ABSTRACT
Pseudomonas aeruginosa is a significant pathogen identified with healthcare-associated infections. The present study evaluates the role of biofilm and efflux pump activities in influencing high-level resistance in virulent P. aeruginosa strains in clinical infection. Phenotypic resistance in biotyped Pseudomonas aeruginosa (n = 147) from diagnosed disease conditions was classified based on multiple antibiotic resistance (MAR) indices and analysed with logistic regression for risk factors. Efflux pump activity, biofilm formation, and virulence factors were analysed for optimal association in Pseudomonas infection using receiver operation characteristics (ROC). Age-specificity (OR [CI] = 0.986 [0.946-1.027]), gender (OR [CI] = 1.44 [0.211-9.827]) and infection sources (OR [CI] = 0.860 [0.438-1.688]) were risk variables for multidrug resistance (MDR)-P. aeruginosa infection (p < 0.05). Biofilm formers caused 48.2% and 18.5% otorrhea and wound infections (95% CI = 0.820-1.032; p = 0.001) respectively and more than 30% multidrug resistance (MDR) strains demonstrated high-level efflux pump activity (95% CI = 0.762-1.016; p = 0.001), protease (95% CI = 0.112-0.480; p = 0.003), lipase (95% CI = 0.143-0.523; p = 0.001), and hemolysin (95% CI = 1.109-1.780; p = 0.001). Resistance relatedness of more than 80% and 60% to cell wall biosynthesis inhibitors (ceftazidime, ceffproxil, augumentin, ampicillin) and, DNA translational and transcriptional inhibitors (gentamicin, ciprofloxacin, ofloxacin, nitrofurantoin) were observed (p < 0.05). Strong efflux correlation (r = 0.85, p = 0.034) with MDR strains, with high predictive performances in efflux pump activity (ROC-AUC 0.78), biofilm formation (ROC-AUC 0.520), and virulence hierarchical-clustering. Combine activities of the expressed efflux pump and biofilm formation in MDR-P. aeruginosa pose risk to clinical management and infection control.
ABSTRACT
To determine the effect of midazolam on ketamine-xylazine anesthesia, 20 guinea fowl (Numida meleagris galeata) were randomly divided into 2 groups. Birds in group KX were anesthetized with ketamine (15 mg/kg i.m.) and xylazine (2.5 mg/kg i.m.), whereas the birds anesthetized in group KXM received midazolam (0.3 mg/kg i.m.) in addition to the ketamine and xylazine protocol. The onset of anesthesia, duration of analgesia, duration of recumbency, and recovery time were determined. Heart and respiratory rates as well as cloacal temperatures were recorded immediately after drug administration and at 10-minute intervals until the birds were sternally recumbent. Analgesia was assessed as a response to artery forceps applied to the digit and skin proximal to the tarsal joint. The mean (SD) duration of analgesia in the group KXM birds was 37.4 +/- 23.5 minutes, whereas no analgesia was apparent with the group KX birds. The duration of recumbency was significantly longer and respiratory rates were significantly lower in group KXM birds compared with those in group KX. Adverse effects were minimal and included diarrhea (n = 1) and hypersalivation (n = 2) in group KX birds, and regurgitation (n = 2) in group KXM birds. Midazolam administered intramuscularly appeared to improve the anesthetic quality of ketamine and xylazine in guinea fowls without adversely affecting safety.
