ABSTRACT
@#This study aimed to determine the in vivo effectiveness of the ethanolic extract of Piper betle L. leaves against Staphylococcus aureus-infected wounds in mice and its antimicrobial properties on clinical isolates of multiple drug-resistant bacterial pathogens. Twenty mice were divided into four groups. Wounds were created in all mice under anesthesia by excision from the dorsal skin down to the subcutaneous fat and inoculating with S. aureus. After 24 h, the wound of each mouse was treated once daily by application of the respective cream. Group I was treated with mupirocin antibacterial cream; Group II received a cream base containing no active ingredient; Groups III and IV were treated with 2.5% and 5.0% concentrations of P. betle cream, respectively. Further, an in vitro study was performed by adding undiluted, 1:50 and 1:100 dilutions of the four studied creams in normal saline containing 1.5 × 108 CFU/mL of the following bacteria: antimicrobial-susceptible S. aureus, Escherichia coli, Pseudomonas aeruginosa, methicillin-resistant S. aureus, extended-spectrum β-lactamase-producing Escherichia coli, vancomycin-resistant Enterococcus, metallo-βlactamase-producing P. aeruginosa and carbapenem-resistant Klebsiella pneumoniae. The mice in Groups III and IV had significantly faster wound contraction and significantly shorter reepithelialization time than Group II (p < 0.05), which were not significantly different from Group I (p > 0.05). P. betle creams inhibited all studied bacterial strains at full concentration and at a dilution of 1:50. The inhibitory effect was more significant than Groups I and II (p < 0.05), except on S. aureus. Specifically, S. aureus inhibition was not significantly different for Groups III and IV (p > 0.05) when compared with Group I. Cream formulations derived from P. betle ethanolic extract have great potential as antimicrobial agents for the treatment of wound infection. Further clinical tests are recommended to determine the safety and efficacy of these formulations in other mammalian species.
ABSTRACT
@#Aim: Multiple drug resistant bacteria are serious health problems worldwide, with carbapenem resistant and extended spectrum-β-lactamase (ESBL) producing Enterobacteriaceae classified by Centers for Disease Control and Prevention under the category of “Urgent Threats” and “Serious Threats”, respectively. The study characterized Escherichia coli from Oreochromis niloticus procured from two wet markets in Metro Manila in January and September 2016 for their drug resistance. Methodology and results: Antimicrobial susceptibility profiles were determined using standard disc diffusion method. Extended-spectrum β-lactamase production was confirmed using clavulanate double disc synergy assay, carbapenemase production was tested using modified Hodge test, and MBL (metallo-β-lactamase) production was tested using EDTA double disc synergy assay. Results show that of the 25 isolated E. coli, 24 or 96% were resistant to at least one antimicrobial, with 60% being multiple drug resistant. These strains exhibited 20 different resistance phenotypes, suggesting these were different strains. Fifteen of the isolates (60%) screened positive for ESBL. Among these, 11 lost their resistance, indicating the instability of the resistance genes in the host, a characteristic of plasmidmediated ESBL production. The ESBL suspects tested were confirmed to be ESBL producers. A high 48% of isolates were found to be resistant to carbapenems, with eight of the 11 tested (73%) being positive for carbapenemase production. MBL positive isolates carried the blaIMP gene as determined by multiplex PCR and nucleotide sequencing. Conclusion, significance and impact of study: Study showed a high prevalence of multiple drug resistant E. coli isolates from the commonly-consumed Tilapia procured from the wet markets. This result is compounded by the alarmingly high prevalence of carbapenem resistant and ESBL-producing strains among these isolates. Considering that the genes coding for these resistances are found in mobile genetic elements such as plasmids and integrons that can be transferred to other bacteria resulting to a rapid increase in drug resistant strains, it is highly imperative for all the concerned government units to establish a well-coordinated national surveillance program to monitor and address the occurrence and increase in drug resistant microorganisms in man, animals and the environment. In addition, prudent use of antimicrobials among these should be seriously instituted.
ABSTRACT
Clinical pharmacists performed pharmaceutical care for one case of patient with multiple drug-resistant pseudomonas aeruginosa sepsis, assisted doctors in formulating anti-infective drug treatment plans and adjusted the regimen according to the results of bacterial culture and drug susceptibility combined with renal function of the patient. The participation of clinical pharmacists in clinical treatment practice ensured the safety and effectiveness of the patient's medication, avoided the occurrence of adverse drug reactions, and finally controlled the infection and improved the condition.
ABSTRACT
Objective • To analyze the bacterial origin and characteristics, and their influence on the process and prognosis in moderately severe acute pancreatitis (MSAP) and severe acute pancreatitis (SAP) patients with pancreatic/peri-pancreatic infections due to multiple drug resistant (MDR) Gram-negative bacteria (GNB). Methods • Patients of pancreatitis hospitalized in the Departments of Emergency, Pancreatic Surgery and Critical Care Medicine were enrolled in this study. The patients with pancreatic/peri-pancreatic GNB infections were screened and divided into MDR-GNB group and non-MDR-GNB group. The basic clinical features, the source of resistant bacteria, the progress of the disease and the prognosis were analyzed and compared within two groups. Results • 92(46.70%) out of 197 MSAP and SAP patients were confirmed as GNB infected, 61 cases (66.30%) with MDR strains and 31 cases (33.70%) with non-MDR strains. 117 GNB were isolated. The main MDR strains were Klebsiella pneumoniae (KP) (39/69) and Acinetobacter Baumannii (AB) (22/69). The incidence of percutaneous catheter drainage (PCD) associated MDR bacterial infections in MDR-GNB group was significantly higher than that of non-MDR-GNB group (36.07% vs 12.90%, P=0.020). The MDR-GNB infections could lead to prolonged mechanical ventilation[ (17.65±11.74) d vs (9.67±9.34) d, P=0.001], increased use of carbapenems and special antibiotics (P=0.000), earlier intervention of first laparotomy [(21.92±11.45) d vs (29.36±21.48) d, P=0.032], increased incidence of multiple operations (45.90% vs 22.58%, P=0.029), prolonged total hospitalization [(54.44±42.38) d vs (32.51±27.62) d, P=0.011] and higher mortality (34.43% vs 12.90%, P=0.028). The incidence of MDR-KP infections in death patients was significantly higher than that in the surviving patients (85.71% vs 52.50%, P=0.000), while the other MDR bacteria did not present statistical difference in the two groups. Conclusion • MDR-KP and MDR-AB are the main resistant GNB in MSAP and SAP patients with pancreatic/peri-pancreatic infections. The PCD associated infection is the main source of nosocomial MDR bacterial infections. Infections due to MDR-GNB could lead to prolonged therapy course, increased use of antibiotics, augmented operation, and poor outcome. The infection of MDR-KP is directly related to poor outcome.
ABSTRACT
Objective:To share a drug treatment experience for multiple drug resistant Pseudomonas aeruginosa.Methods:A retrospective analysis of the pharmaceutical care participated by clinical pharmacist for one case of intervertebral space infection with multiple drug resistant Pseudomonas aeruginosa was carried out.Results:Pharmacists participated in the whole treatment process,made the combined antimicrobial regimen (fosfomycin + ceftazidime + ciprofloxacin),and adjusted the time sequence.As a result,satisfactory curative effect was obtained.Conclusion:The infection with multiple drug resistant Pseudomonas aeruginosa may be treated with the three-drug therapy.Clinical pharmacists can play a positive role in the treatment of complicated infections.
ABSTRACT
PURPOSE: The purpose of this study was to identify factors influencing performance of MultiDrug-Resistant Organisms (MDROs) infection control by nurses in general hospitals. METHODS: The research design was a descriptive survey design using convenience sampling. Data were collected from 130 nurses working in 6 general hospitals. Collected data were analyzed using SPSS/WIN 21.0 program for descriptive statistics, t-test, ANOVA, Pearson correlation coefficients and multiple regression analysis. RESULTS: General hospital nurses' MDROs infection control performance was influenced by their awareness of environmental safety, recognition of MDROs infection control, number of beds in the hospital, whether nurses had nursing experience with infection control and guidelines for MDROs infection control. The most important predictors of MDROs infection control performance were awareness of environmental safety and recognition of MDROs infection control. CONCLUSION: Findings indicate that it is necessary to include content related to awareness of environmental safety and recognition of infection control in developing MDROs infection control education programs for general hospital nurses.
Subject(s)
Education , Hospitals, General , Infection Control , Nursing , Research DesignABSTRACT
Objective To explore the efficacy of tigecycline combined with cefoperazone/sulbactam in the treatment of infections due to multiple drug resistant strains and pandrug-resistant acinetobacter baumannii, so as to guide the reasonable clinical medication.Methods A total of 16 cases of ventilator associated pneumonia caused by multiple drug resistant strains and pandrug-resistant acinetobacter baumannii treated in the First Hospital of Shijiazhuang from November 2012 to November 2014 were retrospectively analyzed, and the severity of the infection, clinical efficacy and mortality were observed.Results The multiple drug resistant strains and pandrugresistant acinetobacter baumannii were frequently detected in the 16 patients.Fifteen cases had been used other antibiotics before tigecycline, such as imipenem, cefoperazone/Shubatan, minocycline etc.The severity of underlying disease was assessed with the acute physiology and chronic health score(APACHE Ⅱ sore) within 24 h of admission, on the first day of tigecycline (TGC) therapy and after 7 days of TGC therapy.It showed that the average APACHE Ⅱ score were (25±6.0), (24.2±6.4) and (17.8±6.6) within 24 hours of admission(P＜0.01), on the first day of TGC therapy and after 7 days of TGC therapy.Thirty days after application of the TGC, the bacterial eradication rate was 56.25％ (9/16).The effective rate was 87.5％ (14/16).The failure rate was 12.5％ (2/16).Conclusion The effect of the tigecycline combined with cefoperazone/sulbactam on the clearance of the multiple drug resistant strains and pandrug-resistant acinetobacter baumanniiis is satisfied.
ABSTRACT
Objective To analyze risk factors of multiple drug-resistant infections in neonatal intensive care unit (NICU). Methods The clinical data from 284 hospitalized pediatric patients were retrospectively analyzed from June 2011 to July 2015 . The differences between 59 cases with multiple drug-resistant infections and 225 cases with non-multiple drug-resistant infections were compared and analyzed by logistic regression. Results All of 284 cases were single birth. Fifty-nine cases ( 13 . 13 ± 9 . 03 days old) had multiple drug-resistant infections, in which 42 were males and 17 were females. Two hundred and twenty-ifve cases ( 14 . 21 ± 8 . 34 days old) had non-multiple drug-resistant infections, in which 175 cases of males and 50 cases of females. Single factor analysis showed that 8 factors, including gestational age, birth weight, days in hospital, Apgar score at birth, mechanical ventilation, parenteral nutrition, and the categories and duration of use of antimicrobial agents, were the risk factors of multiple drug-resistant infections (P?
ABSTRACT
Objective To investigate the distribution and antimicrobial resistance profile of clinical gram-negative bacterial isolates in the First Afifliated Hospital of Nanjing Medical University during 2014.Methods Bacteria identiifcation was performed by API system or the VITEK-2 Compact automatic identiifcation system. Disk diffusion susceptibility testing or VITEK-2 Compact automatic identification system was used to determine the susceptibility to antimicrobial agents. All data were analyzed using WHONET 5.6 software.Results Among the total 7 931 clinical isolates in 2014, gram-negative bacteria accounted for 64.2% (5 088/7 931). The top three pathogens wereE. coli,A. baumannii andK. pneumoniae. Notably, during the year 2014, 195 strains of carbapenem-resistantEnterobacteriaceaewere isolated, about 6.9% of all theEnterobacteriaceae isolates. Meanwhile, 613 (66.5%) strains of multiple drug resistantA. baumannii and 197 (28.7%) strains of multiple drug resistantP. aeruginosa were isolated.Conclusion During the year 2014, the resistance of the gram-negative bacteria in this hospital is mainly characterized by carbapenem-resistantEnterobacteriaceae, multiple drug resistant A. baumanniiand multiple drug resistantP. aeruginosa. Surveillance of antimicrobial resistance is beneifcial for rational use of antibiotics.
ABSTRACT
Ojective To determine the risk factors and the clinical distribution of multiple drug resistant bacteria in stroke- associated pneumonia (SAP) patients with multiple drug-resistant bacterial infections from in-tensive care unit, providing guidance for clinical treatment of SAP. Methods A retrospective study was de-signed to analyze the clinical data of the SAP patients from January 2012 to December 2015. Univariate analysis and multivariable regression analysis were taken for risk factors of MDR infections , and investigated the distribu-tion and drug resistance of MDR. Results There were 183 SAP patients, of which 131patients (71.6%) had MDR infection. There are 193 MDR strains in the 131 patients , the first 5 MDR strains were Acinetobacter bau-mannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, Staphylococcus aureus and Escherichia coli. MDR in-fection is highly associated with sever unconsciousness , time of stay in ICU longer than 7 days , ventilator time longer than 7 days and late-onset pneumonia and the difference was significant (P < 0.05). Conclusion SAP patients with MDR bacterial infections are in association with the following risk factors: sever unconsciousness , time of stay in ICU longer than 7 days, ventilator time longer than 7 days and late-onset pneumonia. The rate of MDR bacterial infections was high , and these MDR strains were widely different degrees of resistance to many antibiotics.
ABSTRACT
Objective To learn drug resistance of bacteria isolated from a hospital of Chengdu from 2012 to 2013 .Methods From 2012 to 2013 ,39 732 clinical specimens were collected ,ATB Express half‐automatic bacteria identification system were used to identify the bacteria ,and paper diffusion(K‐B) method was used to do drug sensitive test ,results were judged according to Clini‐cal and Laboratory Standards Institute 2012 standard interpretation ,Whonet5 .6 was used to do statistical analysis .Results In the bacteria isolated from this hospital in 2012 and 2013 ,gram‐positive bacteria accounted for 27 .7% and 37 .4% respectively ,gram negative bacteria accounted for 72 .3% and 62 .6% .The top five pathogenic bacteria were E .coli(16 .3% ,20 .3% ) ,Pseudomonas aeruginosa(11 .5% ,11 .7% ) ,Staphylococcus aureus (11 .3% ,11 .4% ) ,Acinetobacter baumannii(10 .6% ,9 .3% ) ,Klebsiella pneu‐moniae(14 .7% ,12 .0% ) .The detection rates of Methicillin‐Resistant Staphylococcus(MRSA) were 56 .2% ,47 .7% .The positive rates of producing extended spectrum βlactamases(ESBLs) of E .coli and Klebsiella pneumonia accounted for 41 .0% ,32 .2% and 21 .0% ,10 .8% ,which were high sensitive to carbon penicillium alkene antibiotics and amikacin .Susceptibility monitoring results showed that the drug resistance of Acinetobacter baumannii was rising ,and the drug resistant of Pseudomonas aeruginosa to most antibiotic were decline .Conclusion The top five bacteria isolated from this hospital in 2012 and 2013 are given priority to gram‐negative bacteria ,in addition to the drug resistant trend of Acinetobacter baumannii increased slightly ,the drug resistant of other four common bacteria were decline .Clinical attention should focus on positive ESBLs ,E .coli ,Klebsiella pneumoniae ,MRSA and M ulti‐resistant bacteria .
ABSTRACT
Children with hematological diseases usually accompanied by low autoimmune function,and repeated chemotherapy exacerbated the damage to their immune system and hematopoietic function.Those lead to high incidence of nosocomial infection,most of infection were caused by multi-drug resistant bacteria and fungi.The major infections in hematological children are the following:multi-drug resistant Escherichia coli/Klebsiella pneumonia bacteria;multi-drug resistance Pseudomonas and Acinetobacte;Methicillin-resistant coagulase negative Staphylococcus and aureus;multi-drug resistance Enterococcus faecium.This review presents updated treatment strategies from the published clinical literature and provides recommendations for clinical treatment of multi-drug resistant bacteria in children with hematonosis.
ABSTRACT
INTRODUCTION: Sepsis is always a serious, life-threatening condition, with high mortality rate varying from 30-50% (40-70% in septic shock) in the developed countries, and in developing countries as well. Antibiotic resistance is an important factor in sepsis management. GOAL: To evaluate the resistance patterns of microorganisms, to analyze the correlation between outcome of sepsis patient and multidrug resistant bacterial infection. MATERIALS AND METHODS: This study was designed as a prospective observational study and conducted in a nine bed multidisciplinary intensive care unit (ICU) of a tertiary teaching hospital in Ulaanbaatar, during January 2011 - August 2012. The ICU treatment outcome and length of stay were compared between the patient groups which infected by resistant and non-resistant bacteria. RESULTS: The positive rate of extensively resistant (XDR) and multi drug resistant bacteria by culture test were 22% and 25.1%, respectively. Fifty one percent of sepsis patients were infected by one or more resistant bacteria. Bacteria with an exceptionally high rate of antibiotic resistance (≥60%) were Acinetobacter baumannii, Enterobacter spp and coagulase-negative Staphylococci. Sepsis patients who were infected with resistant bacteria received more mechanical ventilation, renal replacement therapy and suffered from multiple organ dysfunctions when compared to sepsis patients with nonresistant bacterial infection. The length of stay in the ICU was longer in sepsis patients with resistant bacteria but the mortality rate in the ICU did not significantly differ between groups. However, a higher fatality rate was noted in sepsis patients infected with resistant bacteria. In conclusion, resistant bacteria were detected in up to 50% of microbiological samples from critically ill sepsis patients in the ICU of a tertiary teaching hospital in Ulaanbaatar. Antibiotic resistance appears to be a relevant problem of sepsis management in a Mongolian ICU setting.
ABSTRACT
Objective To study the clinical distribution and detection of the efflux pump gene in multiple drug-re?sistant acinetobacter baumannii. Methods The clinical distribution of 96 strains of multiple drug-resistant acinetobacter baumannii was analyzed. K-B method was used to detect 96 strains of multi resistant bauman resisted to 15 kinds of antibiot?ics. PCR amplification was used to detect the efflux pump gene. Results Ninety-six strains of multiple drug-resistant aci?netobacter baumannii mainly distributed in intensive care unit (ICU, 54.2%) and respiratory department (18.8%). The drug resistance rates to quinolone, cephalosporins, amino glucoside, tetracycline were above 70%. The 52 strains of multiple drug-resistant acinetobacter baumannii detected in ICU included 18 strains of adeB (34.62%), 16 strains of adeR (30.77%), 18 strains of adeS (34.62%), 18 strains of adeJ (34.62%), 0 strain of adeE and18 strains of adeM (34.62%). The18 strains of multiple drug-resistant acinetobacter baumannii detected in respiratory department included 9 strains of adeB, 8 strains of adeR, 8 strains of adeS, 8 strains of adeJ, 0 strain of adeE and 8 strains of adeM. Conclusion Efflux pump genes are impor?tant factors for multiple drug-resistant acinetobacter baumannii distributed in ICU and respiratory department.
ABSTRACT
Objective: To analyze the condition of infections caused by MDROs and effect of hospital infection monitoring measures. Methods: Patients with MDROs positive from July 2009 to December 2012were prospectively studied and given Bundle monitoring measures, patients with MDROs positive from January 2006 to June 2012 were retrospectively studied, the condition of hospital acquired infections caused by MDROs and the value of hospital infection monitoring measures were analyzed. Results:(1)the total cases of MDROs infection were 1782, including 839 cases of hospital infection and 944 cases of community infection, separately accounted for 47.08% and 52.92%; the incidence of ESBLs-ECO and MRSA were highest, separately 30.04%,39.09%;(2)after monitoring measures, the incidence of MDROs in surgery department(x2=15.273, P=0.001), internal medicine department(x2=7.532, P=0.021), gynaecology(x2=11.842, P=0.008) and obstetrics department(x2=10.842, P=0.010), paediatrics department(x2=8.834, P=0.017) were lower than those of before monitoring measures;(3)the incidence of hospital acquired infections caused by MDROs were negatively correlated with effective monitoring measures and positively correlated with ommunity infection. Conclusion:Bundle monitoring measures can contribute to the control of hospital acquired infections caused by MDROs.
ABSTRACT
@#BACKGROUND: The virulent factors ofEscherichia coli (E.coli) play an important role in the process of pathopoiesis. The study aimed to compare drug-resistant genes and virulence genes between extended spectrum β-lactamases (ESBLs)-producingE.coli and non-ESBLs-producing E.coli to provide a reference for physicians in management of hospital infection. METHODS: From October 2010 to August 2011, 96 drug-resistant strains ofE.coli isolated were colected from the specimens in Qingdao Municipal Hospital, Qingdao, China. These bacteria strains were divided into a ESBLs-producing group and a non-ESBLs-producing group. Drug sensitivity tests were performed using the Kirby-Bauer (K-B) method. Disinfectant gene, qacEΔ1-sull and 8 virulence genes (CNF2, hlyA, eaeA, VT1, est, bfpA, elt, and CNF1) were tested by polymerase chain reaction (PCR). RESULTS: Among the 96E.coli isolates, the ESBLs-producingE.coli comprised 46 (47.9％) strains and the non-ESBLs-producingE.coli consisted of 50 (52.1％) strains. The detection rates of multiple drug-resistant strain, qacEΔ1-sull, CNF2, hlyA, eaeA,VT1, est, bfpA, elt, and CNF1 in 46 ESBLs-producingE.coli isolates were 89.1％, 76.1％, 6.5％, 69.6％, 69.6％, 89.1％, 10.9％, 26.1％, 8.7％, and 19.6％, respectively. In the non-ESBLs-producingE.coli strains, the positive rates of multiple drug-resistant strain, qacEΔ1-sull, CNF2, hlyA, eaeA, VT1, est, bfpA, elt, and CNF1 were 62.0％, 80.0％, 16.0％, 28.0％, 64.0％, 38.0％, 6.0％, 34.0％, 10.0％, and 24.0％, respectively. The difference in the detection rates of multiple drug-resistant strain, hlyA and VT1 between the ESBLs-producingE.coli strains and the non-ESBLs-producingE.coli strains was statistically significant (P<0.05). CONCLUSION: The positive rate of multiple drug-resistant strains is higher in the ESBLs-producing strains than in the non-ESBLs-producing strains. The expression of some virulence genes hlyA and VT1 varies between the ESBLs-producing strains and the non-ESBLs-producing strains. Increased awareness of clinicians and enhanced testing by laboratories are required to reduce treatment failures and prevent the spread of multiple drug-resistant strains.
ABSTRACT
OBJECTIVE:To observe the therapeutic effect of combined use of capreomycin in treating multiple-drug-resistant tuberculosis.METHODS:After 268 patients with multiple-drug-resistant tuberculosis had underwent intensive treatment with levofloxacin,pyrazinamide,pasiniazid,protioamide and capreomycin for 3 months,they underwent another 9 months of strengthened treatment with levofloxacin,pasiniazid,and rotioamide.RESULTS:The negative rate determined in sputum test for tuberculosis bacteria was up to 78.36%,and the closing rate of the cavity was up to 37.76%.CONCLUSION:The therapeutic effect for treatment of multiple-drug-resistant tuberculosis can be improved by carrying out the principle of whole range direct monitoring of chemotherapy and using capreomycin in combination with other drugs to increase the sensitivity to mycobacterium tuberculosis.