Outcomes of multi drug resistant tuberculosis under programmatic conditions: the experience

Background: Tuberculosis is the most common cause of death from an infectious disease worldwide after HIV/AIDS. Drug resistant tuberculosis continues to be a public health crisis. India stands, one among 27 “high burden” MDR countries and has over 2 million new TB cases every year and TB kill’s nearly 1000 people every day. The WHO 2018 Global Tuberculosis Report estimated that, worldwide, approximately 3.5 percent of all new TB cases and 18 percent of previously treated cases are caused by MDR or rifampicin-mono resistant strains.Methods: Presumptive drug resistance TB cases were subjected for CBNAAT or LPA to detect resistance patterns. About 231 cases of MDR/RR TB cases after pre-treatment evaluation started on CAT- IV regimen and both interim and final outcomes were analyzed.Results: Out of 231cases 172(74.4%) were males and 59(25.6%) were females with age between 13-75yrs. Total of 194 cases culture conversion occurred out of which 28 cases the cultures were reverted back to positives. Final Outcomes were, cured in 84 (36.3%) cases, treatment completed in 42 (18.18%) cases, defaulters in 31 (13.4%) cases, turned to be XDR in 10 (4.32%) cases, treatment failure in 10 (4.32%) cases, 50 (21.6%) cases died, 3(1.29%) cases were transferred out.Conclusions: Approximately 2/3rd of MDR/RR TB cases are retreatment sputum positive cases. Successful outcome observed in 54.54% of cases only. High rates of deaths and defaulters alarm the necessity of more effective implementation and surveillance of the programme.

Multirresistencia de Escherichia coli y Klebsiella pneumoniae provenientes de pacientes con infección del tracto urinario adquirida en la comunidad / Escherichia coli and Klebsiellap neumoniae multiresistance from patients with urinary tract infection acquired in the community

Introducción: El incremento de la multirresistencia bacteriana constituye un problema de salud pública a nivel internacional. Objetivos: Determinar la susceptibilidad antimicrobiana y los patrones de multirresistencia en cepas de Escherichia coli y Klebsiella pneumoniae aisladas de urocultivos. Métodos: Se realizó un estudio descriptivo retrospectivo en el Centro Municipal de Higiene, Epidemiología y Microbiología, municipio Güines, provincia Mayabeque, Cuba, en el periodo comprendido de enero a diciembre de 2017. El estudio incluyó 250 cepas de Escherichia coli y 62 de Klebsiella pneumoniae aisladas e identificadas de muestras de orina de pacientes con infección del tracto urinario adquirida en la comunidad. La susceptibilidad antimicrobiana fue evaluada con el método de difusión en agar empleado la técnica de Kirby Bauer. Resultados: En Escherichia coli se observó niveles de resistencia superiores al 60 por ciento a los antimicrobianos ácido nalidíxico, cefotaxima, trimetoprim - sulfametoxazol y ceftazidima. La nitrofurantoína y la amikacina presentaron 88,8 por ciento y 83,8 por ciento de efectividad, respectivamente. Se apreció en Klebsiella pneumoniae altos valores de resistencia a ceftazidima, trimetoprim - sulfametoxazol y ácido nalidíxico. Amikacina, presentó niveles de sensibilidad de un 71 por ciento. La resistencia a las cefalosporinas de tercera generación se detectó en 78 (31,2 por ciento) de Escherichia coli y 26 (41,9 por ciento) de Klebsiella pneumoniae. De los aislados de Escherichia coli 143 (57,2 por ciento) y Klebsiella pneumoniae 35 (56,4 por ciento) presentaron multidrogoresistencia. Conclusiones: Existe la circulación de cepas resistentes a cefalosporinas de tercera generación y multidrogorresistentes causantes de infecciones de las vías urinarias adquiridas en la comunidad y se informa sobre los antibióticos (nitrofurantoína y amikacina) que podrían ser utilizados para combatirlas de forma empírica en esta área geográfica(AU)

Introduction: The increase of bacterial multiresistance constitutes a public health problem at the international level. Objectives: To determine antimicrobial sensitivity and multiresistance patterns in strains of Escherichia coli and Klebsiellapneumoniae isolated from urine cultures. Methods: A retrospective, descriptive study was conducted at the Municipal Center for Hygiene, Epidemiology and Microbiology, Güines municipality, Mayabeque Province, Cuba, in the period from January to December, 2017. The study included 250 Escherichia coli and 62 Klebsiellapneumoniae strains isolated and identified from urine samples from patients with urinary tract infection acquired in the community. Antimicrobial sensitivity was evaluated with the method of diffusion in agar using Kirby Bauer´s technique. Results: In Escherichia coli, resistance levels higher than the 60% were observed in antimicrobial nalidixic acid, cefotaxime, trimethoprim-sulfamethoxazole and ceftazidime. Nitrofurantoin and amikacin presented 88.8 percent and 83.8 percent of effectiveness, respectively. High values of resistance to ceftazidime, trimethoprim-sulfamethoxazole and nalidixic acid were present in Klebsiellapneumoniae. Amikacin presented sensitivity levels of 71 percent. Resistance to third-generation cephalosporins was detected in 78 (31.2 percent) of Escherichia coli and 26 (41.9 percent) Klebsiellapneumoniae. From the Escherichia coli and Klebsiellapneumoniae isolates, 143 (57.2 percent) and 35 (56.4 percent),respectively, presented multidrug resistance. Conclusions: There is circulation of strains which are resistant to third generation cephalosporins and multidrug resistants that cause urinary tract infections acquired in the community and there are reports on antibiotics (nitrofurantoin and amikacin) that might be used to combat them empirically in this geographical area(AU)

Distributions of Bacillus cereus, Pseudomonas, Enterococcus, and coliforms Isolated from Agricultural Products

A survey was conducted on the bacterial contamination levels from 128 agricultural products, and identified 31 coliforms, 34 Bacillus spp., 35 Pseudomonas spp., and 3 Enterococcus spp.. Antibiotic susceptibility testing of eight Escherichia coli (E. coli) isolates, thirteen Bacillus cereus (B. cereus) isolates and seven Pseudomonas aeruginosa (P. aeruginosa) reveled that none of the E. coli isolates shows multidrug resistance pattern. However, one B. cereus isolate was resistant to Amoxicillin/clavulanic acid + Ampicillin/sulbactam + Cephaloxin, and twelve B. cereus isolates were resistant to Amoxicillin/clavulanic acid + Ampicillin/sulbactam + Cephaloxin + Tetracycline. The data from the current study points out that many agricultural products contain multidrug resistant bacteria, and it can be suggested for the need of proper guidelines and special management on the use of antibiotics in agricultural products.

Distributions of Bacillus cereus, Pseudomonas, Enterococcus, and coliforms Isolated from Agricultural Products

A survey was conducted on the bacterial contamination levels from 128 agricultural products, and identified 31 coliforms, 34 Bacillus spp., 35 Pseudomonas spp., and 3 Enterococcus spp.. Antibiotic susceptibility testing of eight Escherichia coli (E. coli) isolates, thirteen Bacillus cereus (B. cereus) isolates and seven Pseudomonas aeruginosa (P. aeruginosa) reveled that none of the E. coli isolates shows multidrug resistance pattern. However, one B. cereus isolate was resistant to Amoxicillin/clavulanic acid + Ampicillin/sulbactam + Cephaloxin, and twelve B. cereus isolates were resistant to Amoxicillin/clavulanic acid + Ampicillin/sulbactam + Cephaloxin + Tetracycline. The data from the current study points out that many agricultural products contain multidrug resistant bacteria, and it can be suggested for the need of proper guidelines and special management on the use of antibiotics in agricultural products.

Incidence, microbiological profile of nosocomial infections, and their antibiotic resistance patterns in a high volume Cardiac Surgical Intensive Care Unit.

Background: Nosocomial infections (NIs) in the postoperative period not only increase morbidity and mortality, but also impose a significant economic burden on the health care infrastructure. This retrospective study was undertaken to (a) evaluate the incidence, characteristics, risk factors and outcomes of NIs and (b) identify common microorganisms responsible for infection and their antibiotic resistance profile in our Cardiac Surgical Intensive Care Unit (CSICU). Patients and Methods: After ethics committee approval, the CSICU records of all patients who underwent cardiovascular surgery between January 2013 and December 2014 were reviewed retrospectively. The incidence of NI, distribution of NI sites, types of microorganisms and their antibiotic resistance, length of CSICU stay, and patient‑outcome were determined. Results: Three hundred and nineteen of 6864 patients (4.6%) developed NI after cardiac surgery. Lower respiratory tract infections (LRTIs) accounted for most of the infections (44.2%) followed by surgical‑site infection (SSI, 11.6%), bloodstream infection (BSI, 7.5%), urinary tract infection (UTI, 6.9%) and infections from combined sources (29.8%). Acinetobacter, Klebsiella, Escherichia coli, and Staphylococcus were the most frequent pathogens isolated in patients with LRTI, BSI, UTI, and SSI, respectively. The Gram‑negative bacteria isolated from different sources were found to be highly resistant to commonly used antibiotics. Conclusion: The incidence of NI and sepsis‑related mortality, in our CSICU, was 4.6% and 1.9%, respectively. Lower respiratory tract was the most common site of infection and Gram‑negative bacilli, the most common pathogens after cardiac surgery. Antibiotic resistance was maximum with Acinetobacter spp.

Antimicrobial Resistance Patterns of Escherichia Coli Isolated from Urinary Tract Infection in the Midwestern United States.

Aims: To determine the antimicrobial resistance of urinary tract infection isolates in a major metropolitan area for the purposes of tracking increases in resistance and to provide information that will help drive improved therapy. Study Design: Antimicrobial resistance data on Escherichia coli isolated from urinary tract infections was collected and analyzed. Place and Duration of Study: Data was collected from several large healthcare centers in the Detroit, Michigan area. Data collected was from January to July of 2008. Methodology: Data on the antimicrobial susceptibility of 960 Escherichia coli isolated from urinary tract infections was collected and analyzed to determine resistance to typical drugs used in urinary tract infection susceptibility testing. Results: The percentage of isolates that were resistant to one or more of the drugs tested was 47%. The most common drug resistance was to ampicillin (41%); with 11.6% of the isolates being only resistant to ampicillin. As to total resistance, 22.4% of the isolates were resistant to only one drug class, 14.4% were resistant to two classes, 7.2% to three classes, and 4.4% to more than three classes. Resistance as to antimicrobial effects were: 87.9% were resistant to drugs that interfere with cell wall synthesis, 40.3% were resistant to drugs that inhibit protein synthesis, 38.3% to anti-metabolites, and 38.1% to drugs that inhibit nuclei acid synthesis. Conclusion: The data indicate that E. coli isolated from urinary tract infections are manifesting disturbing resistance patterns. Not only is resistance to many drugs increasing, but the bacteria are becoming increasingly multi-drug resistant. This is not only true in this region, but seen worldwide as well.

Prevalence and Genotypic Characterization of Extended- Spectrum Beta-Lactamases Produced by Gram Negative Bacilli at a Tertiary Care Hospital in Rural South Western Uganda.

Aim: To determine the prevalence and genotypic characterisation of extended spectrum beta-lactamases produced by gram negative bacilli isolated at Mbarara Regional Referral Hospital (MRRH). Samples: Gram negative clinical isolates. Study Design: Laboratory-based descriptive cross-sectional study. Place and Duration of the Study: MRRH, June and August 2012. Methods: Gram negative clinical isolates were sub cultured, and identified using biochemical tests. They were screened for ESBL by using oxyimino-cephalosporins and confirmed by double disc synergy Genotyping was performed using the PCR for TEM, SHV and CTX-M. Susceptibility pattern for the extended spectrum beta-lactamases, (ESBL) - positive isolates to other antibiotic classes was performed by the Kirby Bauer Technique. Results: A total of 484 isolates were included in the study. The commonest ESBL producers were Escherichia coli (34%), followed by unidentified coliforms (19.3%) and Klebsiella spp. (12.7%). Phenotypically, 88/484 were ESBL producers while genotypically 213/ 484 possessed ESBL genes. The ESBL genes were blaCTX-M (146; 70%), blaSHV (72; 34%) and blaTEM (100; 47%). 87of 213 isolates expressed more than one ESBL gene. Of these 36 (7.4%) produced blaCTX-M/blaSHV, 28 (5.8%) blaCTX-M /blaTEM, 4 (0.8%) blaSHV/ blaTEM and 19 (3.9%) blaCTX-M/blaSHV/blaTEM. Sixty two (16%) were phenotypically and genotypically positive, 12 (3%) of the isolates were phenotypically positive but genotypically negative and 140 (37%) isolates were phenotypically negative but genotypically positive. The ESBL producers were highly susceptible to imipenem (95%), nitrofurantoin (66%) but less susceptible to ampicillin (4%) and ticarcillin (7%). Conclusion: ESBL production among the Gram-negative clinical isolates at MRRH is very high with several isolates possessing multiple genes. The ESBL producers are highly susceptible to imipenem, but very resistant to ciprofloxacin.

Trends in Antimicrobial Resistance of Staphylococcus aureus Isolated from Clinical Samples at Mbarara Regional Referral Hospital in Rural Uganda.

Aim: This study aimed at describing the antibiotic susceptibility patterns of S. aureus isolated from clinical samples at Mbarara Regional Referral Hospital from 2003 to 2012. Methods: This was a retrospective study that included clinical specimens cultured at the Microbiology laboratory of Mbarara Regional referral hospital between 2003 and 2012. Cultures and sensitivity data were abstracted from the laboratory registers using a data abstraction form. Among the positive culture reports, the antibiotic sensitivity of the common bacteria isolated were also recorded. Analysis of susceptibility data was limited to Staphylococcus aureus, the commonest organism identified. The data were entered into Epi info and exported to Stata Version 12.1 for analysis. Results: A total of 36,080 cultures were performed over a period of 10 years. Of these 7,744 (21.5%) specimens grew an organism. S. aureus was the most prevalent organism isolated. Fifty nine percent of the S. aureus was isolated from blood samples followed by 22% from pus samples, urine (8%) and HVS (5%). During the study period, resistance of S.aureus to chloramphenicol, amoxycillin, penicillin, tetracycline, and cotrimoxazole ranged from 50-90% while S. aureus resistance to Gentamicin and ceftriaxone ranged from 10-20%. Conclusion: Over the last decade, S. aureus isolates showed up to 90% resistance to commonly prescribed oral antibiotics. We recommend regular review of antibiotic resistance patterns to inform hospitals’ on guidelines on empirical antibiotic prescription, especially in resource-limited settings where susceptibility testing may not be feasible.