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The Global increase in colonization by multidrug-resistant (MDR) bacteria poses a significant concern. The precise impact of MDR colonization in solid organ transplant recipients (SOTR) remains not well established. To assess the impact of MDR colonization on SOTR's mortality, infection, or graft loss. Data from PROSPERO, OVID Medline, OVID EMBASE, Wiley Cochrane Library, ProQuest Dissertations, Theses Global, and SCOPUS were systematically reviewed, spanning from inception until 20 March 2023. The study protocol was registered with PROSPERO (CRD42022290011) and followed the PRISMA guidelines. Cohorts and case–control studies that reported on adult SOTR colonized by Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum β-lactamase (ESBL) or carbapenem-resistant Enterobacteriaceae. (CRE), or MDR-pseudomonas, and compared to noncolonized, were included. Two reviewers assessed eligibility, conducted a risk of bias evaluation using the Newcastle-Ottawa Scale, and rated certainty of evidence using the GRADE approach. We employed RevMan for a meta-analysis, using random-effects models to compute pooled odds ratios (OR) and 95% confidence intervals (CI). Statistical heterogeneity was determined using the I2 statistic. 15,202 SOTR (33 cohort, six case–control studies) were included, where liver transplant and VRE colonization (25 and 14 studies) were predominant. MDR colonization significantly increased posttransplant 1-year mortality (OR, 2.35; 95% CI, 1.63–3.38) and mixed infections (OR, 10.74; 95% CI, 7.56–12.26) across transplant types (p < 0.001 and I2 = 58%), but no detected impact on graft loss (p 0.41, I2 = 0). Subgroup analysis indicated a higher association between CRE or ESBL colonization with outcomes (CRE: death OR, 3.94; mixed infections OR, 24.8; ESBL: mixed infections OR, 10.3; no mortality data) compared to MRSA (Death: OR, 2.25; mixed infection: OR, 7.75) or VRE colonization (Death: p 0.20, mixed infections: OR, 5.71). MDR colonization in SOTR, particularly CRE, is associated with increased mortality. Despite the low certainty of the evidence, actions to prevent MDR colonization in transplant candidates are warranted. [ABSTRACT FROM AUTHOR]

Klebsiella pneumoniae is an opportunistic bacterium which can cause nosocomial, community acquired, and respiratory infections. It also has the biofilm forming ability which is difficult to treat through antimicrobial drugs. Therefore, an alternative therapy to antibiotics, such as bacteriophages, are required to control this biofilm producing, multi-drug resistant bacterium. The aim of this study was to isolate and characterize a lytic bacteriophage to control the multi drug resistant K. pneumoniae-3206 planktonic cells and biofilm. Phage RAM-1 was isolated from wastewater. It was characterized through transmission electron microscopy and was classified to be a member of the Podoviridae family. SDS-PAGE analysis showed that the phage consisted of approximately eighteen different proteins (13–200 kDa). Its genome was found to be ds DNA of about of ≈36 kb. Phage RAM-1 displayed good heat (37–65 C) and pH (5–11) stability. Phage RAM-1 showed promising activity against the 24-, 48-, and 72-h biofilms made (underneath static conditions along with media renewal) by K. pneumoniae-3206. After a 6-h phage treatment, about 2.5, 3.6 and 4-log reductions were observed respectively. Thus, we concluded from this study that RAM-1 has potential in eradicating both bacterial planktonic cells and biofilm. However, to achieve complete bacterial eradication, a phage cocktail (a combination of two or more phages) will be more promising [ABSTRACT FROM AUTHOR]

Abstract Introduction Probiotic lactobacilli are generally recognized as safe (GRAS) and are being used in several food and pharma formulations. However, growing concern of antibiotic resistance in bacterial strains of food origin and its possible transmission via functional foods is increasingly being emphasized. Objectives This study screened potential probiotic lactic acid bacteria (LAB) strains for their phenotypic and genotypic antibiotic resistance profiles. Methods Susceptibility to different antibiotics was assayed by the Kirby Bauer standard disc diffusion protocol. Both conventional and SYBR-RTq-PCR were used for detection of resistance coding genes. Results A variable susceptibility pattern was documented against different antibiotic classes. LAB strains irrespective of origin displayed marked phenotypic resistance against cephalosporins, aminoglycosides, quinolones, glycopeptides; and methicillin among beta-lactams with few exceptions. In contrast, high sensitivity was recorded against macrolides, sulphonamides and carbapenems sub-group of beta-lactams with some variations. parC, associated with ciprofloxacin resistance was detected in 76.5% of the strains. Other prevalent resistant determinants observed were aac(6?)Ii (42.1%), ermB, ermC (29.4%), and tetM (20.5%). Six (?17.6%) of the isolates were free from genetic resistance determinants screened in this study. Conclusion Study revealed presence of antibiotic resistance determinants among lactobacilli from both fermented foods and human sources.

ABSTRACT Acinetobacter baumannii is a Gram-negative pathogen, accountable for lethal nosocomial infections, owing to high pathogenicity and multi-drug resistance (MDR). Hence, the World Health Organization has prioritized this bacterium against which new pharmacophores are required urgently. Therefore, this study evaluates the antimicrobial potential of lithium complex based on salicylic acid, and 1,10-phenanthroline {[Li(phen)2sal]} against MDR A. baumannii (MDRAB) through growth inhibition, growth curve assay, biofilm inhibition, and eradication alongside microscopy. The mechanism of action was proposed by flow cytometry and proteomic analysis. Moreover, in vivo efficacy was assessed using an A. baumannii-induced pneumonia model in mice. Results showed that lithium complex significantly inhibited the bacterial growth at 16–32 µg/mL. Growth kinetics revealed that it retarded the bacterial growth after 2–3 h of treatment. Lithium complex significantly inhibited and reduced >70% of biofilms at the MIC level which is a key problem of indwelling and prosthetic devices. Light and atomic force microscopy further indicated disarticulated biofilm and ruptured cellular membrane post-lithium complex treatment. Proteomic analysis revealed that the compound exerted oxidative stress on A. baumannii which may contribute to cell rupturing. Data are available via ProteomeXchange with identifier PXD044293. Flow cytometry confirmed its role in cytoplasmic membrane disintegration. The lithium complex ameliorated the pneumonia symptoms at non-toxic doses of 20 and 40 mg/kg in the pre-clinical A. baumannii-induced pneumonia model as evident by the significant reduction in bacterial burden and parenchymal inflammation. Taken together, these findings suggest that the lithium complex can be a potential drug candidate against MDRAB. IMPORTANCE Multi-drug resistance (MDR) by virtue of evolving resistance and virulence mechanisms among A. baumannii is a global concern which is responsible for lethal hospital-acquired infections. Therefore, it is crucial to develop new therapeutics against it. Metal complexes are compact structures with diverse mechanisms that the pathogens cannot evade easily which make them a strong drug candidate. In this study, we assessed the in vitro and in vivo efficacy of lithium complex {[Li(phen)2 sal]} against biofilm-forming MDR A. baumannii. The lithium complex displayed strong antimicrobial activity and reduced the pre-formed mature biofilm which is key barrier for antimicrobial action. Moreover, it employs oxidative stress as one of its mode of actions and causes cellular rupturing. Lithium complex was non-toxic and was significantly effective to overcome pneumonia in mice model. These results highlight the untapped potential of metal complexes that can be explored and utilized for combating notorious A. baumannii infections.

Introduction: Probiotic lactobacilli are generally recognized as safe (GRAS) and are being used in several food and pharma formulations. However, growing concern of antibiotic resistance in bacterial strains of food origin and its possible transmission via functional foods is increasingly being emphasized. Objectives: This study screened potential probiotic lactic acid bacteria (LAB) strains for their phenotypic and genotypic antibiotic resistance profiles. Methods: Susceptibility to different antibiotics was assayed by the Kirby Bauer standard disc diffusion protocol. Both conventional and SYBR-RTq-PCR were used for detection of resistance coding genes. Results: A variable susceptibility pattern was documented against different antibiotic classes. LAB strains irrespective of origin displayed marked phenotypic resistance against cephalosporins, aminoglycosides, quinolones, glycopeptides; and methicillin among beta-lactams with few exceptions. In contrast, high sensitivity was recorded against macrolides, sulphonamides and carbapenems sub-group of beta-lactams with some variations. parC, associated with ciprofloxacin resistance was detected in 76.5% of the strains. Other prevalent resistant determinants observed were aac(6?)Ii (42.1%), ermB, ermC (29.4%), and tetM (20.5%). Six (?17.6%) of the isolates were free from genetic resistance determinants screened in this study. Conclusion: Study revealed presence of antibiotic resistance determinants among lactobacilli from both fermented foods and human sources. [ABSTRACT FROM AUTHOR]

Background: The hospitals have high burden of nosocomial infections, usually caused by multi drug resistant nosocomial organisms. Amongst them Pseudomonas aeruginosa is one of the most difficult pathogens, an epitome of opportunistic nosocomial infections and causes severe and life-threatening infections. This is a compelling problem in hospital settings and needs to have studies on antimicrobial susceptibility pattern to guide the hospital policy on the appropriate use of antibiotics. Material and methods: A crosssectional study at a tertiary care hospital, RIMS, Ranchi, was conducted from October 2017 to September 2018.Phenotypically identified by standard methods (biochemical tests). Antibiotic susceptibility test was carried out by Kirby-Bauer disc diffusion method as per Clinical Laboratory Standards Institute guidelines (CLSI guidelines). Results: A total of 107 samples were processed. Majority of samples were from IPD (69.15%). Among 107 patients, there were 75.70% males and 24.29% females. About 23% of the patients were >50 years of age. The samples mainly comprised of pus (50.46%) followed by urine (30.84 %). Maximum number of pus samples were obtained from general surgery, neurosurgery, orthopaedics, and ENT in patients. Imipenem (75.70%), Piperacillin-Tazobactam (74.77%), Meropenem (70.09%) in the decreasing order were the most sensitive against P. aeruginosa strains. Comclusion: P. aeruginosa is resistant to common antibiotics that make its survival easy in hospital settings. So, implementation of hospital policy on judicious and rational use of antibiotics must be there in every hospital based on local susceptibility pattern. [ABSTRACT FROM AUTHOR]

The present investigation illustrates the in silico structure based drug design method to identify the target bacterial proteins of diallyl thiosulfinate (allicin) and its inhibitory mode of action against the target proteins through molecular docking simulation. As phytochemicals are continuously gaining attention for antimicrobial therapy against various infectious diseases, a stable, efficient and cost-effective herbal formulation that includes allicin should gain esteemed confidence in accordance to patient compliance in this modern world. Zero violation was observed for Lipinski's rule of drug likeliness for allicin which proves that allicin can be used in herbal medicine formulations. Several bacterial growth promoting enzymes were found susceptible to allicin during in silico analysis. Moreover, allicin has been shown to inhibit several proteins responsible for bacterial drug resistance by binding with their active site residues revealing the mode of action. The best binding was observed with Dihydrofolate reductase enzyme among 32 bacterial strains with average binding energy of −3.75 Kcal/mol. Also, allicin showed interaction with resistant modulating proteins of several multi drug resistant strains. This reflects the theoretical evidence of allicin's antimicrobial property and effectiveness on drug resistant strains studied previously by other researchers. The docking study is also supported by the in vitro analysis. [Display omitted] • Allicin exhibits satisfactory drug likeliness (Lipinski's rule of five) properties. • 337 important bacterial proteins necessary for survival were docked with allicin. • Allicin can bind at the active site of various bacterial enzymes. • Allicin has a potential to be used as anti-drug resistance modulating compound. [ABSTRACT FROM AUTHOR]

ABSTRACT: 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.

Abstract 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.

The remarkable increase in resistance to currently available antibiotics to Gram-negative pathogens particularly multidrug resistant (MDR) Pseudomonas aeruginosa and Acinetobacter baumannii, This has resulted in increasing use of older under evaluated antibiotics such as fosfomycin, nitrofurantoin, and Trimethoprime-Sulfamethoxazole for the treatment of infections caused by MDR pathogens. However, limited in-vitro pharmacodynamic data for fosfomycin and nitrofurantoin against Pseudomonas Spp., and Acinetobacter Spp., is available in literature. The current study demonstrates in-vitro activities of fosfomycin and nitrofurantoin against Pseudomonas and Acinetobacter pathogens (425 Pseudomonas Spp., and 352 Acinetobacter Spp., Total: 777 Strains), isolated from Indian tertiary care hospitals. The minimum inhibitory concentration (MIC50/90) of fosfomycin and nitrofurantoin along with comparator antibiotics were determined using Clinical and Laboratory Standards Institute recommended agar dilution method. Fosfomycin demonstrated excellent in-vitro activity against Pseudomonas while in nitrofurantoin demonstrated poor activity against Pseudomonas Spp.,. Fosfomycin and nitrofurantoin did not show promising activities against Acinetobacter Spp.,. By applying E. coli breakpoints, the susceptibility rates of fosfomycin for Pseudomonas Spp., and Acinetobacter Spp., were 72.4%, and 14.8%, respectively. By applying respective breakpoints, the susceptibility rates of comparator drugs, including imipenem and meropenem, were lower than fosfomycin. Susceptibility rate of nitrofurantoin for Pseudomonas Spp., and Acinetobacter Spp., was <1.2% suggesting its poor activity. The susceptibility rate of fosfomycin was > 70% for Pseudomonas isolates, including strains expressing carbapenemases is encouraging finding and supports its potential use. Nitrofurantoin did not show activity against both the Spp., with susceptibility rates <1.2%. [ABSTRACT FROM AUTHOR]

Objective: The resistance of Mycobacterium (M.) tuberculosis to antituberculosis drugs poses a major threat to global public health. Whole genome sequencing (WGS) is an increasingly preferred method in the diagnostics and monitoring of the transmission dynamics of resistant forms of tuberculosis (TB). The aim of the study was to, for the first time, use the sequencing-based analysis to study the transmission and resistance patterns of a systematic and recent collection of extensively drug resistant (XDR) and multidrug resistant tuberculosis (MDR-TB) isolates and to expand our knowledge about drug resistant (DR) TB epidemiological dynamics in Slovakia. Design: A total of 495 patients with pulmonary TB, who were referred to National Reference Laboratory for Mycobacteriology (Vyšné Hágy, Slovakia) in the years 2018–2019, were studied. Out of the total of 495 patients, 4 XDR-TB (0.8%) and 8 (1.6%) MDR-TB isolates were identified by conventional drug susceptibility testing on Löwenstein-Jensen solid medium and subjected to whole genome sequencing. Sequencing data were evaluated for molecular-epidemiological analysis and identification of resistance patterns. Results: Phylogenetic and cluster analysis showed extensive recent transmission events and the predominance of Euro-American lineage 4.7 in Slovakia. However, phylogenetic analysis revealed the circulation of several lineages that originally occurred in Eastern European countries. Resistance patterns for first- and second-line antituberculosis drugs characterized by whole genome sequencing were in high concordance with the results of phenotypic drug susceptibility testing. Conclusion: Forty percent of at least MDR-TB isolates were not genetically linked, indicating that appropriate measures should be taken to monitor and prevent the spread of drug-resistant tuberculosis within the country as well as in other regions.

Background: India is amongst one of the high multidrug resistant tuberculosis (MDR-TB) burden countries globally with a huge contribution given by the state of Uttar Pradesh. Programmatic Management of Drug Resistant Tuberculosis, initiated in 2007 has taken over the disorganized and unsupervised treatment practice in India. However, regular scrutiny is required which points out both its success and failure. Aim & Objective: This study was conducted to evaluate final treatment outcomes among MDR-TB patients on standard Category IV regimen Settings and Design: Retrospective analysis was done using secondary data from medical records of all patients. Methods and Material: Data of all MDR-TB patients registered under RNTCP at King George's Medical University, Lucknow from 2013 to 2016 was collected. Demographic details along with pre-defined treatment outcomes were recorded (cured, treatment completed, death, treatment failure, treatment default and transfer to higher centre). Statistical analysis used: Descriptive statistics using numbers and percentage. Results: The records of 3580 MDR tuberculosis patients registered at drug resistant tuberculosis centre in King George's Medical University from January 2013 to December 2016 were included which consisted of 67%males and 33%female. Mean age of presentation was 31.17 years (95% CI 30.75-31.59). Mean weight of patients was 40.16 kg (95% CI 39.89-40.43). Year wise distribution of registered cases from 2013 to 2016 was 611, 799, 984 and 1186 patients respectively. Amongst 3580 patients, 30.39% were declared cured, 25.50% completed treatment, 21.39% died, 0.84% showed treatment failure, 12.54% were defaulters, 2.35% were transferred out to higher centre, 6.5% were shifted to regimen for Extensive drug resistant (EDR) TB, 0.16% patients needed to stop treatment due to ADR and 0.33% patient were still on treatment. Conclusion: The treatment success rate of MDR-TB patients is still low. Measures to improve treatment adherence as in National tuberculosis elimination programme (NTEP) attempts to further improve the success rate. [ABSTRACT FROM AUTHOR]

Wound infection with antibiotic-resistant bacteria can extend a patients' debility and increase the expense of treatment in the long term; therefore, careful management of patients with wound infections is necessary to avoid complications. The usage of antimicrobial agent is a major factor in resistance development. This study aims to understand the causes of wound infections, as well as the criteria for diagnosing them for more sensible antibiotic prescribing. Samples from 269 wound patients were collected, and cultured for bacterial growth. Gram stain technique, bacterial identification through VITEK 2 compact system was investigated in this study. Gram-negative bacteria (GNB) accounted for 59.15% of the total isolates, whereas pathogenic Gram-positive bacteria (GPB) accounted for 40.85% of total isolates. Escherichia coli and Pseudomonas aeruginosa are the dominant pathogenic GNB in wounds, whereas Staphylococcus aureus and Staphylococcus epidermidis are the dominant pathogenic GPB. P. aeruginosa showed 100% resistance to the majority of antibiotic tested, including Ampicillin, Amoxicillin/Clavulanic Acid, Aztreona, Ceftriaxone, and others. S. aureus and S. epidermidis are 100% resistant to Ampicillin, Ceftriaxone, and Cefotaxime. For more efficient antibiotic prescriptions, the causative microorganisms, and their current susceptibility patterns need to be mandated for testing before prescribing any antibiotics to patients. Prescriptions are frequently based solely on general information about the antibiotic's function, rather than on individual response variation to the pathogen and the antibiotic. Particularly, when the common pathogens in this study show multidrug resistance in wounds. [ABSTRACT FROM AUTHOR]

Background and Objectives: Immunization is a promising strategy to combat against the life-threatening infections by Multi Drug Resistance Acinetobacter baumannii. In this study, we directed to design and evaluate the efficacy of a recombinant multi-epitope protein against this pathogen. Materials and Methods: Epitopes prediction was performed for candidate proteins OmpA and BAM complex (BamA, BamB, BamC, BamD, BamE) from A. baumannii, using immune-informatics tools with high affinity for the human HLA alleles. After expression and purification of the recombinant protein, its functional activity was confirmed by interaction with positive sera. Results: Cloning and expression of the desired multi-epitopes protein were verified. Circular Dichroism study showed the secondary structure and proper refolding of the recombinant protein was achieved and matched with computational prediction. There was a significant interaction between designed protein with antibodies presented in ICU patients' and staff's sera. Conclusion: The interaction of the recombinant protein with patients' sera antibodies suggests that it may be a promising determinant protein for immunization against of MDR A. baumannii. [ABSTRACT FROM AUTHOR]

• Bloodstream infections in patients with coronavirus disease 2019 (COVID-19). • Secondary infection in patients with COVID-19. • Spread of multi-drug-resistant pathogens among patients with COVID-19. • Impact on the health system of the COVID-19 pandemic. 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). 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. 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. BSIs are a common secondary infection in patients with COVID-19, characterized by increased risk during hospitalization and potentially burdened with high mortality. [ABSTRACT FROM AUTHOR]

Background: Urinary catheterization is a common procedure found in hospitals, and is even more common in intensive care units. There are risk factors associated with urinary tract infection (UTI), of which the use of a urinary catheter accounts for more than 80% of all health care associated UTIs. This study was conducted to determine the antibiotic susceptibility profile of bacteria associated with urinary catheters from UTI patients. Methods: Urine samples were collected aseptically from a removed catheter within 24hours of insertion and cultured on blood agar and Cysteine Lactose Electrolyte Deficient Agar (CLED) and identified. Antibiotic susceptibility test was conducted using disk diffusion method on Mueller Hinton agar. Results: A total of 47 isolates were obtained, E. coli 15(31.92%), P. aeruginosa 4(8.51%), P. mirabilis 5(10.64%), P. vulgaris 5(10.64%), K. pneumonia 3(6.38%), S. aureus 11(23.40%), S. saprophyticus 4(8.51%) and showed various degrees of resistance and susceptibility to various antibiotics. E. coli was 73.3% and 66.7% resistance to gentamycin and cefotaxime respectively. P. aeruginosa showed 100% and 50% resistance to Nitrofurantoin and cefatoxine respectively, P. mirabilis showed 100% resistance to cefatoxine and 60% to gentamycin, nalidixic acid and tetracycline. P. vulgaris was also 100% resistance to gentamycin, ampicillin, cefotaxime and 80% to tetracycline. K. Pneumonia showed 100% resistance to tetracycline, ampicillin and norfloxacin. S. Saprophyticus showed 100% resistance to only teicoplanin. However, all the isolates were 100% susceptible to at least one antibiotic. Conclusion: The bacterial pathogens associated with infection in urinary catheters in this study respond to different antibiotics at different degrees ranging from sensitive to resistant. [ABSTRACT FROM AUTHOR]

Mycobacterium tuberculosis mostly obligate pathogen in humans and causes more than 2 million deaths each year with high degree of morbidity. The lineage of Mycobacterium tuberculosis has a level of nucleotide relevancy which is almost similar with its inheritance. However, a broad comprehension on phylogeny magnitude of Mycobacterium tuberculosis based on the analysis of similarity in genomic size would be a critical point in management of tuberculosis. The significance of genetic relationship could be compared with among size of genomic, biological potential in evolution history, and pathogenesis of a disease. Each strain in the world derived from many lineages of microorganism with various genetic structure and typical virulence ability which are impacted to diagnosis of disease, powerful of treatment, and vaccination. The genetic diversity of Mycobacterium tuberculosis has a special awareness because it could be a nebulous trigger for the emergence of global threats in the world such as outbreak of tuberculosis, MDR (Multi Drug Resistant) dan XDR (Extensively Drug Resistant) of tuberculosis.

Background: Multi-drug resistant gram negative bacteria (MDR GNB) have become a major health challenge worldwide. Colistin has an excellent bactericidal activity against these MDR GNB. However, Colistin resistance has been reported globally. Material and methods: This study was conducted in the Department of Microbiology at Krishna Institute of Medical Sciences, Secunderabad from October 2017 to September 2018. Samples received to the laboratory were identified and AST was done by Vitek 2 compact system, those isolates which are colistin resistant were then later compared with disk diffusion and broth microdilution method. Results: Most common isolate which shows colistin resistance were Klebsiella pneumoniae, Pseudomonas aeruginosa, followed by Acinetobacter baumannii and Escherichia coli. Colistin resistant isolates showed by Vitek 2 compact were further compared by reference broth microdilution method, it was found 65.6 % of them were actually susceptible to colistin, whereas 34.3 % showed resistance pattern. The differences between these two methods were found to be statistically significant. On comparison disk diffusion with BMD, it was found that the difference was not statistically significant. Based on these observations, it can be inferred that disk diffusion was an unreliable method to detect colistin susceptibility. Conclusion: Since disk diffusion was the most frequently used method for drug’s susceptibility but in case of colistin it is an unreliable method. As far as automated system is concerned, Vitek 2 compact also cannot be trusted as far as colistin resistance has to be reported. For the colistin resistant isolates conventional methods like BMD should always be considered.

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

Tuberkulosis paru adalah penyakit menular seringkali dikaitkan dengan kemiskinan dan umumnya menyerang rentang usia produktif (15-59 tahun). Indonesia termasuk peringkat ke-5 dunia dengan kasus TB paru terutama masalah Multi Drug Resistent (MDR). Tujuan penelitian mengetahui bagaimana pengalaman hidup, makna hidup, hambatan serta harapan hidup penderita TB paru. Penelitian ini penelitian kualititatif fenomenologi, menggunakan desain deskriptif fenomenologi dengan metode wawancara mendalam. Data dikumpulkan melalui rekaman wawancara, catatan dan dokumentasi lapangan dianalisis dengan teknik Creswell empat strategi. Terdapat empat makna hasil penelitian yaitu pengalaman kehidupan penderita TB paru terindikasi buruk, makna hidup penderita TB paru adalah penderitaan, hambatan kehidupan yang dirasakan penderita TB paru berupa hambatan fisik (cepat lelah, nafsu makan menurun, batuk, lemas, dan sesak), hambatan psikologi (rasa bosan dalam mengonsumsi obat TB), hambatan sosial (berkurangnya interaksi sosial) hambatan finansial (tidak bekerja sama sekali dan berdiam diri di tempat tinggalnya), dan harapan kehidupan penderita TB paru menginginkan sembuh dari penyakitnya. Mengingat penyakit TB menyebabkan gangguan fisik, sosial, psikologi, finansial bagi penderitanya, dimana penderita akan merasa menderita, sedih tidak produktif, hidup bosan, maka sangat penting mengintensifkan pola penyuluhan agar masyarakat terhindar dari penyakit TB.

Objective: To compare the in vitro disk diffusion method and agar dilution method for sensitivity of Polymyxin B against multi drug resistant Acinetobacter baumannii. Study Design: Comparative cross sectional. Place and Duration of Study: The study was carried out in the department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi from 1st Dec 2016 to 30th Dec 2017. Methodology: Total 253 clinical specimens received from intensive care units with yielded growth of multidrug resistant Acinetobacter baumannii were evaluated for Polymyxin B susceptibility. Both Kirby bauer disk diffusion and agar dilution methods were compared with a reference method, broth microdilution. Results: Among 253 multidrug resistant isolates, 180 (71%) were extensively drug resistant and 221 (87%) were carbapenem resistant. Comparison of the disk diffusion and the MIC method by Agar dilution showed 100% correlation. 251 isolates were sensitive and 2 were resistant to Polymyxin B with MICs and disk zone diameters within the range recommended by the CLSI (2014-17). MIC 50 and MIC 90 of Polymyxin B were found to be 0.5 and 1μg/ml with 99.2% susceptibility. Conclusion: Both disk diffusion and agar dilution can be used together as initial screening methods in low income countries for susceptibility reporting of polymyxins. They are simple, reliable and economical. Also hetero resistance shown by some Acinetobacter baumanii strains can easily be picked up by agar dilution method.

Wound infection with antibiotic-resistant bacteria can extend a patients’ debility and increase the expense of treatment in the long term; therefore, careful management of patients with wound infections is necessary to avoid complications. The usage of antimicrobial agent is a major factor in resistance development. This study aims to understand the causes of wound infections, as well as the criteria for diagnosing them for more sensible antibiotic prescribing. Samples from 269 wound patients were collected, and cultured for bacterial growth. Gram stain technique, bacterial identification via VITEK 2 compact system were investigated in this study. Gram negative bacteria accounted for 59.15% of the total isolates, while pathogenic gram positive bacteria accounted for 40.85% of total isolates. Escherichia coli and Pseudomonas aeruginosa are the dominant pathogenic gram negative bacteria in wounds, while Staphylococcus aureus, and Staphylococcus epidermidis are the dominant pathogenic gram positive bacteria. Pseudomonas aeruginosa showed 100% resistance to the majority of antibiotic tested, including Ampicillin, Amoxicillin/Clavulanic Acid, Aztreona, Ceftriaxone, and others. Staphylococcus aureus and Staphylococcus epidermidis are 100% resistant to Ampicillin, Ceftriaxone, and Cefotaxime. For more efficient antibiotic prescriptions, the causative microorganisms, and their current susceptibility patterns need to be mandated for testing before prescribing any antibiotics to patients. Prescriptions are frequently based solely on general information about the antibiotic's function, rather than on individual response variation to the pathogen and the antibiotic. Particularly when the common pathogens in this study show multidrug resistance in wounds.

Background and Objectives: Immunization is a promising strategy to combat against the life-threatening infections by Multi Drug Resistance Acinetobacter baumannii. In this study, we directed to design and evaluate the efficacy of a recombinant multi-epitope protein against this pathogen. Materials and Methods: Epitopes prediction was performed for candidate proteins OmpA and BAM complex (BamA, BamB, BamC, BamD, BamE) from A. baumannii, using immune-informatics tools with high affinity for the human HLA alleles. After expression and purification of the recombinant protein, its functional activity was confirmed by interaction with positive sera. Results: Cloning and expression of the desired multi-epitopes protein were verified. Circular Dichroism study showed the secondary structure and proper refolding of the recombinant protein was achieved and matched with computational prediction. There was a significant interaction between designed protein with antibodies presented in ICU patients' and staff's sera. Conclusion: The interaction of the recombinant protein with patients' sera antibodies suggests that it may be a promising determinant protein for immunization against of MDR A. baumannii.

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. [ABSTRACT FROM AUTHOR]

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BackgroundHypopharyngeal squamous cell cancer (HSCC) is a head and neck tumor with a poor prognosis. Chemotherapy lacks effectiveness because of multidrug resistance (MDR), which has increased toxic side effects. Thus, there is an urgent need to identify the molecular markers of MDR of chemotherapy for HSCC.MethodsFifty clinical samples of HSCC were derived from patients including 12 sensitive or resistant to chemotherapy drugs. Proteomic screening was performed using liquid chromatography-tandem mass spectrometry (LC-MS), which was based on data-independent acquisition. Molecular markers of MDR of chemotherapy in patients with HSCC were identified with clinical data and validated with ELISA.ResultsA total of 673 differentially expressed proteins were identified in HSCC samples, where 172 were upregulated and 501 were downregulated. A total of 183 differentially expressed proteins including 102 upregulated and 81 downregulated proteins, were identified by comparing cancer sensitive to chemotherapy with cancer resistant to chemotherapy. Clinical HSCC samples had significantly higher expression of FADD and significantly lower expression of RIPK1. Expressions of FADD and RIPK1 proteins were significantly lower in the chemotherapy-sensitive group. These expression differences were not correlated with clinical data. RIPK1 and FADD are involved in necroptosis and the signaling pathway of PRRs. Using ELISA, the low expression of RIPK1 and FADD was found in the patients sensitive to chemotherapy.ConclusionLC-MS proteomics is an effective method to identify the molecular markers of HSCC. FADD and RIPK1 can act as molecular markers of MDR of chemotherapy in patients with HSCC and may function through necroptosis and the PRR signaling pathway.

Background: Hypopharyngeal squamous cell cancer (HSCC) is a head and neck tumor with a poor prognosis. Chemotherapy lacks effectiveness because of multidrug resistance (MDR), which has increased toxic side effects. Thus, there is an urgent need to identify the molecular markers of MDR of chemotherapy for HSCC. Methods: Fifty clinical samples of HSCC were derived from patients including 12 sensitive or resistant to chemotherapy drugs. Proteomic screening was performed using liquid chromatography-tandem mass spectrometry (LC-MS), which was based on data-independent acquisition. Molecular markers of MDR of chemotherapy in patients with HSCC were identified with clinical data and validated with ELISA. Results: A total of 673 differentially expressed proteins were identified in HSCC samples, where 172 were upregulated and 501 were downregulated. A total of 183 differentially expressed proteins including 102 upregulated and 81 downregulated proteins, were identified by comparing cancer sensitive to chemotherapy with cancer resistant to chemotherapy. Clinical HSCC samples had significantly higher expression of FADD and significantly lower expression of RIPK1. Expressions of FADD and RIPK1 proteins were significantly lower in the chemotherapy-sensitive group. These expression differences were not correlated with clinical data. RIPK1 and FADD are involved in necroptosis and the signaling pathway of PRRs. Using ELISA, the low expression of RIPK1 and FADD was found in the patients sensitive to chemotherapy. Conclusion: LC-MS proteomics is an effective method to identify the molecular markers of HSCC. FADD and RIPK1 can act as molecular markers of MDR of chemotherapy in patients with HSCC and may function through necroptosis and the PRR signaling pathway. [ABSTRACT FROM AUTHOR]

Escherichia coli are commonly found in the gastrointestinal tract of humans and other warm-blooded organisms. Since E. coli can be discharge through deposition of fecal material, it has become habituated to soil and water in the environment. Hence the present study was undertaken to isolate and identify E. coli from various environments (viz., cattle waste, piggery, poultry and sewage water) and to determine their antibiogram patterns to different group of antimicrobial agents. A total of 120 samples comprising cattle wastes (30), poultry droppings (30), piggery (30), sewage water/sediment (30) were collected from the Dakshina Kannada and analyzed for the presence of E. coli. Of total samples screened, 82 (68.3%) were found to be positive to E. coli and among the 82 E. coli strains, 25 were isolated from cattle wastes, 18 from piggery, 13 from poultry and 26 from sewage samples. The antibiogram pattern of these strains showed varied multi-drug resistance profile to the selected antibiotics. Of 82 strains, 19 (23.2%) were susceptible to all the antibiotics and 63 were resistant to at least one of the drug tested. The results from present study revealed the higher relative resistance pattern to the tested antibiotic among E. coli suggesting their potentiality in transferring MDR thereby posing public health concerns in treating problems.

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.

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.

One hundred fifty samples were read to eat chicken meaty collected from different restaurants in Luxor city to evaluate bacteriological quality RTE chicken meat. The mean values of APC, Coliform, Staphylococcus counts, Anaerobic count, Yeast count, Mould count (cfu/g). 1.36X1042.94X103&8.42x1023.90x102,4.671.15&1.000.73&7.672.23,2.671.26 to chicken shawirma without addition, 5.58X1031.16X103&3.34x1029.82x10&2.33 1.24&1.000.75&8.332.40&2.671.26 for chicken burger without addition and 4.62X1037.42X102&1.53x1024.85x10&1.330.79&3.001.37&4.331.64,1.670.84 for fried chicken, all samples not detected for Shigella, respectively.9 E.coli (6%) were isolated from samples represented 4(8%), (2) O125:H2, (1) O143:H8 and (1) O111:H1 from chicken shawirma without addition, 3(6%) O55: H2, O158:H3and O86a:H1 from chicken burger without addition, 2 (4%) O142:H3, O26:H1from fried chicken, Also, 8(5.33%) Coagulase positive Staphylococcus aureus were isolated from samples. Represented as 4(8%) isolate from chicken shawirma without addition, 3 (6%) from chicken burger without addition, 1(2%) from fried chicken. 6(4%) of Salmonella were isolated from Samples represented as 2(4%) S. typhimurium and 1(2%) S. enteritidis from shawirma without addition, 1(2%)S. enteritidis and 1(2%) S. Anatum from chicken burger without addition, 1(2%) S.Kentucky from fried chicken. Isolates. Most of E.coli isolate sensitive for Colistin sulphate(10ug) and Nalidixic acid(10ug). St.aureus isolates sensitive to Ampicillin (10ug) and Vancomycin (15ug). Most of Salmonella isolate sensitive for Gentamycin (10ug), Colistin Sulphate(10ug) and Ceftriaxone. [ABSTRACT FROM AUTHOR]

A new member of the class metallo-β-lactamase (MBL), New Delhi metallo-beta-lactamase 1 (NDM-1) has emerged recently as a leading threat to the treatment of infections that have spread in all major Gram-negative pathogens. The enzyme inactivates antibiotics of the carbapenem family, which are a mainstay for the treatment of antibiotic-resistant bacterial infections. This review provides information about NDM-1 spatial structure, potential features of the active site, and its mechanism of action. It also enlists the inhibitors/compounds/drugs against NDM-1 in various development phases. Understanding their mode of inhibition and the structure-activity relationship would be beneficial for development, synthesis, and even increasing biological efficacy of inhibitors, making them more promising drug candidates. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis is an infectious disease which is the second largest cause of death in the world after HIV / AIDS. Tuberculosis caused by Mycobaterium tuberculosis that usually attacks the lungs but can manifest in the oral mucosa. Clinical manifestations of oral tuberculosis related to age, sex, duration of treatment, systemic disease and Multi Drug Resistant therapy. There is no research on descriptive studies of oral manifestations oftuberculosis patients in South Kalimantan specifically in Banjarmasin. Purpose: To analyze descriptively the clinical manifestations of oraltuberculosis inSouth Kalimantan, Indonesia. Method: This was a descriptive analysis with a cross sectional study design, based on history and clinical oral examination. It was used 30 respondents by purposive sampling method. Data was analyzed by Chi square(p<0.05). Results: During treatment it showed the correlation between xerostomia and systemic disease (p=0.007) and correlation between xerostomia and duration of treatment(p=0.024). The correlation between candidiasis and systemic disease (p=0.024). The correlation between angular cheilitis and age, sex, duration of treatment, systemic disease and Multi Drug Resistant therapy (p>0.05). Conclusion: The clinical manifestations of oral tuberculosis are xerostomia, candidiasis and angular cheilitis. The duration of treatment and the systemic diseases are associated with xerostomia and candidiasis in the oral cavity of TB patients. [ABSTRACT FROM AUTHOR]

Pseudomonas aeruginosa is considered as foremost cause of hospital acquired infections due to its innate and plasmid mediated resistance to multiple antibiotics making it a multi drug resistant (MDR) pathogen. Biofilm formation is a pathogenic mechanism harbored by this pathogen which further elevates its resistance to antibiotics and host defense system. The aim of the present study was to evaluate the biofilm forming potential and distribution of pslA gene in multi drug resistant Pseudomonas aeruginosa isolates obtained from different clinical samples. A total of 200 different clinical samples were collected after obtaining written consent from the patients. The samples were subjected to isolation and identification of P. aeruginosa by standard microbiological procedures. Confirmation of isolates was done by polymerase chain reaction targeting oprL gene. Kirby Bauer method was performed for detection of MDR isolates. Congo red agar (CRA) test and Microtiter plate assay (MPA) for observing the biofilm forming ability and amplification of pslA gene was also performed on MDR isolates. The results showed that from 200 samples 52 (26 %) were P. aeruginosa and among them 20 (38.46 %) were MDR isolates. The CRA showed 23 (44.23 %) while MPA detected 49 (94.23 %) isolates as biofilm producers while all the MDR isolates showed biofilm formation by MPA method. The pslA gene was detected in all biofilm forming isolates while 90 % in MDR P. aeruginosa. It was concluded that biofilm forming P. aeruginosa are more resistant to tested antibiotics and biofilm formation is strongly associated with presence of pslA gene. [ABSTRACT FROM AUTHOR]

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 < 0.001) and CTP scores (11.7 vs 10.3, p < 0.001). The control group had lower MELD (16.65 vs. 20.8, p < 0.001) and CTP scores (9.25 vs 10.59, p < 0.001). Conclusions: MDR infections are common in patients with cirrhosis and have serious implications for treatment and outcomes. [ABSTRACT FROM AUTHOR]

Objective: To compare the in vitro disk diffusion method and agar dilution method for sensitivity of Polymyxin B against multi drug resistant Acinetobacter baumannii. Study Design: Comparative cross sectional. Place and Duration of Study: The study was carried out in the department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi from 1st Dec 2016 to 30th Dec 2017. Methodology: Total 253 clinical specimens received from intensive care units with yielded growth of multidrug resistant Acinetobacter baumannii were evaluated for Polymyxin B susceptibility. Both Kirby bauer disk diffusion and agar dilution methods were compared with a reference method, broth microdilution. Results: Among 253 multidrug resistant isolates, 180 (71%) were extensively drug resistant and 221 (87%) were carbapenem resistant. Comparison of the disk diffusion and the MIC method by Agar dilution showed 100% correlation. 251 isolates were sensitive and 2 were resistant to Polymyxin B with MICs and disk zone diameters within the range recommended by the CLSI (2014-17). MIC 50 and MIC 90 of Polymyxin B were found to be 0.5 and 1µg/ml with 99.2% susceptibility. Conclusion: Both disk diffusion and agar dilution can be used together as initial screening methods in low income countries for susceptibility reporting of polymyxins. They are simple, reliable and economical. Also hetero resistance shown by some Acinetobacter baumanii strains can easily be picked up by agar dilution method. [ABSTRACT FROM AUTHOR]

Introduction: Tuberculosis has become a chronic debilitating disease in developing countries, particularly after the emergence of multidrug resistant tuberculosis (MDR-TB). Second line treatments for the disease which were subsequently developed were associated with psychiatric disorders among patients. Psychiatric disorder can either be induced by treatment regiments or psychosocial factors. Cycloserine administration is frequently reported to be associated with psychiatric disorders. In this study, we examined the prevalence and characteristics of psychiatric disorders among MDR-TB patients in Sardjito Hospital, Yogyakarta, Indonesia. Methods: In this descriptive study, we studied medical records of MDR-TB patients admitted for MDR-TB treatments to Sardjito Hospital from January 2014 to July 2016 and screened for psychiatric disorders. Results: We found that 32.8% of the patients had psychiatric disorders, some of which had multiple psychiatric diagnoses (14.1%). The diagnoses were medication induced delirium, substance/medication induced psychotic disorder, substance/medication use depressive disorder, depressive type schizoaffective disorder, bipolar I disorder current episode severe manic with psychotic features, mild depression, moderate depression, major depression without psychotic features, major depression with psychotic features, adjustment disorders with mixed anxiety and depressed mood, adjustment disorder with anxiety, acute stress disorder, and insomnia. Psychiatric disorders were significantly associated with cycloserine dose and sex. Psychotic symptoms were significantly associated with sex and level of education. Conclusion: The presence of psychiatric disorders might disturb MDR-TB treatment resulting in poor outcomes. Precaution and prompt managements are required for psychiatric disorders in patients receiving MDR-TB treatment regiments.

Importance: Multi-drug resistance (MDR) by virtue of evolving resistance and virulence mechanisms among A. baumannii is a global concern which is responsible for lethal hospital-acquired infections. Therefore, it is crucial to develop new therapeutics against it. Metal complexes are compact structures with diverse mechanisms that the pathogens cannot evade easily which make them a strong drug candidate. In this study, we assessed the in vitro and in vivo efficacy of lithium complex {[Li(phen) 2 sal]} against biofilm-forming MDR A. baumannii . The lithium complex displayed strong antimicrobial activity and reduced the pre-formed mature biofilm which is key barrier for antimicrobial action. Moreover, it employs oxidative stress as one of its mode of actions and causes cellular rupturing. Lithium complex was non-toxic and was significantly effective to overcome pneumonia in mice model. These results highlight the untapped potential of metal complexes that can be explored and utilized for combating notorious A. baumannii infections., Competing Interests: The authors declare no conflict of interest.

Background: Polymyxin B and colistin have similar structures except for one amino acid. Usually, physicians choose either polymyxin B or colistin for treatment of infections caused by multidrug-resistant (MDR) organisms. The preference is based on previous experience. Not much data are found in the literature comparing the two drugs against the same microorganisms. In this study, we compared in vitro antimicrobial activities of the two polymyxins against a panel of highly resistant and susceptible microorganisms. Methods: Eighty-nine clinical isolates (27 Klebsiella pneumoniae, 31 Acinetobacter baumannii and 31 Pseudomonas aeruginosa) were tested in broth microdilution assays. Time-kill curve experiments were carried out on selected isolates. Results: Significantly lower MICs for polymyxin B than for colistin were found against all species tested including K. pneumoniae (p <.02), A. baumannii (p <.001) and P. aeruginosa (p <.01). The low MICs caused a change in categorical interpretations of only two K. pneumoniae and two P. aeruginosa. Similar results were obtained in time-kill curve experiments with both susceptible and resistant clinical isolates. Conclusions: Significantly lower MICs were found for polymyxin B against three of the most critical MDR species. Even though differences in categorical interpretations were not striking, lower MICs might be a critical consideration in clinical management of select cases where the concentration of these toxic antibiotics matters because of underlying co-morbidities. These results provide support to previous suggestions that re-consideration of breakpoint interpretations for polymyxins might be needed. [ABSTRACT FROM AUTHOR]

Urinary tract infection (UTI) is a common health-associated problem worldwide. Like other medical conditions, UTI patients may suffer from poor treatment outcomes due to the emergence of antimicrobial resistance. Determining patterns of antimicrobial susceptibility in uropathogens will guide physicians to choose the best antibiotics for treating affected patients. In this project we aimed to evaluate the frequencies of pathogens associated with UTI and their antimicrobial susceptibility patterns. This study was conducted on 2692 urine samples of patients visited Rizgary Teaching Hospital in Erbil city. Aerobic bacterial growth identification and antimicrobial susceptibility tests were performed using VITEK®2 compact system. Our data show that more than 20% of all studied samples were negative for bacterial growth; only 16.72% of them were pathogenic bacteria in which 82.44% of them were Gram negative bacteria (GNB) and the rest were Gram positive bacteria (GPB). Escherichia coli was the most frequent, and Acinetobacter baumannii was the most resistant GNB. Staphylococcus haemolyticus was the most frequent, and Enterococcus faecalis was the most resistant GPB. In general GNB were highly resistant to Ticarcillin and Cefepime, and GPB were also resistant to Ticarcillin, and Tigecycline antibiotics. The amount of negative culture growth indicates that symptoms only based diagnosis for UTI detection is unreliable. E. coli is the most UTI related pathogen, E. faecalis and A. baumannii were among highly antibiotic resistant bacteria. Finally, since many of GNG and GPB isolates were resistant to several antibiotics, there might be a high possibility for multi drug resistant among local population in Erbil. [ABSTRACT FROM AUTHOR]

In this study the sediment samples of Rajapur-unhale and Sangameshwar- Aravali hot springs were collected and aimed to screen the antimicrobial resistance of the isolates against MDR strains and screening of potential enzyme producing strains from hot springs. Seventy seven (77) isolates were obtained from Rajapur-Unhale sediment and in Sangameshwar-Aravali sediment forty two (42) isolates were obtained. Out of 119 isolates five isolates (4.20 %) were positive for amylase activity, twenty one isolates (17.64 %) were positive for protease, four isolates (3.36 %) were positive for lipase enzyme production, eight isolates (6.72 %) were positive for keratinase enzyme and four isolates (3.36%) were positive for urease enzyme. In primary screening, 19 isolates (15.96 %) exhibited antimicrobial activity against Klebsiella pneumonia ATCC 43816T, whereas the isolates were not shown any kind of activity against Pseudomonas aeruginosa - MTCC 2453T and Staphylococcus aureus - ATCC 43300T. Nineteen isolates exhibited antimicrobial activity showing promising activity against test organisms out of which sixteen isolates (13.44 %) were positive for Raajapur-Unhale hot spring. Whereas, in Sangameshwar-Aravali hot spring only three isolates (2.52 %) showed positive zone of inhibition against Klebsiella pneumonia ATCC 43816T. The Fifty five isolates obtained from enzyme screening and antimicrobial screening were identified through 16S rRNA gene sequencing, the sequences were assembled and identified through Ez-Taxon server by blast search analysis of the sequences in fasta format. [ABSTRACT FROM AUTHOR]

Escherichia coli are commonly found in the gastrointestinal tract of humans and other warm-blooded organisms. Since E. coli can be discharge through deposition of fecal material, it has become habituated to soil and water in the environment. Hence the present study was undertaken to isolate and identify E. coli from various environments (viz., cattle waste, piggery, poultry and sewage water) and to determine their antibiogram patterns to different group of antimicrobial agents. A total of 120 samples comprising cattle wastes (30), poultry droppings (30), piggery (30), sewage water/sediment (30) were collected from the Dakshina Kannada and analyzed for the presence of E. coli. Of total samples screened, 82 (68.3%) were found to be positive to E. coli and among the 82 E. coli strains, 25 were isolated from cattle wastes, 18 from piggery, 13 from poultry and 26 from sewage samples. The antibiogram pattern of these strains showed varied multi-drug resistance profile to the selected antibiotics. Of 82 strains, 19 (23.2%) were susceptible to all the antibiotics and 63 were resistant to at least one of the drug tested. The results from present study revealed the higher relative resistance pattern to the tested antibiotic among E. coli suggesting their potentiality in transferring MDR thereby posing public health concerns in treating problems. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background Gram negative pathogens are increasingly resistant to commonly used first line antibiotics and colistin is in most cases the only medicine available. There is very limited information available comparing the effectiveness and costs of low versus high dose colistin with studies showing efficacy with both doses and with variable levels of adverse effects. The absence of a definite dosing strategy makes a model to compare low dose and high dose colistin invaluable in making decisions regarding the appropriate use of colistin. Objective This study was designed to evaluate the cost effectiveness of low versus high dose colistin in the treatment of Pneumonia caused by colistin-only sensitive gram negative bacteria from the perspective of a tertiary care hospital in Saudi Arabia. Setting 300-bed tertiary care hospital in Saudi Arabia. Method A retrospective review was conducted to compare the costs and outcomes of treatment of pneumonia with low versus high dose colistin. The model followed an average patient from initiation of treatment until clinical cure or failure. Main outcome measures The main outcomes were cure, nephrotoxicity, total direct costs per episode, cost per additional cure and cost per nephrotoxicity avoided. Results There was no significant difference between high and low dose colistin with regards to clinical cure (30% vs. 21%; p = 0.292). Significantly more patients experienced nephrotoxicity with high versus low dose colistin (30% vs. 8%; p = 0.004). With low dose colistin the incremental costs per nephrotoxicity avoided was SAR-3056.28. One-way sensitivity analyses did not change the overall results. Conclusion Low dose was not inferior to high dose colistin in terms of clinical cure and had a lower incidence of nephrotoxicity resulting in significant cost avoidance. [ABSTRACT FROM AUTHOR]

The emergence of multi-drug resistant (MDR) pathogens poses a significant global health concern due to the failure of conventional medical treatment. As a result, the development of several metallic (Ag, Au, Zn, Ti, etc.) nanoparticles, has gained prominence as an alternative to conventional antimicrobial therapies. Among these, green-synthesized silver nanoparticles (AgNPs) have gained significant attention due to their notable efficiency and broad spectrum of antimicrobial activity. Bacterial exopolysaccharides (EPS) have recently emerged as a promising biological substrate for the green synthesis of AgNPs. EPS possess polyanionic functional groups (hydroxyl, carboxylic, sulfate, and phosphate) that effectively reduce and stabilize AgNPs. EPS-mediated AgNPs exhibit a wide range of antimicrobial activity against various pathogenic microbes, including Gram-positive and Gram-negative bacteria, as well as fungi. The extraction and purification of bacterial EPS play a vital role in obtaining high-quality and -quantity EPS for industrial applications. This study focuses on the comprehensive methodology of EPS extraction and purification, encompassing screening, fermentation optimization, pretreatment, protein elimination, precipitation, and purification. The review specifically highlights the utilization of bacterial EPS-mediated AgNPs, covering EPS extraction, the synthesis mechanism of green EPS-mediated AgNPs, their characterization, and their potential applications as antimicrobial agents against pathogens. These EPS-mediated AgNPs offer numerous advantages, including biocompatibility, biodegradability, non-toxicity, and eco-friendliness, making them a promising alternative to traditional antimicrobials and opening new avenues in nanotechnology-based approaches to combat microbial infections. [Display omitted] • Green synthesize silver nanoparticle (AgNPs) as a potential agent for antimicrobial activity. • EPS is potential reducing and stabilizing agent for AgNPs synthesis. • Details methodology on EPS extraction and purification. • Synthesis mechanism of EPS mediated AgNPs. • Mechanism of EPS-AgNPs in antimicrobial activity. [ABSTRACT FROM AUTHOR]