Achieving pre-eminence of antimicrobial resistance among non-fermenting Gram-negative bacilli causing septicemia in intensive care units: A single center study of a tertiary care hospital.

Introduction: Bloodstream infections in the intensive care unit have always been a global healthcare challenge. The present study was conducted with the aim to evaluate the yearly trend of antibiotic resistance in non-fermenting Gram-negative bacilli (NFGNB) causing septicemia in intensive care units. Methods: Blood samples were collected from the patients admitted in various intensive care units and processed for isolation and identification of non-fermenting Gram-negative bacilli. The isolated bacterial strains were subjected to antibiotic susceptibility testing as per standard operating procedures. Results: Out of 3632 blood samples, 977 (26.9%) samples showed microbial growth, of which 10.1% were Gram positive cocci, 8.7% were Gram negative bacilli (Enterobacterales), 7% were NFGNB and 1% were Candida spp. Increasing resistance among Acinetobacter baumannii complex was observed to ceftazidime, cefepime, amikacin, ciprofloxacin, levofloxacin, meropenem and trimethoprim-sulfamethoxazole. Moreover, Pseudomonas aeruginosa strains were found to be associated with increased resistance to ciprofloxacin, levofloxacin, ceftazidime and meropenem. A substantial increase in resistance levels was observed among Stenotrophomonas maltophilia and Sphingomonas paucimobilis as well. Conclusions: An increasing trend of antimicrobial resistance in NFGNB envisages the worst consequences in ICUs in the coming years. Therefore, reviewing and strict implementation of the antimicrobial policies including 'rational use of antibiotics' is recommended.

Mechanistic insights of Euphorbia milii des moul mediated biocompatible and non-cytotoxic, antimicrobial nanoparticles: an answer to multidrug resistant bacteria.

The emergence of drug-resistant microbial pathogens is a matter of global concern and become more serious if they linked with healthcare-associated infections (HAIs). As per World Health Organization statistics, multidrug-resistant (MDR) bacterial pathogens account for between 7 and 12% of the worldwide burden of HAIs. The need for an effective and environmentally sustainable response to this situation is urgent. The primary goal of this study was to create copper nanoparticles that are biocompatible and non-toxic by using an extract of Euphorbia des moul, and then to test these nanoparticles' bactericidal efficacy against MDR strains of Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, and Acinetobacter baumannii. UV-Vis spectroscopy, dynamic light scattering, X-ray diffraction, Fourier transform infrared spectroscopy, transmission electron microscopy, and scanning electron microscopy techniques were used to characterize the biogenic G-CuNPs. It was found that G-CuNPs were spherical in shape, with an average diameter of ~ 40 nm and a charge density of - 21.52 mV. The G-CuNPs fully eradicated the MDR strains at a dosage of 2 mg/ml with 3 h of incubation time. Mechanistic analysis showed that the G-CuNPs efficiently disrupted the cell membrane and damaged the DNA and by generating more reactive oxygen species. Moreover, cytotoxic examination revealed that G-CuNPs displayed < 5% toxicity at 2 mg/ml concentration on human RBCs, PBMCs, and A549 cell lines, suggesting that they are biocompatible. This nano-bioagent is an eco-friendly, non-cytotoxic, non-hemolytic organometallic copper nanoparticles (G-CuNPs) with a high therapeutic index for possible use in the prevention of biomedical device-borne infections by preparing an antibacterial layer on indwelling medical devices. However, its potential clinical use has to be further studied through in vivo testing with an animal model.

Prevalence, multidrug-resistance and risk factors for AmpC ß-lactamases producing Escherichia coli from hospitalized patients.

INTRODUCTION: Multi-drug resistance among AmpC ß-lactamases producing Escherichia coli isolates is alarming. The study aimed to know the prevalence and presumptive antibiogram of AmpC producing Escherichia coli isolates and to determine the associated risk factors. METHODOLOGY: Escherichia coli isolated from various clinical specimens from hospitalized patients during the study period (January 2018- December 2018) were taken for the study. Standard biochemical reactions were used for organism identification. Antibiotic susceptibility testing was done using Kirby-Bauer method as per CLSI guidelines. Cefoxitin resistance was taken as screening tool to detect AmpC producing strains. The phenotypic confirmation was done using modified three-dimensional test. Multiplex PCR was used to detect pAmpC. RESULTS: A total non-duplicate consecutive 470 Escherichia coli were isolated from various clinical specimens of hospitalized patients during the study period. Cefoxitin resistance was observed in 51.9% (244/470). Modified three dimensional test was positive in 115/244 (47.1%) strains. Genotypic characterization of phenotypic positive AmpC strains showed presence of CIT and DHA genes among 33/115 and 19/115 isolates respectively. The overall prevalence of pAmpC producing E. coli was found to be 52/470 (11.1%). Multidrug resistance (MDR) was observed in 42/52 (80.7%) pAmpC strains. Antimicrobial use, prolonged hospitalization and interventions were associated risk factors for AmpC producing isolates. CONCLUSIONS: A high prevalence of multidrug resistance among AmpC producing strains suggests plasmid mediated spread of drug resistance in E. coli. Every hospital should formulate and implement infection control policies at-least for the risk group patients to control the dissemination of such microbes as infection prevention is better than infection control.