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Background: ESBL-producing Enterobacteriaceae (ESBL-PE) represent a significant global health threat. In response to this growing concern and the lack of a surveillance system for ESBL-PE infections in Egypt, we conducted this meta-analysis. In this study, we aimed to quantify the prevalence of ESBL-PE based on the source of infection and characterize their molecular dissemination. Additionally, we sought to uncover temporal trends to assess the spread of ESBL-PE over time. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Google Scholar, Web of Science, and the Egyptian Knowledge Bank to identify studies that: (1) report the prevalence of ESBL-PE in Egypt; (2) use valid detection methods; (3) involve clinical specimens; and (4) were published between 2010 and 2024. The quality of the included studies was evaluated using the "Joanna Briggs Institute Critical Appraisal Checklist". Meta-analysis was performed using the R meta package, reporting pooled prevalence with 95% confidence intervals (CI) via a random effects model. Results: This meta-analysis included 34 studies with 4,528 isolates, spanning 2007 to 2023. The overall prevalence of ESBL-PE in Egypt was 60% (95% CI: 54–65). The leave-one-out meta-analysis demonstrated the absence of influential outliers and Egger's test indicated no evidence of publication bias (P = 0.25). The prevalence of ESBL-PE was 62% (95% CI: 55–68) in nosocomial infections and 65% (95% CI: 52–75) in community-acquired infections, with no statistically significant difference (P = 0.68). The prevalence of ESBL producers in E. coli (64%) and K. pneumoniae (63%) is higher than in Proteus mirabilis (46%) (P = 0.06). Temporal analysis showed a stable ESBL prevalence over time. Moreover, in phenotypically confirmed ESBL-producing, E. coli harboring blaCTX−M was most prevalent (73%), followed by blaTEM (60%) and blaSHV (22%), with significant differences (P < 0.01). Subsequent analysis identified blaCTX−M−15 as the predominant variant of the blaCTX−M gene. Conclusions: The prevalence of ESBL-PE in Egypt is alarmingly high at 60%. The observed high rates in both hospital and community-acquired infections underscore the need for public health strategies targeting both settings. One limitation of this study is the high heterogeneity, which partly attributed to regional and institutional variations in antibiotic use and stewardship practices. [ABSTRACT FROM AUTHOR]

Plasmid-mediated resistance is a major mechanism that contributes to the gradual decline in the effectiveness of antibiotics from different classes, including carbapenems. Antibiotics can significantly contribute to the efficiency of plasmid transfer between bacterial strains. To investigate the potential effect of an antibiotic on the efficacy of conjugative plasmid transfer, we conducted mating experiments with Klebsiella pneumoniae strains. Donor strains of K. pneumoniae that carry plasmids with blaKPC or blaOXA-48 carbapenemase genes and recipient plasmid-free K. pneumoniae strains were used in matings. Matings were conducted on the agar with or without meropenem at 1/8×, 1/4×, or 1/2×MIC against the respective recipients. In the second part of our study, we investigated the pharmacodynamic properties of meropenem against transconjugant strains of K. pneumoniae, which were obtained in the first part of this study. As a result, at a concentration equivalent to 1/8×MIC, meropenem primarily inhibited conjugation among K. pneumoniae strains, while at a concentration equal to 1/2×MIC, it facilitated conjugation. Transconjugants derived from K. pneumoniae with intermediate MICs failed to respond to simulated treatment with meropenem using prolonged infusion and a high-dose regimen. This finding suggests that such transconjugants may potentially pose a risk if involved in an infectious process. [ABSTRACT FROM AUTHOR]

Aztreonam/avibactam (ATM/AVI) has been recently approved drug for clinical use in the European Union. The aim of this study was to develop and evaluate a novel selective medium for the isolation of ATM/AVI-resistant strains (Super ATM/AVI selective medium) to help to control their spread. Minimum inhibitory concentrations of ATM/AVI were determined using the broth microdilution method for 77 Gram-negative isolates, including 62 Enterobacterales and 15 Pseudomonas aeruginosa. The Super ATM/AVI selective medium was elaborated using optimal final concentrations of ATM at 5 mg/L and AVI at 4 mg/L, being supplemented with amphotericin B and vancomycin to prevent growth of yeasts and Gram-positive bacteria and with ZnSO4 to optimize the expression of metallo-β-lactamase producers. Super ATM/AVI showed high sensitivity (94.6%) and specificity (100%) at a detection limit of 103 CFU/mL. [ABSTRACT FROM AUTHOR]

The bulb onion (Allium cepa) is second only to tomatoes in value of vegetable crops cultivated worldwide. Water-soaked lesions, bleaching and blight on leaves and slippery skin, sour skin, soft rot near the neck and centre rot on onion bulbs were observed in surveys of the onion fields, storage as well as fruit and vegetable markets of northwestern provinces of Iran in 2020. Thirty-four samples were collected from onion fields of East Azerbaijan, West Azerbaijan and Zanjan provinces and the central storage of Bonab city. Fifty bacterial strains were isolated from symptomatic samples. Pathogenicity of the strains was confirmed by inoculating on onion bulb cultivars Azarshahr and Ghermez Anari. Twenty-eight strains were able to induce soft rot on the inoculated sites of cut onion bulbs. Onion bulbs turned dark brown at lesion sites and became odorous over time. All pathogenic strains were Gram-negative, facultative aerobic and catalase positive. Strains mainly varied in starch and aesculin hydrolysis, potato rot and hypersensitive reaction. Pathogenic strains separated into four groups based on phenotypic assays. In the phylogenetic tree based on concatenated sequences of gyrB and infB genes, the strains were divided into four clusters containing the type strains of Enterobacter ludwigii, Klebsiella variicola, Proteus mirabilis and Pantoea agglomerans, confirming their identity as belonging to these four species. This is the first report of P. mirabilis as a plant pathogen and of K. variicola as a causal agent of onion bulb rot. Moreover, this is the first report of E. ludwigii and P. agglomerans associated with onion bulb rot in Iran. [ABSTRACT FROM AUTHOR]

This retrospective study evaluates the incidence and risk factors of community-acquired urinary tract infections (CA-UTIs) linked to extended-spectrum beta-lactamase–producing Enterobacterales (ESBLPE). The study was conducted in a tertiary hospital in northern Israel and included children younger than 18 years with CA-UTIs due to Enterobacterales who were admitted to the emergency department, during the years 2017 to 2019. Among the 570 children, 9.8% had ESBLPE-associated CA-UTIs. This prevalence remained steady over the study period. ESBLPE exhibited substantial resistance to amoxicillin/clavulanic acid (62.5% vs 20.4%, P <.001, odds ratio [OR] = 6.5), trimethoprim/sulfamethoxazole (58.9% vs 18%, P <.001, OR = 6.6), ciprofloxacin (33.9% vs 3.1%, P <.001, OR = 15.9), piperacillin/tazobactam (26.8% vs 7%, P <.001, OR = 4.9), and gentamicin (21.4% vs 4.3%, P <.001, OR = 6.1), compared with non-ESBLPE. Risk factors for ESBLPE-associated UTIs included recent antibiotic treatment within the past 3 months (P =.003, OR = 3.5) and colonization with ESBLPE (P <.001, OR = 12.8). Given the variable incidence of ESBLPE, relying on local epidemiology for antibiotic selection pending culture results is crucial. The study finding of a low ESBLPE incidence, coupled with global concerns regarding carbapenem resistance, supports cautious use of broad-spectrum antibiotics in nonsevere cases. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Antimicrobial resistance poses a significant public health challenge, particularly with the rise of gram‐negative hospital‐acquired infections resistant to carbapenems. Aztreonam–avibactam (ATM–AVI) is a promising new combination therapy designed to combat multidrug‐resistant (MDR) gram‐negative bacteria, including those producing metallo‐β‐lactamases (MBLs). Aztreonam, a monobactam antibiotic, is resistant to hydrolysis by MBLs but can be degraded by other β‐lactamases. Avibactam, a novel non‐β‐lactam β‐lactamase inhibitor, effectively neutralizes extended‐spectrum β‐lactamases (ESBLs) and AmpC β‐lactamases, restoring aztreonam's efficacy against resistant pathogens. This review covers the chemistry, mechanisms of action, spectrum of activity, pharmacokinetics, pharmacodynamics, and clinical efficacy of ATM–AVI. ATM–AVI combination has shown efficacy against a wide range of resistant Enterobacterales and other gram‐negative bacteria in both in vitro and clinical studies. Pharmacokinetic and pharmacodynamic analyses demonstrate that ATM–AVI maintains effective drug concentrations in the body, with dose adjustments recommended for patients with renal impairment. Clinical trials, including the REVISIT and ASSEMBLE studies, have demonstrated the safety and efficacy of ATM–AVI in treating complicated intra‐abdominal infections (cIAI), urinary tract infections (UTIs), and hospital‐acquired pneumonia (HAP) caused by MDR gram‐negative pathogens. The European Medicines Agency (EMA) has approved ATM–AVI for these indications, and further research is ongoing to optimize dosing regimens and expand its clinical use. This combination represents a critical advancement in the fight against antimicrobial resistance, offering a new therapeutic option for treating severe infections caused by MDR gram‐negative, including MBL‐producing, bacteria. [ABSTRACT FROM AUTHOR]

Carbapenem resistant (CRE) and carbapenemase producing Enterobacterales (CPE) in particular, represent a major threat for healthcare systems worldwide. Rapid, reliable, and easy to perform assays are required to enable targeted and effective therapy. MALDI-TOF MS based carbapenemase diagnostics has potential advantages over molecular and phenotypic sensitivity tests, especially in terms of time to result. So far, only one mass spectrometry (MS)-based carbapenemase test system is commercially available for routine use. The aim of this study was to compare the performance of the established system to a novel MS-based test to identify CPE isolates. Forty consecutive CRE isolates (70% CPEs) were pre-screened for carbapenemase activity by routine laboratory methods. Isolates then were tested using the to date only IVD CE certified MALDI-TOF MS carbapenemase detection assay (MBT STAR-Carba IVD Kit; Bruker Daltonics) and a novel test designed for the recently launched EXS2600 MALDI-TOF MS system (Carbapenemase Activity Kit; Zybio). Valid results were obtained for 93% and 85% isolates by the Bruker and the Zybio assay, respectively. Sensitivities, specificities, positive and negative predictive values were 92%, 91%, 96%, and 83% for the Bruker assay and 96%, 64%, 85%, and 88% for the Zybio assay. There are notable differences concerning the handling of the assays. In summary, both systems featured high sensitivities for the detection of carbapenemases, but the Bruker assay yielded less false-positive results. There are advantages and disadvantages concerning the handling for each system, but both proved to be suitable for the use in a routine laboratory. [ABSTRACT FROM AUTHOR]

Background: Enterobacterales infections in immunocompromised individuals are associated with considerable morbidity, mortality, and health care costs. This study aimed to assess the faecal carriage of extended-spectrum β-lactamase (ESBL) and carbapenemase-producing Enterobacterales (CPE) among HIV-infected patients at Jimma Medical Center. A total of 344 stool samples were collected and inoculated on Mac-Conkey and Eosin-Methylene Blue agar and incubated at 35–37 °C aerobically. ESBL and carbapenemase production were detected using D68C ESBL/AmpC and D73C CARBA plus (Mast Group, UK). Results: A total of 376 Enterobacterales were isolated. The prevalence of ESBL-PE and CPE carriage rate was 13.3% (50/376) and 4.3% (16/376) respectively. The highest proportion of ESBL producing isolates were found in K. pneumoniae 29.0% (9/31) followed by E. coli 13.4% (39/292). Similarly, K. pneumoniae 12.9% (4/31) was the most common carbapenem-resistant isolate followed by E. coli 3.8% (11/292). Multi-drug resistance was observed in 66.5% (250/376) of the isolates. Prior cephalosporin use (AOR = 7.9; 2.31–27.29), CD4 count (≤ 350 cells/µL) (AOR = 3.8; 1.12–12.9), and comorbidities (AOR = 2.3; 1.24–4.32) were significantly associated with ESBL production. Additionally, cephalosporin use (AOR = 6.34; 1.27–31.66) was significantly associated with the presence of CRE. Conclusions: This study revealed a high prevalence of ESBL-PE and CPE among HIV patients, with K. pneumoniae and E. coli being the dominant isolates. MDR was common, with key risk factors being prior cephalosporin use, low CD4 counts, and comorbidities. These findings emphasize the need for enhanced infection prevention and control, regular screening, and improved antibiotic stewardship to curb the spread of resistant bacteria in immunocompromised individuals. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the contamination levels of fresh products by ESBLs-producing Enterobacterales (ESBLs-E) or AmpC-producing Enterobacterales and characterize ESBLs genes. A total of 132 samples (67 vegetables and 65 fruits) were collected from markets in Tebessa, eastern Algeria. Among the samples, 16 third-generation cephalosporin-resistant Enterobacterales isolates were identified with a prevalence of 19.40% in vegetable samples, while there was no positive finding in fruit samples. Isolates showed resistance to most β-lactams, and all of them displayed multidrug resistance. Phenotypic tests for ESBLs detection, using double-disk synergy test and double-disk test were positive for 14 strains, including Klebsiella pneumoniae (n = 5), Klebsiella oxytoca (n = 4), Klebsiella terrigena (n = 2), Kluyvera spp. (n = 2), and Enterobacter cloacae (n = 1). Two AmpC-producing strains (Citrobacter freundii and E. cloacae) were identified through the AmpC disk test. Contamination rates of vegetables by ESBLs-E and AmpC-producing Enterobacterales were 19.40% and 2.98%, respectively. PCR results showed the presence of at least one ESBL gene in seven selected strains, with the dominance of blaCTX-M gene. Notably, K. pneumoniae strains showed the co-occurrence of two or three genes. Sequencing identified uncommon variants of ESBLs genes for the first time in Algeria, including blaCTX-M-79 (2/7), blaCTX-M-107 (2/7), blaCTX-M-117 (2/7), blaTEM-112 (1/7), blaTEM-125 (2/7), blaTEM-194 (1/7), and blaSHV-176 (3/7). [ABSTRACT FROM AUTHOR]

Background: Management of complicated intraabdominal infections (cIAIs) requires containment of the source and appropriate initial antimicrobial therapy. Identifying the local data is important to guide the empirical selection of antimicrobial therapy. In this study, we aimed to describe the pathogen distribution and antimicrobial resistance of cIAI. Methods: In two major tertiary care hospitals in Egypt, we enrolled patients who met the case definition of cIAI from October 2022 to September 2023. Blood cultures were performed using the BACTAlert system (BioMerieux, Marcy l'Etoile, France). A culture of aspirated fluid, resected material, or debridement of the infection site was performed. Identification of pathogens and antimicrobial susceptibility testing were conducted by the VITEK-2 system (BioMerieux, Marcy l'Etoile, France). Gram-negative resistance genes were identified by PCR and confirmed by whole bacterial genome sequencing using the Nextera XT DNA Library Preparation Kit and sequencing with the MiSeq Reagent Kit 600 v3 (Illumina, USA) on the Illumina MiSeq. Results: We enrolled 423 patients, 275 (65.01%) males. The median age was 61.35 (range 25–72 years). We studied 452 recovered bacterial isolates. Gram-negative bacteria were the vast majority, dominated by E. coli, followed by Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Proteus mirabilis (33.6%, 30.5%, 13.7%, 13%, and 5.4%, respectively). High rates of resistance were detected to third- and fourth-generation cephalosporins and fluoroquinolones. No resistance was detected to colistin. Resistance to amikacin and tigecycline was low among all isolates. Resistance to meropenem and ceftazidime/avibactam was moderate. ESBL genes were common in E. coli and K. pneumoniae. CTX-M15 gene was the most frequent. Among Enterobacterales, blaOXA-48 and blaNDM were the most prevalent carbapenemase genes. Pseudomonas aeruginosa isolates harbored a wide variety of carbapenemase genes (OXA, NDM, VIM, SIM, GIM, SPM, IMP, AIM), dominated by metallo-beta-lactamases. In 20.6% of isolates, we identified two or more resistance genes. Conclusion: High resistance rates were detected to third- and fourth-generation cephalosporins and fluoroquinolones. Amikacin and tigecyclines were the most active antimicrobials. Our data call for urgent implementation of antimicrobial stewardship programs and reinforcement of infection control. [ABSTRACT FROM AUTHOR]

Carbapenem-resistant Enterobacterales (CRE) have become a global threat, with colistin being the last resort for treatment. CLSI and EUCAST recommend broth microdilution (BMD) as the reference method for colistin susceptibility testing. Nordmann and Poirel have developed a simple and rapid Polymyxin NP test as an alternative to BMD for screening of colistin-resistant Enterobacterale (CoRE) isolates. This study aimed to evaluate the performance of the colistin rapid NP (CRNP) test for the detection of colistin resistance. CRNP test was performed on thirty-one clinical Enterobacterales isolates [ Klebsiella pneumoniae (21), Enterobacter spp , (9) and Escherichia coli (1), which were resistant to Colistin by the reference BMD method. The results of the NP test were interpreted after 4hr by the change in color of NP solution (original orange to yellow as a result of bacterial growth) and compared with that of BMD. The CRNP test could accurately detect 26/31 of the colistin resistant Enterobacterale isolates, and thus had an overall categorical agreement of 83.8%. Out of thirty-one CoRE isolates, five Enterobacter spp. 5/31 (16.1%) could not be detected by the CRNP test giving a false-negative result. Excluding those five Enterobacter spp. the categorical agreement (CA) of the CRNP test with BMD was 100%. The overall very major error (VME) of the CRNP test was 16% but decreased to < 3% when Enterobacter spp. (5) were excluded. The CRNP test is technically less demanding, yields faster results compared to the reference BMD method, and has 100% agreement with reference BMD in Enterobacterales except for Enterobacter spp. [ABSTRACT FROM AUTHOR]

Objectives. This study aimed to evaluate and compare the performance of different assays for antimicrobial susceptibility testing (AST) and minimum inhibitory concentration (MIC) determination for reserve antibiotics in carbapenem-resistant Enterobacterales (CREs), Pseudomonas aeruginosa (CRPAs), and Acinetobacter baumannii (CRABs). Methods. An analysis was conducted on 100 consecutive isolates: 50 CREs, 35 CRPAs, and 15 CRABs. Sensititre broth microdilution was used as a reference standard to evaluate the performance of VITEK 2 card AST-XN24 (bioMérieux), the respective gradient tests (bioMérieux), and UMIC colistin broth microdilution test strips (Bruker Daltonics). Errors, essential agreement (EA), and categorical agreement of MICs for colistin (COL), meropenem–vaborbactam (MVB), imipenem–relebactam (IRL), and eravacycline (ERV) were assessed. Results. The agreement between both of the COL broth microdilution (BMD) methods was perfect (100/100). The gradient test and VITEK 2 analysis yielded comparable EA rates (92/100 and 72/79, respectively), with the latter not registering any very major errors (VMEs). The MVB gradient test achieved EA in 66 of 85 isolates and VITEK 2 in 70/85. For IRL, EA was reached in 69 and 64 of 85 cases by gradient test and VITEK 2 analysis, respectively. The ERV gradient test yielded false results in nearly all (12/15) CRABs but achieved EA in 46 of 50 CREs. The VITEK system recorded EA for ERV in 60 of 65 isolates. Conclusions. We observed substantial variability in the measured MICs between BMD and the alternative methods. In only a few constellations, VITEK 2 or gradient tests could substitute the reference method. BMD is the method of choice for COL analysis, with VITEK 2 representing an alternative method for CRPA testing. Alternative methods for MVB did not provide reliable results, except for Enterobacterales, when tested with the gradient test. However, resistant results need to be confirmed by BMD. Only BMD can be used for IRL MIC determination. VITEK 2 was mostly accurate in measuring ERV MICs, while the corresponding gradient test yielded reliable results exclusively in CREs. It is essential that laboratories are aware of which testing method provides reliable results for each combination of microorganisms and reserve antibiotics. [ABSTRACT FROM AUTHOR]

To analyze the prevalence and molecular characteristics of 16S rRNA methylase genes in clinical isolates of carbapenem-resistant Enterobacterales, for clinical doctors provide a reference basis for the rational use of drugs. Methods: The Enterobacterales isolated from our hospital from 2020 to 2022 were selected and identified by VITEK 2 Compact automatic bacterial identification instrument. Resistance genes were detected by polymerase chain reaction. Results: A total of 180 carbapenem-resistant Enterobacterales were isolated, of which 158 (87.8%) were resistant to at least one aminoglycoside. The resistance rates to gentamicin, tobramycin and amikacin were 85.0%,82.8% and 54.4%, respectively. Compared with 16S rRNA methyltransferase negative isolates, the positive isolates were more sensitive to trimethoprim-sulfamethoxazole, tetracycline and minocycline, but had higher resistance rates to aztreonam, tobramycin, gentamicin, amikacin and ciprofloxacin. The resistance rates of 16S rRNA methyltransferase gene positive strains to most commonly used antibiotics were more than 80%. But the rates for colistin and tigecycline were less than 10%. There were 114 strains (63.3%) positive for 16S rRNA methyltransferase genes, mainly rmtB, accounting for 70.2%. The positive rates of other armA, rmtA and armA+rmtB genes were 22.8%, 4.4% and 2.6%, respectively. No rmtC, rmtD, rmtE and npmA genes were detected. In addition, 175 of the 180 carbapenem-resistant Enterobacterales carried at least one carbapenemase genes. The blaKPC was the main one (115, 65.7%). There were 111 (61.7%) strains carried both carbapenemase and 16S rRNA methyltransferase genes, simultaneously. Compared with 16S rRNA methyltransferase negative strains, the positive strains carried more blaKPC genes and less blaNDM genes, with P values of 0.034 and 0.003, respectively. Conclusion: blaKPC and rmtB genes are the main resistance mechanisms of Enterobacterales to carbapenems and aminoglycosides in our hospital. It is necessary to strengthen the detection of multi-drug resistant strains to provide scientific basis for clinical rational drug use. [ABSTRACT FROM AUTHOR]

Copyright of Microbes & Infectious Diseases is the property of Microbes & Infectious Diseases and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Identifying risk factors associated with the carriage of antimicrobial-resistant (AMR) bacteria in dogs is crucial to understanding their epidemiology and for developing and refining targeted control measures. However, relevant data is scattered and conflicting findings have been reported. This systematic review aimed to compile risk factors associated with the carriage of AMR-Enterobacterales in dogs worldwide and to identify relevant knowledge gaps for directing future research. A systematic review was conducted according to PRISMA guidelines, searching PubMed, CABi, and Scopus databases for studies reporting risk factors for acquiring AMR-Enterobacterales in dogs. After screening peer-reviewed, English-language studies by title/abstract, eligible studies were subjected to a full-text assessment, data extraction, risk-of-bias assessment, and qualitative synthesis. In the initial search, 774 articles were identified, including 274 duplicates. After screening by title/abstract, 77 articles were subjected to full-text review, from which 40 were eventually selected for data extraction, including 29 cross-sectional, six cohort, and five case-control studies. The most frequently investigated risk factors for AMR-Enterobacterales carriage in dogs were antimicrobial use (28 of 40), age (24), sex (22), hospitalization (19), and feeding raw diet (14). Of these, antimicrobial use was themost common risk factor significantly associated with AMR-Enterobacterales (19/28), followed by raw diet (9/14) and hospitalization (8/19). Our synthesis emphasized the importance of increasing awareness regarding the prudent use of critically important antimicrobials (CIAs), such as fluoroquinolones, in companion animal practices, strengthening infection prevention and control procedures in veterinary clinics and hospitals and educating caregivers about the potential risks of feeding raw diets in order to reduce the burden of AMR-bacteria in dogs. [ABSTRACT FROM AUTHOR]

This study continues surveillance of antimicrobial resistance associated with combat injuries in Ukraine. To compare species composition, antibiotic resistance profiles, and emergence of new resistance genes between 2014–2020 and 2022–2023. This was a retrospective multi-centre microbiological survey in Ukrainian hospitals. Antibiotic susceptibility, whole-genome sequencing and multi-locus sequence typing were conducted on 154 organisms obtained from 125 casualties between 2022 and 2023. The data revealed a predominance of Gram-negative bacteria, particularly Acinetobacter baumannii (35.7%), Pseudomonas aeruginosa (14.9%) and Klebsiella pneumoniae (20.7%). High levels of carbapenem resistance were observed among A. baumannii {meropenem 72.2% [39/54, 95% confidence interval (CI) 58.4–83.5]; imipenem 66.7% (36/54, 95% CI 52.5–78.9)}, K. pneumoniae [meropenem 90.6% (29/32, 95% CI 75.0–98.0); imipenem 81.2% (26/32, 95% CI 63.6–92.8)] and P. aeruginosa [meropenem 47.8% (11/23, 95% CI 26.8–69.4); imipenem 60.8% (14/23, 95% CI 38.5–80.3)] strains. A. baumannii sequence type (ST)-78 and ST-400 were prevalent from 2014 to 2020, while five strains of ST-1077 were newly identified in 2022–2023. P. aeruginosa strains showed diversity across 16 STs, with ST-773 increasing in frequency and new STs emerging, but lacking carbapenemase genes. K. pneumoniae exhibited increased genetic diversity over time, with three STs from 2014 to 2020 and six new STs, including bla NDM-1 , bla OXA-48 and bla KPC2 carriers, in 2022–2023. The prevalence of multi-drug-resistant isolates with STs associated with a high risk of global dissemination is increasing. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial resistance is a major global public health challenge, particularly with the rise of carbapenem-resistant Enterobacterales (CRE) and Pseudomonas aeruginosa (CRPA). This study aimed to describe the characteristics of CRE and CRPA infections in Eastern Europe, focusing on Bulgaria, Croatia, Czechia, Greece, Hungary, Poland, Romania, Serbia, Slovakia, and Slovenia. Methods: Following MOOSE and PRISMA guidelines, a systematic literature review of articles published between 1 November 2017 and 1 November 2023 was conducted using the MEDLINE, Embase, Web of Science, CDSR, DARE, and CENTRAL databases. The search strategy used a combination of free text and subject headings to gather pertinent literature regarding the incidence and treatment patterns of CRE and CRPA infections. A total of 104 studies focusing on infections in both children and adults were included in this review. Results: This review revealed a significant prevalence of carbapenem-resistant Gram-negative isolates and underscored the effectiveness of imipenem/relebactam and ceftazidime/avibactam (CAZ/AVI) against Klebsiella pneumoniae carbapenemase-producing Enterobacterales and of ceftolozane/tazobactam, imipenem/relebactam and ceftazidime/avibactam against non-metallo-β-lactamase-producing CRPA strains. Conclusions: This study highlights the urgent need for comprehensive measures to combat the escalating threat of CRE and CRPA infections in Eastern European countries. At the same time, it shows the activity of the standard of care and new antimicrobials against carbapenem-resistant Gram-negative pathogens in Eastern Europe. Clinical real-world data on the treatment of carbapenem-resistant infections in Eastern Europe are needed. [ABSTRACT FROM AUTHOR]

Background: Acquired 16S rRNA methyltransferases (16S-RMTases) confer high-level resistance to aminoglycosides and are often associated with β-lactam and quinolone resistance determinants. Methods: Using PCR, whole-genome sequencing and conjugation experiments, we conducted a retrospective genomic surveillance study of 16S-RMTase-producing Enterobacterales, collected between 2006 and 2023, to explore transmission dynamics of methyltransferase and associated antibiotic resistance genes. Results: Among the 10,731 consecutive isolates, 150 (1.4%) from 13 species carried armA (92.7%), rmtB (4.7%), and rmtF + rmtB (2.7%) methyltransferase genes. The coexistence of extended-spectrum β-lactamase (blaCTX-M-3/15, blaSHV-12, blaSFO-1), carbapenemase (blaNDM-1/5, blaVIM-1/4/86, blaOXA-48), acquired AmpC (blaCMY-2/4/99, blaDHA-1, blaAAC-1), and plasmid-mediated quinolone resistance (qnrB, qnrS, aac(6′)-Ib-cr) genes within these isolates was also detected. Methyltransferase genes were carried by different plasmids (IncL/M, IncA/C, IncR, IncFIB, and IncFII), suggesting diverse origins and sources of acquisition. armA was co-transferred with blaCTX-M-3/15, blaNDM-1, blaVIM-4/86, blaOXA-48, blaCMY-4, aac(6′)-Ib-cr, qnrB, and qnrS, while rmtF1 was co-transferred with blaSFO-1, highlighting the multidrug-resistant nature of these plasmids. Long-read sequencing of ST6260 K. pneumoniae isolates revealed a novel resistance association, with rmtB1 and blaNDM-5 on the chromosome, blaOXA-232 on a conjugative ColKP3 plasmid, and rmtF1 with blaSFO-1 on self-transmissible IncFIB and IncFII plasmids. Conclusions: The genetic plasticity of plasmids carrying methyltransferase genes suggests their potential to acquire additional resistance genes, turning 16S-RMTase-producing Enterobacterales into a persistent public health threat. [ABSTRACT FROM AUTHOR]

The global emergence of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae presents a significant public health threat and complicates antibiotic treatment for infections. This study aimed to determine the prevalence of ESBL-producing K. pneumoniae in a clinical setting, analyze their antimicrobial susceptibility profiles, and characterize both phenotypic and genetic determinants. A total of 507 non-duplicate clinical isolates of Enterobacterales were collected between 2019 and 2020, and third-generation cephalosporin resistance was screened by disk diffusion. Identification of K. pneumoniae was confirmed using biochemical tests and PCR with species-specific primers. Antimicrobial susceptibility testing was conducted using disk diffusion, and phenotypic ESBL production was confirmed using the combined disk method. Multiplex PCR detected ESBL genes (blaTEM, blaSHV, and blaCTX-M) and identified blaCTX-M groups. The genetic relatedness of ESBL-producing strains was assessed using the ERIC-PCR approach. Fitty-four isolates were confirmed as ESBL producers, all classified as multidrug-resistant (MDR). All ESBL-producing K. pneumoniae isolates exhibited resistance to ampicillin and cefotaxime, with high resistance rates for ciprofloxacin (98.2%), azithromycin (94.4%), piperacillin–tazobactam (88.9%), and trimethoprim (83.3%). Genotypic analysis revealed blaCTX-M was present in 94.4% of isolates, blaSHV in 87%, and blaTEM in 55.5%. The blaCTX-M-1 group was the most prevalent, accounting for 96.1% of isolates. Co-harboring of blaCTX-M, blaSHV, and blaTEM occurred in 42.6% of isolates, with co-carrying of blaCTX-M, and blaSHV was observed in 23/54 isolates. The ERIC-PCR analysis revealed 15 distinct types, indicating high genetic diversity. These findings highlight the urgent need for ongoing monitoring to control the spread of ESBL among K. pneumoniae and emphasize the importance of early detection and appropriate antibiotic selection for effectively treating infection caused by these pathogens. [ABSTRACT FROM AUTHOR]

Background: Colistin is an antibiotic with lipophilic and hydrophilic properties, effective against Enterobacterales and non-fermenter bacteria. Due to the emergence of multidrug-resistant Gram-negative bacilli, colistin is being once again reintroduced as a last resort for their treatment. Resistance is caused by mutations and some are plasmid-mediated. Aims and Objectives: The aim of the study was to determine antibiotic resistance patterns in Gram-negative bacilli and to detect colistin susceptibility patterns in multidrug-resistant Enterobacterales and Pseudomonas aeruginosa. Materials and Methods: This prospective cross-sectional study was carried out in the Department of Microbiology, Calcutta National Medical College and Hospital, using standard laboratory protocol and colistin susceptibility was determined by colistin broth disk elution (CBDE) method. Results: Out of a total of 80 patients infected with MDR isolates, 63.75% were male and 36.25% were female. The most common age group affected was 41-60 years. Multidrugresistant (MDR) bacteria were most commonly isolated from urine samples, and Klebsiella pneumoniae was the most common MDR bacteria isolated. Overall, colistin resistance was 7.5% and it was found most commonly in K. pneumoniae. The use of broad-spectrum antibiotics was the most common risk factor for the emergence of MDR bacterial infections, including colistin resistance. Conclusion: The present study detects colistin resistance using a simple method -- "CBDE test" which can be done in resource-poor settings and can guide clinicians to rationally use the medication as it may be used as an alternative treatment option for "Super bugs" and can even be used as the "last resort" in certain scenario. [ABSTRACT FROM AUTHOR]

Chen-Huan Yu,1 Mao-Song Tsai,2 Chun-Hsing Liao,2 Chia-Jui Yang2 1Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; 2Division of Infectious Disease, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, TaiwanCorrespondence: Chia-Jui Yang, Division of Infectious Disease, Department of Internal Medicine,Far Eastern Memorial Hospital, No. 21, Sec. 2, Nanya S. Road, Banciao Dist, New Taipei City, Taiwan, Fax +886 2 77281321, Email yangcj1206@gmail.comPurpose: Ceftazidime-avibactam (CZA), a novel beta-lactam/beta-lactamase inhibitor, plays an important role in the threat of emerging carbapenem-resistant Enterobacterales (CRE) infection. The study aims to analyze the clinical effectiveness and factors influencing treatment response to CZA for carbapenem-resistant Klebsiella pneumoniae (CRKP) infections.Patients and Methods: From February 2020 to December 2021, patients with CRKP infection treated with CZA were enrolled in this retrospective, single-center cohort study in northern Taiwan. The primary outcome was 28-day survival rate. The secondary outcomes were clinical success, and microbiological cure. Multivariate regression analysis was used to evaluate factors associated with 28-day survival.Results: A total of 142 patients treated with CZA alone (n=82) or in combination therapy (n=60) were included. We found 28-day survival rate, microbiological cure, and clinical success rate were 78% (111/142), 86% (87/101), and 48% (63/132), respectively. In multivariate analysis, there were no significant differences in 28-day survival between monotherapy group and combination therapy group (P=0.424). A relative lower microbiological cure rate can be observed in lower respiratory tract infection from univariate analysis (P=0.07). In addition, significantly better survival was observed in patients with creatinine clearance rate (CCr) ≥ 50 mL/min than CCr < 50 mL/min (P=0.005).Conclusion: CZA is an effective and important treatment option for CRKP infection even when it is treated as monotherapy. In patients with impaired renal function, a potential impact of CZA dose adjustments on poor survival outcomes has been observed, indicating the need for further research to determine optimal renal dose adjustment strategies.Keywords: enterobacterales, Klebsiella pneumoniae, ceftazidime-avibactam

Abstract Background ESBL-producing Enterobacteriaceae (ESBL-PE) represent a significant global health threat. In response to this growing concern and the lack of a surveillance system for ESBL-PE infections in Egypt, we conducted this meta-analysis. In this study, we aimed to quantify the prevalence of ESBL-PE based on the source of infection and characterize their molecular dissemination. Additionally, we sought to uncover temporal trends to assess the spread of ESBL-PE over time. Methods A comprehensive literature search was conducted in PubMed, Scopus, Google Scholar, Web of Science, and the Egyptian Knowledge Bank to identify studies that: (1) report the prevalence of ESBL-PE in Egypt; (2) use valid detection methods; (3) involve clinical specimens; and (4) were published between 2010 and 2024. The quality of the included studies was evaluated using the “Joanna Briggs Institute Critical Appraisal Checklist”. Meta-analysis was performed using the R meta package, reporting pooled prevalence with 95% confidence intervals (CI) via a random effects model. Results This meta-analysis included 34 studies with 4,528 isolates, spanning 2007 to 2023. The overall prevalence of ESBL-PE in Egypt was 60% (95% CI: 54–65). The leave-one-out meta-analysis demonstrated the absence of influential outliers and Egger’s test indicated no evidence of publication bias (P = 0.25). The prevalence of ESBL-PE was 62% (95% CI: 55–68) in nosocomial infections and 65% (95% CI: 52–75) in community-acquired infections, with no statistically significant difference (P = 0.68). The prevalence of ESBL producers in E. coli (64%) and K. pneumoniae (63%) is higher than in Proteus mirabilis (46%) (P = 0.06). Temporal analysis showed a stable ESBL prevalence over time. Moreover, in phenotypically confirmed ESBL-producing, E. coli harboring bla CTX−M was most prevalent (73%), followed by bla TEM (60%) and bla SHV (22%), with significant differences (P

Abstract Background Bloodstream infection (BSI) is associated with poor outcomes especially when effective antimicrobial therapy and control of infection source are delayed. As the frequency of Enterobacterales producing metallo-β-lactamases (MBL) and/or OXA-48–like carbapenemases is increasing in some United States (US) medical centres, effective antimicrobials to treat the infections caused by these organisms are urgently needed. Aztreonam-avibactam is under clinical development for treatment of infections caused by Gram-negative bacteria, including MBL producers. Objectives To evaluate the antimicrobial susceptibility of Enterobacterales causing BSI in US medical centres and compare the activity of aztreonam-avibactam with ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, cefiderocol, and other antimicrobials used to treat BSI. Methods 4,802 Enterobacterales were consecutively collected (1/patient) from 72 US medical centres in 2020–2022 and susceptibility tested by broth microdilution. Aztreonam-avibactam was tested with avibactam at a fixed concentration of 4 mg/L. A pharmacokinetic/pharmacodynamic susceptible breakpoint of ≤ 8 mg/L was applied for aztreonam-avibactam for comparison. Carbapenem-resistant Enterobacterales (CRE) isolates were tested for β-lactamase–encoding genes using Next-generation sequencing. Results Aztreonam-avibactam was highly active against Enterobacterales; only 2 isolates showed aztreonam-avibactam MICs > 8 mg/L: 1 meropenem-susceptible E. coli and 1 K. aerogenes (CRE). All carbapenemase producers and 98.0% of CRE were inhibited at an aztreonam-avibactam MIC of ≤ 8 mg/L. CRE susceptibility rates were 81.6% for ceftazidime-avibactam, 65.3% for meropenem-vaborbactam, 61.2% for imipenem-relebactam, and 87.8% for cefiderocol. Aztreonam-avibactam retained activity (MIC, ≤ 8 mg/L) against all (100.0%) meropenem-vaborbactam nonsusceptible (n = 17), 99.5% of imipenem-relebactam nonsusceptible (n = 206), and 90.0% of ceftazidime-avibactam nonsusceptible (n = 10) isolates. The most common carbapenemases were KPC-2/3 (57.1% of CREs), OXA-48–like (16.3%), and NDM (14.3%). A carbapenemase gene was not observed in 12.3% of CREs. Ceftazidime-avibactam and meropenem-vaborbactam were active against 100.0% of KPC producers, but ceftazidime-avibactam showed limited activity against MBL producers and meropenem-vaborbactam showed limited activity against OXA-48–like and MBL producers. The most active non–β-lactam comparators against CRE were gentamicin (49.0% susceptible) and amikacin (44.9% susceptible). Conclusions Aztreonam-avibactam demonstrated potent activity against a large collection of Enterobacterales isolated from patients with BSI in US hospitals, including CRE, MBL producers, and isolates resistant to recently approved β-lactamase inhibitor combinations.

Abstract Background Enterobacterales infections in immunocompromised individuals are associated with considerable morbidity, mortality, and health care costs. This study aimed to assess the faecal carriage of extended-spectrum β-lactamase (ESBL) and carbapenemase-producing Enterobacterales (CPE) among HIV-infected patients at Jimma Medical Center. A total of 344 stool samples were collected and inoculated on Mac-Conkey and Eosin-Methylene Blue agar and incubated at 35–37 °C aerobically. ESBL and carbapenemase production were detected using D68C ESBL/AmpC and D73C CARBA plus (Mast Group, UK). Results A total of 376 Enterobacterales were isolated. The prevalence of ESBL-PE and CPE carriage rate was 13.3% (50/376) and 4.3% (16/376) respectively. The highest proportion of ESBL producing isolates were found in K. pneumoniae 29.0% (9/31) followed by E. coli 13.4% (39/292). Similarly, K. pneumoniae 12.9% (4/31) was the most common carbapenem-resistant isolate followed by E. coli 3.8% (11/292). Multi-drug resistance was observed in 66.5% (250/376) of the isolates. Prior cephalosporin use (AOR = 7.9; 2.31–27.29), CD4 count (≤ 350 cells/µL) (AOR = 3.8; 1.12–12.9), and comorbidities (AOR = 2.3; 1.24–4.32) were significantly associated with ESBL production. Additionally, cephalosporin use (AOR = 6.34; 1.27–31.66) was significantly associated with the presence of CRE. Conclusions This study revealed a high prevalence of ESBL-PE and CPE among HIV patients, with K. pneumoniae and E. coli being the dominant isolates. MDR was common, with key risk factors being prior cephalosporin use, low CD4 counts, and comorbidities. These findings emphasize the need for enhanced infection prevention and control, regular screening, and improved antibiotic stewardship to curb the spread of resistant bacteria in immunocompromised individuals.

Abstract Carbapenem resistant (CRE) and carbapenemase producing Enterobacterales (CPE) in particular, represent a major threat for healthcare systems worldwide. Rapid, reliable, and easy to perform assays are required to enable targeted and effective therapy. MALDI-TOF MS based carbapenemase diagnostics has potential advantages over molecular and phenotypic sensitivity tests, especially in terms of time to result. So far, only one mass spectrometry (MS)-based carbapenemase test system is commercially available for routine use. The aim of this study was to compare the performance of the established system to a novel MS-based test to identify CPE isolates. Forty consecutive CRE isolates (70% CPEs) were pre-screened for carbapenemase activity by routine laboratory methods. Isolates then were tested using the to date only IVD CE certified MALDI-TOF MS carbapenemase detection assay (MBT STAR-Carba IVD Kit; Bruker Daltonics) and a novel test designed for the recently launched EXS2600 MALDI-TOF MS system (Carbapenemase Activity Kit; Zybio). Valid results were obtained for 93% and 85% isolates by the Bruker and the Zybio assay, respectively. Sensitivities, specificities, positive and negative predictive values were 92%, 91%, 96%, and 83% for the Bruker assay and 96%, 64%, 85%, and 88% for the Zybio assay. There are notable differences concerning the handling of the assays. In summary, both systems featured high sensitivities for the detection of carbapenemases, but the Bruker assay yielded less false-positive results. There are advantages and disadvantages concerning the handling for each system, but both proved to be suitable for the use in a routine laboratory.

We examined the emergence and characteristics of oxacillinase-484–producing Enterobacterales in France during 2012–2023. Genomic analysis identified 2 predominant sequence types in Escherichia coli: ST410 and ST1722. Plasmid analysis revealed that blaOXA-484 genes were carried mostly on an IncX3-type plasmid associated with genetic elements including insertion sequences IS3000 and ISKpn19.

Ana Sheila Duarte Nunes Silva,1 Natalia Chilinque Zambão da Silva,1 Fernanda Moreth do Valle,2 Jaqueline Abel da Rocha,2 Shelley Ehrlich,3,4 Ianick Souto Martins1,5 1Infection Disease Division, Department of Clinical Medicine, Faculty of Medicine, Fluminense Federal University, Niterói, RJ, Brazil; 2Hospital Universitário Antonio Pedro, Faculty of Medicine, Fluminense Federal University, Niterói, RJ, Brazil; 3Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA; 4Department of Environmental and Public Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, USA; 5Infection Control Division, Hospital Do Câncer I, Instituto Nacional Do Câncer, Rio de Janeiro, RJ, BrazilCorrespondence: Ana Sheila Duarte Nunes Silva, Email anasheilasilva@gmail.comAim: ESCPM bacteria include Enterobacter spp, Serratia, Citrobacter spp, Providencia spp, and Morganella spp. These Gram-negative bacilli harbor chromosomally encoded AmpC-type β-lactamases that cause resistance to β-lactam antibiotics, such as penicillins, β-lactam/β-lactamase inhibitors, and first-, second-, and third-generation cephalosporins. Bloodstream infections caused by ESCPM group bacteria (BSI-ESCPM) are difficult to treat.Purpose: To describe 30-day mortality and analyze potential risk factors for death in patients with BSI-ESCPM.Patients and Methods: A cohort study of patients aged ≥ 18 years with BSI-ESCPM was conducted at a University Hospital in Brazil, from January 2013 and December 2018. Potential risk factors for death within 30 days of bloodstream infection BSI diagnosis were analyzed using multivariable logistic regression.Results: Among 138 patients with BSI-ESCPM, 63.0% were males, with a median age of 61 years. Of 155 BSI-ESCPM episodes, 61.3% were hospital-acquired. Primary BSI-ESCPM associated with short-term central venous catheter (37.4%) and BSI-ESCPM secondary to respiratory infection (19.4%) occurred mainly. Mostly, Enterobacter spp. (49.7%) and Serratia spp. (29.0%) were isolated. Multidrug-resistance occurred in 27.7% of BSI-ESCPM episodes, involving Enterobacter spp. (16.1%) and Serratia spp. (7.7%) mainly. The mortality was 24.5%. Developing septic shock within 72 h of BSI-ESCPM diagnosis (OR: 70.26; 95% CI: 16.69– 295.77; P< 0.01) was risk factor for death. Conversely, combined antibiotic therapy (OR: 0.23; 95% CI: 0.05– 0.94; P:0.04), BSI-ESCPM secondary to urinary infection (OR: 0.11; 95% CI: 0.01– 0.99; P:0.05), and Enterobacter spp. BSI (OR: 0.16; 95% CI: 0.05– 0.56; P 0< 0.01) was protective factor against death. Tendency of association between inadequate antibiotic therapy and death (OR: 2.19; 95% CI: 0.51– 9.42; P:0.29) was observed.Conclusion: BSI-ESCPM is severe and has serious outcomes such as sepsis-associated deaths. Combined antibiotic therapy was a protective factor against death in patients with BSI-ESCPM. There is a suggestive association between inadequate antibiotic therapy and mortality. The ESCPM group bacteria that are considered to be at moderate to high risk of clinically significant AmpC production were not associated with death.Keywords: bloodstream infection, Enterobacterales, AmpC β-lactamase, mortality, risk factors of death

ABSTRACT: Objectives: This study was performed to investigate the activity of the novel ß-lactam/ß-lactamase inhibitor combination cefepime/enmetazobactam, against recently circulating Enterobacterales isolates from Europe from 2019 to 2021. Methods: A total of 2627 isolates were collected, and antimicrobial susceptibility was determined according to the European Committee on Antimicrobial Susceptibility Testing guidelines. Isolates with phenotypic resistance to ceftriaxone and ceftazidime (but susceptible to meropenem) and isolates nonsusceptible to meropenem were screened for the presence of ß-lactamases. Results: Overall, susceptibility to third-generation cephalosporins was 77%, and 97.3% were susceptible to meropenem. Cefepime/enmetazobactam susceptibility was 97.9% (72% of these isolates were Klebsiella pneumoniae from Italy), compared with 80.0% susceptibility to piperacillin/tazobactam and 99.4% to ceftazidime/avibactam. A total of 320 isolates (12.2%) were resistant to third-generation cephalosporins but susceptible to meropenem, and virtually all (96.3%) carried an extended-spectrum ß-lactamase with or without an AmpC and these were all susceptible to cefepime/enmetazobactam. Most meropenem-nonsusceptible isolates carried a KPC (68%), which were not inhibited by cefepime/enmetazobactam but were inhibited by ceftazidime/avibactam. Additionally, most meropenem-nonsusceptible isolates carrying OXA-48 (9/12 isolates) were susceptible to cefepime/enmetazobactam. Conclusions: Cefepime/enmetazobactam was highly active against Enterobacterales isolates, especially those resistant to third-generation cephalosporins. These data suggest that cefepime/enmetazobactam could be used as a carbapenem-sparing agent to replace piperacillin/tazobactam.

Abstract Background Infections caused by multi-drug resistant Gram-negative pathogens are associated with worse clinical outcomes in critically ill patients. We evaluated hospital outcomes based on adequacy of overall and newer antibacterial therapy for Enterobacterales (ENT) and Pseudomonas aeruginosa (PsA) in US patients. Methods Hospitalized adults ≥ 18 years old with facility-reported antibiotic susceptibility from 2018–2022 across 161 facilities in the BD Insights Research Database were identified as ENT- or PsA-positive. Generalized linear mixed models were used to evaluate the impact of inadequate empiric therapy (IET) and time to initiate newer antibacterials (ceftazidime-avibactam; ceftolozane-tazobactam; cefiderocol; meropenem-vaborbactam; eravacycline; and imipenem-cilcastatin-relebactam) on hospital mortality and post-culture length of stay (LOS). Results Among 229,320 ENT and 36,027 PsA susceptibility results, 1.7% and 16.8% were carbapenem non-susceptible (carb-NS), respectively. Median time to first susceptibility result was longer for carb-NS vs. carb susceptible in ENT (64 h vs. 48 h) and PsA (67 h vs. 60 h). For ENT, IET was associated with significantly higher mortality (odds ratio [OR],1.29 [95% CI, 1.16–1.43, P

Cefiderocol is a novel cephalosporin–siderophore conjugate antibiotic that holds promise to thwart infections caused by multi-drug-resistant gram-negative bacilli. Its antibacterial activity against normally susceptible species is not affected by most β-lactamases, including metallo-β-lactamases. Due to the siderophore-mediated entry into the cell, the activity of cefiderocol is less affected by porin loss or active efflux resistance than many other β-lactam antibiotics. The aim of this study was to assess in vitro susceptibility to the cefiderocol of carbapenemase-producing gram-negative bacilli from clinical samples of hospitalized patients. We analyzed 102 clinical strains of carbapenemase-producing Enterobacterales and non-fermentives from hospital centers in Łódź, Poland. Antimicrobial susceptibility to cefiderocol was tested by the minimum inhibitory concentration test strips and disc diffusion methods. The obtained results turned out to be ambiguous, and the area of technical uncertainty made their interpretation very difficult. The cost of therapy with this antibiotic, and difficulties in interpreting the drug susceptibility are the limitations to the use of cefiderocol. Intensive work should be carried out to finally standardize an easily accessible and reliable method for the determination of susceptibility to cefiderocol. [ABSTRACT FROM AUTHOR]

Bacterial infections are a common complication in patients with decompensated liver cirrhosis. The complex landscape of cirrhosis, characterized by immune paralysis and an exhausted response to exogenous triggers, explains the higher prevalence of such infections, particularly in advanced disease stages. In clinical practice, the onset of a bacterial infection can lead to further deterioration of hepatic and extra-hepatic function, potentially resulting in acute decompensation or acute-on-chronic liver failure. This has significant clinical implications, particularly for patients awaiting a transplant. In this review, we will discuss the latest evidence on the diagnosis and therapy of bacterial infections in patients with decompensated cirrhosis. Additionally, we will analyze the impact of bacterial infections in the context of liver transplantation, discussing debated topics such as the timing of transplantation in patients with infections, potential implications for prioritization, effects on post-operative recovery, grafts, and patient survival. [ABSTRACT FROM AUTHOR]

It is increasingly important to rapidly receive information on the antimicrobial susceptibility of bacteria due to the rise in antimicrobial resistance worldwide. However, traditional phenotypic methods are time-consuming. Thus, the objective of this study was to develop a rapid assay that can detect antibiotic-resistant bacterial isolates phenotypically in less than 2 h. The microplate assay used in this study is based on absorbance measurements of pure bacterial isolates grown in liquid media with and without antibiotics. Absorbance was measured at the beginning of the assay and after 90 min of incubation at 37 °C. Susceptibility was calculated for bacterial isolates that, in the absence of antibiotics, exhibited more than a 50% growth increase by comparing the absorbance value of the culture in the presence of an antibiotic at 90 min with its initial value. Here, we show that it is possible to phenotypically screen the antibiotic susceptibility of Enterobacterales and Acinetobacter spp. isolates to three different antibiotics in 90 min. The test demonstrated an accuracy of 98.8%, sensitivity of 97.6%, and specificity of 99.6%. The false susceptibility rates were 0.2% and false resistance rates were 1.0%. This rapid and simple absorbance test has proven suitable for the screening of antibiotic susceptibility for a large number of strains with high accuracy and sensitivity. This method can be performed without specialized and costly materials and/or equipment, which makes it highly suitable for laboratories with limited resources. [ABSTRACT FROM AUTHOR]

Objective: The objective was to compare the microbiological characteristics and treatment of early and late surgical site infections (SSIs) in instrumented spinal surgery. Methods: Those patients admitted for SSIs in a single center between January 2010 and December 2022 were included. The subjects were divided into early (eSSIs) and late (lSSIs) SSIs, and demographic, microbiological, treatment, and follow-up data were collected. Results: Instrumented spinal surgery was performed in 2136 patients. Ninety-six cases of infections were identified (prevalence = 4.5%), with 47.9% eSSIs and 52.1% lSSIs. In 58.7% of the cases, the eSSIs were monomicrobial: Staphylococcus aureus (37%) and Enterobacterales (33.3%) were the main bacteria involved. In 66% of the cases, the lSSIs, were monomicrobial: Cutibacterium acnes (30.3%) and staphylococci were predominant. Enterobacterales were isolated in more than 70% of the polymicrobial samples in both the eSSIs and lSSIs. The treatment of the eSSIs mostly consisted of lavage-debridement surgery associated with antibiotic treatment, while the treatment of the lSSIs combined hardware removal or replacement and long-duration antibiotic treatment. A negative outcome was observed in 17.1% of the eSSIs and 5.7% of the lSSIs. Enterobacterales were associated with negative outcomes of eSSIs. Conclusions: Enterobacterales were found in most of the polymicrobial infections regardless of the time of infection onset. Further large studies should be conducted to precisely determine the management and prevention regarding the increasing Gram-negative bacteria SSIs. [ABSTRACT FROM AUTHOR]

Background: Infections caused by multi-drug resistant Gram-negative pathogens are associated with worse clinical outcomes in critically ill patients. We evaluated hospital outcomes based on adequacy of overall and newer antibacterial therapy for Enterobacterales (ENT) and Pseudomonas aeruginosa (PsA) in US patients. Methods: Hospitalized adults ≥ 18 years old with facility-reported antibiotic susceptibility from 2018–2022 across 161 facilities in the BD Insights Research Database were identified as ENT- or PsA-positive. Generalized linear mixed models were used to evaluate the impact of inadequate empiric therapy (IET) and time to initiate newer antibacterials (ceftazidime-avibactam; ceftolozane-tazobactam; cefiderocol; meropenem-vaborbactam; eravacycline; and imipenem-cilcastatin-relebactam) on hospital mortality and post-culture length of stay (LOS). Results: Among 229,320 ENT and 36,027 PsA susceptibility results, 1.7% and 16.8% were carbapenem non-susceptible (carb-NS), respectively. Median time to first susceptibility result was longer for carb-NS vs. carb susceptible in ENT (64 h vs. 48 h) and PsA (67 h vs. 60 h). For ENT, IET was associated with significantly higher mortality (odds ratio [OR],1.29 [95% CI, 1.16–1.43, P < 0.0001]) and longer hospital LOS (14.8 vs. 13.3, P < 0.0001). Delayed start to newer antibacterial therapy was associated with significantly greater hospital mortality for ENT (P = 0.0182) and PsA (P = 0.0249) and significantly longer post-culture LOS for ENT (P < 0.0001) and PsA (P < 0.0001). Conclusions: Overall, IET and delayed use of newer antibacterials are associated with significantly worse hospital outcomes. More rapid identification of high-risk patients can facilitate adequate therapy and timely use of newer antibacterials developed for resistant Gram-negative pathogens. [ABSTRACT FROM AUTHOR]

Antibiotic resistance has become a global threat as it is continuously growing due to the evolution of β‐lactamases diminishing the activity of classic β‐lactam (BL) antibiotics. Recent antibiotic discovery and development efforts have led to the availability of β‐lactamase inhibitors (BLIs) with activity against extended‐spectrum β‐lactamases as well as Klebsiella pneumoniae carbapenemase (KPC)‐producing carbapenem‐resistant organisms (CRO). Nevertheless, there is still a lack of drugs that target metallo‐β‐lactamases (MBL), which hydrolyze carbapenems efficiently, and oxacillinases (OXA) often present in carbapenem‐resistant Acinetobacter baumannii. This review aims to provide a snapshot of microbiology, pharmacology, and clinical data for currently available BL/BLI treatment options as well as agents in late stage development for CRO harboring various β‐lactamases including MBL and OXA‐enzymes. [ABSTRACT FROM AUTHOR]

The extended-spectrum β-lactamases (ESβLs) are bacterial enzymes capable of hydrolyzing penicillins, cephalosporins, and aztreonam. The prevalence of ESβL is increasing among clinically significant microorganisms worldwide, drastically reducing the therapeutic management of infectious diseases. The study aimed to determine the drug susceptibility of ESβL-positive clinical isolates acquired from patients hospitalized in Lodz, central Poland, and analyze the prevalence of specific genes, determining acquired resistance in these bacteria. The samples of ESβL-positive clinical isolates were gathered in 2022 from medical microbiological laboratories in the city of Lodz, central Poland. The strains were subjected to biochemical identification and antimicrobial susceptibility testing following EUCAST guidelines. The presence of studied genes (blaCTX-M, blaSHV, blaTEM, blaPER, blaVEB) was confirmed by PCR. Over 50% of studied isolates were resistant to gentamicin, cefepime, ceftazidime and ciprofloxacin. The most common ESβL gene was blaCTX-M. In most isolates, the resistance genes occurred simultaneously. The blaPER was not detected in any of the tested strains. ESβL-producing strains are largely susceptible to the currently available antibiotics. The observation of the coexistence of different genes in most clinical isolates is alarming. [ABSTRACT FROM AUTHOR]

Multiple drug resistance (MDR) has gained pronounced attention among Enterobacterales. The transfer of multiple antimicrobial resistance genes, frequently carried on conjugative incompatibility F (IncF) plasmids and facilitating interspecies resistance transmission, has been linked to Salmonella spp. and E. coli in broilers. In Egypt, the growing resistance is exacerbated by the limited clinical efficacy of many antimicrobials. In this study, IncF groups were screened and characterized in drug-resistant Salmonella spp. and E. coli isolated from broilers. The antimicrobial resistance profile, PCR-based replicon typing of bacterial isolates pre- and post-plasmid curing, and IncF replicon allele sequence typing were investigated. Five isolates of E. coli (5/31; 16.13%) and Salmonella spp. (5/36; 13.89%) were pan-susceptible to the examined antimicrobial agents, and 85.07% of tested isolates were MDR and extensively drug-resistant (XDR). Twelve MDR and XDR E. coli and Salmonella spp. isolates were examined for the existence of IncF replicons (FII, FIA, and FIB). They shared resistance to ampicillin, ampicillin/sulbactam, amoxicillin/clavulanate, doxycycline, cefotaxime, and colistin. All isolates carried from one to two IncF replicons. The FII-FIA-FIB+ and FII-FIA+FIB- were the predominant replicon patterns. FIB was the most frequently detected replicon after plasmid curing. Three XDR E. coli isolates that were resistant to 12–14 antimicrobials carried a newly FIB replicon allele with four nucleotide substitutions: C99→A, G112→T, C113→T, and G114→A. These findings suggest that broilers are a significant reservoir of IncF replicons with highly divergent IncF-FIB plasmid incompatibility groups circulating among XDR Enterobacterales. Supporting these data with additional comprehensive epidemiological studies involving replicons other than the IncF can provide insights for implementing efficient policies to prevent the spreading of new replicons to humans. [ABSTRACT FROM AUTHOR]

One Health surveillance involves the analysis of human, animal and environmental samples, recognising their interconnectedness in health systems. Such considerations are crucial to investigate the transmission of many pathogens, including drug-resistant bacteria and parasites. The highest rates of antimicrobial resistance (AMR)-associated deaths are observed in sub-Saharan Africa, where concurrently the waterborne parasitic disease schistosomiasis can be highly endemic in both humans and animals. Although there is growing acknowledgment of significant interactions between bacteria and parasites, knowledge of relationships between schistosomes, microbes and AMR remains inadequate. In addition, newly emergent research has revealed the previously underappreciated roles of animals and the environment in both AMR and schistosomiasis transmission. We consider shared environmental drivers and colonisation linkage in this narrative review, with a focus on extended-spectrum beta-lactamase-mediated resistance among bacteria from the Enterobacteriaceae family, which is exceedingly prevalent and responsible for a high burden of AMR-associated deaths. Then we examine novel findings from Malawi, where the landscapes of AMR and schistosomiasis are rapidly evolving, and make comparisons to other geographic areas with similar co-infection epidemiology. We identify several knowledge gaps that could be addressed in future research, including the need to characterise the impact of intestinal schistosomiasis and freshwater contact on intestinal AMR colonisation, before proposing a rationale for connecting AMR surveillance and schistosomiasis research within a One Health framework. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the benefit of targeted antibiotic prophylaxis (TAP) based on rectal swab culture in comparison with standard empiric antimicrobial prophylaxis in patients undergoing transrectal ultrasound-guided needle biopsy of the prostate (TRUS-BP), as well as to assess rate of fecal carriage of Fluoroquinolone-resistant Enterobacterales FQRE. Patients and methods: We prospectively analyzed data that randomized 157 patients within two groups: (G1) TAP according to rectal swab performed 10 days before PB; (G2): empirical antibiotic prophylaxis with ciprofloxacin. Prevalence of FQRE digestive carriage and risk factors were investigated. Incidence of infectious complications after (TRUS-BP) in each group was compared. Results: G2 included 80 patients versus 77 in G1. There was no difference between the two groups regarding age, diabetes, prostate volume, PSA, number of biopsy cores, and risk factors for FQRE. In G2, the prevalence of FQRE digestive carriage was 56.3% all related to E. coli species. In the case of digestive carriage of FQRE, TAP according to the rectal swab culture with third-generation cephalosporins was performed in 73.3%. Patients with FQRE had history of FQ use within the last 6 months in 17.8% (p = 0.03). Rate of febrile urinary tract infection after PB was 13% in G1 and 3.8% in G2 (p = 0.02). Conclusions: Incidence of FQ resistance in the intestinal flora of our local population was prevalent. Risk factor for resistance was the use of FQ within the last 6 months. TAP adapted to rectal swab, mainly with third-generation cephalosporins, significantly reduced the rate of infectious complications after (TRUS-BP). [ABSTRACT FROM AUTHOR]

Background: The challenge of treating infections caused by multidrug-resistant Enterobacterales and Acinetobacter baumannii has significantly increased for medical professionals due to their resistance to conventional antibiotics. In such cases, colistin is employed as a final line of defense. This study was aimed to determine the in-vitro efficacy of colistin against multidrug-resistant gram-negative bacteria. Methods: The research was carried out in the bacteriology department of the Mohammed V Military Teaching Hospital in Rabat, Morocco. 321 isolates of multi-resistant Enterobacterales and Acinetobacter baumannii from various clinical samples were identified by standard microbiological protocols, and the Colistin minimum inhibitory concentrations value was determined using the microdilution method. Results: Of the 321 isolates included in the study, 76.3% were Enterobacterales and 23.6% were Acinetobacter baumannii. The minimum inhibitory analysis showed that 96.3% of the isolates were sensitive, while 3.7% were identified as resistant. The prevalence of resistance to colistin among multi-resistant Enterobacterales was 4.1%, and the MIC50 and MIC90 were 0.5 μg/ml and 1μg/ml respectively. Among the collected Acinetobacter baumannii isolates, the prevalence of colistin resistance was 2.6%, with the MIC50 and MIC90 of 0.5 μg/ml. Conclusion: The research indicates that colistin could be a viable treatment option for infections caused by multi-resistant Enterobacterales and Acinetobacter baumannii. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance poses a significant threat to global public health, especially for Enterobacterales. In this study, we investigated the distribution and antimicrobial resistance of Enterobacterales in children in the China Antimicrobial Surveillance Network (CHINET) in 2015–2021. In total, 81,681 strains isolated from children were collected in this period, accounting for 50.1% of Gram-negative organisms. The most frequently isolated Enterobacterales were Escherichia coli, Klebsiella spp., Salmonella spp., and Enterobacter spp. The main sources of the isolates were urine and the respiratory tract, accounting for 29.3% and 27.7% of isolates, respectively. The proportions of E. coli, Klebsiella pneumoniae, and Proteus mirabilis expressing extended-spectrum β-lactamase were 48.8%–57.6%, 49.3%–66.7%, and 23.1%–33.8%, respectively. The prevalence of carbapenem-resistant Enterobacterales was 5.7%–9.5%, which showed a decreasing trend from 2015 to 2021. The detection rates of carbapenem-resistant Klebsiella spp., carbapenem-resistant Enterobacter spp., and carbapenem-resistant E. coli were 14.1%–22.6%, 7.1%–15.7% and 2.0%–3.4%, respectively. In Enterobacterales, the resistance rates to ciprofloxacin were higher than to levofloxacin. However, the Enterobacterales strains were highly susceptible to amikacin, polymyxin B, and tigecycline. The resistance rate of Salmonella spp. to ampicillin was > 70%, whereas their resistance rate to ceftriaxone was < 30%. These findings indicate that the resistant rates of some Enterobacterales isolates in children to common antimicrobial agents show decreasing trends. Continuous monitoring of bacterial resistance should be strengthened to prevent and control the spread of drug-resistant bacteria. [ABSTRACT FROM AUTHOR]

Carbapenemase-producing Enterobacterales are increasingly being recognized in nosocomial infections. The performance of a flow cytometry-based rapid assay for their detection and differentiation was evaluated. This is a disruptive phenotypic technology, phenotypic and growth-independent, that searches for the lesions produced by drugs acting on cells after a short incubation time. Overall, 180 Gram-negative bacteria were studied, and results were compared with those obtained molecularly by PCR and phenotypically by 'KPC, MBL and OXA-48 Confirm Kit'. This phenotypic method was used as reference for comparison purposes. Susceptibility to carbapenems (imipenem, meropenem, and ertapenem) was determined by standard broth microdilution. Overall, 112 isolates (62.2%) were carbapenemase producers, 41 KPCs, 36 MβLs, and 31 OXA-48, and 4 strains were KPC + MβL co-producers. Sixty-eight isolates were carbapenemase-negative. The percentage of agreement, sensitivity, and specificity were calculated according to ISO 20776-2:2021. The FASTinov assay showed 97.7% agreement with the reference method for carbapenemase detection. Discrepant flow cytometry results were obtained in four isolates compared with both reference and PCR results. The sensitivity and specificity of this new technology were 95.3% and 98.5%, respectively, for KPCs, 97.6% and 99.3% for MβLs, and 96.9% and 98% for OXA-48 detection. In conclusion, we describe a rapid flow cytometry assay with high accuracy for carbapenemase detection and the differentiation of various carbapenemases, which should impact clinical microbiology laboratories and patient management. [ABSTRACT FROM AUTHOR]

In a retrospective multicenter study of 575 patients with bloodstream infections or pneumonia due to wild-type AmpC β-lactamase–producing Enterobacterales, species with low in vitro mutation rates for AmpC derepression were associated with fewer treatment failures due to AmpC overproduction (adjusted hazard ratio, 0.5 [95% CI,.2–.9]). However, compared to cefepime/carbapenems, using third-generation cephalosporins as definitive therapy remained associated with this adverse outcome (15% vs 1%). [ABSTRACT FROM AUTHOR]

Gram-negative antibiotic resistance continues to grow as a global problem due to the evolution and spread of β-lactamases. The early β-lactamase inhibitors (BLIs) are characterized by spectra limited to class A β-lactamases and ineffective against carbapenemases and most extended spectrum β-lactamases. In order to address this therapeutic need, newer BLIs were developed with the goal of treating carbapenemase producing, carbapenem resistant organisms (CRO), specifically targeting the Klebsiella pneumoniae carbapenemase (KPC). These BL/BLI combination drugs, avibactam/avibactam, meropenem/vaborbactam, and imipenem/relebactam, have proven to be indispensable tools in this effort. However, non-KPC mechanisms of resistance are rising in prevalence and increasingly challenging to treat. It is critical for clinicians to understand the unique spectra of these BL/BLIs with respect to non-KPC CRO. In Part 1of this 2-part series, we describe the non-KPC attributes of the newer BL/BLIs with a focus on utility against Enterobacterales and Pseudomonas aeruginosa. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the performance of the rapid colorimetric polymyxin B microelution (RCPEm) in determining polymyxin B resistance directly from Enterobacterales-positive blood cultures. Methods: A set volume of positive blood culture bottles (diluted 1:10) was inoculated into a glucose-broth-phenol red solution (NP solution), where a polymyxin B disk was previously eluted (final concentration of 3 µg/mL). Test was read each 1 h for up to 4 h. Color change from red/orange to yellow indicated resistant isolates. Results were compared to the reference method, broth microdilution (BMD), performed from colonies grown on solid media from the same blood culture bottle. Results: One hundred fifty-two Enterobacterales-positive blood cultures were evaluated, 22.4% (34/152) of them resistant to polymyxin B (including 6.6% with borderline MICs). When performing directly from positive blood cultures (RCPEm-BC), specificity and sensitivity were 99.1% and 94.1%, respectively. Of note, 79.4% (27/34) of truly resistant isolates required 3 h of incubation, compared to the 18 ± 2 h incubation that microtiter plates of BMD demand before reading can be performed. Conclusions: RCPEm directly from blood cultures has great potential to be part of the routine of clinical microbiology laboratories to establish polymyxin B susceptibility, impacting outcome of patients with bloodstream infections caused by carbapenem-resistant Enterobacterales. [ABSTRACT FROM AUTHOR]

Purpose: The current study evaluated the in vitro activities of ceftolozane/tazobactam (C/T), imipenem/relebactam (IMI/REL), and comparators against recent (2017–2021) clinical isolates of gram-negative bacilli from two countries in southern Europe. Methods: Nine clinical laboratories (two in Greece; seven in Italy) each collected up to 250 consecutive gram-negative isolates per year from lower respiratory tract, intraabdominal, urinary tract, and bloodstream infection samples. MICs were determined by the CLSI broth microdilution method and interpreted using 2022 EUCAST breakpoints. β-lactamase genes were identified in select β-lactam-nonsusceptible isolate subsets. Results: C/T inhibited the growth of 85–87% of Enterobacterales and 94–96% of ESBL-positive non-CRE NME (non-Morganellaceae Enterobacterales) isolates from both countries. IMI/REL inhibited 95–98% of NME, 100% of ESBL-positive non-CRE NME, and 98–99% of KPC-positive NME isolates from both countries. Country-specific differences in percent susceptible values for C/T, IMI/REL, meropenem, piperacillin/tazobactam, levofloxacin, and amikacin were more pronounced for Pseudomonas aeruginosa than Enterobacterales. C/T and IMI/REL both inhibited 84% of P. aeruginosa isolates from Greece and 91–92% of isolates from Italy. MBL rates were estimated as 4% of Enterobacterales and 10% of P. aeruginosa isolates from Greece compared to 1% of Enterobacterales and 3% of P. aeruginosa isolates from Italy. KPC rates among Enterobacterales isolates were similar in both countries (7–8%). OXA-48-like enzymes were only identified in Enterobacterales isolates from Italy (1%) while GES carbapenemase genes were only identified in P. aeruginosa isolates from Italy (2%). Conclusion: We conclude that C/T and IMI/REL may provide viable treatment options for many patients from Greece and Italy. [ABSTRACT FROM AUTHOR]

Bacterial soft rots are amongst the most economically important diseases that cause significant yield losses in various crops. A clear identification of the causal agents is required to develop management strategies. In 2022 and 2023, after the widespread occurrence of soft rot disease in sugar beet fields in the Firuzan region, Hamedan Province, Iran, the current study was conducted to identify and characterize the causal agents. A total of 38 bacterial isolates were obtained from sugar beet plants with soft rot symptoms and subjected to biochemical and phenotypical characterization and pathogenicity tests on healthy slices from potato tubers and sugar beet taproots. Twelve isolates from this study along with the type strain Pectobacterium carotovorum ICMP 5702 were selected for subsequent screening by BOX‐PCR. Six isolates were chosen for sequencing the 16SrRNA gene and phylogenetic analysis. In BLAST analyses, the pathogenic isolates S2, S9, S22, S11, S23 and 111 showed the highest similarity values (≥99%) with the reference sequences of Raoultella terrigena, Klebsiella michiganensis, Erwinia (Winslowiella) iniecta, Pantoea agglomerans and P. carotovorum, respectively. These isolates induced soft rot and maceration on plant materials from five species (bell pepper fruits, garlic cloves and slices from sugar beet taproot, potato tubers and carrot roots) 72 h after inoculation. In the greenhouse experiment, they caused soft rot symptoms in the taproots of 2‐month‐old sugar beet plants 3 weeks after inoculation. These soft rot agents had Gram‐negative, catalase‐positive and oxidase‐negative reactions, grew under both aerobic and anaerobic conditions, tolerated and grew at 37°C and 5% NaCl. In general, the results of this research showed that in addition to Pectobacterium, four other genera from the order Enterobacterales including Erwinia, Pantoea, Klebsiella and Raoultella, are amongst the causes of soft rot in sugar beet in Firuzan region of Hamedan. [ABSTRACT FROM AUTHOR]

Background: People living with HIV/AIDS (PLWHA) are prone to opportunistic bacterial infections caused by multidrug-resistant organisms. The aim of this study was to determine the susceptibility of Enterobacterales isolated from urine and stool samples of PLWA attending the BOYAMBI Hospital Center, Kinshasa, Democratic Republic of the Congo to commonly used antibiotics and to detect extended-spectrum β-lactamases (ESBLs) producers among the isolates. Methodology: A total of 163 HIV-infected patients attending the BOYAMBI Hospital, Kinshasa, DRC, were randomly selected for this study. Urine samples were collected from 108 patients, while stool samples were collected from 55 of them. Samples were cultured in MacConkey agar and identified using conventional microbiological methods. Antibiotic susceptibility on each isolate to selected antibiotics was performed by the disc diffusion method. Phenotypic detection of ESBL was done by the double-disc synergy test. Results: A total of 120 Enterobacterales were isolated from the samples of the 163 HIV-infected patients with 65 of 108 (60.2%) urine and 55 of 55 (100.0%) stool samples. Escherichia coli was the most frequent bacterial species from both urine and stool with 84 (70.0%), followed by Klebsiellaspecieswith23 (19.2%). Other bacterial pathogens were Citrobacter (n=6, 5.0%), Enterobacter (n=4, 3.3%), Proteus (n=2, 1.7%) and Morganella (n=1, 0.8%) species. Escherichia coli isolates were resistant to amoxicillin (90.5%), sulfamethoxazole-trimethoprim (81.0%), ciprofloxacin (77.4%), ceftriaxone (77.4%), ceftazidime (73.8%), amoxicillin–clavulanic acid (61.9%), imipenem (60.7%), and cefotaxime (50.0%). Klebsiella pneumoniae isolates were resistant to ceftazidime (95.7%), ceftriaxone (91.3%), imipenem (91.3%), ciprofloxacin (87%), sulfamethoxazole-trimethoprim (78.3%), cefotaxime (56.5%), and amoxicillin–clavulanic acid (52.2%). Citrobacter, Enterobacter, Morganella and Proteus species were resistant to the majority of antibiotics. The rate of ESBL production was 23.0% (28/120) with Citrobacter spp being the most frequent ESBL-producer, followed Klebsiella spp, Enterobacter spp and E. coli. Conclusion: The results obtained showed a high rate of ESBL-producing Enterobacterales isolates which were multi-drug resistant. Nitrofurantoin, gentamicin, chloramphenicol, cefixime and nalidixic acid were the most active antibiotics against the isolates. [ABSTRACT FROM AUTHOR]