Bacteriologic profile, antibiotics resistance pattern, and outcomes of patients admitted to Lancet General Hospital from June 2022 to June 2023: A retrospective cohort study

Background Prior studies indicated increased antimicrobial resistance in Ethiopia, with related health, economic, and environmental costs. Knowing an institutions and population microbiologic profile allows for proper antibi-otic treatment, which substantially impact patients' outcomes such as healthcare related costs, morbidity, and mortality. The current study assessed the bacteriologic profile, resistance pattern, and treatment outcome in Lancet General Hospital. Method A retrospective cohort study on the bacteriologic profile, antibiotics resistance pattern, and outcome of patients was done on 128 eligible patients who were admitted to Lancet General Hospital from June 2022 to June 2023. Data from all hospitalized patients with culture-confirmed infection were analyzed. SPSS version 26.0 was used to analyze the data. Association between independent and dependent variables was analyzed using binary logistic regression model. Results Gram-negative bacteria were recovered in 77% of the cases. Extended-spectrum beta-lactamase producing Enterobacteriaceae was found in 37.5% (54) isolates and carbapenem resistant bacteria were identified in 27.8% of patients. In-hospital mortality from multidrug resistant bacterial infection was 14.8%. Age ≥ 65 years, presence of septic shock, and presence of carbapenem-resistant bacteria were independently associated with in-creased in-hospital mortality. Conclusion High number of resistant microorganisms was isolated, and increased mortality was documented from infections caused by carbapenem-resistant bacteria. Multi-center studies should be done to determine the extent of resistant organisms in health facilities throughout the country. epidemiology, and the findings should be factored into clinical decision making and program design for disease prevention, screening, and treatment. It also calls for further prospective research to learn more about the conditions in the context of additional relevant personal and clinical characteristics

Extended-Spectrum Beta-lactamase and Metallo-beta-lactamase Production among Escherichia coli and Klebsiella pneumoniae Strains from Urine of Pregnant Women in Afikpo, Ebonyi State, Nigeria

Aim: The aim of this study was to determine the occurrence of Extended-spectrum beta-lactamase (ESBL) and Metallo-beta-lactamase (MBL) among Escherichia coli and Klebsiella pneumoniae strains from pregnant women attending Mater Misericordia Hospital Afikpo, Ebonyi state, Nigeria. Study Design: This is a laboratory based prospective study carried out on pregnant women suspected of having urinary tract infection and was requested to undergo diagnosis at microbiology laboratory of the hospital. Place and Duration of Study: The study was conducted in the Department of Science Laboratory Technology, Akanu Ibiam Federal Polytechnic, Unwana, Afikpo, Ebonyi State, Nigeria from October, 2022 to January, 2023. Methodology: Clean-catch midstream urine samples were collected from 206 pregnant women suspected of having urinary tract infection and were requested to undergo medical diagnosis at microbiology laboratory of the hospital. The urine samples were processed following standard microbiological procedure. Antimicrobial susceptibility testing was determined using the disc diffusion method, while ESBL phenotypes were determine by the Double-Disc Synergy Test (DDST). Disc potentiation test was performed to check for MBL production. Results: Out of the 206 urine samples processed, 24 (11.7 %) E. coli and 12 (5.8 %) K. pneumoniae were isolated. The antimicrobial susceptibility of the isolates recorded a 100 % resistance with Amoxicillin/Clavulanic acid and Cotrimoxazole. The Gram-negative isolates showed a high sensitivity of 100 % to Netilmicin, Meropenem and Ofloxacin. Overall, 35 (97.2 %) multidrug resistance (MDR) was observed of the bacteria isolates. A total of 9 (37.5 %) E. coli and 4 (33.3 %) K. pneumoniae was found positive for ESBL production whereas, 5 (20.8 %) E. coli and 2 (16.7 %) K. pneumoniae were MBL positive. Conclusion: The level of drug resistance in this study underscores the need for regular surveillance for effective management of urinary tract infection in pregnancy.

Risk factors for extended-spectrum beta-lactamase- and carbapenem- resistant Enterobacteriaceae in patients with urinary tract infection from a tertiary care hospital

Background: Urinary tract infection (UTI) is a common health problem in both community and nosocomial settings. However, the predisposing factors which are responsible for production of extended spectrum beta-lactamase (ESBL) and carbapenem-resistant Enterobacteriaceae makes the treatment option narrow and cause multidrug resistance. Aim and Objectives: This study demonstrate various risk factors associated with multidrug resistance in Enterobacteriaceae from UTI at tertiary care center in Gujarat. Material and Methods: A retrospective observational study was conducted at a tertiary-care hospital. Urine samples were received from various departments and outpatient department (OPD). Organisms from Enterobacteriaceae group were isolated and identified by various biochemical methods. ESBL and Carbapenemase producing organisms were then processed for Antibiotic susceptibility test as per CLSI guideline. Results: A total of 196 Enterobacteriaceae organisms were isolated from processed urine samples of tertiary care Hospitals. The most prevalent in people aged 45–65 years (36%) followed by those aged 17–30 (22%) years. UTI due to ESBL and Carbapenemase producer are more isolated in female (28%, 11%) as compare to male (16%, 6%). Indoor patients had higher prevalence of ESBL (29%) and carbapenemases (10%) isolation compare to OPD patient (ESBL-15%, Carbapenemases-7%) and among them most common ward was medicine department. The most common predisposing factor was catheterization followed by diabetes mellitus and obstructive uropathy. Conclusion: High prevalence of ESBL and Carbapenemase producing Enterobacteriaceae is found in Indoor patients than OPD patients. Most of these patients are from Medicine department. Catheterization is the most common risk factor associated with ESBL and carbapenemase producing organism.

Detection and correlation of antimicrobial resistance pattern in Enterobacteriaceae from UTI patients in GMERS Medical College, Gujarat

Background: Bacterial resistance to antibiotics is a growing public health threat worldwide. The increasing rate of antimicrobial resistance among bacterial pathogens causing both hospital- and community-acquired infections is a serious threat to public health world-wide. This inappropriate and non-judicious usage of antibiotics has resulted in the development of worldwide antibiotic resistance in bacteria, leading to the emergence of multi-resistant strains of bacterial pathogens. This study focuses on the prevalence of antibiotic resistance in the Enterobacteriaceae group of organisms in urine samples and also detects various methods of antibiotic resistance. Antibiotic resistance detection may be useful for epidemiological and research purposes, as well as for preventing the spread of drug-resistant organisms within hospitals through good infection control practices. Aims and Objectives: The aim of the study was to detect occurrence of ?-lactamases, extended-spectrum beta-lactamases (ESBL) and Carbapenemase by phenotypic methods in Enterobacteriaceae from urine samples along with pattern of antibiotic resistance for various antibiotics in them. Materials and Methods: A descriptive study was conducted at a tertiary-care hospital. Testing of ESBL and carbapenemase production detection done according to CLSI (M100) guideline by the Kirby-Bauer disk diffusion method, combination disc diffusion test, and modified Carbapenem inactivation method. Results: A total of 220 Enterobacteriaceae organisms were isolated from processed urine samples of tertiary care Hospitals. Rate of cephalosporin resistance in ESBL and carbapenem-resistant Enterobacteriaceae (CRE) is more than 90% while in non-ESBL more than 70% and in non-CRE 75–80%. Carbapenem resistance in ESBL and non-ESBL is the same. Resistance to fluoroquinolone group, Aminoglycoside group, and Cotrimoxazole and Tetracycline group of antibiotics were more noticed in ESBL and carbapenemase producing organisms. In our study, fosfomycin and Nitrofurantoin are effective treatment in case of ESBL and CRE producing organism. Conclusion: The ESBL and Carbapenemase producing isolates were multi-drug resistant making therapeutic choices limited. Fosfomycin and Nitrofurantoin are effective treatment in multidrug resistance urinary tract infection.

Characterization of third generation cephalosporin-resistant Escherichia coli clinical isolates from Ushuaia, Argentina / Caracterización de aislamientos clínicos de Escherichia coli resistente a cefalosporinas de tercera generación de Ushuaia, Argentina

Abstract Escherichia coli is one of the main human pathogens causing different hospital- and community-acquired infections. During the period from January 2013 to March 2015, 1.96% (32/1632) of E. coli isolates recovered at the Hospital Regional de Ushuaia, Tierra del Fuego province, were resistant to third-generation cephalosporins (TGCs). These isolates were resistant to cefotaxime (91%) and/or ceftazidime (28%). No resistance to carbapenems was detected. Twenty-six isolates were positive for blaCTX-M gene, grouped as CTX-M-1/15 (54%); CTX-M-9/14 (25%); CTX-M-2 (17%); and CTX-M-1/15 plus CTX-M-9/14 (4%). Five TGC-resistant strains were positive for blaCMY gene, while one strain harbored TEM-19 ESBL. Twelve isolates were identified as ST131 E. coli hyperepidemic clone, and one as ST69. Genome sequence analysis of seven blaCTX-M-15 E. coli selected isolates confirm the circulation of ST131, ST617 and ST405 international high-risk clones in the city of Ushuaia.

Resumen Escherichia coli es uno de los principales patógenos humanos causantes de diferentes infecciones de inicio hospitalario y comunitario. Se determinó que el 1,96% (32/1.632) de los aislamientos de E. coli recuperados entre enero de 2013 y marzo de 2015 en el Hospital Regional de Ushuaia, provincia de Tierra del Fuego, fueron resistentes a cefalosporinas de tercera generación (CTG). Estos aislamientos fueron resistentes a cefotaxima (91%) y/o a ceftazidima (28%). No se detectó resistencia a los carbapenemes. Veintiséis aislamientos fueron positivos para el gen blaCTX-M, agrupados como CTX-M-1/15 (54%), CTX-M-9/14 (25%), CTX-M-2 (17%) y CTX-M-1/15 más CTX-M-9/14 (4%). Cinco cepas resistentes a CTG dieron positivo para el gen blaCMY, mientras que un aislamiento presentó la BLEE TEM-19. Doce aislamientos se identificaron como clon hiperepidémico E. coli ST131 y uno como ST69. El análisis de las secuencias del genoma de siete aislamientos seleccionados de E. coli blaCTX-M-15 confirmó la circulación de los clones internacionales de alto riesgo ST131, ST617 y ST405 en la ciudad de Ushuaia.

Impacto de infecciones y enterobacterias productoras de betalactamasa de espectro extendido en la supervivencia del injerto y del paciente en un programa de trasplante renal en México / Impact of infections and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae on graft and patient survival in a kidney transplantation program in Mexico

Resumen Introducción: Los tratamientos inmunosupresores han mejorado las tasas de supervivencia del injerto y del paciente, pero pueden incrementar las infecciones postrasplante. Objetivos: Analizar los datos de pacientes con trasplante renal y describir las bacterias responsables de las infecciones que presentan. Métodos: Estudio observacional, longitudinal y analítico de 103 pacientes sometidos a trasplante renal. El periodo de seguimiento fue de 5.07 ± 1.28 años. Resultados: La tasa de mortalidad fue de 10.68 % y la de pérdida del injerto de 14.56 %. Respecto al riesgo de muerte del receptor, el modelo de regresión de Cox mostró un cociente de riesgo (HR, hazard ratio) de 5.66 en los pacientes con cultivo bacteriano positivo y de 2.22 en aquellos con cepas productoras de betalactamasas de espectro extendido (BLEE); en cuanto a la pérdida del injerto, el HR fue de 4.59 en quienes tuvieron cultivo bacteriano positivo y de 4.25 en aquellos con cepas productoras de BLEE. Conclusiones: Se encontró riesgo significativo de muerte en receptores de trasplante renal con cultivo bacteriano positivo y mayor riesgo de pérdida del injerto en aquellos con cultivo bacteriano positivo y aislamiento de cepas productoras de BLEE. La tasa de enterobacterias productoras de BLEE es alta, por ello son necesarias estrategias más estrictas para controlar del uso de antibióticos.

Abstract Introduction: Immunosuppressive treatments have improved graft and patient survival rates, but can increase the incidence of post-transplant infections. Objectives: To analyze data from kidney transplant patients and describe the pathogens responsible for the infections they experience. Methods: Longitudinal, analytical, observational study of 103 patients who underwent kidney transplantation. The follow-up period was 5.07 ± 1.28 years. Results: Overall mortality rate was 10.68% and graft loss rate was 14.56%. Regarding recipient risk of death, the Cox regression model showed a hazard ratio (HR) of 5.66 for positive bacterial cultures and 2.22 for positive extended-spectrum beta-lactamase (ESBL)-producing strains; as for graft loss, HR was 4.59 in those with positive bacterial cultures and 4.25 in those who were positive for ESBL-producing strains Conclusions: Significant death risk was found in kidney transplant recipients with positive bacterial cultures and an increased risk of graft loss in those with positive bacterial cultures and in those who were positive for ESBL-producing Enterobacteriaceae isolates. The rate of ESBL-producing Enterobacteriaceae is high, and stricter strategies are therefore necessary to control the use of antibiotics.

Risk factors for ESBL-positive Escherichia coli urinary tract infections / Factores de riesgo para infección urinaria por Escherichia coli BLEE positiva

Abstract Objective: to determine the association of prior antibiotic use, prior hospitalizations, prior urinary tract infections, age, sex and comorbidities in adult patients hospitalized with urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. Materials and methods: a case-control study carried out in the hospital setting of private clinics in Lima. Thirty cases and 30 controls were included, with cases defined as hospitalized patients with an ESBL-producing E. coli urinary tract infection diagnosed by urine culture, and controls defined as hospitalized patients without ESBL-producing E. coli infection. Data were taken from incident cases. A bivariate analysis was performed followed by multivariate logistic regression using the significant variables from the bivariate analysis. Results: the associated factors were: prior antibiotic use OR: 261 (22.5-11,017.4), prior hospitalization OR: 4.6 (1.39-16.1), and prior urinary tract infection OR: 36 (6.9-227.2). After adjusting for potential confounding factors using logistic regression, the main statistically significant associated factor was prior antibiotic use, OR: 97.7 (8.4-1,128.3, p<0.000). Conclusion: evidence was found that prior antibiotic use is a risk factor significantly associated with ESBL E. coli urinary tract infections. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2131).

Resumen Objetivo: establecer la asociación del uso previo de antibióticos, hospitalizaciones previas, infección urinaria previa, edad, sexo y comorbilidades en pacientes adultos hospitalizados con infección urinaria por Escherichia coli productora de beta lactamasas de espectro extendido (BLEE). Material y métodos: estudio caso control, realizado en clínicas privadas de Lima en ámbito hospitalario. Se incluyeron 30 casos y 30 controles, definiéndose como caso al paciente hospitalizado que cuente con diagnóstico de infección urinaria por urocultivo de E. coli productora de BLEE y como control al paciente hospitalizado sin infección por E. coli BLEE. Se recolectó la información de casos incidentes. Se realizó un análisis bivariado y regresión logística multivariable con las variables que fueron significativas en el análisis bivariado. Resultados: los factores asociados fueron: uso previo de antibióticos OR: 261 (22.5-11017.4), hospitalización previa OR: 4.6 (1.39-16.1), infección urinaria previa OR: 36 (6.9-227.2). Al ajustar por variables potencialmente confusoras mediante regresión logística, se observó que el principal factor asociado con significación estadística fue el uso previo de antibióticos, OR: 97.7 (8.4-1128.3, p<0.000). Conclusión: se encontró evidencia de que el uso previo de antibióticos es un factor de riesgo asociado significativamente a infección urinaria por E. coli BLEE. (Acta Med Colomb 2022; 47. DOI:https://doi.org/10.36104/amc.2022.2131).

Extended Spectrum Beta Lactamase producing Gram negative bacteria - An emerging menace in Neonatal Sepsis.

Introduction: Neonatal sepsis caused by extended spectrum beta lactamase (ESBL) producing Gram negative bacteria (GNB) is associated with significantly high mortality and morbidity. Clinical features and risk factors for such neonatal sepsis can help in identifying it early. Objectives: Aim of the study was to estimate the incidence, risk factors, clinical features and antibiotic sensitivity of GNB and outcomes of ESBL GNB in neonatal sepsis. Methodology: A prospective observational conducted at regional tertiary care health center. Statistical analysis was carried out with SPSS version 23.0. Results: A total of 87 cases of Gram negative neonatal sepsis were included in study. Male: female was 1.7:1. Forty nine (56.3%) isolates were ESBL positive strains. The clinical features in order of frequency were shock, lethargy, sclerema, disseminated intravascular coagulation and severe thrombocytopenia. Out born neonates (p=0.03), late onset sepsis (p=0.05) and mechanical ventilation (p=0.002) were the risk factors for ESBL GNB sepsis. Mortality associated with ESBL sepsis was 26.5%. Carbapenems and Piperacillin + Tazobactum were most sensitive antibiotics and high resistant for cephalosporins was observed. Conclusion: ESBL GNB neonatal sepsis is an emerging threat with high mortality in Neonatal Intensive care unit.

Isolation and Molecular Characterization of Extended Spectrum Beta Lactamase Producing Escherichia coli from Milk

Milk plays a major role as a source of nutrition in the diet but contaminated milk can be a source of harmful bacteria. Escherichia coli is opportunistic pathogen and is responsible for a wide range of infections. The prevalence of pathogenic multi-drug resistant extended-spectrum β-lactamase (ESBL)-producing E. coli is increasing and becoming a global concern. A study was carried out to isolate ESBL producing E. coli from 150 milk samples from Anand and around villages. Total 94(62.66%) samples were found positive as E. coli by isolation on MacConkey and Eosin Methylene Blue agar which were confirmed by primary & biochemical tests including Gram’s staining. Antibiotic sensitivity test (ABST) was performed against 6 antibiotics and isolates found resistant to Aztrionem: 58(61%), Cefoxitin: 20(21%), Ceftriaxone: 56(59%), Ceftazidime: 62(65%), Cefpodoxime: 34(44.73%) & Ceftazidime + Clavulanic acid: 8(8.5%). A total 34(36.17%) ESBL producing E. coli were phenotypically confirmed by ABST and Epsilometer test. Genotypic confirmation of 34 isolates was done by PCR and isolates found positive for bla CTX M-3 gene: 18(52.94%), bla CTX M-9 gene 6(17.64%), bla SHV gene: 5(14.70%) and bla TEM gene: 5(14.70%). In summary, analyzed milk samples were found to have a health risk for consumers due to contamination by ESBL producing E. coli, their pathogenicity and treatment failure as a result of antibiotic resistance

Bacteriological study of post-operative wound infections with special reference to MRSA and ESBL in a tertiary care hospital

Background: Surgical site infections are known to be one of the most common causes of nosocomial infections worldwide and raises an important public health concern.Methods: A prospective observational study was conducted across 12 months (July 2018-June 2019) in a tertiary care hospital. The present study includes 50 pus samples from clinically suspected cases of post-operative wound infections from various surgical wards which were inoculated in Department of Microbiology. The phenotypic identification of different bacterial isolates especially MRSA and ESBL producers along with their antimicrobial susceptibility testing was interpreted according to CLSI guidelines.Results: Out of 50 samples, 44 showed positive culture. The infections were more common in emergency situations, age group of 20-30 years and in females. The most common bacterial isolates were Staphylococcus aureus (43.18%) followed by E. coli (22.72%), Klebsiella (15.9%), CONS (13.63%) and Pseudomonas (4.54%). Out of 19 Staphylococcus aureus 9 were MRSA and these gram-positive bacteria were highly sensitive to Linejolid and Clindamycin. In gram negative group 22.72% of E. coli and 15.9% of Klebsiella were ESBL producers who were susceptible mainly to Aztreonam, Linezolid or Cefoxitine.Conclusions: Post-operative wound or surgical site infections is the most important factor responsible for significant morbidity, mortality, prolonged hospitalization and additional cost to treatment in surgical patients. Marked resistance of isolates to commonly used antibiotics indicates the need of judicious use of these drugs to prevent the emergence of multi-drug resistant strains.

Biliary tract infections and their Microbiological Spectrum- A study from coastal region of Southern India / Infecciones de vías biliares y su espectro microbiologico- Un estudio en región de la costa del sur de la India

Objective: Biliary tract infections include cholangitis and cholecystitis. They are associated with high morbidity and mortality in elderly patients with co-morbid disease. The present study was undertaken to determine the microbial aetiology causing biliary tract infections and also to study their antimicrobial resistance profile. Materials & methods: A retrospective study was conducted from January 2011 to December 2016 at the Enteric Diseases Division, Kasturba Medical College Hospital, Manipal. Patients with biliary tract infections admitted in tertiary referral health care hospital, Manipal were included for the study. Aerobic and anaerobic bacteriological and fungal aetiology of biliary tract infections were recorded along with their antimicrobial resistance profile. Results: Out of 307 bile samples sent for aerobic culture and susceptibly testing 187 (60.91%) were positive for culture, of which Escherichia coli (44.4%) was the predominant aetiology followed by Klebsiella pneumoniae (27.3%). Among the 14 samples sent for anaerobic culture, 5 (35.75%) specimens showed growth, of which Bacteroides fragilis group was found to be the predominant anaerobe. Among the 201 bacterial pathogens tested for their antimicrobial susceptibility, 108 (53.73%) isolates were resistant, out of which 9 were PDR Enterobacteriaceae with 12 ESBL strains. All the Candida species were susceptible to fluconazole with the exception of C. glabrata and C. krusei. All the anaerobic isolates were found to be susceptible to Metronidazole. Conclusions: The high rate of bacterial infection particularly gram-negative bacteria was recorded. It is necessary that antimicrobial therapy be initiated when culture or the clinical conditions reports caution. Routine aerobic and anaerobic culturing of bile samples with biliary tract infections are imperatively necessary. With the emergence of multidrug resistant pathogens and change in the microbiological spectrum of biliary tract infections, there is a need for the empirical antimicrobial therapy in every clinical setting.

Objectivo: Las infecciones del tracto biliar incluyen colangitis y colecistitis. Se asocian a gran mortalidad y morbildiad en pacientes ancianos y con comorbilidad. El presente studio se hizo para detemrianr la etiologia microbiana que produce infecciones biliares y para estudiar su perfil de resistencia antimicrobiana. Materiales & metodos: Se hizo un studio retrospectivo entre los meses de Enero 2011 a Diciembre de 2016 en la "Enteric Diseases Division, Kasturba Medical College Hospital, Manipal" en India. Los pacientes con infección de vías biliares admitidos al centro de atención de tercer nivel se incluyeron en el estudio. Se buscaron bacterias aerobicas y anaerobicas y etiologia fungica y se analizó su perfil de resistencia antibiotica. Resultados: De 307 muestras de bilis enviadas para cultivo aerobico y antibiograma, 187 (60.91%) crecieron en el medio de cultivo, predominando Escherichia coli (44.4%) seguida por Klebsiella pneumoniae (27.3%). Entre las 14 muestras analizadas en medio anaerobio, 5 (35.75%) mostraron crecimiento de Bacteroides fragilis. Entre 201 bacterias probadas por antibiograma, 108 (53.73%) tuvieron perfil de resistencia, de los cuales 9 fueron PDR Enterobacteriaceae con 12 cepas ESBL. Todas las especies de Candida fueron susceptibles al fluconazol con la excepción de C. glabrata y C. krusei. Todos los aislados anaerobios fueron susceptibles al Metronidazol. Conclusiones: Se encontró una alta tasa de infección bacteriana con predominio de gram-negativos. Se hace necesario iniciar terapia antimicrobiana cuando lo sugieren las condiciones clínicas o el resultado del cultivo. El cultivo rutinario de bilis es imperioso. Dado el aumento de patógenos multirresistentes se requiere inicio empírico inmediato

In vitro screening of multidrug resistance uropathogenic Escherichia coli from the urban area of Namakkal district

The aim of the study is to screen the multiple drug resistance (MDR) Uropathogenic Escherichia coli (UPEC) fromthe urban area of Namakkal district. To detect UPEC resistant by using different antibiotics and to analyze the virulentcharacteristics of UPEC and amplification of extended-spectrum beta-lactamases genes by multiplex polymerasechain reaction. Total 450 samples individually collected from the urinary tract infection (UTI) patients’ and directstreaked on to the eosin methylene blue agar plates. Significant growth indicates E. coli. HiCrome UTI agar was usedfor rapid identification of uropathogenic E. coli. Out of 450 samples, only 62 isolates of E. coli were subjected tovirulence characteristics, such as slime production (34%), hemolytic activity (56%), and beta-lactamase production(43%). Antibiotic sensitivity test was performed with 13 different antibiotics. Among them, 62 isolates were E. coli,only five were resistant to 10 antibiotics, possess virulence characteristics. Four strains (E-12, E23, E-58, and E-97)have Temoneira, sulfhydryl variable, and cefotaxime hydrolyzing capabilities (CTX-M) antibiotic resistance genes,and E-07 have only CTX-M gene. As E. coli is the main infectious agent in patients with UTI and a potent pathogen,it was difficult to treat with routine antibiotics because day-by-day microbes are resisting to common drugs. Hence,they need alternative therapy

Inhibition of Carbapenem-Resistant NDM-1 Klebsiella pneumoniae isolated from a Hospital Outbreak Patient by a Synbiotic: A Nonantibiotic Treatment Option

Objective: Klebsiella (K.) pneumoniae is globally responsible for an alarming increase in hospital infections, especially in intensive care units (ICUs). The acquisition of resistance against a broad range of antibiotics has turned infections with this pathogen into a major worldwide healthcare concern. The aim of the study was to investigate if multistrain synbiotics can complement the current treatment options of multidrug-resistant K. pneumoniae infections. Methods: Antimicrobial susceptibility and PCR testing were used to characterize the K. pneumoniae causing a hospital outbreak. Effect of multistrain synbiotic administration on the presence of K. pneumoniae in an infected patient was investigated by microbiological testing for the pathogen. Effects of the synbiotic mixture and its individual probiotic bacteria on K. pneumoniae isolated from patients and of the K. pneumoniae subsp. pneumoniae ATCC© 700603TM reference strain were investigated by pathogen in-vitro inhibition experiments. Results: The outbreak K. pneumoniae strain was found to be resistant against a range of antibiotics including carbapenems, and to be a producer of New Delhi metallo-β-lactamase 1 (NDM-1). Treatment of a NDM-1 K. pneumoniae carrier with a multistrain synbiotic resulted in successful elimination of the pathogen from the patient. In-vitro inhibition experiments showed that the NDM-1 K. pneumoniae (and the reference strain K. pneumoniae subsp. pneumoniae, ATCC© 700603TM) could be effectively inhibited by the bacteria mixture of the synbiotic preparation. Conclusion: Findings of the study indicate for the first time that a multistrain synbiotic can add to the treatment repertoire available for the management of NDM-1 K. pneumoniae infections.

Contribution of acrB upregulation & OmpC/Ompk36 loss over the presence of blaNDM towards carbapenem resistance development among pathogenic Escherichia coli & Klebsiella spp.

Background & objectives: The global spread of carbapenem-resistant Enterobacteriaceae (CRE) is an emerging clinical problem. Hence, in this study, the plausible role of extended-spectrum beta-lactamases (ESBLs)/carbapenemases, OmpC/Ompk36, acrB and their combinations was explored among CRE. Methods: The minimum inhibitory concentration (MIC) of meropenem, enzyme-phenotypes (ESBLs/IR and metallo-beta-lactamase (MBL)/non-MBL carbapenemase), genotypes (blaTEM, blaSHV and blaCTX-M; blaNDM and blaVIM; blaKPC and blaOXA-48-like variants), acrB and outer membrane protein (OMP) expressions were analyzed with a total of 101 non-duplicate clinical isolates, obtained from various samples of patients visiting two tertiary care units of Eastern India during May 2013 - October 2016. This included Escherichia coli (n=36) and Klebsiella pneumoniae (n=65), categorized into two groups, namely Group I (resistant to all carbapenems; n=93; E. coli=34 and Klebsiella spp.=59) and Group II (non-resistant to all the carbapenems; n=8; E. coli=2 and Klebsiella spp.=6). Results: Though 88.17 per cent of Group I isolates exhibited ESBL property, the presence of carbapenemase activity (70.96%) and that of blaNDM gene (42/66: 63.63%) indicated their contributions towards the emergence of CRE. Further, porin loss and/or efflux pump activation among ESBL/carbapenemase-producing isolates heightened the MIC of meropenem from 64 to 256 mg/l (range exhibited by only ESBL/carbapenemase-producing isolates) to >256 mg/l. Interpretation & conclusions: These findings implied the major contribution of porin loss and/or efflux pump activation over the presence of ESBLs/carbapenemases in imparting carbapenem resistance in pathogenic bacteria.

Clinical Prediction Score for Community-Onset Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase-Producing Escherichia coli and Klebsiella Species

BACKGROUND: This study aimed to identify the predictors and build a prediction score for community-onset bloodstream infections (CO-BSIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli and Klebsiella species. METHODS: All CO-BSIs caused by E. coli and Klebsiella species from 2012 to 2015 were grouped into derivation (BSIs from 2012 to 2014) and validation (BSIs in 2015) cohorts. A prediction score was built using the coefficients of the multivariate logistic regression model from the derivation cohort. RESULTS: The study included 886 CO-BSIs (594 and 292 in the derivation and validation cohorts, respectively). The independent predictors of CO-BSIs caused by ESBL-producing E. coli and Klebsiella species included: 1) identification of ESBL-producing microorganisms from any clinical culture within one year of admission, 2) beta-lactam or fluoroquinolone treatment within 30 days (with 2 or more courses within 90 days; with 1 course within 90 days), 3) hospitalization within one year, 4) the presence of an indwelling urinary catheter at the time of admission. The area under the curve (AUC) of the clinical prediction score was 0.72 (95% confidence interval [CI], 0.68–0.77). In the validation cohort, the AUC was 0.70 (95% CI, 0.63–0.77). CONCLUSIONS: The results of this study suggest a simple and easy-to-use scoring system to predict CO-BSIs caused by ESBL-producing E. coli and Klebsiella species.

Molecular epidemiology and mechanisms of fosfomycin-resistant Escherichia coli producing extended-spectrum β-lactamases isolated from urine / 临床检验杂志

Objective@#To investigate the molecular epidemiology and mechanisms of fosfomycin-resistant Escherichia coli isolates producing extended-spectrum β-lactamases (ESBLs) isolated from urine. @*Methods@#Fosfomycin-resistant phenotypes were screened by drug susceptibility test in ESBLs-producing E.coli stains. The ESBLs gene and fosfomycin resistant gene were amplified by PCR. The molecular typing was analyzed by multiple sequence type (MLST). The transferability of the drug resistant gene was verified by conjugation assays. @*Results@#Among the 308 strains of E.coli isolated from urine, there were 168 (54.54%) ESBLs producing strains and 18 (10.71%, 18/168) fosfomycin resistant strains. In the drug resistant genes, the incidence of bla SHV was about 88.9% (16/18), bla CTX-M was 77.8% (14/18), bla TEM-208 was 5.6% (1/18), bla TEM-1b was 61.1% (11/18) and fosA3 was 83.3% (15/18). The main MLST genotype was ST131. The conjugation test confirmed the transferability of resistance in fosA3 positive strain. @*Conclusion@#The fosfomycin resistant rate of ESBLs producing E.coli in urethral infection was in a low level. The fosA3 gene was the main mechanism of fosomycin resistance and located on the conjugation plasmids, which should be the main node of horizontal gene transmission. We need to pay great attention to this resistant gene.

Carbapenem Resistance in Gram-negative Bacteria in South-western Nigeria: The Role of Extended-spectrum lactamase CTX-M-15 / Resistencia al carbapenem en las bacterias gramnegativas en Nigeria Suroccidental: papel de la betalactamasa de espectro extendido tipo CTX-M-15

ABSTRACT Objective: To determine the role of extended-spectrum β-lactamases in carbapenem-resistant Gram-negative bacteria from south-western Nigeria. Methods: Twenty-seven carbapenem-resistant isolates that were found to be non-carbapenemase producers (15 Escherichia coli, 9 Klebsiella pneumoniae and 3 Pseudomonas aeruginosa) were further studied. These isolates were subjected to analysis including phenotypic and genotypic detection of various β-lactamases, efflux activity, outer membrane protein, plasmids replicon typing, detection of transferable genes and resistances and typing using random amplified polymorphic DNA tests. Results: No isolates demonstrated de-repression of efflux, but all showed either complete loss or reduced production of outer membrane proteins. Transconjugants from these strains contained various genes including plasmid-mediated quinolone resistance and extended-spectrum beta-lactamases. All the transconjugants carried the blaCTX-M-15 gene. The transconjugants had varying minimum inhibitory concentrations of carbapenems ranging from 0.03 μg/ml to 8 μg/ml. Varying resistances to other antimicrobial agents were also transferred with the plasmids. The donor isolates were not clonally related by molecular typing. Conclusion: Resistance to carbapenem antibiotics in this sample was not mediated only by carbapenemases but also by production of extended-spectrum β-lactamases (largely CTX-M-15), accompanied by protein loss. This was an important mechanism underpinning carbapenem resistance in these clinical isolates of various species.

RESUMEN Objetivo: Determinar el papel de las betalactamasas de espectro extendido en la resistencia al carbapenem en las bacterias gramnegativas en Nigeria. Métodos: Veintisiete aislados resistentes al carbapenem que fueron hallados productores de no carbapenemasas (15 Escherichia coli, 9 Klebsiella pneumoniae, y 3 Pseudomonas aeruginosa) fueron estudiados con mayor profundidad. Estos aislados fueron sometidos a análisis incluyendo la detección fenotípica y genotípica de varias betalactamasas, la actividad de eflujo, las porinas de la membrana externa, la tipificación del replicón plasmídico, la detección de genes transferibles y resistencias y tipificación usando pruebas de ADN polimórficas amplificadas aleatorias. Resultados: Ninguno de los aislamientos mostró desrepresión de eflujo, pero todos demostraron la pérdida completa o la producción reducida de porinas externas de la membrana. Los transconjugantes de estas cepas contenían varios genes incluyendo resistencia a la quinolona mediada por plásmidos y betalactamasas de espectro extendido. Todos los transconjugantes portaban el gen blaCTX-M-15. Los transconjugantes tenían diversas concentraciones inhibitorias mínimas de carbapenemas que oscilaban entre 0.03 μg/ml y 8 μg/ml. Varias resistencias a otros agentes antimicrobianos fueron también transferidas con los plásmidos. Los aislamientos del donante no estuvieron relacionados clonalmente por tipificación molecular. Conclusión: La resistencia al antibiótico carbapenem en esta muestra no fue mediada solamente por las carbapenemasas, sino también por la producción de betalactamasas de espectro extendido (en gran parte CTX-M-15), acompañado por pérdida de porina. Éste era un mecanismo importante que sustentaba la resistencia al carbapenem en estos aislados clínicos de varias especies.

Características y factores de riesgo de la infección de vías urinarias con cultivo positivo para betalactamasas de espectro extendido en adultos atendidos en urgencias en el Hospital Militar Central / Clinical characteristics and risk factors for urinary tract infection with extended spectrum betalactamase infections in the emergency service of the Central Military Hospital

Objetivo: El objetivo del estudio fue describir los factores de riesgo de los pacientes adultos con infección de vías urinarias (IVU) por enterobacterias productoras de betalactamasas de espectro extendido (BLEE) en la población usuaria del Hospital Militar Central (HMC) los años 2012 y 2014. Se analizaron factores de riesgo como hospitalización previa, residente en unidad de cuidado crónico, uso previo de antibióticos, uso previo de esteroides, instrumentación del tracto urinario y usuario de sonda vesical. Materiales y métodos: Se realizó un estudio de casos y controles, retrospectivo, la fuente de información fueron las historias clínicas de los pacientes adultos mayores de 18 años de edad, que consultaron al servicio de urgencias del HMC, con diagnostico de IVU por una enterobacteria productora de BLEE. Se establecieron las características de la muestra y se determinó cuales fueron los factores de riesgo asociados al desarrollo de la infección por gérmenes productores de BLEE en la muestra seleccionada. Resultados: De los 1986 aislamientos que cumplían los criterios de selección, 14% correspondían a microorganismos productores de BLEE. De los seis factores de riesgo estudiados, tres presentaron una diferencia estadísticamente significativa: la hospitalización previa, el uso previo de antibióticos y la instrumentación del tracto urinario. De los factores de riesgo identificados, se realizó un análisis multivariado donde se mantuvieron como factores de riesgo significativos el uso previo de antibióticos y la instrumentación del tracto urinario que aumentan el riesgo de IVU por gérmenes productores de BLEE en 1,9 y 3,18 veces respectivamente. Conclusiones: Si bien los otros factores de riesgo descritos no alcanzaron una diferencia estadísticamente significativa, se deben realizar estudios prospectivos para poder evaluar su asociación con el desarrollo de infecciones por gérmenes resistentes y así desarrollar una escala de riesgo que permita al personal de urgencias administrar antibioticoterapia dirigida para este subgrupo poblacional.

Objectives: The objective of the study was to describe the risk factors of adult patients with urinary tract infection (UTI) with extended spectrum beta-lactamase producing bacteria (ESBL) in the population of the Hospital Militar Central (HMC) in 2012 and 2014. Risk factors such as previous hospitalization, chronic care unit resident, previous use of antibiotics, previous use of steroids, urinary tract instrumentation and bladder catheter were analyzed. Material and methods: We conducted a retrospective case-control study, the source of information were the medical records of adult patients older than 18 years of age, who consulted the emergency department of the HMC, diagnosed with UTI by a bacterium carrying ESBL. The characteristics of the sample were established and the risk factors associated with the development of infection by ESBL-producing bacteria in the selected sample were determined. Results: Of the 1986 isolates that fulfilled the selection criteria, 14% reported microorganisms producing ESBL. Of the six risk factors studied, three presented a statistically significant difference: previous hospitalization, previous use of antibiotics and urinary tract instrumentation. Of the risk factors identified, a multivariate analysis was performed in which the previous use of antibiotics and urinary tract instrumentation were maintained as significant risk factors that increase the risk of UTI by ESBL-producing bacterias in 1,9 and 3,18 times respectively. Conclusions: Although the other risk factors described did not reach a statistically significant difference, prospective studies should be performed to assess their association with the development of resistant germ infections and to develop a risk scale that allows emergency personnel to administer targeted antibiotic therapy to this population subgroup.

Failure of Ciprofloxacin Therapy in the Treatment of Community-Acquired Acute Pyelonephritis caused by In-Vitro Susceptible Escherichia coli Strain Producing CTX-Type Extended-Spectrum β-Lactamase

While carbapenems are the drug of choice to treat extended-spectrum-β-lactamase (ESBL)-producing strains, some alternative carbapenem-sparing regimens are suggested for antibiotic stewardship. We experienced a case of ciprofloxacin treatment failure for acute pyelonephritis caused by an apparently susceptible Escherichia coli. A 71-year-old woman presented the emergency department with fever for 7 days and bilateral flank pain for 2 days. The laboratory results and abdominopelvic computed tomography finding were compatible with acute pyelonephritis. During 3-day ciprofloxacin therapy, the patient remained febrile with persistent bacteremia. After the change in antibiotics to ertapenem, the patient’s clinical course started to improve. ESBL-producing E. coli isolates were identified in all three consecutive blood samples. Pulsed-field gel electrophoresis (PFGE) patterns, serotypes, and sequence types showed the three isolates were derived from the identical strain. The isolates produced CTX-M-14 type ESBL belonging to the ST69 clonal group. Despite in vitro susceptibility, the failure was attributed to a gyrA point mutation encoding Ser83Leu within quinolone resistance-determining regions. This case suggests that ciprofloxacin should be used cautiously in the treatment of serious infections caused by ciprofloxacin-susceptible, ESBL-producing E. coli, even in acute pyelonephritis because in-vitro susceptibility tests could fail to detect certain genetic mutations.

Failure of Ciprofloxacin Therapy in the Treatment of Community-Acquired Acute Pyelonephritis caused by In-Vitro Susceptible Escherichia coli Strain Producing CTX-Type Extended-Spectrum β-Lactamase

While carbapenems are the drug of choice to treat extended-spectrum-β-lactamase (ESBL)-producing strains, some alternative carbapenem-sparing regimens are suggested for antibiotic stewardship. We experienced a case of ciprofloxacin treatment failure for acute pyelonephritis caused by an apparently susceptible Escherichia coli. A 71-year-old woman presented the emergency department with fever for 7 days and bilateral flank pain for 2 days. The laboratory results and abdominopelvic computed tomography finding were compatible with acute pyelonephritis. During 3-day ciprofloxacin therapy, the patient remained febrile with persistent bacteremia. After the change in antibiotics to ertapenem, the patient’s clinical course started to improve. ESBL-producing E. coli isolates were identified in all three consecutive blood samples. Pulsed-field gel electrophoresis (PFGE) patterns, serotypes, and sequence types showed the three isolates were derived from the identical strain. The isolates produced CTX-M-14 type ESBL belonging to the ST69 clonal group. Despite in vitro susceptibility, the failure was attributed to a gyrA point mutation encoding Ser83Leu within quinolone resistance-determining regions. This case suggests that ciprofloxacin should be used cautiously in the treatment of serious infections caused by ciprofloxacin-susceptible, ESBL-producing E. coli, even in acute pyelonephritis because in-vitro susceptibility tests could fail to detect certain genetic mutations.