacotherapy of syndromic management of STIs: a two year cross-sectional prospective study

Background: Syndromic management has been the centre for treating STIs in a resource constraint facility since its introduction by WHO and CDC more than a decade back. Recently there has been lots of debate on its empirical use in an era of antibiotics resistance and ever-changing varieties of microorganisms causing these infections. Present study evaluated the efficacy of pharmacotherapy of syndromic management measured by symptomatic improvement in females presenting with STIs.Methods: It was a two year cross-sectional prospective study including all the females of STI syndromes, attending Gynecology OPD of Sanjay Gandhi Memorial Hospital and results were assessed in pharmacology department, Gajra Raja medical college Gwalior from Jan 2015 to December 2016.Results: During the study period total of 24,556 patients attended the Gynecology OPD out of which 8562 patients presented with different STI syndromes. Lower abdomen pain with vaginal discharge was the most common symptom while Ulcerative lesions were the least common complaint. Maximum recurrence was seen in patients of vaginal discharge and itching followed by PID syndrome which responded to second line of drugs.Conclusions: Syndromic Management of STIs is an old approach to deal with a very common gynecological problem and needs to be reviewed in an era of wide spread antibiotics resistance.

Human Resistome Study with Metagenomic Sequencing Data / 한양의대학술지

With the introduction of synthetic antibiotics, many lives including humans and animals have been saved against bacterial infection. An increasing level of antibiotics use, however, raises serious problems of multi-drug resistance and transferring of resistance genes across different environments and countries. Advances in high-throughput sequencing technology and efficient bioinformatics methods allow us to perform a large-scale screening and analysis of resistomes in the human and environmental microbiomes. Recent studies on human microbiomes have revealed a diverse distribution of resistance genes and their transferring activities in the communities. This review discusses recent progresses in metagenomic approaches to identify resistance genes in the human microbiome, including genomic sequence search and functional metagenomics methods. Using Rifampicin ADP-ribosyltransferase as an example, an integrative approach that analyzes the sequences and three-dimensional structures of the proteins derived from resistance genes is also introduced.

An analysis of relative factors, bacteriological profile and antibiogram of neonatal sepsis / 中华预防医学杂志

Objective@#This study was designed to identify the relative factors, bacteriological profile and their antibiotic susceptibility pattern of neonatal sepsis.@*Methods@#A retrospective survey was conducted on the clinical information, pathogen identification and antibiotic sensitivity results of 425 newborns with neonatal sepsis admitted to Nanjing Maternity and Child Health Care Hospital from 2010 to 2017. Of the 425 positive blood-cultures, 148 (34.82%) were early-onset neonatal sepsis (EOS) and 277 (65.18%) were late-onset neonatal sepsis (LOS). Clinical information and pathogen identification were compared between EOS and LOS. Antibiotic sensitivity of gram negative organisms (G-) and gram positive organisms (G+) were also detected.@*Results@#The rates of premature delivery (78.70%, n=218), low birth weights (67.15%, n=186) and cesarean delivery (59.57%, n=165) were significantly increased in LOS (P<0.05) compared with those rates in EOS, which were 41.89% (n=62), 37.84% (n=56) and 46.62% (n=69). Parturients fever (18.24%, n=27) and meconium like amniotic fluid (25.68%, n=38) were significantly increased in EOS (P<0.05) compared with those rates in LOS, which were 7.94% (n=22) and 5.42% (n=15). Among the identified pathogen, the incidence of G- and G+ bacteria were 216 (50.83%) and 201 (47.29%) respectively, and the rest was Candida glabrata (1.88%, n=8). Escherichia coli 68 (16.00%) was the predominant isolate followed by Klebsiella pneumoniae (13.18%, n=56). The detection rate of Hemolytic staphylococcus (10.81%, n=16) was significantly increased in EOS (P<0.001) compared with LOS (1.44%, n=4). However, the incidence of Klebsiella pneumonia (5.88%, n=44) was higher in LOS (P=0.024) compared with EOS (8.11%, n=12). Most of the gram positive isolates exhibited high resistance to penicillin (90.32%-100.00%) and cephalosporin group antibiotics (25.00%-100.00%). Similarly, the majority of the gram negative isolates showed higher resistance to ampicillin (83.33%-100.00%), but susceptible to aminoglycosides (0-11.76%), quinolones (0-17.65%) and β-lactams (0-5.88%).@*Conclusion@#Among the study population, the percent of preterm, low birth weight and cesarean section were higher in LOS while parturients fever and meconium-like amniotic fluid were higher in EOS. The pathogens with the highest detection rate were Escherichia coli and Klebsiella pneumoniae. The results of antibiotic susceptibility test showed that common pathogens had high resistance to commonly used antibacterial drugs.

Detección de Betalactamasas de espectro extendido en Enterobacteriaceae en un Centro de Salud de Maracaibo, Venezuela / Detection of Extended-Spectrum ß-lactamase-producing Enterobacteriaceae in a Healthcare Center from Maracaibo city, Venezuela

La alta incidencia de las enfermedades infecciosas y el aumento de la resistencia a los antibióticos se han convertido en la actualidad en un problema de salud pública, siendo las enterobacterias productoras de Betalactamasas de Espectro Extendido (BLEE) un ejemplo de este fenómeno. En el presente estudio se determinó la producción de BLEE en aislados clínicos de la familia Enterobacteriaceae procedentes de una institución de salud de la ciudad de Maracaibo, durante el periodo septiembre de 2014 a febrero de 2015. Para la detección de BLEE se utilizó como método preliminar el de Kirby-Baüer, siguiendo los lineamientos del CLSI; adicionalmente se utilizó como prueba confirmatoria fenotípica el método de sinergia del doble disco y como prueba confirmatoria genotípica la detección de los genes blaCTX-M, blaTEM y blaSHV mediante PCR. Se analizaron 55 enterobacterias productoras de BLEE, distribuidas de la siguiente manera: Escherichia coli 56,36%, Klebsiella pneumoniae 21,82%, Enterobacter cloacae 7,27%, Proteus mirabilis y Serratia marcescens 5,45% para cada especie, por último, Salmonella spp. y Morganella morganii 1,82% respectivamente. En cuanto al tipo de BLEE detectado mediante PCR, se observó que el 83,63% de los aislados presentó el tipo TEM, seguido de CTX-M (23,63%) y SHV (21,81%), mientras que el 27,27% de los aislados produjo dos o tres BLEE de manera simultánea. Los resultados de este estudio confirman la alta diseminación de este mecanismo de resistencia entre las enterobacterias productoras de infecciones en nuestras instituciones públicas de salud, por lo que deben aplicarse medidas de control que permitan controlar y disminuir su incidencia.

The high incidence of the infectious diseases and the antimicrobial resistance arise represent a public health threat today. The extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae are an example of this phenomenon. We determined the ESBL-production in Enterobacteriaceae isolates from a Healthcare Center in Maracaibo, during September 2014 to February 2015. The Kirby-Baüer method was perform to preliminary phenotypic detection of ESBL, according to CLSI guidelines. ESBL-production was confirmed by a double-disk synergy test according to the CLSI standards. To genotypic confirmation, the genes blaCTX-M, blaTEM and blaSHV were amplified by PCR. Fifty-five (n=55) strains were analyzed distributed in Escherichia coli (56.36 %), Klebsiella pneumoniae (21.82 %), Enterobacter cloacae (7.27 %), Proteus mirabilis and Serratia marcescens (5.45 % each one), Salmonella spp. and Morganella morganii (1.82 % each one). The major encoded ESBL was the blaTEM gene (83.63 %); followed by 23.63% of the blaCTX-M gene, and 21.81 % encoded the blaSHV gene. 27.27 % of the isolates produced two or three ESBL simultaneously. These results confirmed the high spread of this resistant mechanism among Enterobacteriaceae-producing infections in our public health institutions, therefore control measures should applied to control and reduce its incidence.

Antibiotic resistance and molecular epidemiology characteristics of methicillin-resistant Staphylococcus aureus in Shenzhen area / 中国人兽共患病学报

The aim of this study is to investigate antibiotic resistance and molecular epidemiology characteristics of methicillin-resistant Staphylococcus aureus (MRSA) in Shenzhen area.We collected 428 Staphylococcus aureus isolates from eight hospitals in Shenzhen in 2012.According to the results of minimum inhibitory concentration (MIC) to cefoxitin,26.2％ of Staphylococcus aureus isolates (112/428) were identified as MRSA.The MIC of 10 antimicrobial agents was determined by agar dilution method.Panton-Valentine leucocidin(PVL) was detected by polymerase chain reaction(PCR).Positive strains of PVL were detected by multilocus sequence typing(MLST).Among the 112 strains,the resistance rates to trimethoprim-sulfamethoxazole,moxifloxacin,ciprofloxacin,gentamicin,erythromycin,clindamycin and tetracycline were 4.46％,12.50％,16.96％,19.64％,46.42％,25.00％ and 26.79％ respectively.No isolates resistant to vancomycin,linezolid and teicoplanin were found.Among the 112 strains,there were 13 (11.61％) strains carried PVL gene.There were no significant differences in the resistance rates of PVL positive strains and negative strains to 10 kinds of antimicrobial agents.Among the 13 strains carried PVL gene,7 kinds of old sequences and 1 kind of new sequence type were found by MLST.ST338 and ST25 were the most common type.All the data indicate that surveillance of MRSA in Shenzhen has a distinct genetic background from other regions.

Antibiotics resistance of Group B streptococcus / 中华实用儿科临床杂志

Group B streptococcus(GBS)is one of the main pathogens of serious perinatal infectious diseases, associated with neonatal high morbidity and mortality.Recently,with maternal intrapartum antibiotic prophylaxis poli-cies were implemented for the prevention of GBS infections and widespread use of antibiotics,the antibiotics resistance of GBS emerged and GBS resistant to some antibiotics severely.This review aimes to summarize the current status of an-tibiotics resistance and the resistance mechanism of GBS.

Bacterial contaminations of Iraqi Currencies collected from Duhok City, Iraq.

Background: Paper currency is widely exchanged and because of the high frequency changing from hand to hand, could serve as vehicles for transmission of multi-resistant bacterial pathogens. The aim was to find out bacterial contaminations of Iraqi currencies collected from various communities and their susceptibility to antibiotics at Duhok city, Iraq. Methods: A total of 302 Iraqi currencies were collected from 8 community populations and analyzed by screened on Blood, Mannitol salt, MacConkey and Chocolate agar followed by the identification of the isolates using standard conventional bacteriological methods. Antibiotic susceptibility testing against fourteen drugs was carried out as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: Out of 302 collected samples, 96% showed bacterial contamination, of them 16% had multiple bacterial isolates. A total of 9 different bacterial species were isolated from six Iraqi currencies. Of them, (24.2%) was Bacillus subtillis followed by E. coli (14.6%), S. aureus (13.4%), Micrococcus (13.0%), S. albus (10.6%), P. aeruginosa (10.2%), Klbseiella (9.9%), Proteus (2.5%) and Enterobacter (1.6%).overall isolates exhibited high resistance to vancomycin, erythromycin, ampicillin and cefixime ,while absent or little resistance was against antibiotics like amikacin, gentamicin, ciprofloxacin, norfloxacin, azithromycin, ceftriaxone and rifampin. Conclusion: Study revealed that Iraqi currencies circulating in Duhok city was contaminated with different pathogenic and potential pathogenic bacteria including multi drug resistant strains. So the need to improve health consciousness among people while handling currency is an urgent issue.

Antibiotics resistance of Acinetobacter baumannii in intensive care unit / 国际检验医学杂志

Objective To investigate the specimen source and antibiotics resistance of Acinetobacter baumannii isolated from in‐patient in Intensive Care Unit(ICU) .Methods Specimen source and antibiotics resistance of 520 strains of Acinetobacter bauman‐nii ,isolated from patients of ICU in Affiliated Hospital of North Sichuan Medical College from 2011 to 2014 ,were retrospectively analyzed .Results The main source of Acinetobacter baumannii was sputum specimens ,accounting for 90 .4% .Acinetobacter bau‐mannii isolates showed the lowest resistance rates to cefoperazone‐sulbactam and minocycline(32 .0% and 25 .2% ,respectively) .A‐bout 68 .1% and 74 .9% of these strains were resistant to trimethoprim‐sulfamethoxazole and levofloxacin ,respectively .More than 86 .0% of the strains were resistant to other tested antibacterial agents .Conclusion Acinetobacter baumanii strains ,isolated from ICU ,could have high resistance rates to many kinds of antibacterial agents ,and cefoperazone‐sulbactam and minocycline might be with fine antibacterial activity against Acinetobacter baumanii .Drug resistance monitoring of Acinetobacter baumanii should be strengthened ,and antibacterial agents should be selected and used rationally according to the results of drug sensitivity test .