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Introduction This study aimed to determine the prevalence of multidrug-resistant Gram-negative bacteria (GNB) from blood cultures in a tertiary-care hospital and the multiplex PCR assay's ability to detect resistance genes. Methods A total of 388 GNB isolates obtained from hospitalized patients between November 2019 and November 2021 were included in the study. Antimicrobial susceptibility testing was done by VITEK 2 system and broth microdilution method. Beta-lactamase-encoding genes were detected by multiplex PCR assays, BioFire-Blood Culture Identification 2 (BCID2) panel (bioMerieux, France). Extended-spectrum beta-lactamases (ESBLs) were detected phenotypically with VITEK AST-GN71 card (bioMerieux, France). The isolates of GNB were classified into multidrug-resistant, extensively-drug-resistant, and pandrug-resistant categories, and their prevalence and distribution in different wards, including coronavirus diseases 2019 (COVID-19) intensive care units (ICU), were calculated. Results Results revealed that all isolates of Acinetobacter baumannii and Pseudomonas aeruginosa were multidrug-resistant as well as 91.6% of Enterobacter cloacae, 80.6% of Proteus mirabilis, and 76.1% of Klebsiella pneumoniae, respectively. In fermentative bacteria, blaOXA-48-like (58.1%), blaNDM (16.1%), blaKPC (9.7%) and blaVIM (6.5%) genes were detected. More than half of Enterobacter cloacae (58.3%) and Klebsiella pneumoniae (53.7%) produced ESBLs. Among non-fermenters, the blaNDM gene was carried by 55% of Pseudomonas aeruginosa and 19.5% of Acinetobacter baumannii. In the COVID-19 ICU, Acinetobacter baumannii was the most common isolate (86.1%). Conclusions This study revealed high proportions of multidrug-resistant blood isolates and various underlying resistance genes in Gram-negative strains. The BCID2 panel seems to be helpful for the detection of the most prevalent resistance genes of fermentative bacteria.Copyright © GERMS 2022.
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Background: Improving basic infection control (IC) practices, diagnostics and anti-microbial stewardship (AMS) are key tools to handle antimicrobial resistance (AMR). Material(s) and Method(s): This is a retrospective study done over 6 years (2016-2021) in an oncology centre in North India with many on-going interventions to improve IC practices, diagnostics and AMS. This study looked into AMR patterns from clinical isolates, rates of hospital acquired infections (HAI) and clinical outcomes. Result(s): Over all, 98,915 samples were sent for culture from 158,191 admitted patients. Most commonly isolated organism was E. coli (n = 6951;30.1%) followed by Klebsiella pneumoniae (n = 5801;25.1%) and Pseudomonas aeroginosa (n = 3041;13.1%). VRE (Vancomycin resistant Enterococcus) rates fell down from 43.5% in Jan-June 2016 to 12.2% in July-Dec 2021, same was seen in CR (carbapenem resistant) Pseudomonas (23.0%-20.6%, CR Acinetobacter (66.6%-17.02%) and CR E. coli (21.6%-19.4%) over the same study period. Rate of isolation of Candida spp. from non-sterile sites also showed reduction (1.68 per 100 patients to 0.65 per 100 patients). Incidence of health care associated infections also fell from 2.3 to 1.19 per 1000 line days for CLABSI, 2.28 to 1.88 per 1000 catheter days for CAUTI. There was no change in overall mortality rates across the study period. Conclusion(s): This study emphasizes the point that improving compliance to standard IC recommendations and improving diagnostics can help in reducing the burden of antimicrobial resistance.Copyright © 2023 Indian Association of Medical Microbiologists
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Introduction and Aim: The ability of Acinetobacter baumannii to form biofilms on biotic and abiotic surfaces is regulated by several pathogens' virulence factors, and this is thought to be at the root of the bacteria's resistance to antibiotics. We hope to learn how temperature, pH, and iron concentrations influence the development of biofilms in A. baumannii isolated from COVID-19 and non-COVID-19 individuals, and which genes are relevant for biofilm formation and antibiotic resistance. Material(s) and Method(s): Eight strong adherent isolates of A. baumannii from respiratory tract infection Iraqi patients (4 from COVID-19 and the other from non-COVID-19 just respiratory patients) had been used in this study which conducted from 10/1/2021 to 10/2/2022. The antibiotic sensitivity of all isolates was determined using the VITEK-2 system. The biofilm associated genes OXA-51, bap, Chaperone Usher (CsuE) and Integron-1, was detected using PCR. Isolates of A. baumainni were put through a battery of tests to determine whether they possessed the capacity to produce robust biofilms under a wide range of both physical (temperature, pH) and chemical circumstances. Result(s): A. baumannii showed that all isolates were multidrug resistant and positive for the biofilm genes studied. Effect on temperature on biofilm formation showed at 44C biofilm formation was significantly lower than that at 37C (mean differences of 0.178000 (t= 8.355, df:3, P=0.004) and 0.204000 (t=26.521, df:3, P=0.000) respectively). The adhesion factor value in the COVID-19 positive and negative groups decreased significantly because of the pH change. Iron concentration of 60 microM significantly lowered biofilm formation among COVID-19 group and non-COVID-19 group. Conclusion(s): A. baumanni are multidrug resistance isolates with a capacity to form biofilms. The ability to form biofilms by A. baumannii is strongly influenced by physical and chemical factors.Copyright © 2023, Indian Association of Biomedical Scientists. All rights reserved.
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Background: The use of smart phones inside hospitals especially in clinically sensitive areas is a subject of debate because it may improve the quality of healthcare but can also be a vehicle of hospital acquired infections. Aim: To determine dentist's knowledge and behavior related to the use of smart phones in clinical environment and to determine the presence of microbial growth on these devices. Methods: This is a cross-sectional study in which validated survey tool was used to collect data about knowledge and behavior of 397 dental graduates from 8 dental colleges of Pakistan, regarding their usage of smart phones in clinical environment. Bacterial isolates were collected from the smart phones of 45 participants from Fatima Memorial Dental Hospital, Lahore. Results: The SPTC Scale was used to divide the participants into 3 categories;low, moderate and high users. The behavior related to smart phone usage in clinical environment was significantly different among the participants. Moderate users had significantly higher average behavior score of 3.7 (p-value = 0.034). The growth of pathogenic bacterial flora was greater on high users of smart phones (95%,) whereas those participants who were low users the percentage was 37%. Conclusion: Hospital-acquired infections (HAIs) are increasing significantly in number of patients and these can be prevented by adhering to proper hand hygiene practices and if hand hygiene is improved the amount of bacterial load will be less and disinfection of smart phone devices will not be required.
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This study was conducted to investigate isolation and molecular identification of Acinetobacter baumannii in COVID-19 patients from clinical specimens includes, sputum, lower respirayory secretion of patients admitted to Medical Teaching City and Al-Yarmouk Teaching Hospital in Baghdad, Al-Hussein teaching hospital in Karbala, with study the rate of biofilm formation in Acinetobacter baumannii. In addition to investigate the to determine the frequency of responsible virulence genes. During a period from the first of October 2020 to the end of May 2021. A total of 100 respiratory patients 25 patients positive A. baumannii enrolled in this study, patient’s age ranged from (≤ 25-88) year, 9 female and 16 male. A. baumannii were isolated and diagnosed primarily by characteristic features on culture media and biochemical tests then by VITEK 2 system to confirm diagnosis. A total of (25%) Acinetobacter baumannii were isolated in this study. The highest proportion (21%) of Acinetobacter baumannii was from sputum specimens, which include 27.59% in males and 21.43% in females, followed by (4%) in lower respiratory secretion of patients, which is all from males. According of infection a 25 A. baumannii isolated from covid-19 patients. the result showed that positive of A. baumannii 9 (36.0%) of isolated respiratory patients of Negative covid-19, while 16(64.0%) of positive A. baumannii of positive covid-19. In present study, out of 16 isolates of Covid 19 patient that were ITS gene (68.80%). In conclusion, high frequency of Acinetobacter baumannii infection was observed among (>45 year) and covid-19 patients.
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Microbiological monitoring after infectious diseases in the system of epidemiological surveillance implies simultaneous pathogen identification both among patients and in hospital environment. Our aim is to assess potential hospital environmental hazard for the two in-patient infectious disease hospitals of the Khabarovsk city by using bacteriological and epidemiological analysis during new coronavirus disease pandemic. Materials and methods. Bacteriological assessment of nasopharyngeal microflora in 241 patients suffering from community-acquired pneumonia that were hospitalized in the two prevention and treatment facilities of the Khabarovsk city was performed. Sanitary-bacteriological control of hospital environment (428 hospital environment samples and 91 air samples) was carried out in parallel. Bacteriological assessment was performed with classical methods. Identification of isolated bacteriological pathogens and evaluation of drug-resistant strains were carried out by utilizing bacteriological analyzer Vitek 2 Compact. Results. Nine different pathogens (Pseudomonas aeruginosa, Pseudomonas stutzeri, Acinetobacter baumannii, Klebsiella pneumoniae, Klebsiella oxytoca, Enterobacter cloacae, Pantoea, Enterococcus faecium, Staphylococcus haemolyticus) were isolated in 20 out of 428 samples — 4.7% [2.7–6.7]. Half of isolated agents — 2.3% [0.9–3.8] — were represented by drug-resistant isolates (10 out of 20 isolates) including 5 carbapenem-resistant isolates (Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae) and 5 isolates with multiple drug resistance (Enterobacter cloacae, Pantoea, Enterococcus faecium, Staphylococcus haemolyticus). Air samples contained pathogenic biological agents found in 6 out of 91 samples — 6.6% [1.5–11.7], and half of them — 3.3% [0.6–7.9] — were identified as drug-resistant variants, including S. aureus и S. haemolyticus. One of the surveyed hospitals was recognized as more hazardous due to microflora isolated from intensive care unit (A. baumannii and P. aeruginosa were resistant to 3rd–4th generation cephalosporins and carbapenems). Conclusion. Revealed circulation of wide range of microorganisms isolated from environment of two in-patient hospitals indicates high risk of healthcare-associated infections formation. Intensive care units can serve as a reservoir of healthcare-associated infections due to high percentage of patients with severe disease cases (“main reservoir” of drug-resistant strains).
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Background: COVID-19 has a high rate of severe infection and mortality, which is thought to be due in part to a lack of natural immunity and viral replication in the lower respiratory tract, as well as superinfections. COVID-19 patients suffer to infect with secondary bacterial infection and the ability of these pathogens to infect the host and causing disease is referred to as virulence factors. Methodology: 200 samples from patients with COVID-19 were collected from blood, pharyngeal swabs, sputum, and nasal swab. Reverse transcription-polymerase chain reaction (RT-PCR), was used to confirm the disease. Biochemical tests, culture media and a Vitek-2 compact system were used to identify the isolates. AST, Biofilm formation, hemolysin and lipase were done on all isolates. Results: Forty-five (23%) isolates were obtained from a total of 200 samples while 77% showed negative growth. All isolates were distributed between gram positive as Staphylococcus aureus and gram negative such as Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae. High resistance to antibiotics was detected which the isolates classified to MDR and XDR as showed S. aureus (40%,60%), A. baumannii (30%, 70%), P. aeruginosa (20%, 80%) and K. pneumonia (45%, 55%) respectively. Virulence factors of the SBIs associated with Antibiotics resistance (MDR and XDR) in COVID-19 patients showed 100% of both S. aureus and P. aeruginosa hemolysin positive while all the isolates of A. baumannii and K. pneumonia were negative. The results showed that 25% of MDR S. aureus and (75%) XDR, A. baumannii MDR (20%) and (80%) XDR, P. aeruginosa (20%) MDR and (80%) XDR and K. pneumonia (25%) MDR and (75%) XDR. Biofilm formation showed S. aureus (20%) MDR and (80%) XDR were produced biofilms, A. baumannii (15%) MDR and (85%) XDR, P. aeruginosa (10%) MDR and (90%) XDR and K. pneumonia (25%) MDR and (75%) XDR. Conclusions: Biofilm formation, hemolysin and lipase are virulence factors that confirmed secondary bacterial infection with high antibiotic resistance in COVID-19 patients which due to sever infection and elongated the period of healing as well as the side effects and complication during the infection period which were noticed in the most cases under the study.
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Background. Although CRE are a global threat, data in low- and middle-income countries are scarce. Colonization data are vital for informing antibiotic resistance strategies. We characterized the colonization prevalence of CRE in various settings in Botswana. Methods. This study was conducted in 3 districts in Botswana (1 hospital and 2 clinics per district). Adult inpatients and clinic patients were randomly selected for enrollment. Community subjects were enrolled by inviting each enrolled clinic subject to refer up to 3 adults. Each adult clinic or community subject was also asked to refer their children. All subjects had rectal swabs obtained and inoculated on selective chromogenic media for preliminary identification of CRE. Final identification and susceptibility testing were performed using MALDI-TOF MS and VITEK-2, respectively. CRE underwent genotyping for carbapenemase genes. Results. Subjects were enrolled from 1/15/20-9/4/20 with a pause from 4/2/20-5/21/20 due to a countrywide COVID lockdown. Of 5,088 subjects approached, 2,469 (49%) participated. Enrollment by subject type was: hospital - 469 (19%);clinic - 959 (39%);community adult - 477 (19%);and community child - 564 (23%). Of 2,469 subjects, the median (interquartile range) age was 32 years (19-44) and 1,783 (72%) were female. 42 (1.7%) subjects were colonized with at least one CRE;10 subjects were colonized with multiple strains. E. coli (n=17), K. pneumoniae (n=20), and E. cloacae complex (n=11) were most common. CRE colonization prevalence was 6.8% for hospital subjects, 0.7% for clinic subjects, 0.2% for adult community subjects, and 0.5% for child community subjects (p< 0.001)). CRE prevalence varied across regions (Figure 1) and was significantly higher pre- vs post-lockdown (Figure 2). VIM and NDM were the most common carbapenemase genes (Figure 3). Conclusion. CRE colonization was significantly higher in hospital vs community settings in Botswana. CRE prevalence varied by region and decreased significantly following a countrywide lockdown. With CRE prevalence still modest, elucidating risk factors for CRE colonization holds promise in developing strategies to curb further emergence of CRE. Additional investigation of the CRE isolates without identified resistance genes is warranted.
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Background. Although ESCrE are a global challenge, data on ESCrE in low- and middle-income countries are limited. In particular, colonization data are critical for larger antibiotic resistance efforts. We characterized the colonization prevalence of ESCrE in various settings in Botswana. Methods. This study was conducted in 3 hospitals and 6 clinics located in 3 districts in Botswana. In each hospital, we conducted surveillance of adult patients. Adult clinic patients were also randomly selected for participation. Finally, we enrolled community subjects by inviting each enrolled clinic subject to refer up to 3 adults. Each adult clinic or community subject was also allowed to refer their children. All subjects had rectal swabs obtained which were inoculated onto chromogenic media for preliminary identification of ESCrE. Final identification and susceptibility testing were performed using MALDI-TOF MS and VITEK-2, respectively. Genotyping was done for identification of extended-spectrum beta-lactamase (ESBL) genes. Results. Enrollment occurred from 1/15/20-9/4/20 but paused from 4/2/20-5/21/20 due to a countrywide COVID lockdown. Of 5,088 subjects approached, 2,469 (49%) participated. Enrollment by subject type was: hospital - 469 (19%);clinic - 959 (39%);community adult - 477 (19%);and community child - 564 (23%). Of 2,469 subjects, the median (interquartile range) age was 32 years (19-44) and 1,783 (72%) were female. 759 (31%) subjects were colonized with at least one ESCrE;130 subjects were colonized with multiple strains. E. coli (n=663) and K. pneumoniae (n=121) were most common. ESCrE colonization prevalence was 43% for hospital subjects, 31% for clinic subjects, 24% for adult community subjects, and 26% for child community subjects (p< 0.001)). ESCrE prevalence varied significantly across regions (Figure 1) and was significantly higher pre-lockdown vs post-lockdown (Figure 2). CTX-M was the most common ESBL gene (Figure 3). Conclusion. ESCrE colonization was common in both healthcare and community settings in Botswana. Colonization prevalence varies by region and clinical setting and decreased following a countrywide lockdown. These findings provide important clues regarding potential drivers of ESCrE that might serve as targets for intervention.
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Introduction: The Coronavirus Disease 2019 (COVID-19) is associated with damage of cells of both innate and adaptive immunity, which results in immune system's impairment leading to secondary infections. Microbiological evaluation helps in diagnostic as well as antimicrobial stewardship leading to accurate treatment of COVID-19 infected patients. Aim: To evaluate superadded bacterial and fungal infections in COVID-19 infected patients and to evaluate bacterial and fungal infections in COVID-19 non infected patients admitted with Acute Respiratory Illness (ARI). Materials and Methods: This retrospective study was carried out in a tertiary care hospital in Delhi, India, over a period of eight months (May to December, 2020). Respiratory samples, received from indoor patients with history of ARI, were processed for COVID-19 (TrueNat Real Time Polymerase chain reaction) as well as for bacterial and fungal cultures following Standard Operating Procedures (SOP). Identification and susceptibility pattern was evaluated by Vitek2 compact system (bioMérieux, Inc. Durham, North Carolina/USA). Quality control strains used were American Type Culture Collection (ATCC) Staphylococcus aureus 29213, Escherichia coli 25922 and Candida parapsilosis ATCC 22019. Minimum Inhibitory Concentration (MIC) levels were standardised as per Clinical and Laboratory Standards Institute (CLSI) guideline, 2020. All statistical analysis was done by Chi-square test using Software Statistical Package for the Social Sciences (SPSS) version 22.0. Results: Total patients admitted with the history of ARI were 542;COVID-19 Positive Group (CPG) included 115 (21.22%) while COVID-19 Negative Group (CNG) included 427 (78.78%). Growth in bacterial and fungal cultures in CPG was 59.13% (68/115) while in CNG;it was 47.78% (204/427). Among the bacterial isolates, most common isolate was Klebsiella pneumoniae {CPG: 41.93% (26/62);CNG: 36.72% (76/207)}, followed by Pseudomonas aeruginosa {CPG: 33.87% (21/62);CNG: 31.88% (66/207)}. Fungal isolates in CPG was 19.48% (15/77) (p-value 0.0445). On comparing Antimicrobial Susceptibility (AST) pattern of Enterobacterales in both CPG (n=36) and CNG (n=102), no statistically significant difference was observed. Co-morbid conditions were found mostly in CNG 89% (140/158) with ARI while only 11% (18/158) was found in CPG. Conclusion: Secondary respiratory infections are quite common amongst COVID-19 positive patients. However, growth in culture, type of isolates, Antimicrobial Resistance (AMR) was almost similar with COVID-19 non infected patients admitted with ARI. Co-morbidity had the similar impact as COVID-19 infection with respect to co-infections.