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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: Since patients admitted to the intensive care unit have a compromised im-mune system and are more prone to infection than other patients, timely diagnosis and treatment of corneal ulcers among this group of patients can prevent vision loss. Therefore, it is necessary to treat eye infections and corneal ulcers promptly and economize prohibitive costs. Objective(s): Appropriate treatment with the most effective antibiotic before the answer is available to prevent corneal ulcer complications and blindness. Method(s): This study was conducted from November 2019 to November 2020 and after approval by the ethics committee of Hamedan University of Medical Sciences with the code of ethics: IR.UMSHA.REC.1398.716. First, the corneal secretions of 121 patients admitted to the intensive care unit of Sina Hospital are prepared by an ophthalmologist (after anesthetizing the cornea with tetra-caine drops and sterile swabs) and culture in four growth mediums (blood agar, chocolate agar, thio-glycolate, and EMB). Microbial cultures are examined after 48 hours and a fungal culture is examined one week later. Disc diffusions are placed in positive microbial cultures. Antibiotic susceptibility or resistance of the antibiogram was recorded. Other demographic data, including patients' age and sex, are extracted from ICU files. Also, test results and patient identifications are recorded in a checklist designed for this purpose. Result(s): Of all the antibiotics used against common bacteria, vancomycin (84%), colistin (80.43%), cefazolin (80%), and levofloxacin (60%) had the highest sensitivity and gentamicin (93.75%), ceftazidime (86.42%) Erythromycin (85%) had the highest resistance against isolated bacteria. Conclusion(s): The data obtained from this study showed that the most common microorganisms in the age group under the age of 30 years were Acinetobacter Baumannii, in the group of 30-60 years old was Klebsiella pneumonia, and age group over 61 years old was Staphylococcus aureus, and the most sensitive antibiotics in the age group under 30 years were vancomycin and levofloxacin and the age group30-60 were colistin and vancomycin and in the age group over 61 years were vancomycin and cefazolin.Copyright © 2023 Bentham Science Publishers.
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Carbapenem administration is an important therapy for nosocomial infections due to MDRO, especially Acinetobacter baumannii. The global increase in carbapenem-resistant A. baumannii (CRAB) that causes this pathogen has significantly threatened public health due to the lack of adequate treatment options due to the very few currently available antimicrobial agents that actively fight CRAB. Antimicrobial resistance is a major negative impact of inappropriate antimicrobial prescribing. Ineffective empiric treatment (initial antibiotic regimen not sensitive to identified pathogens based on in vitro sensitivity test results) is associated with a higher rate of deaths compared to effective empiric treatment. In this study, we analyzed the correlation between the suitability of empiric and definitive antibiotics and the clinical outcomes of patients with bacteremia due to CRAB treated in the inpatient ward of Dr. Soetomo Tertiary Referral Hospital, Surabaya. There were 227 isolates of bacteremia due to CRAB, consisting of 156 carbapenem-resistant A. baumanni and 71 carbapenem-sensitive A. baumannii. There were 88 isolates that met the inclusion and exclusion criteria, and all of them were resistant to ceftriaxone, cefepime, and ciprofloxacin. A total of 29.5% of the isolates were sensitive to cotrimoxazole, 3.4% of the isolates were sensitive to tigecycline, and 2.3% of the isolates were sensitive to amikacin, levofloxacin, and cefoperazone sulbactam. Adequate empirical antibiotics and definitive antibiotics (sensitive based on culture sensitivity test) amounted to 12.5% and 27.3%, respectively. There is no significant correlation between the suitability of empiric and definitive therapies with the patients' clinical outcomes (death and length of stay).Copyright © 2022 Phcogj.Com.
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Lymphangitis carcinomatosa refers to pulmonary interstitial involvement by cancer and is a dreaded clinical finding in oncology because it is a late manifestation indicative of metastatic malignancy, from either a lung or a nonlung primary cancer, and is associated with poor prognosis. Its presentation is nonspecific, often with subacute dyspnoea and a nonproductive cough in a person with a known history of malignancy, but in some cases is the first manifestation of cancer. CT imaging can be suggestive, typically demonstrating thickening of the peribronchovascular interstitium, interlobular septa and fissures. However, a biopsy may be required to confirm the pathological diagnosis as these changes can also be due to concurrent disease such as heart failure, ILD, infection, radiation pneumonitis and drug reactions. Diagnosis allows symptomatic treatment, with personalised treatment directed towards the primary cancer most likely to provide a meaningful benefit. Future research should focus on prospective clinical trials to identify new interventions to improve both diagnosis and treatment of lymphangitis carcinomatosa.Copyright © ERS 2021.
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Frequency of bacterial co-infections among patients with COVID-19 is not high, and over-prescribing of antibiotics may contribute the selection of resistant strains of enterobacteria and gram-negative non-fermenting bacteria. The aim of the study was to assess the local features of antibiotic resistance of K. pneumoniae and its genetic mechanisms against background of the COVID-19 infection pandemic. Material and methods. There was selected 37 carbapenem-resistant K. pneumoniae strains isolated in 2016, 2017 and 2020 from hospitalized patients, including 15 strains, isolated from patients with COVID-19 infection. Minimal inhibitory concentrations (MICs) of meropenem and colistin were determined by broth microdilution method. Determination of MICs of eravacycline, ceftazidime/avibactam, meropenem/vaborbactam, imipenem/relebactam was performed using Sensititre diagnostic system on EUMDROXF plates. Susceptibility to 11 combinations of 2 antibiotics was detected by modified method of multiply combination bactericidal testing. For 4 K. pneumoniae strains high-throughput sequencing was performed, followed with the subsequent search for determinants of antibiotic resistance and virulence, assessment of plasmid profiles. Results. All strains were resistant to meropenem (MIC50 32 mg/l, MIC90 128 mg/l) and produced KPC and OXA-48 carbapenemases. Strains isolated in 2016-2017 were susceptible to colistin (MIC <=2 mg/l), in 2020 only 26.7% of the strains retained their susceptibility (MIC50 64 mg/l, MIC90 256 mg/l). Susceptibility to combinations of two antibiotics with colistin included reduced from 84.6-100% in 2016-2017 till 26.6-66.7% in 2020. The strains isolated in 2020 retained their susceptibility to ceftazidime/avibactam (MIC <=1 mg/l). 5 strains resistant to cefiderocol with a MIC 8 mg/l were identified. Strains 2564 and 3125 isolated in 2020 from sputum of patients with COVID-19 infection belonged to different sequence-types (ST12 and ST23) and contained the blaOXA-48 carbapenemase gene, additionally strain 2564 contained the blaKPC-27carbapenemase gene. Resistance to colistin was caused by inactivation of the mgrB genes due to insertion of IS1 and IS5-like transposons. Conclusion. The performed genetic studies demonstrate a diversity of mechanisms of antibiotic resistance in K. pneumoniae leading to the formation of resistance including to antibiotics that haven't been used in Belarus till now.Copyright © 2021 Geotar Media Publishing Group. All Rights Reserved.
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Antibiotics play an essential role in antimicrobial therapy. Among all the medications in children, the most commonly prescribed therapy is antibiotics and is currently the indispensable means to cure transmissible diseases. Several categories of antibiotics have been introduced into clinical practice to treat microbial infections. Reducing the unnecessary use of antibiotics is a global need and priority. This article aims to provide better knowledge and understanding of the impact of the early use of antibiotics. This article highlights the proper use of antibiotics in chil-dren, detailing how early and inappropriate use of antibiotics affect the gut microbiome during normal body development and consequently affect the metabolism due to diabetes mellitus, obe-sity, and recurrence of infections, such as UTI. Several new antibiotics in their development stage, newly marketed antibiotics, and some recalled and withdrawn from the market are also briefly discussed in this article. This study will help future researchers in exploring the latest information about antibiotics used in paediatrics.Copyright © 2023 Bentham Science Publishers.
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COVID-19 is an emerging pandemic. The course and management of the disease in the liver transplant setting may be difficult due to a long-standing immunosuppressive state. In Egypt, the only available option is living donor liver transplantation (LDLT). In our centre, we have transplanted 440 livers since 2008. In this study, we report a single-centre experience with COVID-19 infection in long-term liver transplant recipients. A total of 25 recipients (5.7 %) had COVID-19 infections since March 2020. Among these recipients, two developed COVID-19 infections twice, approximately three and two months apart, respectively.Copyright © 2021 The Author(s)
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Background. The spread of extensive drug-resistance among gram-negative bacteria calls for the search for antimicrobics with new mechanisms of actions. The aim was to assess susceptibility of extensively drug-resistant K.pneumoniae strains to cefiderocol and other new inhibitor-protected beta-lactams, and to determine genetic mechanisms of antibiotic resistance. Methods. This study included 30 extensively drug-resistant K.pneumoniae strains collected in 2016-2021 from 4 regions of Belarus. Carbapenemase genes were detected by real-time PCR. Minimum inhibitory concentrations (MICs) for cefiderocol and other new antibiotics were assessed by microdilution method using the Sensititre system. Whole genome sequencing was performed for 2 resistant and 3 cefiderocol-susceptible strains. Genome assemblies and annotation were performed using UGENE v. 37.0 software. Nucleotide sequences were translated using CLC Sequence Viewer v. 8.0 (QIAGEN) package. The PROVEAN software was used to assess amino asides substitutions and their influence on the functional activity of proteins. Results. KPC carbapenemase-producers were 4 strains, OXA-48 - 17, KPC+OXA-48 - 1, NDM - 7, OXA-48 + NDM - 1. All KPC-producers were susceptible to imipenem/relebactam and meropenem/vaborbactam. Resistance to ceftazidime-avibactam was noted in all NDM producers and OXA-48+NDM co-producer. The study has identified 9 cefiderocol-resistant strains. These were NDM and OXA-48-producers isolated from hospitalized patients with COVID-19 infection from 3 regions of Belarus. Resistant strains had functionally significant nonsynonymous substitutions in the genes of TonB-dependent receptors for catecholate siderophores FepA (F472V, P64S) and Fiu (T92S). Conclusion. The study has shown high efficacy of new inhibitor-protected carbapenems and cephalosporins against certain types of carbapenemase-producers. Strains with mutational resistance to cefiderocol, an antibiotic not previously used in Belarus, have been identified.Copyright © Team of Authors, 2022.
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Plasmid-mediated quinolone resistance (PMQR) genes confer low resistance to Fluoroquinolones (FQs). This study aims to detect five PMQR genes among FQs-resistant Klebsiella pneumoniae isolated from various clinical specimens. Out of 120 K. pneumoniae isolates, 68 FQs-resistance K. pneumoniae were included in a molecular study. Standard microbiological tests were used for identification and antimicrobial susceptibility. For the detection of PMQR genes, conventional polymerase chain reaction was used. A molecular study revealed that (73.5%) of samples harbored PMQR genes, and among them, 58% were co-carriages of PMQR gene variants. Aac (6')-Ib-cr gene was predominant (47.1%) among samples, and qepA had the lowest percentage (11.8%), qnr genes were (32.4%) (29.4%) (20.6%) qnrS, qnrB, and qnrA respectively. Overall, high percentages of PMQR genes were detected, and almost all of samples were phenotypically resistant to ciprofloxacin. As well, there was a significant statistical relationship between phenotypically ESBL-producers and qnrB and qepA genes.Copyright © Abdulkareem MM et al. This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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The medical world has been seeking solutions in solving the Coronavirus disease 2019 (COVID-19) outbreak since 2019. Amongst several alter-natives, hemoperfusion therapy has been reported to be beneficial for alleviating symptoms and reducing mortality in severely ill COVID-19 patients. Hemoperfusion is a process of filtering blood to eliminate toxins and inflammatory factors from the body. This case series aims to high-light the unexpected adverse clinical and labora-tory outcomes in the majority of COVID-19 patients treated with hemoperfusion in our hospi-tal. We included fifteen patients admitted to the Intensive Care Unit (ICU) with moderate-to-se-vere COVID-19 between August and December 2020 and were all given two to four sessions of hemoperfusion using the MG150 cartridge. All ten men and five women showed no improve-ment in their neutrophil-lymphocyte ratio (NLR), ferritin, D-dimer, and C-reactive protein (CRP) values after the hemoperfusion regiments, both survivors and non-survivors. In addition, eleven out of twelve patients with respiratory failure who were then intubated resulted in death. Based on our findings and previous evi-dence, we recommended only performing hemoperfusion for investigational instead of therapeutic purposes due to its poorly under-stood pathophysiology in COVID-19. We also recommended further research regarding the us-age of hemoperfusion in COVID-19 patients, es-pecially in the matter of determining the best time to start the therapy.Copyright © 2023, The Indonesian Foundation of Critical Care Medicine. All rights reserved.
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In the COVID-19 pandemic, to minimize aerosol-generating procedures, cardiac magnetic resonance imaging (CMR) was utilized at our institution as an alternative to transesophageal echocardiography (TEE) for diagnosing infective endocarditis (IE). This retrospective study evaluated the clinical utility of CMR for detecting IE among 14 patients growing typical microorganisms on blood cultures or meeting modified Duke Criteria. Seven cases were treated for IE. In 2 cases, CMR results were notable for possible leaflet vegetations and were clinically meaningful in guiding antibiotic therapy, obtaining further imaging, and/or pursuing surgical intervention. In 2 cases, vegetations were missed on CMR but detected on TEE. In 3 cases, CMR was non-diagnostic, but patients were treated empirically. There was no difference in antibiotic duration or outcomes over 1 year. CMR demonstrated mixed results in diagnosing valvular vegetations and guiding clinical decision-making. Further prospective controlled trials of CMR Vs TEE are warranted. © 2022 Elsevier Inc.
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Introduction: Novel last resort beta-lactam antibiotics are now available for management of infections due to New-Delhi Metallo-Beta-Lactamase (NDM) producing Enterobacterales and non-fermenters with Difficult-to-Treat Resistance. However, data regarding the use of imipenem-cilastatin-relebactam (IMI-REL), cefiderocol (CFD) and ceftazidime-avibactam plus aztreonam (CAZ-AVI-ATM) are scarce in real-life settings. This study aimed to describe the use of last resort beta-lactam antibiotics, the microbiology and the outcome, in patients hospitalized in a tertiary hospital. Methods: We conducted a monocentric observational cohort study from 2020/01/01, to 2022/08/31. We screened all patients admitted to Nimes University Hospital who have received ≥ 1 dose of last resort beta-lactam antibiotics during the study period, using the Pharmacy database. We included patients treated with IMI-REL, CFD and CAZ-AVI-ATM. The primary endpoint was the infection-free survival rate. We also calculated rates of microbiological and clinical cure, recurrent infection, death and adverse events. Results: Twenty-seven patients were included in the study and 30 treatment courses were analyzed: CFD (N=24; 80%), CAZ-AVI-ATM (N=3; 10%) and IMI-REL (N=3; 10%). Antibiotics were used in 21 males (70%) and 9 females (30%) with a median age at 65-year-old [50-73.5] and a median Charlson index at 1 [0-2]. Almost all the patients had ≥ 1 risk factor for carbapenem resistant bacteria, a half of them was hospitalized for severe COVID-19, and most of antibiotic courses (N=26; 87%) were associated with ICU admission. In the study population, the probability of infection-free survival at day-90 after last resort beta-lactam therapy initiation was 48.4% CI95% [33.2-70.5]. Clinical failure rate was at 30%, microbiological failure rate at 33% and mortality rate at 23%. Adverse events were documented in 5 antibiotic courses (17%). In details, P. aeruginosa were mainly treated with CFD and IMI-REL, S. maltophilia with CFD and CAZ-AVI-ATM, A. baumannii with CFD, and NDM producing-K. pneumoniae with CAZ-AVI-ATM and CFD. After a treatment course with CFD, CAZ-AVI-ATM and IMI-REL, the probability of infection-free survival was 48% CI95% [10.4-73.5], 33.3% CI95% [6.7-100], 66.7% CI95% [30-100], respectively. Discussion/conclusion: Use of last resort beta-lactam antimicrobials in real-life settings was a safe and efficient therapeutic option for severe infections related to Gram-negative bacteria with Difficult-to-Treat Resistance.
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COVID-19 , Male , Female , Humans , Aged , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , beta-Lactamases , Gram-Negative Bacteria , Drug Combinations , Klebsiella pneumoniae , Microbial Sensitivity TestsABSTRACT
SESSION TITLE: COVID-19 Co-Infections SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/19/2022 12:45 pm - 1:45 pm INTRODUCTION: The COVID-19 pandemic has highlighted the emergence of multidrug-resistant bacterial pathogens. Here we present a case of the successful treatment of a COVID-19 superinfection with Citrobacter freundii, which produced both a Klebsiella pneumoniae carbapenemase (KPC) as well as a New Delhi Metallo-Beta-Lactamase (NDM-1). CASE PRESENTATION: A 53-year-old male without significant past medical history was admitted to the intensive care unit for acute hypoxemic respiratory failure due to COVID-19 pneumonia. His hospital course was complicated by progressive hypoxia requiring intubation and mechanical ventilation. Due to persistent fevers and increased respiratory secretions, he was placed on empiric antibiotic therapy including vancomycin, cefepime, and briefly meropenem. Blood cultures were periodically drawn and ultimately demonstrated no growth. However, a respiratory culture via bronchoalveolar lavage was positive for multidrug-resistant Citrobacter freundii. Susceptibilities showed high level of resistance to meropenem, Imipenem, Ceftazidime-Avibactam as well as Aztreonam. Molecular testing confirmed the presence of both KPC and NDM-1 β-lactamases. The patient was treated with a combination of Aztreonam 2g plus Ceftazidime-Avibactam 2.5g IV every eight hours via simultaneous infusion for fourteen days, resulting in clinical improvement and discharge to a rehabilitation facility. DISCUSSION: The emergence of carbapenem-resistant enterobacteria has been identified as a major clinical problem. The high rates and high mortality of carbapenem-resistant enterobacteria complicating the course of COVID patients during the pandemic highlighted the importance of this issue. Among the Enterobacteriaceae, β-lactam resistance is primarily caused by enzymatic degradation by β-lactamases. Two carbapenemase subclasses are especially problematic: KPC and NDM-1. Horizontal gene transfer and clonal expansion have enabled KPC and NDM-1 to spread worldwide. However, coexistence of these two resistant mechanisms within the same pathogen has rarely been reported. Recently, high stability, non-inferior fitness, and transferability among patients of KPC-2-NDM-1-CRKPs have been documented, raising further concerns about the risk for further spread and increasing rates [1]. Therapeutic options are limited. We used a combination of Ceftazidime/Avibactam plus Aztreonam for treatment, based on limited in vitro studies demonstrating a synergistic effect and superior clearance rather than either antibiotic alone or administered in sequence [2,3]. CONCLUSIONS: Superinfections with carbapenem-resistant enterobacteria have increased in the context of the COVID-19 pandemic and are likely to become more prevalent in our hospitals. Prompt recognition and appropriate therapeutic selection are paramount for treating these highly resistant organisms. Reference #1: Gao H, Liu Y, Wang R, Wang Q, Jin L, Wang H. The transferability and evolution of NDM-1 and KPC-2 co-producing Klebsiella pneumoniae from clinical settings. EBioMedicine. 2020 Jan;51:102599. doi: 10.1016/j.ebiom.2019.102599. Epub 2020 Jan 3. PMID: 31911273;PMCID: PMC6948161. Reference #2: Marshall S, Hujer AM, Rojas LJ, Papp-Wallace KM, Humphries RM, Spellberg B, Hujer KM, Marshall EK, Rudin SD, Perez F, Wilson BM, Wasserman RB, Chikowski L, Paterson DL, Vila AJ, van Duin D, Kreiswirth BN, Chambers HF, Fowler VG Jr, Jacobs MR, Pulse ME, Weiss WJ, Bonomo RA. Can Ceftazidime-Avibactam and Aztreonam Overcome β-Lactam Resistance Conferred by Metallo-β-Lactamases in Enterobacteriaceae? Antimicrob Agents Chemother. 2017 Mar 24;61(4):e02243-16. doi: 10.1128/AAC.02243-16. PMID: 28167541;PMCID: PMC5365724. Reference #3: Lodise TP, Smith NM, O'Donnell N, et al. Determining the optimal dosing of a novel combination regimen of ceftazidime/avibactam with aztreonam against NDM-1-producing Enterobacteriaceae using a hollow-fibre infection model. J Antimicrob Chemother 202 ;75(9): 2622-32 DISCLOSURES: No relevant relationships by wisam daoud No relevant relationships by Christopher Walker No relevant relationships by Amanda Westbrook No relevant relationships by Nicola Zetola
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This study was conducted in the College of Medicine, Wasit University Cooperation with the Al Zahraa Teaching Hospital, Al Kut Hospital laboratory in Wasit, Al-Karama hospital and private clinics of internal from the period of November 2020 to April 2021. It has been carried out on 150 samples of nasal and throat swabs from post COVID-19 patients who suffered from nasal and throat infection from both sex (male &female). The infections were in age group between (4-88) years. The results of throat swabs showed that 84(56%) were infected with bacteria and 66(44%) non-infected and the results of nasal swabs showed that 67(44.66%) were infected with bacteria and 83(55.33%) non-infected. The results of culture appeared that from 150 throat swab sample found that 66(44%) samples were no growth and 84(56%) were infected with bacteria. The results were Pseudomonas aeruginosa 12/150(8%), E. coli 9/150(6%), Enterobacter spp. 2/150(1.33), Pseudomonas spp. 2/ 150(1.33%), Klebsiella spp. 2/150(1.33%), Staphylococcus spp. 4/150(2.66%), Staphylococcus aureus 4/150(2.66%), Streptococcus viridans 43/150(28.66%) and mix of Staphylococcus spp. and Streptococcus viridans 6/150(4%). Out of 150 nasal swab sample found that 83/150(55.33%) sample were no growth and 67/150(44.67%) were infected with bacteria. The result were Pseudomonas aeruginosa 7/150(4.66%), E.coli 3/150(2%), Enterobacter spp. 2/150(1.33), Pseudomonas spp. 5/ 150(3.33%), Klebsiella spp. 6/150(4%), Staphylococcus spp. 12/150(8%), Staphylococcus aureus 3/150(2%), Streptococcus viridans 24/150(16%) and mix of Staphylococcus spp. and Streptococcus viridans 3/150(5.33%) and mix of E. coli and Pseudomonas spp. 2/150(1.33%). Antimicrobial sensitivity for Pseudomonas aeruginosa showed sensitivity to Amikacin (100%), levofloxacin (90%), Meropenem (90%), Cefipime (70%), Imipenem (60%), Aztreonam (30%), Chloramphenicol (5%), and don’t show sensitive to Tetracycline, Pipracillin, Ampicillin, Trimethoprim-Sulphamethoxazole and Clarithromycin. To facilitate species identification, used molecular methods (PCR analysis) by 16s rRNA primers gene for more predominant bacteria isolates (Pseudomonas aeruginosa) isolates studied were detected by 16S rRNA gene and there virulence factors based on multiplex polymerase chain reaction technique amplifying five virulence factors primer for Pseudomonas aeruginosa (aprA, filC, toxA, pilA, pslA). In this study, we concluded that the production of virulence factors genes in Pseudomonas aeruginosa is important to human infection especially (ToxA) gene and the PCR technique was very specific and fast method in detection virulence factor genes in Pseudomonas aeruginosa.
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INTRODUCTION: Acinetobacter baumannii is an important causative agent of ventilation-associated pneumonia capable of long-term survival in the hospital setting. Increasing resistance to antibiotics effective against this pathogen is of concern. In this study, the antibiotic resistance profiles of A. baumannii strains grown in endotracheal aspirate (ETA) cultures in intensive care units and the effect of the COVID-19 pandemic on the resistance profiles in our province where the highest number of cases were observed in our country for a long time were investigated. METHODS: Our study included 74 A. baumannii isolates isolated from ETA samples that was sent to our laboratory from the intensive care units of Bafra State Hospital between January 2019 and December 2020. Bacteria were identified using conventional methods and a semi automatic bacterial identification system Vitek-2 (bioMerieux, France). The antibiotic susceptibility tests of the isolated strains were studied in accordance with the European Committee for Antimicrobial Susceptibility Testing (EUCAST) standards. Antibiotic susceptibility of A. baumannii strains was tested with Vitek-2 system. RESULTS: The mean age and standard deviations of 18 patients before the COVID-19 pandemic and 56 patients after the pandemic were found to be 83.0 +or- 8.3 and 70.5 +or- 14.9 (p < 0.001), respectively. A statistically significant difference was found between the distributions of gender by years (p=0.025). While 55.6% of the patients were female in 2019, 73.2% of the patients in 2020 were male. There was no difference between the two periods in terms of death rates (p=0.628) and respiratory support needs (p=0.191). It was determined that the pandemic increased the number of isolated A. baumannii by 311%. For the two periods, resistance was greatest for piperacillin/tazobactam, ceftazidime, ciprofloxacin and against imipenem. Examinig the two periods, amikacin resistance was seen to a lesser extent in 2020. A statistically significant difference was found between tigecycline resistance rates according to years (p < 0.001). While the tigecycline susceptibility of strains was 88.9% in 2019, it was found to be 26.8% in 2020.11.1% of the strains in 2019 and 64.3% in 2020 were found to be moderately susceptible. In this study, colistin resistance was observed in one (1.4%) of all isolates, while tigecycline resistance was detected in five isolates (6.8%). One isolate (1.4%) was susceptible to all antibiotics except ceftazidime. When the multi-antibiotic resistance of 73 A. baumannii isolates was examined, multidrug resistant (MDR) was 22.9% (n: 17), extensive drug resistance (XDR) was 74.3% (n: 55), pandrug resistance (PDR) was 1.4% (n: 1). Although there was a statistical difference in amikacin, meropenem and tigecycline resistances before and after the pandemic, no difference was found between the resistance patterns (p=0.281). DISCUSSION AND CONCLUSION: It has been observed that the most effective antibiotics against A. baumannii are colistin and tigecycline. It was determined that the COVID-19 pandemic did not change the resistance pattern rates. It is thought that success in fighting this infection will increase when each hospital determines its own resistance patterns, updates empirical treatment protocols based on their results, and clinicians use appropriate antibiotics early.
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P. aeruginosa is still one of the most threatening pathogens responsible for serious hospital-acquired infections. It is intrinsically resistant to many antimicrobial agents and additional acquired resistance further complicates the management of such infections. High rates of combined antimicrobial resistance persist in many countries, especially in the eastern and south-eastern parts of Europe. The aim of this narrative review is to provide a comprehensive assessment of the epidemiology, latest data, and clinical evidence on the current and new available drugs active against P. aeruginosa isolates with limited treatment options. The latest evidence and recommendations supporting the use of ceftolozane-tazobactam and ceftazidime-avibactam, characterized by targeted clinical activity against a significant proportion of P. aeruginosa strains with limited treatment options, are described based on a review of the latest microbiological and clinical studies. Cefiderocol, with excellent in vitro activity against P. aeruginosa isolates, good stability to all ß-lactamases and against porin and efflux pumps mutations, is also examined. New carbapenem combinations are explored, reviewing the latest experimental and initial clinical evidence. One section is devoted to a review of new anti-pseudomonal antibiotics in the pipeline, such as cefepime-taniborbactam and cefepime-zidebactam. Finally, other "old" antimicrobials, mainly fosfomycin, that can be used as combination strategies, are described.
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Background. One of the complications in patients hospitalized with COVID-19 is a secondary bacterial infection. Its frequency can reach 15%, which makes it important to determine the etiology and antimicrobial resistance of the key pathogens responsible for the development of this pathology, in order to further improve the practice of prescribing and increase the effectiveness of antimicrobial chemotherapy. Aims — to assess the etiological structure and antibiotic resistance of the main pathogens of SBIs to improve the practice of antibiotic prescription. Methods. This retrospective study reviewed medical records of the patients hospitalized with COVID-19 in the Moscow city hospital No. 4 between April 28 and November 1, 2020. Demographic, clinical outcomes, etiology, and antimicrobial resistance data of the SBIs were collected. Outcomes were also compared between patients who were classified as severe and critical on admission. Results. Among 3180 patients hospitalized with COVID-19, 220 (6.9%) patients had acquired SBIs, and 50.0% of cases were fatal. The mean age was 72.7 ± 13.07 years. A higher mortality rate was observed in the group of critical patients (63%). 560 strains of bacteria isolated from the SBIs (58.8% isolated from lungs, 21% from urine and 20.2% from blood). 330 strains (58.9%) were Gram-negative bacteria. 109 patients had infections with mixed bacteria. 45 of them (20.5% of the total number of patients included in the study) had 2 pathogens, and 64 patients (29.1%) 3 or more strains. The top three bacteria of SBIs were A. baumannii (23.6%;132/560), K. pneumoniae (22.9%;128/560), and S. epidermidis (10.4%;58/560). The isolation rates of carbapenem-resistant A. baumannii were 97%. Cefoperazone/sulbactam was the most active antibiotic against this pathogen with 62.1% sensitivity. Among K. pneumoniae strains, the level of resistance to carbapenems was 77.4% to meropenem and 54% to imipenem. The proportion of resistant strains to tigecycline and to colistin was 4 and 2.3% respectively. Meticillin resistance was present in 38.5% of S. aureus. 50% of E. faecium strains were vancomycinresistant. Conclusions. Gram-negative bacteria, especially A. baumannii and K. pneumoniae, were the main pathogens, and the resistance rates of the major isolated bacteria were generally high, which indicates that more accurate use of antibacterial agents is necessary for SBIs in patients hospitalized with COVID-19.
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Introduction: Angioinvasive aspergillosis is a rare opportunistic infection. its occurrence increases the mortality and morbidity of organ transplant recipients. Methods: It is about a 27-year-old patient with a history of end-stage renal failure due to an apparent mineralocorticoid deficiency, hemodialysis for 10 months until he received a kidney transplant from a related living donor sharing 4 HLA identities. He received induction therapy with globulin antithymocyte and methylprednisolone followed by maintenance therapy with Mycophenolate Mofetil, prednisolone, tacrolimus. Since the recipient was not immune to cytomegalovirus (CMV), he received ganciclovir prophylaxis immediately after transplant. Post-transplant evolution was marked by the immediate resumption of diuresis, creatinine figures stagnating between 200 and 250 µmol/l. The remainder of her usual treatment consists of a proton pump inhibitor, β-blocker, cotrimoxazole. Our patient presented 2 months post transplant with febrile neutropenia. Clinically, apart from a fever of 38 °, the examination was without abnormalities. Biologically, pancytopenia, inflammatory syndrome (high CRP and procalcitonin), hypokalaemia, hypophosphatemia and hypomagnesemia, hyperferritinemia and hypertriglyceridemia were noted. A post-infectious macrophagic activation syndrome was suspected, confirmed by a sternal puncture. An etiological investigation has been launched;viral serologies (HBV, HCV, HIV, EBV, CMV, COVID 19, HSV) were negative, a cardiac ultrasound ruled out infective endocarditis, a thoracoabdominal CT scan showed multifocal sub-segmental parenchymal condensations of the right lung surrounded by a halo, an appearance suggesting angio-invasive pulmonary aspergillosis and intracortical graft hematomas. Sputum bacteriological examination did not show pneumocystis but isolated two types of candida crucei and tropicalis. A weakly positive aspergillus antigenemia (index : 0.53) was noticed. Our patient received triple antibiotic therapy (vancomycin / imipenem / levofloxacin) and an antifungal (voriconazole) after adaptation according to the antibiogram for a total duration of 15 days with daily dosage of tacrolimus. In addition, he received venoglobulins for 5 days at a dose of (0.4 mg / kg / day). The clinical and biological course was favorable with apyrexia and improvement in the blood count from the third day of treatment. Aspergillus antigenemia and a follow-up chest CT scan were scheduled after the end of treatment. Results: Initially, In view of the intensity of the induction treatment received, leuconeutropenia and in order of frequency, the 2 most evoked causes were CMV et covid19 but the CT aspect straightened the diagnosis, which was supported by aspergillary antigenemia. The emerging interest of this case report is the clinical and computed tomography discordance and the unusual rapidly favorable outcome to an aspect of angioinvasive pulmonary aspergillosis which usually show respiratory signs such as cough, hemoptysis or even respiratory distress. Conclusions: Invasive mycoses, associated with significant morbidity and mortality, are a frequent difficulty in solid organ transplantation. The clinical pictures differ and we could be faced with an atypical presentation which affects the therapeutic management. No conflict of interest
ABSTRACT
The acquisition of multi-drug resistance (MDR) genes by pathogenic bacterial bugs and their dispersal to different food webs has become a silent pandemic. The multiplied use of different antibacterial therapeutics during COVID-19 pandemic has accelerated the process among emerging pathogens. Wild migratory birds play an important role in the spread of MDR pathogens and MDR gene flow due to the consumption of contaminated food and water. Escherichia fergusonii is an emerging pathogen of family Enterobacteriaceae and commonly causes disease in human and animals. The present study focused on the isolation of E. fergusonii from blood, saliva, and intestine of selected migratory birds of the Hazara Division. The sensitivity of isolated strains was assessed against ten different antibiotics. The isolation frequency of E. fergusonii was 69%. In blood samples, a high rate of resistance was observed against ceftriaxone (80%) followed by ampicillin (76%) whereas, in oral and intestinal samples, ceftriaxone resistant strains were 56% and 57% while ampicillin resistance was 49% and 52% respectively. The overall ceftriaxone and ampicillin-resistant cases in all three sample sources were 71% and 65% respectively. In comparison to oral and intestinal samples, high numbers of ceftriaxone-resistant strains were isolated from the blood of mallard while ampicillin-resistant strains were observed in blood samples of cattle egrets. 16S rRNA-based confirmed strains of E. fergusonii were processed for detection of CTX-M and TEM-1 gene through Polymerase chain reaction (PCR) after DNA extraction. Hundred percent ceftriaxone resistant isolates possessed CTX-M and all ampicillin-resistant strains harbored TEM-1 genes. Amplified products were sequenced by using the Sanger sequencing method and the resulted sequences were checked for similarity in the nucleotide Database through the BLAST program. TEM-1 gene showed 99% and the CTX-M gene showed 98% similar sequences in the Database. The 16S rRNA sequence and nucleotide sequences for TEM-1 and CTX-M genes were submitted to Gene Bank with accession numbers LC521304, LC521306, LC521307 respectively. We posit to combat MDR gene flow among the bacterial pathogens across different geographical locations, regular surveillance of new zoonotic pathogens must be conducted.
ABSTRACT
The WHO has set Defined Daily Dose which represent the average daily dose of an antibiotic in a standard patient. The DDD mai nly focuses on population-based parameters & assumes that patients as well as hospitals are homogenous entities. DOTs are very useful in order to classify antibiotic days based on patient-level exposure. DOTs merely mean the number of days that a patient is on an antibiotic, irrespective of dose. DOTs signifies that the underlying assumptions about antibiotic dosing was appropriate. Additionally, when patients receive more than one antibiotic, supplementary DOT may be counted. The 300-bed tertiary care medical center serves adults and paediatrics. An all-time Microbiology Consultant and a Clinical Pharmacology trainee used to go for round daily and used to collect data for ASP for the period of 3 months that is April to June,2021. In this study we have compared DOT of some important antibiotics for a specific period of time for both COVID and NON COVID patient. ASP-focused antibiotics were antibiotics routinely evaluated by the ASP team for appropriateness during therapy and the potential to optimize their appropriate use through policies, protocols, formulary restrictions, or clinician education. ASP-focused antibiotics included meropenem, linezolid, pip-taz, poly b, colistin, teicoplanin. In this study we have compared the DDD for 2 specific period of time for better understanding the consumption of those antibiotics. In conclusion, following the initiation of an ASP, significant decreases in utilization, increases in cost savings occurred. In our study we have reduced the consumption and DDD of linezolid which is clinically significant. When it comes to DOTs;We have reduced the DOTs of piptaz and teicoplanin for covid patient And Reduced the DOTs of meropenem and teicoplanin for non-covid patient which is clinically and statistically significant.