Prevotella bloodstream infection:a 10-year single-center retrospective study / 中国感染控制杂志

Objective To improve clinicians'understanding on Prevotella bloodstream infection(BSI),reduce the rate of misdiagnosis and missed diagnosis,and broaden the ideas of diagnosis and treatment.Methods Clinical data of patients with Prevotella BSI at a hospital affiliated to a medical school of Nanjing University from May 2013 to May 2023 were collected.Risk factors,sources of infection,strains of infection,clinical manifestations,laboratory test results,treatment,and outcomes of patients with Prevotella BSI were retrospectively analyzed.Results A to-tal of 23 patients diagnosed with Prevotella BSI were included in analysis,15(65.2％)were males and 8(34.8％)were females.Most patients had related predisposing factors before BSI,such as surgical procedures(n=11,47.8％),malignant tumors(n=10,43.5％),diabetes(n=9,39.1％),and indwelling urinary catheter(n=10,43.5％),etc.There were 9 types of infected bacteria,mainly Prevotella buccalis(n=6,26.1％),Prevotella bivia(n=5,21.7％)and Prevotella intermedia(n=4,17.4％).The main sources of infection were hepatobiliary system(n=6,26.1％),abdominal and thoracic cavities(n=4,17.4％),as well as urogenital tract(n=4,17.4％).All pa-tients showed symptoms of chills and fever,with significantly elevated blood inflammation indicators.Four cases(17.4％)developed septic shock,and 18 cases(78.3％)had a good prognosis after appropriate anti-infection treat-ment.Conclusion When atypical BSI caused by Prevotella is suspected,predisposing factors should be removed as soon as possible,blood should be actively collected and performed culture,rational use of antimicrobial agents based on antimicrobial susceptibility testing is beneficial for rapid control of infection and improvement of prognosis.

Magnitude and factors associated with catheter associated urinary tract infection, and antimicrobial susceptibility profile at Hawassa, Sidama Regional State, Ethiopia: A prospective cross-sectional study

Introduction: The use of urinary catheter benefit patients who are unable to urinate for various medical rea-sons. Despite its use, a urinary catheter during its application may introduce bacteria to the urinary tract and result in Urinary tract infection (UTI). Even though the burden of catheter-associated UTI is expected to be high in resource-limited countries, there is limited data. The aim of this study was to determine the magnitude of culture-confirmed catheter-associated urinary tract infection (CAUTI), associated factors, and antimicrobial sus-acceptability profiles of bacteria. Methods: This prospective cross-sectional study was conducted at Hawassa University Comprehensive Specialized Hospital (HUCSH), Sidama region, from May-August 2022. One hundred forty-nine catheterized patients at HUCSH were included. Socio-demographic, clinical, and laboratory data were collected using structured questionnaire. Urine specimens were cultured on blood and MacConkey agar. Culture-confirmed catheter-associated urinary tract infection was established if >1 X 105colonies of bacteria per milliliters of urine was detected. The disc diffusion method was used for antimicrobial susceptibility testing. For data analysis, SPSS version 26 was used. Factors associated with culture confirmed CAUTI were assessed using binary logistic regression. Results: The magnitude of culture confirmed CAUTI was 30.2% (n=45; 95% CI=22.8−37.6). The most common bacterial isolates were Escherichia coli (n=12; 26.7%), followed by Klebsiella species (n=10; 22.2%), and Staphylococcus aureus (n=6; 13.3%). Duration of catheterization (AOR=9.6, 95% CI=3.8−24.2) and comorbidities (AOR=4.1, 95% CI=1.7−9.8) were significantly associated with culture-confirmed CAUTI. Most Gram-neg-active bacteria were resistant to commonly prescribed antimicrobial agents. Conclusions:The magnitude of culture-confirmed CAUTI at HUCSH was high.E.coli was the leading bacteria and most of them were resistant to various types of antimicrobial agents. Duration of catheterization and comorbidities were significantly associated with culture-confirmed CAUTI

IDENTIFICATION AND ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF ENTEROBACTER SPECIES BY VITEK-2 SYSTEM ISOLATED FROM VARIOUS CLINICAL SPECIMEN IN GOVT MEDICAL COLLEGE KOTA (RAJASTHAN)

Background: Enterobacter were proposed as a genus in 1960 by Hormaeche and Edwards based on the division of the former genus Aerobacter into motile, ornithine decarboxylase (ODC)–positive strains (Enterobacter) and nonmotile ODC-negative strains (Klebsiella). The Vitek-2 system is the second generation of Vitek and offers a more sophisticated model of data analysis as well as a fully automated process for card identification, organism suspension dilution and card filling. To study Aim and Objectives: identification and antimicrobial susceptibility pattern of Enterobacter species by Vitek-2 system isolated from various clinical samples. Material and Methods: A total of 100 Enterobacter species obtained from various clinical samples like urine, pus, sputum, endotracheal aspirate and body fiuids (pleural, ascitic, peritoneal and CSF) etc. of patients received at Department of Microbiology, Government Medical College & Associated Group of Hospitals, Kota during a period of approximately 1 year from May 2021 to May 2022 were taken for the identification and Antibiotic sensitivity testing by Vitek-2 system. Out of 100 Enterobacter isolates, 69% w Result: ere E.cloacae and 31% were E.aerogenes. Antimicrobial susceptibility results of Enterobacter species revealed the susceptibility of 56.41% for Nitrofurantoin, 69% for Piperacillin/ Tazobactam and 72% for Cefoperazone/ salbactam. Enterobacter seems to be emerged with increasi Conclusion: ng resistance to multiple antibiotics.

Molecular Detection of Enterotoxigenic Staphylococcus aureus in Ready-to-eat Cowhide (‘Ponmo’) Collected from Lagos Metropolis, Nigeria

Aims: Ready-to-eat [RTE] animal products like ponmo are preferred by consumers due to its palatability and quality. However, foodborne pathogens particularly Staphylococcus aureus are sources of concern due to cross-contamination of raw and cooked cowhide. This study aimed to investigate the incidence of enterotoxigenic S. aureus in ready-to-eat locally processed cowhide. Methodology: Sixty (60) RTE cowhide samples were collected from different locations in Lagos, Nigeria and analyzed using conventional microbiological and molecular techniques for the detection of toxigenic S. aureus contamination. Suspected S. aureus isolates were confirmed by the presence of thermostable endonuclease [nuc] gene in their genome. Results: Result showed that 25 (41.67%) and 20 (33.50%) samples harbored coagulase-positive S. aureus and 20 other bacterial species different from S. aureus, respectively while 15 (24.83%) of the tested ponmo samples yielded no bacterial growth. Thirteen of the 15 randomly selected from the 25 suspected isolates were confirmed as S. aureus by the presence of thermostable endonuclease [nuc] gene in their genome. Enterotoxigenic genes were confirmed in all the 13 PCR detected S. aureus. Enterotoxin B gene is most prevalent in ponmo. Multiplex PCR detection of S. aureus enterotoxins [SE] genes revealed the molecular detection of different isolates carrying staphylococcal enterotoxin types A and B, mixed strain carrying both staphylococcal enterotoxins type A and type D. Antibiotic susceptibility of 20 S. aureus isolates revealed varying degrees of susceptibility patterns against the antimicrobial agents. Generally, gentamicin 70% (14/20), azithromycin 75% (15/20), co-trimoxazole 85% (17/20), levofloxacin 95% (19/20) were the most effective antibiotics to S. aureus. A low, ?50% susceptibility was recorded to chloramphenicol 55% (11/20) and nitrofurantoin 65% (13/20). A higher resistance to streptomycin (90%; 18/20) and ceftazidime (95%; 19/20) was identified, with resistance to ceftazidime being the highest (95%; 19/20). Conclusion: It can be concluded that RTE ponmo vended in the study sites is of low hygienic quality and may be of health risk to consumers. High level hygiene practice and good manufacturing practices are required during the production, distribution and marketing of ponmo to curb the potential health consequences of eating ponmo.

Identification of Bacterial Isolates and Their Antimicrobial Susceptibility Pattern from Wound/Pus Sample in a Tertiary Care Hospital, Gwalior, India

Objective: The goal of this investigation was to look at the frequency and dispersal of bacteria isolated from pus/wound, as well as their susceptibility patterns. Materials and Methods?A study was conducted on 175 patients who provided pus and/or wound discharge samples in different wards (outpatient department or inpatient department). MacConkey agar and blood agar plates were immediately inoculated with samples and incubated at 37°C for 24?hours. The Gram stain and biochemical tests were used to identify all isolates after incubation. Kirby–Bauer's disc diffusion method was used to perform sensitivity tests on Mueller–Hinton agar plates. Results?This study covered 175 patients, with a bacterial isolation rate of 102 (58.28%). Males outnumbered females in the samples (M:F?=?1.8:1), with a median age of 45 years as majority were in the age group of 40 to 60 years which was 41 (40.20%). Total 90.1% samples showed monomicrobial infection, whereas 9.8% showed polymicrobial infection, and total 112 bacterial strains were isolated. Conclusion?Escherichia coli was the most prevalent isolate in present investigation, followed by Pseudomonas aeruginosa. Chloramphenicol is the only antibiotic which is effective for both gram-negative bacilli and gram-positive cocci. This report's susceptibility statistic may be worth considering for developing empiric treatment regimens for pyogenic infections.

Study of prevalence and antimicrobial susceptibility pattern of organisms isolated from various clinical specimen of the patients admitted in intensive care unit of tertiary care hospital

Background: Mostly intensive care unit (ICU) patients are more susceptible to nosocomial infections caused by hospital-based various strains of bacteria and other opportunistic pathogens. Due to the widespread use of broad-spectrum antibiotics, these strains of pathogens are often multi-drug resistant. To prevent resistance against the antimicrobial agent various departments of the health care system have to work together, so we can use the antimicrobial agents as effectively as we can to treat illnesses. Aim and Objectives: The objective of this study was to know the prevalence of different micro-organisms causing infections in ICU and their sensitivity and resistance pattern and to determine the overall microbiological and resistance profile which helps formulate therapeutic guidelines in ICU. Materials and Methods: A cross-sectional study was conducted at a tertiary care teaching hospital in Ahmedabad to assess the culture and sensitivity pattern of clinical samples such as blood, urine, sputum, wound, and endotracheal aspiration for a 1-year duration (August 2019 - August 2020). Results: A total of 941 samples were received for microbiological investigation from ICU, out of which 322 were positive. The Utmost isolated organism was - Klebsiella (37.26%) followed by Escherichia coli (16.45%), Pseudomonas (12.42%), and Staphylococcus aureus (7.45%). The Gram-negative bacteria (GNB) were most sensitive to drugs like colistin (96.26% %) and tigecycline (83.40%) followed by carbapenems (71.79%), aminoglycosides (71.36%), and fluoroquinolones (67.21%). More sensitive drugs for isolated Gram-positive organisms were linezolid (100%) followed by teicoplanin (98.41%) and vancomycin (98.41%). Conclusion: High prevalence of multidrug-resistant organisms such as methicillin-resistant S. aureus, vancomycin-resistant enterococci and GNB producing Extended-spectrum Beta-lactamase, AmpC, or carbapenem-resistant GNB in our study, raise serious concerns about antibiotic resistance. The main reason for increasing antimicrobial-resistant bacteria is poor infection control practices and inappropriate use of antibiotics. Hence, research regarding antibiotic sensitivity and resistance will be very helpful for doctors to initiate appropriate empirical antibiotics in treating critical illnesses.

Rapid bacterial identification and antimicrobial susceptibility testing assay in positive blood cultures / 预防医学

Objective@#To establish a rapid bacterial identification and antimicrobial susceptibility testing assay in positive blood cultures, so as to provide insights into timely diagnosis and treatment of bloodstream infections.@*Methods@#A total of 1 154 blood culture samples were collected from inpatients in Zhejiang Hospital from February to May, 2022. The bacterial isolates were enriched and purified using improved separation gel method, and bacterial identification and antimicrobial susceptibility tests were performed using VITEK2 mass spectrometry system and VITEK2 Compact automated microbiology system. The accuracy of the new assay for bacterial identification and antimicrobial susceptibility tests was evaluated with the conventional VITEK 2 compact system as the standard. @*Results@#Of 1 154 blood culture specimens, the conventional VITEK 2 compact system detected 174 positives and 980 negatives. The new assay and the conventional VITEK 2 compact system identified consistent bacterial isolates in 165 out of 174 positive blood culture samples, and the accuracy of bacterial identification was 94.83% for the new assay, with a 99.21% accuracy for identifying Gram-negative bacteria and 82.22% for Gram-positive bacteria. Antimicrobial susceptibility tests were performed in 158 bacterial isolates, and the new assay presented a 90.17% accuracy, with a 90.27% accuracy for Gram-negative bacteria and 89.74% for Gram-positive bacteria. The conventional VITEK 2 compact system required 30 hours and longer to complete bacterial identification and antimicrobial susceptibility tests, and the new assay required 9 to 18 hours.@*Conclusions@#The new rapid bacterial identification and antimicrobial susceptibility testing assay shortens the time of bacterial culture, achieves rapid bacterial identification and antimicrobial susceptibility testing in blood culture specimens and has a high accuracy that meets clinical needs, which facilitates rapid diagnosis and treatment of bloodstream infections.

Prevalence and Susceptibility of Staphylococcus aureus Nasal Carriage Strains Isolated from Haemodialysis Patients

@#Introduction: Staphylococcus aureus is part of the normal human flora that can commonly be found on the skin and mucous membranes of the nasal area. However, in immunosuppressed patients such as those with kidney failures, colonization can potentially lead to infection. There is a concern of increasing antibiotic resistance in S. aureus. This study aimed to determine the prevalence of S. aureus nasal colonization and its antimicrobial susceptibility among haemodialysis-dependent populations. Methods: A cross-sectional study at the Nephrology Unit, Hospital Canselori Tuanku Mukhriz (HCTM) was conducted among haemodialysis-dependent patients between February 2017 to February 2018. Nasal swabs were obtained and cultured on mannitol salt agar. S. aureus isolates were identified by gram staining, tube coagulase and Deoxyribonuclease (DNase). Cefoxitin disc (30 µg) were used to identified the presence of MRSA (methicillin-resistance S. aureus). The S. aureus colonies were further tested against six antibiotics using Kirby Bauer disc diffusion. Result: A total of 134 patients were recruited. S. aureus isolates were detected from 27 patients (20.1%). All S. aureus were phenotypically identified as methicillin-sensitive S. aureus (MSSA) based on the cefoxitin disc. Teicoplanin and linezolid were the most effective with 100% susceptibility. S. aureus exhibited a high resistance rate towards erythromycin (29.6%). No MRSA was isolated in this study. Conclusion: This study highlighted the high prevalence of S. aureus nasal colonization in haemodialysis patients. Teicoplanin and linezolid were found to be the most effective antibiotics against isolated S. aureus.

Isolation, identification and anti-fungal susceptibility pattern of dermatophytes from clinical samples

Aims@#Dermatophytosis is an emerging health problem in all age group people. The treatment is very challenging due to the high side effects of oral anti-fungal drugs and the increased resistance pattern against drugs and ointments. The aim of this study was to evaluate the sensitivity and resistance pattern of isolated and characterized dermatophytes to find the sensitive essential oil as a natural source of medicine to inhibit dermatophytosis@*Methodology and results@# A total of 50 dermatophytes were isolated from different age groups and further sensitivity testing was performed against anti-fungal drugs, ointments, and essential oils. The best sensitivity was observed againstanti-fungal cream and three essential oils. @*Conclusion, significance and impact of study@#From 50 dermatophytes, the highest percentage of dermatophytes were obtained by the male patient under the age group of 19-64. In all, Trichophyton were the highly isolated species and showed high sensitivity against essential oil. Anti-fungal susceptibility testing is also vital for resistance surveillance and for comparing the in vitro activity of new and existing agents. The present study shows that natural essential oil can be a good alternative source of medication against these dermatophytes with no side effects.

Causative Microorganisms Isolated from Patients with Intra-Abdominal Infections and Their Drug Resistance Profiles: An 11-Year (2011-2021) Single-Center Retrospective Study / 生物医学与环境科学（英文）

OBJECTIVE@#To investigate the distribution and antimicrobial susceptibility of causative microorganisms recovered from patients with intra-abdominal infections (IAIs).@*METHODS@#A total of 2,926 bacterial and fungal strains were identified in samples collected from 1,679 patients with IAIs at the Peking Union Medical College Hospital between 2011 and 2021. Pathogenic bacteria and fungi were identified using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Antimicrobial susceptibility testing (AST) was performed using the VITEK 2 compact system and the Kirby-Bauer method. AST results were interpreted based on the M100-Ed31 clinical breakpoints of the Clinical and Laboratory Standards Institute.@*RESULTS@#Of the 2,926 strains identified, 49.2%, 40.8%, and 9.5% were gram-negative bacteria, gram-positive bacteria, and fungi, respectively. Escherichia coli was the most prevalent pathogen in intensive care unit (ICU) and non-ICU patients; however, a significant decrease was observed in the isolation of E. coli between 2011 and 2021. Specifically, significant decreases were observed between 2011 and 2021 in the levels of extended-spectrum β-lactamase (ESBL)-producing E. coli (from 76.9% to 14.3%) and Klebsiella pneumoniae (from 45.8% to 4.8%). Polymicrobial infections, particularly those involving co-infection with gram-positive and gram-negative bacteria, were commonly observed in IAI patients. Moreover, Candida albicans was more commonly isolated from hospital-associated IAI samples, while Staphylococcus epidermidis had a higher ratio in community-associated IAIs. Additionally, AST results revealed that most antimicrobial agents performed better in non-ESBL-producers than in ESBL-producers, while the overall resistance rates (56.9%-76.8%) of Acinetobacter baumanmii were higher against all antimicrobial agents than those of other common gram-negative bacteria. Indeed, Enterococcus faecium, Enterococcus faecalis, S. epidermidis, and S. aureus were consistently found to be susceptible to vancomycin, teicoplanin, and linezolid. Similarly, C. albicans exhibited high susceptibility to all the tested antifungal drugs.@*CONCLUSION@#The distribution and antimicrobial susceptibility of the causative microorganisms from patients with IAIs were altered between 2011 and 2021. This finding is valuable for the implementation of evidence-based antimicrobial therapy and provides guidance for the control of hospital infections.

Antimicrobial resistance of bacteria from pleural and peritoneal effusion:surveillance report from Hunan Provincial Antimicrobial Resistance Sys-tem,2012-2021 / 中国感染控制杂志

Objective To understand the distribution and antimicrobial resistance changes of bacteria isolated from pleural and peritoneal effusion in Hunan Province,and provide reference for correct clinical diagnosis and rational antimicrobial use.Methods Data reported by member units of Hunan Provincial Antimicrobial Resistance Survei-llance System from 2012 to 2021 were collected.Bacteria antimicrobial resistance surveillance method was imple-mented according to technical scheme of China Antimicrobial Resistance Surveillance System(CARSS),and WHO-NET 5.6 software was used to analyze the data of bacteria isolated from pleural and peritoneal effusion as well as antimicrobial susceptibility testing results.Results From 2012 to 2021,a total of 28 934 bacterial strains were iso-lated from specimens of pleural and peritoneal effusions from member units of Hunan Provincial Antimicrobial Re-sistance Surveillance System,with 5 752 strains from pleural effusion and 23 182 from peritoneal effusion.The top five bacteria isolated from pleural effusion were Escherichia coli(n=907,15.8％),Staphylococcus aureus(n=535,9.3％),Klebsiella pneumoniae(n=369,6.4％),Staphylococcus epidermidis(n=452,7.9％),and Staphy-lococcus haemolyticus(n=285,5.0％).The detection rate of methicillin-resistant Staphylococcus aureus(MR-SA)from pleural effusion was 24.3％-39.2％,and that of methicillin-resistant coagulase negative Staphylococcus(MRCNS)was 58.8％-77.1％.The top five bacteria isolated from peritoneal effusion were Escherichia coli(n=8 264,35.6％),Klebsiella pneumoniae(n=2 074,9.0％),Enterococcus faecium(n=1 458,6.3％),Staphylo-coccus epidermidis(n=1 383,6.0％),and Pseudomonas aeruginosa(n=1 152,5.0％).The detection rate of MRSA from peritoneal effusion was 22.1％-52.4％,which presented a decreasing trend(P=0.004).The detec-tion rate of MRCNS was 60.4％-79.4％.The resistance rates of Enterobacterales from peritoneal effusion to ce-fazolin,cefuroxime,ceftriaxone and cefepime all showed decreasing trends(all P＜0.05).Vancomycin-,linezo-lid-,and teicoplanin-resistant Staphylococcus strains were not found in pleural and peritoneal effusions.The resis-tance rates of Enterococcus faecium to most tested antimicrobial agents were higher than those of Enterococcus fae-calis.The resistance rates of Enterobacterales to imipenem and meropenem were ≤8.5％.The resistance rates of non-fermentative Gram-negative bacilli to imipenem and meropenem were ≤43.3％.Conclusion The data structure of Hunan Antimicrobial Resistance Surveillance System for pleural and peritoneal effusions from 2012 to 2021 is relatively complete.The constituent and antimicrobial susceptibility of isolated pathogenic bacteria vary in different years.

In vitro and in vivo antimicrobial activity of pimozide against Staphylo-coccus aureus / 中国感染控制杂志

Objective To explore the in vitro and in vivo antimicrobial activity of antipsychotic agent pimozide against Staphylococcus aureus(S.aureu).Methods The minimal inhibitory concentration(MIC)and minimum bactericidal concentration(MBC)of pimozide were determined by micro-dilution assay.Biofilm was cultured in 96-well cell culture plate,and the anti-biofilm activity of pimozide was detected by turbidimetry.The effect of pimozide on biofilm was further observed through laser confocal microscopy and SYTO9/PI staining.Combined antimicrobial effect of pimozide and other antimicrobial agents was detected by chessboard dilution method,and cytotoxicity of pimozide was detected by CCK-8 assay kit.A model of skin abscess was constructed,in vivo antimicrobial activity and toxicity of pimozide was tested.Results Pimozide showed significant dose-dependent antimicrobial activity against S.aureu,with a MIC of 8-16 μg/mL.It could significantly inhibit the formation of S.aureu biofilm and disperse the formed biofilm.The combination of pimozide and doxycycline has a synergistic antimicrobial effect in vitro,with a synergistic antimicrobial index of 0.5.It can significantly reduce the bacterial load in mouse abscess tissue in vivo,and reduce the live bacterial count from(8.25±0.13)lgarithmic value of CFU/abscess to(3.31± 0.81)logarithmic value of CFU/abscess(q=3.74,P＜0.05).The cytotoxicity of pimozide was extremely low,with a half inhibitory concentration of 64 μg/mL on cells.Conclusion Pimozide exhibits significant antimicrobial activity in vitro and in vivo with extremely low toxicity,thus is promising for the treatment of S.aureu-related local infection in psychiatric patients.

Detection and multi⁃locus sequence typing of low⁃affinity penicillin⁃binding protein of β⁃lactam resistant Enterococcus faecalis / 安徽医科大学学报

Objective @# To detect the low⁃affinity penicillin⁃binding protein drug resistance , pbp4 gene , and multi⁃ locus sequence typing (MLST) of clinically isolated E. faecalis .@*Methods @#78 clinical isolates of E. faecalis were collected , and their drug resistance was detected by automated instruments ; the mutation of pbp4 gene mutation was analyzed by PCR amplification and MLST . @*Results @# 78 strains of E. faecalis were highly resistant to ciprofloxacin , levofloxacin , rifampicin , erythromycin , tetracycline and high concentration of gentamicin , and were resistant to penicillin and gentamicin . The ampicillin resistance rate was 10. 3% , and no strains were found to be resistant to nitrofurantoin , vancomycin , teicoplanin and linezolid ; 8 strains of 78 E. faecalis had amplified TEM genes , and all of them were resistant to penicillin and ampicillin resistance , with a positive rate of 10. 3% ; the allelic profiles and sequence types of 78 strains of E. faecalis which were divided into 16 sequence types , of which ST179 and ST16 were the most , with 21 and 21 strains , respectively . 20 strains , accounting for 26. 9% and 25 . 6% , the rest were ST6 type 8 strains (10. 3% ) , ST4 type 7 strains (9 . 0% ) , ST585 type 6 strains (7 . 7% ) , ST480 type 4 strains (5 . 1% ) , ST28 strains 3 strains (3 . 8% ) of the ST type were detected , and only 1 strain was detected for the oth⁃ er ST types . The analysis of the relationship between ST types and drug resistance showed that E. faecalis with the same ST type had similar drug resistance profiles . @*Conclusion @#The resistance mechanism of E. faecalis to β ⁃lactam antibiotics is mainly caused by the production of β⁃lactamase mediated by TEM gene , which is not necessarily related to the mutation of pbp4 gene . The isolates of E. faecalis are mainly CC16 ( including ST16 and ST179) clones and drug resistance is serious . It is necessary to guide clinical medication and strengthen nosocomial infection monitoring according to its characteristics .

Occurrence of the bacteria in a hospital environment and their sensitivity profile to the main antimicrobials in a reference general hospital in Curitiba, Brazil / Ocorrência de bactérias em ambiente hospitalar, e seu perfil de sensibilidade aos principais antimicrobianos em um hospital de referência em Curitiba, Brasil / Ocurrencia de bacterias en ambiente hospitalario y su perfil de sensibilidad a los principales antimicrobianos en un hospital de referencia en Curitiba, Brasil

Introduction: Antimicrobial resistance rates are increasing in both hospital and community settings, creating a favorable environment for the development of superbacteria. Therefore, local studies are necessary for the proper management of current antimicrobial arsenals and for addressing the current bacteriological scenario. Aim: The aim of this study is to profile bacterial epidemiology in a hospital in Curitiba, Brazil and associate it with the effectiveness of antimicrobial therapy. Methodology: Data from 2019 to 2021 were collected by the Center for Epidemiology and Hospital Infection Control (CEHIC), and this was a quantitative single-center study. Results: The most commonly detected microorganisms were Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Staphylococcus epidermidis, Pseudomonas aeruginosa, Enterococcus faecalis, Acinetobacter baumannii, Staphylococcus haemolyticus, Staphylococcus hominis, and Enterobacter cloacae. A. baumannii and K. pneumoniae had the lowest mean sensitivity coefficients, while S. aureus was the most sensitive. Erythromycin was the least effective antimicrobial agent, while daptomycin was the most effective. Conclusion: These results are consistent with the literature and can be used to optimize empiric therapies, as there are already important therapeutic failures associated with antimicrobial resistance.

Introdução: As taxas de resistência antimicrobiana estão em ascensão tanto em ambientes hospitalares como comunitários, criando um cenário propício para o desenvolvimento de superbactérias e, assim, torna-se necessário estudos locais para uma gestão adequada dos arsenais antimicrobianos atuais e frente ao cenário bacteriológico atual. Objetivo: O escopo desse estudo visa traçar o perfil epidemiológico bacteriano num hospital em Curitiba, Brasil e associá-lo à eficácia da terapia antimicrobiana. Metodologia: Os dados de 2019 a 2021 foram recolhidos pelo Centro de Epidemiologia e Controle de Infecções Hospitalares (CECIH), sendo este um estudo unicêntrico quantitativo. Resultados: Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Staphylococcus epidermidis, Pseudomonas aeruginosa, Enterococcus faecalis, Acinetobacter baumannii, Staphylococcus haemolyticus, Staphylococcus hominis, e Enterobacter cloacae foram os microrganismos mais comuns detectados. A. baumannii e K. pneumoniae tinham as médias de coeficiente de sensibilidade mais baixas, enquanto S. aureus era o mais sensível. A eritromicina era o agente antimicrobiano menos eficaz, enquanto a daptomicina era o mais eficaz. Conclusão: Estes resultados estão de acordo com a literatura e podem ser utilizados para otimizar as terapias empíricas, visto que já há falhas terapêuticas importantes associadas a resistência antimicrobiana.

Introducción: Las tasas de resistencia antimicrobiana están en aumento tanto en el ámbito hospitalario como en el comunitario, creando un escenario propicio para el desarrollo de superbacterias, por lo que son necesarios estudios locales para una gestión adecuada de los actuales arsenales antimicrobianos y hacer frente al escenario bacteriológico actual. Objetivo: El alcance de este estudio pretende trazar el perfil epidemiológico bacteriano en un hospital de Curitiba, Brasil y asociarlo a la eficacia de la terapia antimicrobiana. Metodología: Los datos de 2019 a 2021 fueron recogidos por el Centro de Epidemiología y Control de Infecciones Hospitalarias (CECIH), siendo un estudio cuantitativo unicéntrico. Resultados: Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Staphylococcus epidermidis, Pseudomonas aeruginosa, Enterococcus faecalis, Acinetobacter baumannii, Staphylococcus haemolyticus, Staphylococcus hominis y Enterobacter cloacae fueron los microorganismos más frecuentes detectados. A. baumannii y K. pneumoniae presentaron los coeficientes medios de sensibilidad más bajos, mientras que S. aureus fue el más sensible. La eritromicina fue el agente antimicrobiano menos eficaz, mientras que la daptomicina fue el más eficaz. Conclusión: Estos resultados concuerdan con la literatura y pueden ser utilizados para optimizar las terapias empíricas, pues ya existen importantes fracasos terapéuticos asociados a la resistencia antimicrobiana.

PREVALENCE AND ANTI MICROBIAL SUSCEPTIBILITY OF CLINICAL ISOLATES OF ENTEROCOCCUS SPECIES WITH SPECIAL REFERENCE TO VANCOMYCIN RESISTANCE

Background: Among enterococcus species , 80 -90% and 5-10% of human infection are caused by enterococcus faecalis and faecium respectively .The rate of isolation of Enterococcus faecium and other species is increase at recent times from various clinical samples . Enterococcus faecium showing higher degree of drug resistance. Enterococcus gallinarum and Enterococcus casseliflavus are intrinsically resistant to vancomycin thereby inappropriate treatment can be avoided. Materials and methods: The clinical samples included blood, urine and exudates (pus,tissues, sterile body fluids) were collected aseptically and processed as per standard methods for isolation and identification of organism. Antimicrobial susceptibility testing was performed using Kirby Bauer disc diffusion method. A total of 64 Enterococcus strains were isolated from clinic Result: al samples during the study period.The maximum number of Enterococcus isolates were obtained from Exudates 37(57.8%) ,urine 23(35.9%) followed by blood 4(6.2%) .Among Enterococcus species ,E.faecalis 59 (92.2%) and E.faecium 5 (7.8%) was isolated. The isolates from urine and exudates were predominantly resistance to antimicrobials like ampicillin, high level aminoglycoside, ciprofloxacin and sensitive to linezolid, vancomycin and nitrofurantoin for urine samples. Enterococcus faecalis isolates were uniformly sensitive to Ampicillin, Gentamicin, Ciprofloxacin, Linezolid and Vancomycin. Enterococcus faecium isolates were sensitive to Linezolid and Vancomycin and resistant to Ampicillin, Gentamicin, Ciprofloxacin. Conclusion: This study illustrates the prevalence and antibiotic susceptibility pattern of enterococcus species from various clinical samples . In our study Enterococci did not show resistant to vancomycin.

Caracterización fenotípica y molecular de cepas de Klebsiella pneumoniae productores de carbapenemasas tipo OXA-48 circulantes en Chile / Phenotypic and molecular characterization of OXA-48 like producing Klebsiella pneumoniae isolates in Chile

INTRODUCCIÓN: La aparición y diseminación de Enterobacterales resistentes a carbapenémicos ha generado un gran impacto en las infecciones asociadas a la atención de salud en el mundo. Recientemente, en Chile se detectó un brote por Klebsiella pneumoniae productora de carbapenemasas tipo oxacilinasas (OXA) de la subfamilia tipo OXA-48, reportándose los primeros casos en pacientes hospitalizados mayoritariamente en la zona norte del país. OBJETIVO: Determinar los perfiles fenotípicos, genotípicos y de susceptibilidad antimicrobiana de 16 cepas referidas durante mayo del año 2021 desde las regiones de Antofagasta y Metropolitana al Laboratorio de Referencia del Instituto de Salud Pública. METODOLOGÍA: Las cepas provenientes de muestras clínicas fueron analizadas mediante técnicas tradicionales (Kirby-Bauer y epsilometría) y automatizadas, además de técnicas colorimétricas, inmunocromatográficas y moleculares (RPC y PFGE). Resultados: Se detectó la presencia de los genes blaoxa-48 y blaoxa-232 con una resistencia inusual, tanto a carbapenémicos (ertapenem, imipenem y meropenem) como a cefalosporinas (cefepime, cefotaxima y ceftazidima), además de piperacilina/tazobactam y temocilina. Se detectaron dos subtipos por PFGE, siendo predominante el clon CL-Kpn-Spe-329 (93,8%) con dos mecanismos de resistencia identificados: carbapenemasa y β-lactamasa de espectro extendido (BLEE). CONCLUSIÓN: Ante esta alerta epidemiológica es necesario unificar criterios existentes en la red asistencial nacional para la oportuna detección, vigilancia y control de posibles brotes de cepas productores de oxacilinasa tipo OXA-48.

BACKGROUND: The appearance and spread of carbapenems-resistant Enterobacterales have generated a major impact on health care-associated infections worldwide. Recently, a Klebsiella pneumoniae outbreak expressing OXA-48 like-carbapenemases was detected in Chile, the first reported cases corresponded to hospitalized patients mainly from northern Chile. AIM: To characterize the phenotypic and genotypic profiles of antimicrobial susceptibility of 16 clinical isolates referred during May 2021 from Antofagasta and Metropolitan regions to the Reference Laboratory of Instituto de Salud Publica. METHODS: Antimicrobial susceptibility of all strains was analyzed using traditional (Kirby-Bauer and epsilometry) and automated methods, and complemented with colorimetric, immunochromatographic and molecular (PCR and PFGE) techniques. RESULTS: As a result of the genetic characterization, blaoxa-48 and blaoxa-232 genes were detected, showing the isolates an unusual resistance profile to both carbapenems (ertapenem, imipenem, and meropenem) and cephalosporins (cefepime, cefotaxime, and ceftazidine), as well as piperacillin/ tazobactam and temocillin. Two subtypes were detected by PFGE, with a predominant clone CL-Kpn-Spe-329 (93.8%), with two resistance mechanisms identified: carbapenemase and extended-spectrum β-lactamase (ESBL). CONCLUSION: Due to this epidemiological alert, it is essential the establishment of national guidelines for early detection, surveillance, and control of future outbreaks of OXA-48 like carbapenemases isolates.

Microbial Profile of Neonatal Septicemia and its Antibiogram Prevalent in a Tertiary Care Hospital of Western Odisha

Introduction : A disseminated disease with positive Blood Culture during the first month of life and encompasses various systemic infections of the newborn such as septicemia, meningitis, pneumonia, arthritis, osteomyelitis and Urinary Tract Infection is defined as Neonatal Sepsis. It is one of the leading causes of morbidity and mortality amongst neonates of developing countries. Aim : To determine the microbial profile of Blood Culture-positive Septicemia cases and study their antimicrobial susceptibility pattern. Materials and Methods : Blood Culture and C-reactive Protein (CRP) estimation were done for all 220 clinically suspected neonates. All the pure Bacterial and Candida isolates were identified using standard biochemical tests. Antimicrobial susceptibility testing was done for all bacterial isolates using the Kirby-Bauer disk diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Results : Out of 220 cases, 68.2% were culture positive. Early-onset Neonatal Septicemia (EONS) cases were 74% and Late-onset Neonatal Septicemia (LONS) 26%. The male to female ratio was 1.9:1. Bacterial cases were 66% and 34% were due to Candida. Gram-negative isolates predominated, with Klebsiella pneumonia being the most common one. In the case of Gram-positive isolates, Staphylococcus aureus was most common. The best overall sensitivity of Gram-negative isolates was to Amikacin (100%), Colistin (100%), and Imipenem (96%). Grampositive isolates reported 100% sensitivity to Vancomycin, Teicoplanin and 97.4% to Linezolid. Conclusion : Gram-negative isolates were the leading cause of Sepsis in our study. Strict antimicrobial stewardship should be implemented to prevent the emergence of multi-drug resistant strains.

Spectrum of bacterial keratitis in North India: A retrospective analysis of six years at a tertiary care eye center

Purpose: To analyze the pattern of bacterial pathogens causing infective keratitis and their resistance to the recommended antibiotics over six years. Methods: It was a retrospective study of 9,357 cases of bacterial keratitis from January 2015 to December 2020, at a tertiary care ophthalmic center. A total of 9,547 corneal specimens were obtained from the study subjects. Demographic details of the patients, pathogenic bacteria isolated, and their antimicrobial susceptibility were noted and analyzed. Results: Bacterial pathogens were identified in 23.52% of the specimens. The most common isolates were coagulase?negative Staphylococci (60.75%), followed by Pseudomonas aeruginosa (14.23%), Staphylococcus aureus (13.92%), gram negative bacilli of the family Enterobacterales (8.64%), Streptococcus spp. (1.72%), Acinetobacter spp. (0.13%), and other non?fermenting gram?negative bacilli (0.57%). In Staphylococci, 55–80% of isolates were resistant to erythromycin, and 40–70% to fluoroquinolones, while no resistance was observed against vancomycin. 40–60% of isolates of P. aeruginosa were resistant to cephalosporins, 40–55% to fluoroquinolones, and 30–60% to aminoglycosides. Also, 40–80% of isolates of Enterobacterales were resistant to cephalosporins, and 50–60% to fluoroquinolones. Most gram?negative isolates were susceptible to carbapenems and polymyxin B. Conclusion: To the best of our knowledge, our study is the largest compilation of microbiological profile of bacterial keratitis from North India. It highlights the current trend of the bacterial pathogens that cause infectious keratitis. Staphylococci and Pseudomonas were found to be the most common pathogens. Increased resistance was seen against some of the commonly prescribed empirical antibiotics. Such evidence is useful for restructuring the empirical prescription practices from time to time.

Recomendaciones para diagnóstico y tratamiento de la infección del tracto urinario en pediatría. Parte 1: Grupo de trabajo asociado al Comité de Antimicrobianos, Sociedad Chilena de Infectología (SOCHINF) / Recommendations for the diagnosis and treatment of urinary tract infection in pediatrics. Part 1: Working group associated with the Antimicrobial Committee, Chilean Society of Infectology

Resumen La infección del tracto urinario (ITU) es una de las infecciones bacterianas más frecuentes en la infancia. Un adecuado diagnóstico es esencial para poder realizar un tratamiento racional, eficiente y eficaz; sin embargo, existe gran heterogeneidad en los métodos diagnósticos, específicamente en el estudio de la susceptibilidad antimicrobiana. El objetivo de estas recomendaciones es entregar herramientas para uniformar los criterios diagnósticos, el estudio de susceptibilidad bacteriana in vitro y el tratamiento antimicrobiano de la ITU en la población pediátrica, con un enfoque de uso racional de los antimicrobianos. En esta primera parte, se presentan las recomendaciones en cuanto a cómo obtener una adecuada muestra de orina, el diagnóstico de laboratorio incluyendo puntos de corte -unidades formadoras de colonias/mL de orina-, además de consideraciones microbiológicas para el estudio de susceptibilidad y finalmente, el manejo de la ITU en pediatría. En la segunda parte se detalla el tratamiento antimicrobiano de sus complicaciones, el manejo de ITU en situaciones especiales y consideraciones farmacocinéticas y farmacodinámicas de los antimicrobianos a indicar en ITU.

Abstract The urinary tract infection (UTI) is one of the most common bacterial infections in childhood. An adequate diagnosis is essential to be able to carry out a rational, efficient and effective treatment, however, there great heterogeneity in diagnostic methods, specifically in the study of antimicrobial susceptibility. The aim of these recommendations is to provide tools to homogenize the diagnosis criteria, susceptibility study and antimicrobial treatment of urinary tract infection in the pediatric population, with a rational use of antibiotics approach. In the first part, the recommendations regarding diagnosis are presented, such as sampling and cut-off points, as well as microbiological considerations for susceptibility study and management of UTI in pediatrics. The second part details the management of complications, UTI in special situations, and pharmacokinetic and pharmacodynamic considerations of antimicrobials to be prescribed in UTI.

Secondary bacterial infections in patients with coronavirus disease 2019-associated pneumonia

SUMMARY OBJECTIVE: The vast majority of patients who hospitalized with coronavirus disease 2019 are given empirical antibiotic therapy. However, information on the frequency, microorganism species, and resistance rates of secondary bacterial infections in coronavirus disease 2019 patients are insufficient. We aimed to show the frequency of secondary infections and resistance conditions in patients with coronavirus disease 2019 hospitalized in the intensive care unit. METHODS: The results of tracheal aspirate culture, blood culture, and urine culture obtained from coronavirus disease 2019 patients - at least 2 days after their admission to the intensive care unit - were examined microbiologically. RESULTS: A total of 514 patients hospitalized in intensive care unit were included in our study. Tracheal aspirate, blood, or urine cultures were collected from 369 patients (71.8%). Bacterial reproduction was detected in at least one sample in 171 (33.3%) of all patients. The rate of respiratory tract infection and/or bloodstream infection was found to be 21%. Acinetobacter baumannii, Klebsiella pneumoniae, and Pseudomonas aeruginosa in tracheal aspirate culture; Coagulase-negative staphylococci, K. pneumoniae, and A. baumannii in blood culture; and Escherichia coli, K. pneumoniae, and Enterococcus faecalis in urine culture were the most common microorganisms. A. baumannii was resistant to most antibiotics except colistin and P. aeruginosa strains were resistant to most antibiotics except amikacin, colistin, cefepime, and imipenem. In K. pneumoniae, the highest meropenem sensitivity (73%) was observed; there was a strong resistance to most of the remaining antibiotics. CONCLUSIONS: We think that our study can be useful in choosing empirical antibiotic therapy in the coronavirus disease 2019 pandemic and reducing the mortality that may occur with secondary infection.