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Despite the development of new antiseizure drugs (ASDs), around one third of epilepsy patients become refractory to treatment or experience adverse events due to ASDs. Therefore, discovery of new ASDs and new therapy options are crucial to improve the quality of life. Herein, we report a 3-year-old child with multi-drug resistant epilepsy caused by perinatal asphyxia whose seizures were reduced by 90% after the introduction of ketogenic diet, vagal nerve stimulation (VNS) AspireSR (SR-seizure response) and oral cannabidiol.

Background Correlation between coronavirus disease 2019 (COVID-19) and superinfections has been investigated, but remains to be fully assessed. This multi-centre study reports the impact of the pandemic on bloodstream infections (BSIs). Methods This study included all patients with BSIs admitted to four Italian hospitals between 1 January and 30 June 2020. Clinical, demographic and microbiologic data were compared with data for patients hospitalized during the same period in 2019. Results Among 26,012 patients admitted between 1 January and 30 June 2020, 1182 had COVID-19. Among the patients with COVID-19, 107 BSIs were observed, with an incidence rate of 8.19 episodes per 1000 patient-days. The incidence of BSI was significantly higher in these patients compared with patients without COVID-19 (2.72/1000 patient-days) and patients admitted in 2019 (2.76/1000 patient-days). In comparison with patients without COVID-19, BSI onset in patients with COVID-19 was delayed during the course of hospitalization (16.0 vs 5 days, respectively). Thirty-day mortality among patients with COVID-19 was 40.2%, which was significantly higher compared with patients without COVID-19 (23.7%). BSIs in patients with COVID-19 were frequently caused by multi-drug-resistant pathogens, which were often centre-dependent. Conclusions BSIs are a common secondary infection in patients with COVID-19, characterized by increased risk during hospitalization and potentially burdened with high mortality.

Summary Background Conflicting results have been published on the impact of contact precautions (CPs) on reduction of transmission of multi-drug-resistant micro-organisms (MDROs) in the endemic setting. Ambiguous definitions coupled with low adherence partly explain these differences. Aim We prospectively monitored the level of adherence to CPs and aimed to relate it to in-hospital transmission of MDROs. Methods Between January 2016 and March 2018, all patients under CPs underwent continuous monitoring of adherence to CPs by routine on-site visits on days 0, 3 and 7 after initiating CPs using a standardized checklist. The protocol included 10 interventions that were routinely checked such as CP sign at the door as well as wearing of gowns and gloves upon entry to the patient room. Patients requiring CPs were defined as colonized or infected with MDROs (meticillin-resistant Staphylococcus aureus (MRSA), non-Escherichia coli extended-spectrum beta lactamase (ESBL) Enterobacterales, vancomycin-resistant enterococci (VRE) and carbapenem-resistant Gram-negative micro-organisms (CRGN)) as well as patients infected with respiratory viruses, norovirus, scabies and hypervirulent strains of Clostridioides difficile. Findings Overall, data from 13,756 CP records from 1378 visits of 812 patients were analysed. Adherence varied between 93% and 100% for each intervention, except for “separate space for contaminated material” with an adherence of 5.3–6.1%. The incidence of in-hospital transmission during the study period was extremely low for MRSA, VRE, non-E.coli ESBL Enterobacterales and CRGN with 0.00–0.064 cases/1000 patient days. Conclusion High adherence coupled with continuous monitoring of CPs correlated with a very low in-hospital transmission rate. These results indicate that CPs are highly effective if routine monitoring of adherence is implemented.

Introduction: Fosfomycin has re-emerged as a possible therapeutic alternative for the treatment of resistant bacterial pathogens. Its main mechanism of action is the inhibition of the initial step of cell wall synthesis and is active against both Gram-positive and Gram-negative bacteria. However, its clinical effectiveness against multidrug resistant bacteria remains largely unknown. Therefore, we aim to evaluate the clinical and microbiological effectiveness of intravenous fosfomycin as well as its safety in a tertiary care teaching hospital in Lebanon. Methodology: This is a retrospective chart review of adult patients who had presented to the hospital and were treated with intravenous fosfomycin for at least 24 hours for any type of infection between 2014 and 2019. Results: Among 31 episodes treated with intravenous fosfomycin, 68% had an overall favorable clinical response. In 84% of the episodes, fosfomycin was administered in combination with other antibiotics, commonly tigecycline. Of those with available cultures at end of therapy, 73% achieved microbiological success. No relapse was documented within 30 days of completion of therapy. In the episodes secondary to resistant pathogens, the rates of favorable clinical outcome and microbiological success at the end of therapy were 71% and 73%, respectively. Fosfomycin resistance developed in two cases and mild adverse events occurred in 65% of the episodes during the course of treatment. Conclusions: Fosfomycin is a safe and effective option in the treatment of multi-drug resistant infections. Nevertheless, careful stewardship is important to maintain its efficacy and to reduce the risk of selection of antimicrobial resistance.

Objective: To determine the superbug infection in a burn centre, its impact on mortality/morbidity and to review all preventive/therapeutic steps taken to fight this menace. Study Design: Retrospective cross sectional study. Place and Duration of Study: Department of Burns & Plastic Surgery, Army Burn Centre, Combined Military Hospital Kharian, from Oct 2018 to Sep 2019. Methodology: A detailed retrospective audit of departmental data was carried out. Parameters like direct admission vs transferred patient, percentage of burns (Total Burn Surface Area-TBSA%), records of all burns related deaths and all culture/sensitivity reports were analysed using SPSS-20. As a standard practice in our unit blood, tracheal secretions and pus culture specimens of all patients are collected at the time of admission and then periodically fresh samples are taken every week or earlier when-ever required. Results: Out of 515 patients, 283 (54.95%) were children under the age of 12 years. The overall survival rate improved by 13.43% as compared to last year. Out of 584 bacteriology reports 396 (67.81%) were positive and 188 (32.19%) were negative. On culture 508 organisms were isolated, majority of which were Carbapenem Resistant Pseudomonas, Acinetobacter, Enterobacteriaceae and Methicillin resistant staphylococcus aureus. Conclusion: Multi drug resistant superbug infection is a worldwide menace. The best clinical practices, strict contact isolation, enhanced environmental cleaning and judicious use of appropriate antibiotics are the main strategies in this war. Need for newer more effective antibiotics cannot be overemphasized.

Objective: To explore the effects of bronchoscopy alveolar lavage in the treatment of severe pneumonia caused by multiple drug bacterial infection. Methods: A total of 84 patients with severe pneumonia infected by multi-drug resistant bacteria were randomly selected from Kunming Second People’s Hospital, which is our hospital from January 2019 to December 2020 for this research. They were divided into a reference group and a study group using a digital table method, with 42 cases in each group. The reference group was given the routine treatment, the research group performed bronchoscopy alveolar lavage on this basis to observe the curative effect. Results: Before treatment, there was no significant difference in serum factor indexes and blood gas analysis indexes between the two groups of patients, P>0.05. After treatment, the time of fever, cough, moist rales disappearing and infection control time in the study group were shorter than those in the reference group, P

TB is the seventh leading cause of death worldwide and third leading cause of death among women in the 15–44 age group1. However, in 2010, the number of multidrug-resistant tuberculosis (MDR-TB) cases rose to 650,000 worldwide, with more than 150,000 deaths. All of the well-known widely available methods such as chest X-ray, culture in liquid and solid media should be accompanied with the modern and more accurate methods such as chest CT and molecular diagnostic tests which proved the necessity of usage with high sensitivity and accuracy, especially in smear-negative pulmonary TB patients and patients with the multi drug resistant forms.

Rationale: Linezolid (LNZ) induced Cutaneous Adverse Drug Reactions (CADRs) have rare atypical presentation. Till date, there are very few published case reports on LNZ induced CADRs among the multidrug-resistant patients suffering from Infective Endocarditis (MDR IE). Here, we present a rare case report of LNZ induced CARs in a MDR IE patient. Case report: A 24-year-old female patient was admitted to the hospital with chief complaints of fever (101°C) associated with rigors, chills, and shortness of breath (grade IV) for the past 4 days. She was diagnosed with MDR IE, having a prior history of rheumatic heart disease. She was prescribed LNZ 600mg IV BD for MDR IE, against Staphylococcus coagulase-negative. The patient experienced flares of cutaneous reactions with multiple hyper-pigmented maculopapular lesions all over the body after one week of LNZ therapy. Upon causality assessment, she was found to be suffering from LNZ induced CADRs. LNZ dose was tapered gradually and discontinued. The patient was prescribed corticosteroids along with other supportive care. Her reactions completely subsided and infection got controlled following 1 month of therapy. Conclusion: Healthcare professionals should be vigilant for rare CADRs, while monitoring the patients on LNZ therapy especially in MDR patients as they are exposed to multiple drugs. Moreover, strengthened spontaneous reporting is required for better quantification.

Background: Infection by multi–drug-resistant (MDR) bacteria is a high-risk factor for poor clinical results. Pancreatoduodenectomy (PD) has been associated with a high rate of complications, inclu...

Limited data are present regarding the steady-state pharmacokinetics and pharmacodynamics of colistin in critically ill patients suffering from multi-drug-resistant gram-negative bacterial (MDR-GNB) infections. We aimed to profile the steady-state pharmacokinetics and pharmacodynamics of colistin in critically ill patients with MDR-GNB infections, along with determining the predictors that could influence the clinical, microbiological and safety outcome. We recruited 30 critically ill patients suffering from MDR-GNB infections in our prospective open-label study. Intravenous colistimethate sodium (CMS) 2 million IU was administered concurrently with inhalational CMS 1 million IU every 8 hours. Steady-state plasma colistin levels were measured. Logistic regression analysis was used to identify various predictors of clinical, microbiological and safety outcome. A large variability was observed in the steady-state colistin pharmacokinetic/pharmacodynamic parameters, along with the factors that influenced the clinical, microbiological and safety outcome. In conclusion, steady-state colistin pharmacokinetic and pharmacodynamic parameters observed in our study were largely consistent with those reported in previous studies. High acute physiology and chronic health evaluation II scores were associated with poor clinical outcome. Log-transformed colistin maximum concentration, area under the plasma concentration curve for 8 hours, apparent total body clearance and apparent volume of distribution were significantly associated with the safety outcome.

Background: Multi-drug resistant (MDR) Citrobacter freundii (C. freundii) as a causative agent of nosocomial infections is a health threat, especially in hospitals. This study was conducted to determine the prevalence of MDR C. freundii, considering isolation sites and a variety of utilized antibiotics. Materials and Methods: In this cross-sectional study, the clinical samples of C. freundii strains were collected and screened using traditional bacteriological tests in Zareh Hospital, Sari City, Iran, during 2016-2017. We used disk diffusion methods to assess the susceptibility patterns of isolates according to the Clinical Laboratory Standard Institute (CLSI) guidelines. Results: Out of 3248 clinical samples, C. freundii strains were detected in 109 samples (32.1% females and 67.9% males). Susceptibility tests indicated that 89 isolates (81.65%) were MDR strains. Frequencies of MDR C. freundii strains were higher in the Behavioral Intensive Care Unit (BICU) (37.61%) and restoration ward (29.35%) compared with other hospital wards. Conclusion: Considering the MDR C. freundii strains detected from burn hospital wards, it is necessary to implement prevention criteria for their eradication from burn hospitals. The results indicate the urgent need to design more practical methods for controlling infection in hospital wards.

BACKGROUND Re-treatment pulmonary tuberculosis (PTB) has a high risk of being multi-drug- or rifampicin-resistant tuberculosis (MDR/RR-TB). The Xpert MTB/RIF assay possesses high efficacy for the evaluation of rifampicin resistance. The aim of the present study was to assess the benefit of the Xpert MTB/ RIF assay in the screening and treatment of MDR/RR-TB in re-treatment PTB patients. METHODS Patients with suspected re-treatment PTB were prospectively enrolled and divided into Xpert MTB/RIF and mycobacterial tuberculosis (MTB) culture groups. No Xpert MTB/RIF assay was carried out in the MTB culture group. The diagnostic performance and turn-around time (TAT) of MDR/RRTB detection and the culture results of MDR/RR-TB patients following two-month chemotherapy in two groups were calculated and compared. RESULTS Using phenotypic DST as a reference standard, the positive predictive value of Xpert MTB/RIF for the detection of RR-TB and MDR-TB among re-treatment PTB patients was 90.72% and 77.32%, respectively. The Xpert MTB/RIF group had a significantly shorter interval for the initiation of anti-MDR/ RR-TB treatment {1 [1-1] vs. 52 [47-57] days, P

India is one of the high burden countries for tuberculosis (TB) including multi-drug resistant TB (MDR-TB) and extensively-drug resistant (XDR) TB. Drug-resistant (DR) TB has threatened the TB care and is a major health problem in many countries; treatment of DR TB has been difficult requiring use of reserve or second-line drugs, cost factors, has extensive side-effect profile and long duration of treatment. Treatment in MDR-TB are increasingly becoming individualised mainly due to preference for oral over injectable, results of drug susceptibility testing (DST), population resistance levels, history of previous TB treatment, drug tolerability and drug-to-drug interactions. Bedaquilline (BDQ) and delaminid (DLM) are new drugs available for treatment of these patients. World Health Organization (WHO) recommends use of BDQ in more than 15 y (>15 kg) patients only. Under Revised National Tuberculosis Control Programme (RNTCP) the use of this drug is recommended for patients older than 18 y only. Under RNTCP, the use of DLM is approved in children 6 y and above. Pediatric MDR/XDR TB treatment outcome with newer anti-TB drugs and regimen is lacking. Children when treated with individualized regimens have improved survival.

Background: Multi-drug resistance is considered a serious health threat particularly in the intensive care unit (ICU) setting. Studies evaluating multi-drug–resistant (MDR) pathogens in critically ...

Multi-drug resistant Staphylococcus aureus is one of the major causes of severe infections. Due to the delays of conventional antibiotic susceptibility test (AST), most cases were prescribed by experience with a lower recovery rate. Linking a 7-year study of over 20,000 Staphylococcus aureus infected patients, we incorporated mass spectrometry and machine learning technology to predict the susceptibilities of patients for 4 different antibiotics that can enable early antibiotic decisions. The predictive models were externally validated in an independent patient cohort, resulting in an area under the receiver operating characteristic curve of 0.94, 0.90, 0.86, 0.91 and an area under the precision-recall curve of 0.93, 0.87, 0.87, 0.81 for oxacillin (OXA), clindamycin (CLI), erythromycin (ERY) and trimethoprim-sulfamethoxazole (SXT), respectively. Moreover, our pipeline provides AST 24–36 h faster than standard workflows, reduction of inappropriate antibiotic usage with preclinical prediction, and demonstrates the potential of combining mass spectrometry with machine learning (ML) to assist early and accurate prescription. Therapies to individual patients could be tailored in the process of precision medicine.

Cefiderocol is a new siderophore-cephalosporin for the treatment of multi-drug resistant Gram-negative pathogens. As a reserve agent, it will and should be used primarily in critically ill patients in the upcoming years. Due to the novelty of the substance little data on the pharmacokinetics in critically ill patients with septic shock and renal failure (including continuous renal replacement therapy and cytokine adsorber therapy) is available. We performed therapeutic drug monitoring in a cohort of five patients treated with cefiderocol, to improve the knowledge on pharmacokinetics in this vulnerable patient population. As expected for a cephalosporin with predominantly renal elimination the maintenance dose could be reduced in patients with renal impairment or on continuous renal replacement therapy. The manufacturer's dosing instructions were sufficient to achieve a drug level well above the MIC. However, the addition of a cytokine adsorber might reduce serum levels substantially, so that in this context therapeutic drug monitoring and dose adjustment are recommended.

The emergence of multi-drug resistant (MDR) bacteria is recognised today as one of the greatest challenges to public health. As traditional antimicrobials are becoming ineffective and research into new antibiotics is diminishing, a number of alternative treatments for MDR bacteria have been receiving greater attention. Bacteriophage therapies are being revisited and present a promising opportunity to reduce the burden of bacterial infection in this post-antibiotic era. This review focuses on the current evidence supporting bacteriophage therapy against prevalent or emerging multi-drug resistant bacterial pathogens in respiratory medicine and the challenges ahead in preclinical data generation. Starting with efforts to improve delivery of bacteriophages to the lung surface, the current developments in animal models for relevant efficacy data on respiratory infections are discussed before finishing with a summary of findings from the select human trials performed to date.

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Biofilm represents one of the crucial factors for the emergence of multi-drug resistance bacterial infections. The high mortality, morbidity and medical device-related infections are associated with biofilm formation, which requires primarily seek alternative treatment strategies. Recently, nanotechnology has emerged as a promising method for eradicating bacterial biofilm-related infection. The efficacy of nanoparticles (NPs) against bacterial infections interest great attention, and the researches on the subject are rapidly increasing. However, the majority of studies continue to focus on the antimicrobial effects of NPs in vitro, while only a few achieved in vivo and very few registered as clinical trials. The present review aimed to organize the scattered available information regarding NPs approach to eradicate bacterial biofilm-related infections. The current review highlighted the advantages and disadvantages associated with this approach, in addition to the challenges that prevent reaching the clinical applications. It was appeared that the production of NPs either as antimicrobials or as drug carriers requires further investigations to overcome the obstacles associated with their kinetic and biocompatibility.

Introduction: Due to lack of data for the early diagnosis and treatment of multi drug resistant spinal tuberculosis, the aim of the present study was to estimate the prevalence of multi drug resistant spinal tuberculosis and study the clinical outcomes. Materials & methods: A total of 80 patients were selected for the study. On the basis of the clinico-radiological diagnosis the anti-tubercular treatment was started in all the included patients diagnosed with drug resistant spinal tuberculosis. All the tissue specimen from the biopsy and samples obtained were subjected to histopathological examination, CBNAAT and MGIT culture.Results: Functional and clinical outcome of the patients were evaluated by VAS and ASIA grading. The baseline score of the VAS score was found to be 6 – 7, this score was used to compare with the follow up score. When VAS and ASIA score was compared with previous follow up visit VAS score, significant improvement was noted up to 9 months. Conclusion: In conclusion, early detection of MDR Spinal Tuberculosis would be helpful to avoid consequences arising due to in appropriate chemotherapy and, hence, would also result in favourable outcomes. However, further similar studies with larger samples are needed before we can make definitive statement about the usage of CBNAAT Test as routine diagnostic tool in suspected MDR Spinal Tuberculosis cases.

Introduction and objectives: Multidrug-resistant (MDR) infections in cirrhosis are associated with poor outcomes. We attempted a prospective study on infections in patients with cirrhosis evaluating microbiology of these infections and how outcomes depended on factors like bacterial resistance, appropriate antibiotics, stage of liver disease and whether outcomes were significantly different from patients who did not have infections. Materials and methods: This was a prospective evaluation involving one hundred and fifty nine patients with cirrhosis who were admitted at Peerless Hospitex Hospital and Research Center, Kolkata, West Bengal, India, during a 24 month period. One hundred and nineteen of these patients either had an infection at the time of admission or developed infection during hospitalization. Forty patients did not have an infection at admission and did not acquire infection while admitted. Data was collected about demographics, etiology of cirrhosis, liver and renal function and microbiology. Results: Infections were community acquired in 27.7% of patients, healthcare associated in 52.9% and nosocomial in 19.3%. Gram negative bacilli (Escherichia coli 47.4% Klebsiella pneumoniae 23%) were common. 84.9% of enterobacteriaceae produced ESBL, AmpC or Carbapenemases. Spontaneous bacteria peritonitis (SBP) and urinary tract infection (UTI) were the most common sites of infection. In hospital mortality was 21.9%. Non-survivors had higher MELD (26 vs 19, p

Background: Post-operative central nervous system infection (PCNSI) caused by multi-drug–resistant/extensively drug-resistant (MDR/XDR) Acinetobacter baumannii is a severe complication. Th...

Introduction. The priority direction of hygienic science at the present stage is the study of the nutritional status of patients with multi-drug-resistant tuberculosis (MDR-TB) of the lungs. The aim of study is to identify the basic patterns of formation of the structure of the nutritional status of patients with MDR-TBof the lungs in order to adopt a reasonable system of measures for their optimization(from a hygienic point of view). Materials and research methods. The actual nutrition of 103 patients with MDR-TBof the lungs was studied using a specially prepared standardized questionnaire, which included information on previous and yesterday nutrition. Nutritional status was determined by evaluating anthropometric indices (height, body mass, chest circumference), on the basis of which the Quetelet index was calculated. Surveyed control group included 20 relatively healthy patients. Bioimpedancemetrywas a special research method. Results and discussion. In the case of multiple correlation analysis, a high direct correlation of the total protein level with the indicator of fat mass according to bioimpedancemetry (r=0.63; p

Nowadays, tuberculosis (TB) is an important global public health problem, being responsible for millions of TB-related deaths worldwide. Due to the increased number of cases and resistance of Mycobacterium tuberculosis to all drugs used for the treatment of this disease, we desperately need new drugs and strategies that could reduce treatment time with fewer side effects, reduced cost and highly active drugs against resistant strains and latent disease. Considering that, 4H-1,3-benzothiazin-4-one is a promising class of antimycobacterial agents in special against TB-resistant strains being the aim of this review the discussion of different aspects of this chemical class such as synthesis, mechanism of action, medicinal chemistry and combination with other drugs.

This article tackles the issue of the growing morbidity and mortality caused by multi-drug-resistant (extreme drug-resistant) tuberculosis (TB). This issue is aggravated by the alarming rise of immunocompromized patients and immigration worldwide. In order to solve this problem, an interdisciplinary approach is needed. Here we offer to: (1) develop innovative diagnostic techniques for identifying dangerous lineages of TB with mutations and drug resistance genes; (2) develop antibiotics with new modes of action effective against multiple drug resistance and extreme drug-resistant strains of TB and HIV; (3) develop new genetically engineered vaccines; and, (4) develop new vaccine adjuvants based on probiotic Lactobacillus and Bifidobacterium stains, with selective immunomodulatory activity.

Multi-drug-resistant Gram-negative organisms (MDRGNO) are an emerging global threat, reflected in the increasing incidence of infections in Ireland and elsewhere. The response to this threat has been the development of Infection Prevention and Control (IPC) guidelines. A survey of IPC teams in Ireland was undertaken to assess compliance with national guidelines. To place these survey results in context, IPC guidelines from the Irish Health Protection Surveillance Centre (HPSC) are compared with guidelines from Healthcare Infection Society (HIS), European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and Centre for Disease Control (CDC). Thirty-three percent of hospitals responded across a range of hospital types. The results highlight the variability in implementation of guidelines across Ireland, as well as the variability between guidelines internationally. Respondents are less than 90% compliant with the majority of MDRGNO screening guidelines. Hospitals have variable access to isolation facilities with an average of 29% single rooms available (range 2.6-100%), resulting in some patients with MDRGNO not being isolated. Broad variability in application of guidance on personal protective equipment was demonstrated. This survey gives an insight into the real-life applicability of HPSC guidelines. Survey results are placed in context with a comparison of five MDRGNO IPC guidelines. Although core tenets of IPC are standard across guidelines, research into which practices are efficient in reducing MDRGNO transmission while being cost-effective would be worthwhile.

We conducted a two-phase retrospective study to investigate the impact of a short-term carbapenem restriction on the incidence of non-pseudomonal multidrug-resistant (MDR) Gram-negative bacilli in our intensive care unit (ICU). The first phase of the study (before carbapenem restriction) was conducted between May and July 2016, and the second phase (implementation of carbapenem restriction) between September and November 2016. The incidence of all non-pseudomonal MDR Gram-negative bacilli (extended-spectrum β-lactamase-producing

The study was taken up to identify the various bacterial agents causing intertrigo of feet and to determine the antimicrobial sensitivity pattern of the isolated bacterial agents. A total of 75 pus samples were collected from infected toe, web space infection by using sterile swabs.Samples were inoculated into Blood agar and MacConkey agar for the bacterial isolation and antibiotic susceptibility testing was performed as per CLSI Guidelines. Out of 75 samples examined 38 were from male patients and 37 were collected from female patients. 101 different types of bacteria were grown in the present study. Among them38 Gram-PositiveCocci (GPC) and 63 Gram-Negative Bacilli (GNB). Of 38 Gram positive cocci isolated, Staphylococcus aureuswere19 (18.81%), followed by Coagulase negative staphylococcus (CONS) 12 (11.88%) and Streptococcus spp7 (6.93%). Of 63 Gram negative bacilli isolated Pseudomonas were19 (18.81%), followed by Proteus 16 (15.84%) and Klebsiella13 (12.87%). 25.8% Staphylococcus sppare Methecillin Resistant (MR) strains. Among the Gram negative bacteria 9.25% of the strains were showing resistance to Colistin or Tigecycline. It is known fact that different microbes and factors play very important role in lesions of toe web space. In the present study 25.8% of Staphylococcus species and 9.25% of Gram negative bacteria were multi drug resistant.Therefore, clinical and microbiologic studies are needed to help in the selection of appropriate treatment, prevention of important complications and emergence of drug resistance pathogens.

Objective: The prevalence of multi-drug resistant organism (MDRO) colonization in nursing home residents has been well documented, but little is known about the impact of MDRO bloodstream infections (BSIs). The aim of this study was to assess the prevalence, cost, and outcomes of MDRO-BSI vs. non-MDRO-BSI among nursing home residents. Design: Retrospective cohort study Setting: 960 bed tertiary academic medical center Patients: Persons ≥18 years old admitted to an acute care tertiary hospital from Skilled Nursing Facilities with a diagnosis of sepsis between 2015 and 2018. Interventions: Retrospective analysis of prevalence and outcomes. Measurements and Main Results: Among patients admitted to the study hospital with a diagnosis of sepsis during the study period, 7% were from nursing homes. The prevalence of MDRO-BSI was 47%. We identified 54 (50%) gram positive BSIs, 48 (45%) gram negative BSI and 5 (5%) fungal BSI. Thirty-one (57%) of the gram-positive infections and 14 (30%) of the gram-negative infections were with MDROs. The prevalence of BSI organisms were Staphylococcus aureus in 24%, Escherichia coli in 14%, Proteus mirabilis in 13%, Staphylococcus epidermidis in 8%, Enterococcus faecalis in 7%, and Klebsiella pneumoniae in 6%. We found that intensive care unit length of stay (7 days vs 5 days, P = .009), direct cost ($13,639 vs $9,922, P = .027), and total cost ($23,752 vs $17,900 P = .032) were significantly higher in patients with MDRO-BSI vs. non-MDRO-BSI. Patients with MDRO-BSI were twice as likely to receive inappropriate empiric antiinfective therapy (31% vs 16%, P = .006) and were more likely to die (49.1% vs 29.6%, P = .049). Conclusion: Nursing home residents have a high prevalence of MDRO-BSI, which is associated with higher risk of receiving inappropriate initial anti-infective therapy, higher cost, higher ICU LOS, and higher mortality. Our research adds new information about the prevalence of fungemia in this population.

BACKGROUD To analyze the risk factors for acquiring multi-drug resistant Klebsiella pneumoniae (MDR-Kpn). METHODS Data were collected from patients who were admitted into a tertiary teaching hospital in China from January 2018 to October 2020. Sensitive Klebsiella pneumoniae (Kpn) was detected in 82 patients. After a period of treatment, 41 patients were detected with MDR-Kpn, and they were designed as the MDR-Kpn group. Another 41 patients always detected with sensitive Klebsiella pneumoniae were assigned to the sensitive Kpn group. The baseline characteristics and clinical parameters were compared between these two groups. Multivariate logistic regression analysis were conducted to determine the risk factors for acquiring MDR-Kpn. RESULTS The proportion of sex, history of smoking and department distribution had no significant differences between these two groups. However, the patients with chronic pulmonary diseases and neurological disorders were more likely to acquire MDR-Kpn. It also showed longer hospital stay before the first detection of multi-drug resistant Kpn in MDR-Kpn group than the hospital stay before the last detection of sensitive-Kpn in sensitive Kpn group. Additionally, days of hospitalization, ICU stay, days of drainage tube use, times of sputum suction, days of foley catheter use, days of vascular catheter use between the twice detection (it represents the time interval between first detection of sensitive-Kpn to first detection of resistant-Kpn in MDR-Kpn group, and also represents the time interval between first detection of sensitive-Kpn to last detection of sensitive-Kpn in sensitive Kpn group), were higher in MDR-Kpn group. The results showed more categories of antimicrobials in patients of acquiring MDR-Kpn, along with more days of using broad-spectrum cephalosporins, fluoroquinolones and glycylcyclines, compared to non-transition group. Multivariate logistic regression analysis showed that the number of comorbidities, hospital stay before the first detection of multidrug-resistan Kpn (MDR-Kpn group) or last detection of sensitive Kpn (Sensitive group), days of using drainage tube and number of antimicrobial categories between the two detection were independent risk factors of acquiring multidrug-resistance for Kpn. CONCLUSION: The number of comorbidities, the hospital stay, the number of antimicrobial categories, and days of using drainage tube were independent risk factors for acquiring MDR-Kpn.

Background: To determine the distribution and antimicrobial susceptibility pattern of pathogenic bacteria in patients with chronic cutaneous wounds on a national scale.Methods: A retrospective study was conducted using the data recorded between January 1, 2018 and January1, 2020 in 195 hospitals across China. After screening the data, 815 patients with chronic wounds were finally analyzed. The data collected included information about the patients' general condition and local cutaneous wound assessments, especially microbial culture and antibiotic susceptibility tests. The analyses were performed using SPSS Version 26.Results: The study included 815 patients (290 [35.6%] females; 63 [50–74] years). The most common causes of chronic cutaneous wounds were diabetes (183, 22.5%), infection (178, 21.8%), and pressure (140, 17.2%). Among these, 521(63.9%) samples tested yielded microbial growth, including 70 (13.4%) polymicrobial infection and 451 (86.6%) monomicrobial infection. The positive rate of microbial culture was highest in wound tissue of ulcers caused by infection (87.6%), followed by pressure (77.1%), diabetes (68.3%), and venous diseases (67.7%). Bates-Jensen wound assessment tool (BWAT) scores >25 and wounds that lasted for more than 3 months had a higher positive rate of microbial culture. BWAT scores >25 and wounds in the rump, perineum, and feet were more likely to exhibit polymicrobial infection. A total of 600 strains were isolated, of which 46.2% (277 strains) were Gram-positive bacteria, 51.3% (308 strains) were Gram-negative bacteria, and 2.5% (15 strains) were fungi. The most common bacterial isolates were Staphylococcus aureus (29.2%), Escherichia coli (11.5%), Pseudomonas aeruginosa (11.0%), Proteus mirabilis (8.0%), and Klebsiella pneumoniae (5.8%). The susceptibility tests showed that 116 cultured bacteria were Multidrug resistant (MDR) strains. The resistance rates of S. aureus were 92.0% (161/175) to penicillin, 58.3% (102/175) to erythromycin, and 50.9% (89/175) to clindamycin. Vancomycin was the most effective antibiotic (0% resistance rate) against all Gram-positive bacteria. Besides, the resistance rates of E. coli were 68.1% (47/69) to ampicillin, 68.1% (47/69) to ciprofloxacin, 60.9% (42/69) to levofloxacin. However, all the isolated Gram-negative bacteria showed low resistance rates to tigecycline (3.9%) and amikacin (3.6%).Conclusions: The distribution of bacteria isolated from chronic cutaneous wounds varies with the BWAT scores, causes, duration, and the location of wounds. Multidrug resistance is a serious health issue, and therefore antibiotics used in chronic wounds must be under strict regulation. Our findings may help clinicians in making informed decisions regarding antibiotic therapy.

The increasing global threat of multi drug resistant pathogens is indicating that this is the time to put together our efforts to develop some approaches to turn down the spread of drug resistivity among the microbial world. The best way to reduce the evolution of antimicrobial resistance is to eliminate the heavy burden of antibiotics from our environment. The unfeasibility of elimination of antibiotics from our healthcare system directs us to develop some effective means to reduce their use at the least level. For this, we need to shift from completely antibiotic dependent therapeutic strategy to the multiple prophylactic and therapeutic approaches. Substantial efforts are being invested worldwide to find the sustainable line of defense against the rising pressure of antimicrobial resistance.

BackgroundBacterial infections are a frequent cause of hospitalization and a leading cause of death, particularly with the emergence of antibiotics resistance. The emergence of Carbapenem resistance among gram-negative bacteria (GNB) is one of the evolving alerts as its use is considered the last resort of treatment [1]. Therefore, this urged studying the risk factors for the development of multi-drug resistant [2] GNB, identify the clinical outcomes and factors associated with mortality, especially among critically ill patients who are expected to have the worst outcomes.Materials/methodsThis is a retrospective observational study of critically ill patients who had an infection with Carbapenem-resistant Enterobacteriaceae (CRE), or MDR Pseudomonas aeruginosa, or MDR Acinetobacter spp. between May 2016- Nov 2018. Baseline demographics, co-morbidities, and clinical outcomes were collected and were evaluated for association with 28 days mortality. ResultsA total of 255 patients with MDR Gram-negative cultures were screened, 77 patients met the inclusion criteria. Pseudomonas aeruginosa was the most common index organism (53% of patients), followed by Acinetobacter spp. and CRE, respectively. The mortality rate at 28 days was (59.7%). Non-survivors were significantly older (mean age 64 vs. 44 years, P= 0.0001), had significantly worse disease severity scores on ICU admission, higher incidence of chronic kidney disease (CKD) (43% vs. 16%, P= 0.010), required more continuous renal replacement therapy (CRRT) (54% vs. 13% P= 0.0001), had longer hospital length of stay prior to infection (median 34 vs. 13 days, P= 0.018), and required longer inotropic and vasopressors support (median 19 vs. 8 days, P = 0.0001). In multivariate logistic regression the following factors were significantly associated with mortality; requirement of inotropic support [OR 10.01 (95% CI 1.55-64.77); P= 0.015], age [OR 1.05 (95% CI 1.0-1.1); P=0.01], APACHE IV score on ICU admission [OR 1.03 (95% CI 1.0- 1.06); P= 0.04], and ICU length of stay [OR 1.03 (95% CI 1.0- 1.06); P= 0.035].ConclusionMDR Gram-negative infection is associated with significant in-hospital mortality among critically ill patients. Old age, high APACHE IV score, higher ICU length of stay, and higher hemodynamic support are associated with higher mortality.Trial registrationretrospectively registered.

Background: Rates of infections with multi-drug-resistant organisms (MDROs) are increasing among critically ill patients. Among non-surgical patients, MDROs increase directly the risk of adverse secondary events including death. However, similar effects do not appear to occur among surgical patients. Specifically, among critically injured trauma patients, it is unknown whether degree of injury versus the presence of an MDRO increases the risk of death. Methods: This is a retrospective chart review of admitted adult trauma patients. Data included demographics, medical comorbidities, injury severity score, infections, occurrence of pneumonia including microbiology sensitivity profile, hospital course, and outcomes. Results: Patients requiring adminission to the intensive care unit (ICU) were more severely injured with greater degree of thoracic and head trauma and had a greater burden of pre-trauma medical comorbidities. Among those admitted to the ICU, 93 patients developed pneumonia. Patients who developed pneumonia were younger and more severely injured, with higher rates of thoracic and head injuries and higher rates of smoking. Development of pneumonia was associated with worse outcomes. However, among patients with pneumonia, comparing MDRO to pan-sensitive (PanSens) infections, PanSens infection occurred earlier and were more likely associated with pre-trauma smoking status. There was no difference in injury patterns, medical comorbidities, or outcomes. Conclusion: The development of pneumonia among trauma patients reflects degree of injury and underlying medical status. However, development of MDRO versus PanSens pneumonia did not affect trauma-related outcomes further. This information will guide family discussions and critical care decisions better among vulnerable trauma patients.

PURPOSE. To analyze the relevance of introduction of modern diagnostics methods for the evaluation of drug-related complications that affect the nervous system in TB treatment practice. MATERIALS AND METHODS. We have analyzed the literature data regarding the problem of diagnosing drug-related complications that affect the nervous system in patients with multi-drug resistant pulmonary tuberculosis during the main course of chemotherapy. RESULTS. According to the results of the analysis, it was revealed that today in the TB practice there is over- or under-diagnosing of drug-related complications from the part of nervous system in patients with multi-drug resistant pulmonary tuberculosis during the main course of chemotherapy, which is due to the lack of technical possibilities of control and the need to get conclusions from specialists with narrow expertise – otolaryngologists, ophthalmologists and neuropathologists. CONCLUSIONS. The lack of data on the prevalence of drug-related nervous system complications is due to the possibility of their detection only with the help of specific technical means of control and on the basis of the conclusions of narrow specialists. The wide introduction of electroencephalography using evoked potentials and audiometry in TB practice will allow obtaining objective data on prevalence, carrying out clear differential diagnostics, monitoring the development of such complications, as well as providing timely treatment within the required amount.