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Methicillin-resistant Staphylococcus (MRS) bacteria, including methicillin-resistant S. aureus and methicillin-resistant S. pseudintermedius (MRSP), pose a significant threat in veterinary medicine, given their potential for zoonotic transmission and their implications for companion animals and humans' health. This study aimed to assess the prevalence of MRS and antimicrobial resistance patterns at a university clinical hospital in Madrid, Spain. Samples were collected from both the environment and hospital staff at Veterinary Clinical Hospital of Alfonso X el Sabio University. Anti-microbial susceptibility assays, molecular detection of mecA gene and genetic relationships among the identified bacterial strains were performed. The study revealed an MRS prevalence of 1.50% in environmental samples, with MRSP accounting for 0.75% of the cases. Genetically related MRSP strains were found in different hospital areas. Among hospital staff, there was a MRS prevalence of 14.03%, including S. pseudintermedius and S. epidermidis strains. Antibiogram tests revealed multi-drug resistance among MRSP strains. Additionally, methicillin-resistant coagulase-negative staphylococci were isolated, suggesting potential crossspecies transmission. This study underscores the presence of MRS in a veterinary clinical hospital, highlighting the significance of infection control through the implementation of protective measures, stringent hygiene practices among personnel and in the environment and responsible use of antibiotics. Further research is necessary to assess MRS incidence in animal patients and explore geographical variations, enhancing our understanding of MRS in veterinary medicine and addressing its challenges. [ABSTRACT FROM AUTHOR]

Objective: Pseudomonas aeruginosa has strong drug resistance and can tolerate a variety of antibiotics, which is a major problem in the management of antibiotic-resistant infections. Direct prediction of multi-drug resistance (MDR) resistance phenotypes of P. aeruginosa isolates and clinical samples by genotype is helpful for timely antibiotic treatment. Methods: In the study, whole genome sequencing (WGS) data of 494 P. aeruginosa isolates were used to screen key anti-microbial resistance (AMR)- associated genes related to imipenem (IPM), meropenem (MEM), piperacillin/tazobactam (TZP), and levofloxacin (LVFX) resistance in P. aeruginosa by comparing genes with copy number differences between resistance and sensitive strains. Subsequently, for the direct prediction of the resistance of P. aeruginosa to four antibiotics by the AMR-associated features screened, we collected 74 P. aeruginosa positive sputum samples to sequence by metagenomics nextgeneration sequencing (mNGS), of which 1 sample with low quality was eliminated. Then, we constructed the resistance prediction model. Results: We identified 93, 88, 80, 140 AMR-associated features for IPM, MEM, TZP, and LVFX resistance in P. aeruginosa. The relative abundance of AMR-associated genes was obtained by matching mNGS and WGS data. The top 20 features with importance degree for IPM, MEM, TZP, and LVFX resistance were used to model, respectively. Then, we used the random forest algorithm to construct resistance prediction models of P. aeruginosa, in which the areas under the curves of the IPM, MEM, TZP, and LVFX resistance prediction models were all greater than 0.8, suggesting these resistance prediction models had good performance. Conclusion: In summary, mNGS can predict the resistance of P. aeruginosa by directly detecting AMR-associated genes, which provides a reference for rapid clinical detection of drug resistance of pathogenic bacteria. [ABSTRACT FROM AUTHOR]

Aims: Salmonella enterica is a leading cause of acute enteritis in people, and dairy cattle are an important reservoir of this pathogen. The objective of this study was to analyse serotype and anti‐microbial resistance trends of Salmonella isolated from dairy cattle in the United States between 2007 and 2021. Methods and Results: We collected data for bovine Salmonella isolates obtained from samples submitted to Cornell University's Animal Health Diagnostic Center (AHDC). We analysed 5114 isolates for serotype trends, and a subset of 2521 isolates tested for anti‐microbial susceptibility were analysed for resistance trends. The most frequently identified serotypes were Salmonella Cerro, Dublin, Typhimurium, Montevideo, 4,[5],12:i:‐, and Newport. Among these serotypes, a Cochran–Armitage trend test determined there was a significant increase in the proportion of isolates serotyped as Salmonella Dublin (p < 0.0001) and Montevideo (p < 0.0001) over time. There was a significant decrease in the proportion of isolates serotyped as Salmonella Cerro (p < 0.0001), Typhimurium (p < 0.0001), and Newport (p < 0.0001). For the anti‐microbial resistance (AMR) analysis, we found an overall increase in the proportion of multi‐drug‐resistant isolates over time (p = 0.009). There was a significant increase in the proportion of isolates resistant to ampicillin (p = 0.007), florfenicol (p = 0.0002), and ceftiofur (p < 0.0001) and a marginal increase in resistance to enrofloxacin (p = 0.05). There was a significant decrease in the proportion of isolates resistant to spectinomycin (p = 0.0002), trimethoprim/sulphamethoxazole (p = 0.01), sulphadimethoxine (p = 0.003), neomycin (p < 0.0001), and gentamicin (p = 0.0002). Conclusions: Our results provide evidence of an increase in resistance to key anti‐microbial agents, although the observed trends were driven by the sharp increase in the proportion of Salmonella Dublin isolates over time. [ABSTRACT FROM AUTHOR]

Transition graphs or transition diagrams, describing the rates and probabilities with which a system changes between discrete states, are common throughout the sciences. In many cases, parameterisations of transition graphs are inferred from different datasets, for example in the context of Markov or hidden Markov models. An important task for followup analysis is to find efficient and effective ways to compare transition graphs with different parameterisations. Here, we introduce the Weight-Filtration Comparison Curve (WFCC), an approach by which the differences between two or more parameterisations of a transition graph can be quantified and compared. Borrowing from topological data analysis, the WFCC allows graphs learned from different datasets and/or null models to be systematically compared, and differences in both the fine- and coarse-grained structure and dynamics of transition graphs to be quantitatively assessed. We demonstrate WFCC with simple illustrative cases and real-world cases of transition graphs inferred from global data on the evolution of antimicrobial resistance in different countries, showing how different inferred dynamics, and different levels of uncertainty, are reported by structural aspects of these comparison curves.

The purpose of this work was to test a simple MATLAB algorithm for the automatic analysis of Kirby-Bauer diffusion technique antibiograms. The experimental setup includes a digital camera connected to a computer for acquisition of the Petri dish images and an algorithm developed in MATLAB for the automatic interpretation of the image data. The workflow data required by this software includes patient identification, sample identification and the list of the antibiotics tested. The growth inhibition area corresponding to each of the antibiotics tested is identified, measured and interpreted automatically by the software which also calculates the results and returns data on the strain's sensibility to an antibiotic. The results are also presented as a graphical chart ranking the antibiotics based on their efficiency, which simplifies the physician's task of choosing the proper treatment for the patient. This algorithm represents another fast and cost-effective way for the interpretation of the laboratory bacterial antibiotic resistance test results. [ABSTRACT FROM AUTHOR]

Cholera continues to pose a significant global public health challenge. The occurrence of severe weather events, including floods, droughts, and cyclones, has led to a surge in new cholera outbreaks and exacerbated both epidemic and endemic conditions in numerous countries. We propose a ten-state ordinary differential system of equations to model antimicrobial resistant cholera infections, considering both direct and indirect transmission pathways. Antimicrobial resistant cholera infection is considered to occur in some infected individuals receiving antibiotic treatment. The model integrates key interventions such as vaccination, screening, and treatment to curb cholera spread. Loss of infection-acquired immunity for the recovered individuals is also considered in the model. A threshold quantity referred to as the model reproduction number Rc is computed and stability analysis of equilibrium points for the full model and submodels is performed. Sensitivity analysis is performed and specific measures to reduce parameters associated with cholera transmission and enhance parameters related to control measures are suggested. Numerical simulations are carried out to support theoretical findings. The results obtained places a significant emphasis on antimicrobial resistance and its impact on cholera control. The importance of minimizing antimicrobial resistance through targeted interventions is highlighted. Therefore, there is an urgent need to implement policies aimed at mitigating the spread of antimicrobial resistance.

This work examined the use of over-the-counter drugs and its health implications in Awka South LGA of Anambra State, Nigeria. The objective of the study is to empirically interrogate the prevalence of over-the-counter drug use in Awka South LGA of Anambra State, Nigeria; the factors influencing it, and its health implications. The study used a mixed methods research approach, with 204 respondents selected through a multistage sampling procedure. The structured questionnaire and In-Depth Interview (IDI) guide acted as data-gathering tools. The quantitative data were coded and processed with SPSS version 20. Frequency tables were utilized to evaluate, characterize, and show the data, whereas quantitative data were manually transcribed and analyzed using content analysis. Two study hypotheses were developed and tested using chi-square inference statistics. This study revealed that various factors influence the use of OTC drugs in Awka South LGA. The study equally found that the use of OTC drugs is very prevalent in Awka South LGA. Moreover, the study also found that abusing OTC drugs has health implications. Based on these findings, this study recommended that the government should regulate the production, sale, and advertisement of OTC drugs. The study also recommended that sensitization and awareness programs should be carried out periodically to teach people when and when not to use OTC drugs.

Microorganisms, crucial for environmental equilibrium, could be destructive, resulting in detrimental pathophysiology to the human host. Moreover, with the emergence of antibiotic resistance (ABR), the microbial communities pose the century’s largest public health challenges in terms of effective treatment strategies. Furthermore, given the large diversity and number of known bacterial strains, describing treatment choices for infected patients using experimental methodologies is time-consuming. An alternative technique, gaining popularity as sequencing prices fall and technology advances, is to use bacterial genotype rather than phenotype to determine ABR. Complementing machine learning into clinical practice provides a data-driven platform for categorization and interpretation of bacterial datasets. In the present study, k-mers were generated from nucleotide sequences of pathogenic bacteria resistant to antibiotics. Subsequently, they were clustered into groups of bacteria sharing similar genomic features using the Affinity propagation algorithm with a Silhouette coefficient of 0.82. Thereafter, a prediction model based on Random Forest algorithm was developed to explore the prediction capability of the k-mers. It yielded an overall specificity of 0.99 and a sensitivity of 0.98. Additionally, the genes and ABR drivers related to the k-mers were identified to explore their biological relevance. Furthermore, a multilayer perceptron model with a hamming loss of 0.05 was built to classify the bacterial strains into resistant and non-resistant strains against various antibiotics. Segregating pathogenic bacteria based on genomic similarities could be a valuable approach for assessing the severity of diseases caused by new bacterial strains. Utilization of this strategy could aid in enhancing our understanding of ABR patterns, paving the way for more informed and effective treatment options.

ObjectivesThe continuing spread of tuberculosis (TB) worldwide, especially drug-resistant TB, poses a major challenge to healthcare systems globally. Addressing this requires appraising the cost effectiveness of existing pharmacological interventions against TB to identify key drivers of cost effectiveness and value and guide pharmaceutical innovation and novel drug regimen development.MethodsStudies were identified from a search of six database: MEDLINE MEDLINE-In Process, MEDLINE Epub Ahead of Print, EMBASE, Cochrane Database of Systematic Reviews, and Econlit in July 2022. Two reviewers independently assessed all identified studies and reports using pre-defined inclusion/exclusion criteria. Study methodological quality was assessed, data were extracted in standard tables, and results were narratively synthesized.ResultsOverall, 991 studies and 53 HTA reports were identified with 20 studies and 3 HTA reports meeting the inclusion criteria. Quality assessment of the 20 studies identified 4 with minor limitations, while the remainder were assessed as having potentially or very serious limitations. Sixteen studies conducted cost-utility analyses, 6 conducted cost-effectiveness analyses, and 2 conducted cost-comparison analyses with some studies performing multiple analyses. The majority (n = 16) were model-based. Eleven studies analyzed the cost-effectiveness of bedaquiline, 6 compared shorter to longer/standard duration regimens, 2 assessed ethambutol, and 1 assessed delamanid. Key drivers of cost effectiveness were drug costs, the number of TB cases, the portion of cases with sputum culture conversion, treatment delivery costs, and treatment efficacy. Common value elements considered included adverse events, drug resistance, and improving treatment adherence.ConclusionOur results suggest that out of the pharmacological treatments assessed, bedaquiline is likely a cost-effective addition to existing treatment regimens/background treatment regimens, while ethambutol is not likely to be. Newer shorter regimens, even if more costly, seem to be more cost-effective compared to longer regimens. These results illustrate the limited number of novel cost-effective pharmacological interventions and highlight a need to develop new drugs/regimens against TB to overcome resistance, taking into account the key drivers of cost effectiveness and other value attributes identified from this review.

According to the World Health Organisation (WHO), diarrhoea is the second leading cause of death in children under the age of five. It is a common symptom associated with gastrointestinal bacterial infections. Many antibiotics have lost their efficacy due to the rapid emergence of Antimicrobial Resistant (AMR) bacterial pathogens. Traditional Ayurvedic medicinal plants are likely to play a significant role in the development of new effective and safe therapies in the fight against AMR in gastrointestinal bacteria. Recent research has reported the effectiveness of numerous different Ayurvedic medicines in the treatment of gastrointestinal infections. One example is Triphala, which is a polyherbal formulation consisting of an equal mixture of dried fruit powders from the three Ayurvedic plants Terminalia bellirica (Gaertn.) Roxb., Terminalia chebula Retz. and Emblica officinalis Linn. This review discusses the principles of Ayurveda and summarises the traditional use of Ayurvedic plants in the treatment of diarrhoea, dysentery, and stomach discomfort. [ABSTRACT FROM AUTHOR]

Conjugative transposons in Gram-negative bacteria have a significant role in the dissemination of antibiotic-resistance-conferring genes between bacteria. This study aims to genomically characterize plasmids and conjugative transposons carrying integrons in clinical isolates of Klebsiella pneumoniae. The genetic composition of conjugative transposons and phenotypic assessment of 50 multidrug-resistant K. pneumoniae isolates from a tertiary-care hospital (SQUH), Muscat, Oman, were investigated. Horizontal transferability was investigated by filter mating conjugation experiments. Whole-genome sequencing (WGS) was performed to determine the sequence type (ST), acquired resistome, and plasmidome of integron-carrying strains. Class 1 integrons were detected in 96% of isolates and, among integron-positive isolates, 18 stains contained variable regions. Horizontal transferability by conjugation confirmed the successful transfer of integrons between cells and WGS confirmed their presence in conjugative plasmids. Dihydrofolate reductase (dfrA14) was the most prevalent (34.8%) gene cassette in class 1 integrons. MLST analysis detected predominantly ST-231 and ST-395. BlaOXA-232 and blaCTX-M-15 were the most frequently detected carbapenemases and beta-lactamases in the sequenced isolates. This study highlighted the high transmissibility of MDR-conferring conjugative plasmids in clinical isolates of K. pneumoniae. Therefore, the wise use of antibiotics and the adherence to effective infection control measures are necessary to limit the further dissemination of multidrug-resistant bacteria. [ABSTRACT FROM AUTHOR]

Urinary tract infections (UTIs) are among the most common infections diagnosed in clinical practice. Treatment is often initiated before microbiological confirmation and anti-microbial susceptibility testing. With the rapidly rising antibiotic resistance treatment failures are not uncommon. Beta-lactamase production by gram-negative bacteria causing UTI is the commonest mode of drug resistance. The aim of current study was to detect and determine the hospital based prevalence of UTI, causative uropathogens and their antimicrobial susceptibility patterns. A total of 9,518 clean catch, mid stream urine samples were processed over 2 years. Semi-quantitative urine cultures and AST were performed. Diverse underlying resistance mechanisms were determined by detecting ESBLs, Carbapenemases, AmpC β-Lactamases, and Metallo-β-Lactamases through various standardized phenotypic methods. Out of the 9,518 samples tested 1171 (12.3%) were culture positive. Majority (66.7%) were from female patients. Highest prevalence (60%) was seen in patients > 40 years of age. E. coli (48%) was the predominant causative organism, followed by Enterococcus spp. (23%). Among GNB high resistance rates were observed against Beta-lactams, Beta-lactam/β-lactamase inhibitor combinations, and fluoroquinolones. 34.5% of GNB were confirmed as ESBL, 40% as carbapenemase, 36.5% as AmpC β-Lactamase, and 41.5% as MBL producers. We found very high levels of resistance against a broad range of antibiotics including the most widely used β-lactam group. With the resistance slopes getting steeper and steeper empirical treatment of UTIs might be fraught with the danger of many failures. Culturing and performing AST for all patients with UTI might be a prudent step for their rationale treatment and a step forward in halting the emergence of further resistance.

Community-acquired infections (CAIs) represent a major burden for health-care system. This directly aids the emergence of antibiotic-resistant organisms. India is not immune to it. This review assessed the current guideline recommendations for the usage of oral cephalosporins in the management of common CAIs. The researchers conducted iterative searches in PubMed, SCOPUS, and Google Scholar for published articles using various keywords. The search was conducted in November 2022 and considered articles published till date. Different CAIs are caused by similar organisms, susceptible to first-line antibiotics such as penicillin and cephalosporins. Most of the guidelines recommend the use of oral cephalosporins for the management of the commonly prevalent CAIs. These antibiotics however should be used as a monotherapy and not as fixed-dose combinations (FDCs), as FDCs with oral cephalosporins lack scientific basis and may be detrimental. For burden of CAIs intensified by anti-microbial resistance, guidelines are useful for the management of CAIs to educate the prescribers and preserve currently available antibiotics.

Urinary tract infections (UTIs) are among the most common infections diagnosed in clinical practice. Treatment is often initiated before microbiological confirmation and anti-microbial susceptibility testing. With the rapidly rising antibiotic resistance treatment failures are not uncommon. Beta-lactamase production by gram-negative bacteria causing UTI is the commonest mode of drug resistance. The aim of current study was to detect and determine the hospital based prevalence of UTI, causative uropathogens and their antimicrobial susceptibility patterns. A total of 9,518 clean catch, mid stream urine samples were processed over 2 years. Semi-quantitative urine cultures and AST were performed. Diverse underlying resistance mechanisms were determined by detecting ESBLs, Carbapenemases, AmpC b-Lactamases, and Metallo-b-Lactamases through various standardized phenotypic methods. Out of the 9,518 samples tested 1171 (12.3%) were culture positive. Majority (66.7%) were from female patients. Highest prevalence (60%) was seen in patients > 40 years of age. E. coli (48%) was the predominant causative organism, followed by Enterococcus spp. (23%). Among GNB high resistance rates were observed against Beta-lactams, Beta-lactam/b-lactamase inhibitor combinations, and fluoroquinolones. 34.5% of GNB were confirmed as ESBL, 40% as carbapenemase, 36.5% as AmpC b-Lactamase, and 41.5% as MBL producers. We found very high levels of resistance against a broad range of antibiotics including the most widely used b-lactam group. With the resistance slopes getting steeper and steeper empirical treatment of UTIs might be fraught with the danger of many failures. Culturing and performing AST for all patients with UTI might be a prudent step for their rationale treatment and a step forward in halting the emergence of further resistance. [ABSTRACT FROM AUTHOR]

Community-acquired infections (CAIs) represent a major burden for health-care system. This directly aids the emergence of antibiotic-resistant organisms. India is not immune to it. This review assessed the current guideline recommendations for the usage of oral cephalosporins in the management of common CAIs. The researchers conducted iterative searches in PubMed, SCOPUS, and Google Scholar for published articles using various keywords. The search was conducted in November 2022 and considered articles published till date. Different CAIs are caused by similar organisms, susceptible to first-line antibiotics such as penicillin and cephalosporins. Most of the guidelines recommend the use of oral cephalosporins for the management of the commonly prevalent CAIs. These antibiotics however should be used as a monotherapy and not as fixed-dose combinations (FDCs), as FDCs with oral cephalosporins lack scientific basis and may be detrimental. For burden of CAIs intensified by anti-microbial resistance, guidelines are useful for the management of CAIs to educate the prescribers and preserve currently available antibiotics. [ABSTRACT FROM AUTHOR]

Background: Antibiotic resistance is a global public health concern that requires an understanding of public knowledge, attitudes, and practices (KAP) towards antibiotics. This study aimed to assess the KAP regarding antibiotic use and AMR among the general population in Bangladesh. Methods: A cross-sectional survey was conducted among 656 respondents in Bangladesh. Data on socio-demographic characteristics, knowledge, attitudes, and practices regarding antibiotics use and AMR were collected through a structured questionnaire. Descriptive statistics and ordered logit regression analysis were performed to analyze the data. Results: The study involved participants, with 52.44 % aged 18 to 30, 77.29 % males, and 92.53 % having primary education or higher. Urban residents were 80 %, and students formed the largest occupational group (29.57 %), followed by businessmen (25 %), service holders (24.7 %), housewives (10.52 %), and day laborers (8.84 %). The majority of respondents demonstrated average knowledge (52.29 %), moderate attitudes (67.84 %), and good practices (50.61 %) regarding antibiotic use and AMR. Socioeconomic factors such as education, media exposure, and urban residence significantly (1 % level of significance) influenced KAP. The findings revealed knowledge gaps and misconceptions among the respondents, including incorrect beliefs about antibiotic resistance (42%), and inadequate awareness of the importance of completing full antibiotic courses (54.88 %). Conclusion: This study sheds light on the existing KAP related to antibiotic use and AMR within the general population of Bangladesh. The findings reveal varying levels of knowledge, attitudes, and practices among the participants. The results underscore the importance of addressing knowledge gaps, and misconceptions for awareness building through educational campaigns utilizing social media platforms and newspapers. These insights provide a foundation for informed strategies to ensure the continued efficacy of antibiotics.

Enteric protozoan pathogenic infections significantly contribute to the global burden of gastrointestinal illnesses. Their occurrence is considerable within remote and indigenous communities and regions due to reduced access to clean water and adequate sanitation. The robustness of these pathogens leads to a requirement of harsh treatment methods, such as medicinal drugs or antibiotics. However, in addition to protozoal infection itself, these treatments impact the gut microbiome and create dysbiosis. This often leads to opportunistic pathogen invasion, anti-microbial resistance, or functional gastrointestinal disorders, such as irritable bowel syndrome. Moreover, these impacts do not remain confined to the gut and are reflected across the gut–brain, gut–liver, and gut–lung axes, among others. Therefore, apart from medicinal treatment, nutritional supplementation is also a key aspect of providing recovery from this dysbiosis. Future proteins, prebiotics, probiotics, synbiotics, and food formulations offer a good solution to remedy this dysbiosis. Furthermore, nutritional supplementation also helps to build resilience against opportunistic pathogens and potential future infections and disorders that may arise due to the dysbiosis. Systems biology techniques have shown to be highly effective tools to understand the biochemistry of these processes. Systems biology techniques characterize the fundamental host–pathogen interaction biochemical pathways at various infection and recovery stages. This same mechanism also allows the impact of the abovementioned treatment methods of gut microbiome remediation to be tracked. This manuscript discusses system biology approaches, analytical techniques, and interaction and association networks, to understand (1) infection mechanisms and current global status; (2) cross-organ impacts of dysbiosis, particularly within the gut–liver and gut–lung axes; and (3) nutritional interventions. This study highlights the impact of anti-microbial resistance and multi-drug resistance from the perspective of protozoal infections. It also highlights the role of nutritional interventions to add resilience against the chronic problems caused by these phenomena. [ABSTRACT FROM AUTHOR]

Background: There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empiric therapy to be adjusted according to the result of culture sensitivity reports. Objective: Using culture sensitivity reports to optimize antibiotic prescribing in a teaching hospital in Pakistan. Methods: A retrospective observational study was undertaken in Ghurki Trust Teaching Hospital. A total of 465 positive cultures were taken from patients during the study period (May 2018 and December 2018). The results of pathogen identification and susceptibility testing from patient-infected sites were assessed. Additional data was collected from the patient's medical file. This included demographic data, sample type, causative microbe, antimicrobial treatment, and whether empiric or definitive treatment as well as medicine costs. Antimicrobial data was assessed using World Health Organization's Defined Daily Dose methodology. Results: A total of 497 isolates were detected from the 465 patient samples as 32 patients had polymicrobes, which included 309 g-negative rods and 188 g-positive cocci. Out of 497 isolates, the most common Gram-positive pathogen isolated was Staphylococcus aureus (Methicillin-sensitive Staphylococcus aureus) (125) (25.1%) and the most common Gram-negative pathogen was Escherichia coli (140) (28.1%). Most of the gram-negative isolates were found to be resistant to ampicillin and co-amoxiclav. Most of the Acinetobacter baumannii isolates were resistant to carbapenems. Gram-positive bacteria showed the maximum sensitivity to linezolid and vancomycin. The most widely used antibiotics for empiric therapy were cefoperazone plus sulbactam, ceftriaxone, amikacin, vancomycin, and metronidazole whereas high use of linezolid, clindamycin, meropenem, and piperacillin + tazobactam was seen in definitive treatment. Empiric therapy was adjusted in 220 (71.1%) cases of Gram-negative infections and 134 (71.2%) cases of Gram-positive infections. Compared with empiric therapy, there was a 13.8% reduction in the number of antibiotics in definitive treatment. The average cost of antibiotics in definitive treatment was less than seen with empiric treatment (8.2%) and the length of hospitalization also decreased. Conclusions: Culture sensitivity reports helped reduced antibiotic utilization and costs as well as helped select the most appropriate treatment. We also found an urgent need for implementing antimicrobial stewardship programs in hospitals and the development of hospital antibiotic guidelines to reduce unnecessary prescribing of broad-spectrum antibiotics. [ABSTRACT FROM AUTHOR]

Abdul Haseeb,1 Zikria Saleem,2 Ummara Altaf,3 Narjis Batool,4 Brian Godman,5– 7 Umar Ahsan,8 Mehreen Ashiq,9 Mutiba Razzaq,9 Rabia Hanif,9 Zill E-Huma,9 Afreenish Amir,10 Mohammad Akbar Hossain,11 Mohamed Raafat,12 Rozan Mohammad Radwan,13 Muhammad Shahid Iqbal,14 Sairah Hafeez Kamran15 1Department of Clinical Pharmacy, College of Pharmacy, Umm AL-Qura University, Makkah, Saudi Arabia; 2Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan; 3Department of Pharmacy, Ghurki Trust Teaching Hospital, Lahore, Pakistan; 4Australian Institute of Health Innovation, Center of Health Systems and Safety Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia; 5Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK; 6School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa; 7Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates; 8Department of Infection Prevention and Control, Al Noor Specialist Hospital, Ministry of health, Makkah, Kingdom of Saudi Arabia; 9Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan; 10Department of Microbiology, National University of Medical Sciences, Rawalpindi, Pakistan; 11Department of Pharmacology and Toxicology, Faculty of Medicine in Al-Qunfudah, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia; 12Department of Pharmacology and Toxicology, College of Pharmacy, Umm AL-Qura University, Makkah, Saudi Arabia; 13Pharmaceutical Care Department, Al Noor Specialist Hospital, Ministry of Health, Makkah, Saudi Arabia; 14Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia; 15Institute of Pharmacy, Lahore College for Women University, Lahore, PakistanCorrespondence: Zikria Saleem, Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan, Email xikria@gmail.comBackground: Antibiotic de-escalation is a key element of antimicrobial stewardship programs that restrict the spread and emergence of resistance. This study was performed to evaluate the impact of positive culture sensitivity reports of E. coli or Methicillin sensitive Staphylococcus aureus (MSSA) on de-escalation of antibiotic therapy.Methods: This prospective observational study was performed on 256 infected patients. The samples were obtained principally from the pus of infected sites for the identification of pathogens and culture-sensitivity testing. The data were collected from patient medical files, which included their demographic data, sample type, causative microbe and antimicrobial treatment as empiric or definitive treatment based on cultures. Data were analyzed using SPSS.Results: Of 256 isolated microbes, 138 (53.9%) were MSSA and 118 were E. coli (46.1%). MSSA showed 100% sensitivity to cefoxitin, oxacillin, vancomycin, fosfomycin, colistin and more than 90% to linezolid (95.3%), tigecycline (93.1%), chloramphenicol (92.2%) and amikacin (90.2%). E. coli showed 100% sensitivity to only fosfomycin and more than 90% to colistin (96.7%), polymyxin-B (95.1%) and tigecycline (92.9%). The high use of cefoperazone+sulbactam (151), amikacin (149), ceftriaxone (33), metronidazole (30) and piperacillin + tazobactam (22) was seen with empiric prescribing. Following susceptibility testing, the most common antibiotics prescribed for E. coli were meropenem IV (34), amikacin (34), ciprofloxacin (29) and cefoperazone+sulbactam (25). For MSSA cases, linezolid (48), clindamycin (30), cefoperazone+ sulbactam IV (16) and amikacin (15) was used commonly. Overall, there was 23% reduction in antibiotic use in case of E. coli and 43% reduction in MSSA cases.Conclusion: Culture sensitivity reports helped in the de-escalation of antimicrobial therapy, reducing the prescribing of especially broad-spectrum antibiotics. Consequently, it is recommended that local hospital guidelines be developed based on local antimicrobial susceptibility patterns while preventing the unnecessary use of broad-spectrum antibiotics for empiric treatment.Keywords: antimicrobial resistance, antimicrobial stewardship, culture sensitivity reports, definitive treatment, empirical treatment, de-escalation, Pakistan

This study aimed to investigate preputial aerobic bacterial flora from Camels in the arid zone of Northern Nigeria. Preputial swabs were randomly collected from twenty (20) clinically healthy adult Camels (Camelus dromedarius). Using standard bacteriological techniques, the following bacteria were identified; Escherichia coli (22.9%), Streptococcus species (22.9%), Staphylococcus aureus (21.4%), Klebsiella Species (17.1%) and Shigella (15.7%). These isolated bacteria were found to be susceptible to Amoxicillin, Ampiclox, Ciprofloxacin, Gentamycin and Levofloxacin. However, Klebsiella and Shigella species showed intermediate susceptibility to streptomycin and Shigella further showed resistance to chloramphenicol. The results of this study showed that some bacteria colonized the prepuce of camel and there is a need for preputial washing before breeding to reduce the transmission of venereal disease. Amoxicillin, Ampiclox, Ciprofloxacin, Gentamycin and Levofloxacin could be used as therapeutic agents for venereal diseases that could be caused by the aforementioned bacteria in Camelids. [ABSTRACT FROM AUTHOR]

Purpose: To study the role of prolonged prophylactic antibiotic therapy (PAT) in the prevention of Inter-costal drain (ICD) related infectious complications in patients with Blunt Trauma Chest (BTC). Methods: Patients of age 15 years and above with BTC requiring ICD were included. Patients with penetrating chest injuries, associated injuries/illnesses requiring antibiotic administration, need for mechanical ventilation, known pulmonary disease or immuno-compromised status and need for open thoracotomy were excluded. 120 patients were randomized equally to two groups; no prolonged PAT group (Group A) and prolonged PAT group (group B). Both group patients received one shot of injectable antibiotic prior to ICD insertion. Primary outcome measure was comparison of ICD related infectious complications (pneumonia, empyema and SSI) and secondary outcome measures included the duration of ICD, Length of Hospital stay (LOS) and in-hospital mortality in both the groups. Results: Infectious complications (pneumonia, empyema and SSI) were seen in only one patient in antibiotic group, and none in no antibiotic group (p value = 0.500). Other complications such as post ICD pain scores, respiratory failure requiring ventilatory support, retained hemothorax or recurrent pneumothorax, did not show any statistical difference between both groups. Also, no significant difference was seen in both the groups in terms of mean duration of ICD (p value = 0.600) and LOS (p value = 0.259).m Conclusion: Overall prevalence of ICD related infectious complications are low in BTC patients. Definitive role of prolonged prophylactic antibiotics in reducing infectious complications and other associated co morbidities in BTC patients with ICDs could not be established. Trial registry details: Clinical Trial Registry, India (Trial registered at ctri.nic.in/clinical trials/login.php, number REF/2019/021704 dated 18/10/2019). [ABSTRACT FROM AUTHOR]

Abstract Background Indiscriminate and widespread use of antibiotics has resulted in emergence of many antibiotic-resistant organisms. Antibiotic administration during pregnancy is mostly avoided, unless there is compelling medical condition. We hypothesized that the uropathogens isolated from pregnant women would be more susceptible to antibiotics compared to those isolated from nonpregnant women, thus will be helpful in formulating separate empiric guideline for pregnant women based on the resistance pattern. Methods This was a prospective cross-sectional study conducted over a period of 2 years in which females with the clinical diagnosis of either cystitis or asymptomatic bacteriuria during pregnancy were included from the community settings. Uropathogen species and their antimicrobial resistance pattern were compared between the pregnant and nonpregnant groups. After accounting for centre-to-centre variation and adjusting for age and socio-economic status, the adjusted odds ratio for antibiotic resistance was calculated and compared between pregnant and nonpregnant women using logistic regression analysis. Results A total of 1758 women (pregnant: 43.3%; nonpregnant: 56.6%) were screened in the study over a period of 2 years, out of which 9.3% (163/1758) were having significant bacteriuria. Escherichia coli and Klebsiella pneumoniae were the two commonest uropathogen in both the groups; their prevalence being 83.6% in pregnant women and 85.2% in nonpregnant women, respectively. Resistance against ampicillin, cefixime, cefoxitin, ceftazidime, ceftriaxone and amoxicillin-clavulanic acid were found significantly lower in the pregnant women compared to nonpregnant. After adjusting the age and socio-economic status accounting for centre-to-centre variation, the odds of resistance for cefixime, amoxicillin-clavulanic acid and co-trimoxazole were found lower and statistically significant among the pregnant women group. Conclusions The antimicrobial resistance was significantly higher among the community-dwelling nonpregnant women compared to pregnant women in case of few antibiotics. The study highlighted the need of building local antibiogram that could help to initiate the empirical treatment and thus prevent emergence of antimicrobial resistance.

Technologically enhanced surveillance systems have been proposed for the task of monitoring and responding to antimicrobial resistance (AMR) in both human, animal and environmental contexts. The use of these systems is in their infancy, although the advent of COVID-19 has progressed similar technologies in response to that pandemic. We conducted qualitative research to identify the Australian public's key concerns about the ethical, legal and social implications of an artificial intelligence (AI) and machine learning-enhanced One Health AMR surveillance system. Our study provides preliminary evidence of public support for AI/machine learning-enhanced One Health monitoring systems for AMR, provided that three main conditions are met: personal health care data must be deidentified; data use and access must be tightly regulated under strong governance; and the system must generate high-quality, reliable analyses to guide trusted health care decisionmakers. [ABSTRACT FROM AUTHOR]

Background: Indiscriminate and widespread use of antibiotics has resulted in emergence of many antibiotic-resistant organisms. Antibiotic administration during pregnancy is mostly avoided, unless there is compelling medical condition. We hypothesized that the uropathogens isolated from pregnant women would be more susceptible to antibiotics compared to those isolated from nonpregnant women, thus will be helpful in formulating separate empiric guideline for pregnant women based on the resistance pattern. Methods: This was a prospective cross-sectional study conducted over a period of 2 years in which females with the clinical diagnosis of either cystitis or asymptomatic bacteriuria during pregnancy were included from the community settings. Uropathogen species and their antimicrobial resistance pattern were compared between the pregnant and nonpregnant groups. After accounting for centre-to-centre variation and adjusting for age and socio-economic status, the adjusted odds ratio for antibiotic resistance was calculated and compared between pregnant and nonpregnant women using logistic regression analysis. Results: A total of 1758 women (pregnant: 43.3%; nonpregnant: 56.6%) were screened in the study over a period of 2 years, out of which 9.3% (163/1758) were having significant bacteriuria. Escherichia coli and Klebsiella pneumoniae were the two commonest uropathogen in both the groups; their prevalence being 83.6% in pregnant women and 85.2% in nonpregnant women, respectively. Resistance against ampicillin, cefixime, cefoxitin, ceftazidime, ceftriaxone and amoxicillin-clavulanic acid were found significantly lower in the pregnant women compared to nonpregnant. After adjusting the age and socio-economic status accounting for centre-to-centre variation, the odds of resistance for cefixime, amoxicillin-clavulanic acid and co-trimoxazole were found lower and statistically significant among the pregnant women group. Conclusions: The antimicrobial resistance was significantly higher among the community-dwelling nonpregnant women compared to pregnant women in case of few antibiotics. The study highlighted the need of building local antibiogram that could help to initiate the empirical treatment and thus prevent emergence of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Nanotechnology has recently received much interest in various fields, including medicine. South Africa (SA) was the first country in Africa to adopt the technology with the aim of enhancing the national bio-economy and global competitiveness by using innovative nanotechnology-based solutions. Since its inception in 2005 in SA, researchers have seized opportunities to increase and develop niche areas for its application in the health, energy, food, agriculture, and water sectors. We ventured into this field and have performed pioneering work on nanotechnology-based treatment strategies over the years. This perspective highlights the journey, with associated successes over the years, in order to display the impact of our nanotechnology research in health. The focus is on the nanotechnology outputs that have emanated from the Department of Science and Innovation (DSI)/Mintek Nanotechnology Innovation Centre (NIC) Biolabels Research Node (BRN) at the University of the Western Cape (UWC). BRN's research interests were on nano-enabled materials for developing therapeutic agents, photothermal sensitizers, and targeted drug-delivery systems for treatment of chronic diseases and antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Ventilator associated pneumonia (VAP) caused by P. aeruginosa is a cause of morbidity and mortality in critically ill patients. The spread of pathogens with anti-microbial resistance mandates the investigation of novel therapies. Specific polyclonal anti- P. aeruginosa IgY-antibodies (Pa- IgY) might be effective for VAP caused by P. aeruginosa. The objective of this study was to investigate if intravenous Pa- IgY decreases the lower airway concentration of P. aeruginosa in VAP. We used a double blind randomized placebo controlled porcine model of VAP caused by P. aeruginosa. Eighteen pigs were randomized to either receive intravenous Pa- IgY or placebo. Repeated registration of physiological parameters and sampling was performed for 27 h. Concentration of P. aeruginosa in BAL-cultures was similar in both groups with 104.97 ± 102.09 CFU/mL in the intervention group vs 104.37 ± 102.62 CFU/mL in the control group at the end of the experiment. The intervention group had higher heart rate, cardiac index, oxygen delivery and arterial oxygen tension/fraction of inspired oxygen-ratio, but lower plasma lactate and blood hemoglobin levels than the control group. In summary, in an anesthetized and mechanically ventilated porcine model of VAP, Pa- IgY at the dose used did not decrease concentrations of P. aeruginosa in the lower airways. [ABSTRACT FROM AUTHOR]

Anti-Microbial Resistance is one of the greatest threats that mankind faces right now due to the inappropriate use of antibiotics. Institution of appropriate antibiotics in right dose for the right patient at right time is the “gamechanger” in fighting AMR. Antibiotic Sensitivity Testing (AST) or antibiogram is done to ascertain the sensitivity profile of the organism. The most widely used method in laboratory practice in India is the Kirby-Bauer’s disk diffusion test. There are few shortcomings in the manual interpretation of antibiograms in the form of high interoperator variability, mandatory requirement of trained microbiologists – which is difficult in low-resource settings and high degree of interpersonal bias due to various factors like stress, workload, and visual acuity. We propose the Ab.ai tool for automating the AST procedures in laboratory. The Ab.ai tool comprises of 3 phases: first for data collection, second for data processing and the third for generation of antibiotic sensitivity reports. Various software packages like OpenCV and EasyOCR are used for the development of the Ab.ai tool. A total of 50 antibiograms of both GPC and GNB are interpreted both by manual and automated method. The manual method is considered the “gold-standard” and the performance of Ab.ai tool was compared against the manual method. The Ab.ai tool achieved an agreement of 98.4% on susceptibility categorization of GPC antibiotics and 97.6% on that of GNB antibiotics against the gold standard manual method. The proposed Ab.ai tool serves as a perfect candidate for automating AST procedures and would prove to be a “game-changer” in battling AMR. [ABSTRACT FROM AUTHOR]

Anthropogenic activities and climate change profoundly impact water quality, leading to a concerning increase in the prevalence and abundance of bacterial pathogens across diverse aquatic environments. This rise has resulted in a growing challenge concerning the safety of water sources, particularly surface waters and marine environments. This comprehensive review delves into the multifaceted challenges presented by bacterial pathogens, emphasizing threads to human health within ground and surface waters, including marine ecosystems. The exploration encompasses the intricate survival mechanisms employed by bacterial pathogens and the proliferation of antimicrobial resistance, largely driven by human-generated antibiotic contamination in aquatic systems. The review further addresses prevalent pathogenic bacteria, elucidating associated risk factors, exploring their eco-physiology, and discussing the production of potent toxins. The spectrum of detection techniques, ranging from conventional to cutting-edge molecular approaches, is thoroughly examined to underscore their significance in identifying and understanding waterborne bacterial pathogens. A critical aspect highlighted in this review is the imperative for real-time monitoring of biomarkers associated with waterborne bacterial pathogens. This monitoring serves as an early warning system, facilitating the swift implementation of action plans to preserve and protect global water resources. In conclusion, this comprehensive review provides fresh insights and perspectives, emphasizing the paramount importance of preserving the quality of aquatic resources to safeguard human health on a global scale. [Display omitted] • Pathogenic bacteria found in diverse aquatic systems were comprehensively reviewed. • Niche-specific sources, occurrence & survival tactics of pathogens were discussed. • Role of virulence factors of water-borne pathogens and their assessment was addressed. • Anthropogenic activity and antibiotic release drives water deterioration & AMR. • Future perspectives & challenges shaping the public health policies were discussed. [ABSTRACT FROM AUTHOR]

Conjugative transposons in Gram-negative bacteria have a significant role in the dissemination of antibiotic-resistance-conferring genes between bacteria. This study aims to genomically characterize plasmids and conjugative transposons carrying integrons in clinical isolates of Klebsiella pneumoniae. The genetic composition of conjugative transposons and phenotypic assessment of 50 multidrug-resistant K. pneumoniae isolates from a tertiary-care hospital (SQUH), Muscat, Oman, were investigated. Horizontal transferability was investigated by filter mating conjugation experiments. Whole-genome sequencing (WGS) was performed to determine the sequence type (ST), acquired resistome, and plasmidome of integron-carrying strains. Class 1 integrons were detected in 96% of isolates and, among integron-positive isolates, 18 stains contained variable regions. Horizontal transferability by conjugation confirmed the successful transfer of integrons between cells and WGS confirmed their presence in conjugative plasmids. Dihydrofolate reductase (dfrA14) was the most prevalent (34.8%) gene cassette in class 1 integrons. MLST analysis detected predominantly ST-231 and ST-395. BlaOXA-232 and blaCTX-M-15 were the most frequently detected carbapenemases and beta-lactamases in the sequenced isolates. This study highlighted the high transmissibility of MDR-conferring conjugative plasmids in clinical isolates of K. pneumoniae. Therefore, the wise use of antibiotics and the adherence to effective infection control measures are necessary to limit the further dissemination of multidrug-resistant bacteria.

Background: There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empiric therapy to be adjusted according to the result of culture sensitivity reports. Objective: Using culture sensitivity reports to optimize antibiotic prescribing in a teaching hospital in Pakistan. Methods: A retrospective observational study was undertaken in Ghurki Trust Teaching Hospital. A total of 465 positive cultures were taken from patients during the study period (May 2018 and December 2018). The results of pathogen identification and susceptibility testing from patient-infected sites were assessed. Additional data was collected from the patient’s medical file. This included demographic data, sample type, causative microbe, antimicrobial treatment, and whether empiric or definitive treatment as well as medicine costs. Antimicrobial data was assessed using World Health Organization’s Defined Daily Dose methodology. Results: A total of 497 isolates were detected from the 465 patient samples as 32 patients had polymicrobes, which included 309 g-negative rods and 188 g-positive cocci. Out of 497 isolates, the most common Gram-positive pathogen isolated was Staphylococcus aureus (Methicillin-sensitive Staphylococcus aureus) (125) (25.1%) and the most common Gram-negative pathogen was Escherichia coli (140) (28.1%). Most of the gram-negative isolates were found to be resistant to ampicillin and co-amoxiclav. Most of the Acinetobacter baumannii isolates were resistant to carbapenems. Gram-positive bacteria showed the maximum sensitivity to linezolid and vancomycin. The most widely used antibiotics for empiric therapy were cefoperazone plus sulbactam, ceftriaxone, amikacin, vancomycin, and metronidazole whereas high use of linezolid, clindamycin, meropenem, and piperacillin + tazobactam was seen in definitive treatment. Empiric therapy was adjusted in 220 (71.1%) cases of Gram-negative infections and 134 (71.2%) cases of Gram-positive infections. Compared with empiric therapy, there was a 13.8% reduction in the number of antibiotics in definitive treatment. The average cost of antibiotics in definitive treatment was less than seen with empiric treatment (8.2%) and the length of hospitalization also decreased. Conclusions: Culture sensitivity reports helped reduced antibiotic utilization and costs as well as helped select the most appropriate treatment. We also found an urgent need for implementing antimicrobial stewardship programs in hospitals and the development of hospital antibiotic guidelines to reduce unnecessary prescribing of broad-spectrum antibiotics.

Enteric protozoan pathogenic infections significantly contribute to the global burden of gastrointestinal illnesses. Their occurrence is considerable within remote and indigenous communities and regions due to reduced access to clean water and adequate sanitation. The robustness of these pathogens leads to a requirement of harsh treatment methods, such as medicinal drugs or antibiotics. However, in addition to protozoal infection itself, these treatments impact the gut microbiome and create dysbiosis. This often leads to opportunistic pathogen invasion, anti-microbial resistance, or functional gastrointestinal disorders, such as irritable bowel syndrome. Moreover, these impacts do not remain confined to the gut and are reflected across the gut–brain, gut–liver, and gut–lung axes, among others. Therefore, apart from medicinal treatment, nutritional supplementation is also a key aspect of providing recovery from this dysbiosis. Future proteins, prebiotics, probiotics, synbiotics, and food formulations offer a good solution to remedy this dysbiosis. Furthermore, nutritional supplementation also helps to build resilience against opportunistic pathogens and potential future infections and disorders that may arise due to the dysbiosis. Systems biology techniques have shown to be highly effective tools to understand the biochemistry of these processes. Systems biology techniques characterize the fundamental host–pathogen interaction biochemical pathways at various infection and recovery stages. This same mechanism also allows the impact of the abovementioned treatment methods of gut microbiome remediation to be tracked. This manuscript discusses system biology approaches, analytical techniques, and interaction and association networks, to understand (1) infection mechanisms and current global status; (2) cross-organ impacts of dysbiosis, particularly within the gut–liver and gut–lung axes; and (3) nutritional interventions. This study highlights the impact of anti-microbial resistance and multi-drug resistance from the perspective of protozoal infections. It also highlights the role of nutritional interventions to add resilience against the chronic problems caused by these phenomena.

ABSTRACT Infections by Acinetobacter species are recognized as a serious global threat due to causing severe disease and their high levels of antibiotic resistance. Acinetobacter baumannii is the most prevalent pathogen in the genus, but infection by Acinetobacter nosocomialis has been reported widely. Diagnosis of patients with A. baumannii infection is often misdiagnosed with other Acinetobacter species, especially A. nosocomialis. This study investigated whether there were significant differences in clinical outcomes between patients infected with A. baumannii versus A. nosocomialis in Northeast Thailand, and to characterize serological responses to infection with these pathogens. The results show that A. baumannii had higher levels of multidrug resistance. Despite this, clinical outcomes for infection with A. baumannii or A. nosocomialis were similar with mortalities of 33% and 36%, respectively. Both pathogens caused community-acquired infections (A. baumannii 35% and A. nosocomialis 29% of cases). Plasma from uninfected healthy controls contained IgG antibody that recognized both organisms, and infected patients did not show a significantly enhanced antibody response from the first week versus 2 weeks later. Finally, the patterns of antigen recognition for plasma IgG were similar for patients infected with A. baumannii or A. nosocomialis infection, and distinct to the pattern for patients infected with non-Acinetobacter. In conclusion, our data revealed that infection with A. nosocomialis was associated with a similarly high level of mortality as infection with A. baumannii, the high rate of community-acquired infection and antibodies in uninfected individuals suggesting that there is significant community exposure to both pathogens. IMPORTANCE Bacterial infections by Acinetobacter species are global threats due to their severity and high levels of antibiotic resistance. A. baumannii is the most common pathogen in the genus; however, infection by A. nosocomialis has also been widely reported but is thought to be less severe. In this study, we have prospectively investigated 48 reported cases of A. baumannii infection in Northeast Thailand, and characterized the serological responses to infection. We found that 14 (29%) of these infections were actually caused by A. nosocomialis. Furthermore, the incidence of antibiotic resistance among A. nosocomialis strains, APACHE II scores, and mortality for patients infected with A. nosocomialis were much higher than published data. Both A. baumannii and A. nosocomialis had unexpectedly mortality rates of over 30%, and both pathogens caused a high rate of community-acquired infections. Importantly, background antibodies in uninfected individuals suggest significant community exposure to both pathogens in the environment.

Poultry and poultry‐derived products such as meat and eggs are among the main sources of non‐typhoidal Salmonella (NTS) transmission to humans. Therefore, we performed a systematic review and used random‐effects meta‐analyses to (1) estimate the prevalence of NTS in poultry samples from birds, products and subproducts and environmental samples, (2) examine the diversity and frequency of their serovars and (3) estimate the prevalence and profiles of anti‐microbial resistance (AMR) in NTS isolates reported in studies from the Americas. We included 157 studies from 15 countries comprising 261,408 poultry samples and estimated an overall pooled prevalence of 17.9% (95% Confidence Interval: 10.8–26.3) in birds, 21.8% (17.7–26.1) in products and subproducts and 29.5% (24.2–35.1) in environmental samples. At the national level, the prevalence of NTS was heterogeneous across countries with the highest values in Mexico, the United States and Canada. In total, 131 serovars were identified from 13,388 isolates; Heidelberg, Kentucky, Enteritidis and Typhimurium were the most prevalent in the overall top 10 ranking (range 6.5%–20.8%). At the national level, Enteritidis and Typhimurium were identified in most of the countries, though with national differences in their ranks. The prevalence of AMR increased from 24.1% for 1 antibiotic to 36.2% for 2–3 antibiotics and 49.6% for ≥ 4 antibiotics. Kentucky, Heidelberg, Typhimurium and Enteritidis were the serovars with the highest prevalence of AMR. Besides, tetracycline, ampicillin, streptomycin, ceftiofur and amoxicillin‐clavulanic acid were the most frequent antibiotics to which NTS showed resistance. In conclusion, NTS was distributed through the avian production chain with high and heterogeneous values of prevalence in poultry samples. Besides, there were distinctive patterns of serovars distribution across countries and an alarming prevalence of AMR among zoonotic serovars. [ABSTRACT FROM AUTHOR]

Background: Helicobacter pylori infection is responsible for considerable morbidity and mortality worldwide, and eradication rates are falling in many countries, primarily due to clarithromycin and metronidazole resistance. Aims: There is a paucity of contemporary Australian data, which we sought to address by evaluating local rates of resistance of H. pylori to amoxicillin, clarithromycin, metronidazole and tetracycline over the past 20 years. Methods: All gastric biopsy specimens collected at endoscopy to detect H. pylori infection at a single centre underwent routine culture and antibiotic susceptibility testing between 1998 and 2017. Specimens from 12 842 patients were cultured for H. pylori, of which 1473 positive cultures were tested for antibiotic susceptibility. Results: Antibiotic resistance to clarithromycin increased by 3.7% per year (incidence rate ratio [IRR] 1.037; P = 0.014) over 20 years, with a corresponding 5.0% annual increase in minimum inhibitory concentration (MIC) (odds ratio 1.050; P < 0.001). Since 2010, average clarithromycin resistance has exceeded 20%, with >25% of isolates resistant in the past 2 years of data capture. In contrast, rates of resistance to metronidazole (35.3%), amoxicillin (0.14%) and tetracycline (0.34%) and their MIC have remained stable. Review of a representative sample (n = 120; 8%) of these patients revealed that only 5% had documented prior H. pylori eradication therapy. Conclusions: Over the past 20 years there has been a substantial rise in clarithromycin resistance, with stable metronidazole resistance and low rates of resistance to amoxicillin and tetracycline. Current first‐line H. pylori eradication therapy may fail to achieve adequate eradication rates, and optimal first‐line therapy in Australia should be revisited. [ABSTRACT FROM AUTHOR]

Aim: The incidence of biofilm linked catheter‐associated urinary tract infections is increasing worldwide and Pseudomonas aeruginosa is one of the major causes. Perillaldehyde (PLD): as a natural, widely used flavouring agent, has been reported to possess various pharmacological properties. We hypothesized that PLD can inhibit biofilm formation and virulence factor (VF) production by P. aeruginosa by hampering the quorum sensing (QS) system(s). Methods and Results: Minimum inhibitory concentration (MIC) of PLD was assessed for standard strain and two multi‐drug resistant catheter isolates of P. aeruginosa utilizing the microdilution method. Microtiter plate assay, crystal violet staining and scanning electron microscopy were used to evaluate the biofilm inhibition property. CFU was utilized to assess the antifouling property of PLD. Detection of VFs and expression analysis of virulence determinants were applied to investigate the anti‐virulence activity. Gene expression and molecular docking studies were also executed to explore the QS inhibition and binding of PLD with QS receptors. In the present study, PLD has significantly inhibited biofilm formation and antivirulence activity at sub‐MIC levels (2.5 and 3.5 mM) in all the tested strains. In addition, molecular docking studies revealed a significant affinity towards QS receptors. Discussions: Perillaldehyde, being a non‐toxic food flavouring agent, significantly inhibited biofilm formation and exhibited antifouling property. PLD exhibited significantly reduced levels of VFs (p < 0.001) and their respective genetic determinants (p < 0.001). Gene expression analysis and molecular docking studies confirmed the interactions of PLD to the QS receptors, indicating the plausible mechanism for the anti‐virulence property. Significance and Impact of Study: This study identified the anti‐virulence potential of PLD and provided mechanistic insights. PLD can be a suitable, non‐toxic candidate for countering biofilms and associated pathogens, contributing to the prevention of biofilm‐associated nosocomial infections. [ABSTRACT FROM AUTHOR]

FtsZ forms a ring-like assembly at the site of division in bacteria. It is the first protein involved in the formation of the divisome complex to split the cell into two halves, indicating its importance in bacterial cell division. FtsZ is an attractive target for developing new anti-microbial drugs to overcome the challenges of antibiotic resistance. The most potent inhibitor against FtsZ is PC190723, which is effective against all strains and species of Staphylococcus, including the methicillin- and multi-drug-resistant Staphylococcus aureus and strains of Bacillus. However, FtsZs from bacteria such as E. coli, Streptococcus, and Enterococcus were shown to be resistant to this inhibitor. In this study, we provide further evidence that the three pairwise bridging interactions, between residues S227 and G191, R307 and E198 and D299 and R202, between S7, S9, S10 β-strands and the H7 helix occlude the inhibitor from binding to E. coli FtsZ. We generated single, double and triple mutations to disrupt those bridges and tested the effectiveness of PC190723 directly on Z-ring assembly in vivo. Our results show that the disruption of S227-G191 and R307-E198 bridges render EcFtsZ highly sensitive to PC190723 for Z-ring assembly. Ectopic expression of the double mutants, FtsZ S227I R307V results in hypersensitivity of the susceptible E. coli imp4213 strain to PC190723. Our studies could further predict the effectiveness of PC190723 or its derivatives towards FtsZs of other bacterial genera., (© 2024 The Author(s). Cytoskeleton published by Wiley Periodicals LLC.)

Water and sanitation services are critical for public health. The importance of these services is reflected in SDG 6 and the associated targets 6.1, 6.2 and 6.3. Much progress remains to be made to achieve these targets, but it is already becoming clear that greater ambition is needed. This paper looks at three global challenges: the need to increase the level of service to protect public health including infectious respiratory diseases; the role of sanitation in combatting anti-microbial resistance (AMR); and the urgent need to build more climate-resilient services. We need to upgrade the SDG targets to focus on universal access to piped water on premises, to incorporate action on AMR in definitions of safe sanitation and to embed actions to improve resilience, which take into account the greater ambition called for in the SDG 6 targets. This requires a shift in thinking in the sector, away from relying on households and communities to manage their services to properly funded, professional services staffed by trained technical, managerial and finance staff. This will require more public finance and better use of financial instruments that have proved effective in other sectors. Increasing our ambition will mean the world can achieve the aim of universal access to safe, sustainable, and resilient services and protect public health. HIGHLIGHTS Protecting public health requires higher levels of water and sanitation service.; Tackling anti-microbial resistance should become a key element of safe sanitation.; Climate change poses challenges for water and sanitation, investing in resilience is critical.; Greater professionalisation is needed to provide safe, sustainable and resilient services.; More and better use of public finance is needed for services.;

Md A Nahid,1 Jaclyn M Griffin,2 Michael B Lustik,3 Jordan J Hayes,3 Keith SK Fong,3 Timothy S Horseman,3 Massimo Menguito,4 Erik C Snesrud5 ,† Jason C Barnhill,4,6 Michael A Washington4 1Department of Dental and Craniomaxillofacial Trauma Research, United States Army Institute of Surgical Research, JBSA Fort Sam, Houston, TX 78234, USA; 2Department of Vascular Surgery, Tripler Army Medical Center, Honolulu, HI, 96859, USA; 3Department of Clinical Investigation, Tripler Army Medical Center, Honolulu, HI 96859, USA; 4Department of Chemistry and Life Science, United States Military Academy, West Point, NY 10996, USA; 5Multidrug-Resistant Organism Repository and Surveillance Network (MRSN), Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA; 6Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA†Dr Erik C Snesrud passed away on February 10, 2020Correspondence: Md A NahidUnited States Army Institute of Surgical Research, JBSA Fort Sam, Houston, TX 78234, USATel +1 210-539-6419Fax +1 210-539-3877Email md.a.nahid.mil@mail.milPurpose: The biology of chronic wounds is complex and many factors act concurrently to impede healing progress. In this study, the dynamics of microflora changes and their antibiotic susceptibility patterns were evaluated longitudinally over 30 days using data from 28 patients with a total of 47 chronic lower extremity wounds.Materials and Methods: In this study, colonized wound isolates were characterized using cultural, biochemical, and VITEK 2 methods. Antibiotic susceptibility patterns of the wound isolates were analyzed using various phenotypic assays. Furthermore, antimicrobial resistance patterns and the presence of mutations were evaluated by a genotypic assay, whole-genome sequencing (WGS).Results: Staphylococcus aureus and Pseudomonas aeruginosa were found to be the most common strains at early time points, while members of Enterobacteriaceae were prevalent at later stages of infection. Antimicrobial resistance testing and whole-genome sequencing revealed that the molecular and phenotypic characteristics of the identified wound pathogens remained relatively stable throughout the study period. It was also noted that Enterobacter and Klebsiella species may serve as reservoirs for quinolone resistance in the Pacific region.Conclusion: Our observations showed that wounds were colonized with diverse bacteria and interestingly their numbers and/or types were changed over the course of infection. The rapid genetic changes that accompanied the first 4 weeks after presentation did not directly contribute to the development of antibiotic resistance. In addition, standard wound care procedures did not appear to select for resistant bacterial strains. Future efforts should focus on defining those genetic changes associated with the wound colonizing microorganisms that occur beyond 4 weeks.Keywords: anti-microbial resistance, antimicrobial susceptibility profiling, non-healing wound, wound microflora, wound healing

Abstract Background The development of antimicrobial resistance is of global concern, and is commonly monitored by the analysis of certain bacteria. The aim of the present study was to study the antibiotic susceptibility in isolates of Staphylococcus spp. and Escherichia (E.) coli obtained from healthy pigs originating from nineteen herds enrolled in a study on herd health management in Lira district, northern Uganda. Skin and nasal swabs were analyzed for the presence of Staphylococcus spp., and selectively cultivated to investigate the presence of methicillin-resistant Staphylococcus (S.) aureus (MRSA), and rectal swabs were analyzed for the presence of E. coli. Antibiotic susceptibility was tested by broth micro-dilution. Information on the antibiotic usage and treatment regimens during the previous year was gathered using structured interviews and longitudinal data. Results In Staphylococcus spp., resistance to penicillin (10/19 isolates; 53%), fusidic acid (42%) and tetracycline (37%) were most commonly found. In E. coli, resistance to sulfamethoxazole (46/52 isolates; 88%), tetracycline (54%) and trimethoprim (17%) was most frequent. Methicillin-resistant S. aureus was found in one sample (1/50; 2%). Multi-drug resistant isolates of Staphylococcus spp. and E. coli were found in 54 and 47% of the herds, respectively. At the herd level, no associations could be made between antibiotic resistance and herd size or treatment regimens for either of the bacteria. Conclusion In conclusion, resistance to important antibiotics frequently used in animals in Uganda was common, and the presence of MRSA was demonstrated, in Ugandan pig herds.

Antibiotic resistance (AR) is one of the major health threats of our time. The presence of antibiotics in the environment and their continuous release from sewage treatment plants, chemical manufacturing plants and animal husbandry, agriculture and aquaculture, result in constant selection pressure on microbial organisms. This presence leads to the emergence, mobilization, horizontal gene transfer and a selection of antibiotic resistance genes, resistant bacteria and mobile genetic elements. Under these circumstances, aquatic wildlife is impacted in all compartments, including freshwater organisms with partially impermeable microbiota. In this narrative review, recent advancements in terms of occurrence of antibiotics and antibiotic resistance genes in sewage treatment plant effluents source compared to freshwater have been examined, occurrence of antibiotic resistance in wildlife, as well as experiments on antibiotic exposure. Based on this current state of knowledge, we propose the hypothesis that freshwater aquatic wildlife may play a crucial role in the dissemination of antibiotic resistance within the environment. Specifically, we suggest that organisms with high bacterial density tissues, which are partially isolated from the external environment, such as fishes and amphibians, could potentially be reservoirs and amplifiers of antibiotic resistance in the environment, potentially favoring the increase of the abundance of antibiotic resistance genes and resistant bacteria. Potential avenues for further research (trophic transfer, innovative exposure experiment) and action (biodiversity eco-engineering) are finally proposed. [Display omitted] • Constant low concentrations of antibiotics and ARGs are measured in freshwater. • Antibiotics and ARGs concentration higher in effluent wastewater than freshwater. • Aquatic wildlife is reservoir/vector for dissemination of antibiotic resistance. • Aquatic wildlife microbiota are potential amplifiers of antibiotic resistance. • Trophic transfer experiment and biodiversity as research perspectives are proposed. [ABSTRACT FROM AUTHOR]

About 95-99% of microorganisms exist in nature as biofilms. The homogenous or heterogeneous communities of pathogenic bacteria constituting microbial biofilms exert anti-microbial resistance. Several natural anti-biofilm agents have been recognized, like phytochemicals, biosurfactants, anti-microbial peptides, and microbial enzymes. The present study investigates the effect of aqueous extract of Saraca asoca Linn. on the in vitro formation of pseudomonas aeruginosa biofilm. The quantitative assessment of biofilm formation was done by crystal violet staining assay. Various factors such as temperature, pH, and concentration were optimized for enhanced effect in inhibiting the biofilm by aq. Saraca asoca leaves extract. Aq. Saraca asoca leaves extract was characterized using GC-MS analysis. Brine shrimp lethality bioassay was also carried out to investigate the cytotoxicity of aq. extract. Saraca asoca was observed as a potential source of anti-biofilm molecules and can be further harnessed to maximum potential. [ABSTRACT FROM AUTHOR]

Amorphophallus paeoniifolius is a very common tuber plant having diverse secondary metabolites and palatability levels. Keeping the problems of food shortage & novel infectious diseases throughout the world, an attempt has been made through fieldworks during 2009 to 2020 to gather the information on its ethnobotany, bioactive compounds from lab work and pharmacological properties from secondary sources to make it future nutraceutical against food disorders & novel microbial diseases. The tuber is used as food and medicines, it is rich with primary & secondary metabolites and its extracts are used to treat various infectious diseases. The compounds present in the species have potential to make novel drugs against present health problems throughout the world. The present study highlights the importance of wild tuberous plants in mitigation of food shortage, food disorders, anti-microbial resistance, novel bacterial & viral diseases like MDR-TB and COVID-19. [ABSTRACT FROM AUTHOR]

Abstract Background Ukraine has a high burden of drug-resistant tuberculosis (DR-TB). Mental health problems, including alcohol use disorder, are common co-morbidities. One in five DR-TB patients has human immunodeficiency virus (HIV). As part of health reform, the country is moving from inpatient care to ambulatory primary care for tuberculosis (TB). In Zhytomyr oblast, Médecins Sans Frontières (MSF) is supporting care for DR-TB patients on all-oral short DR-TB regimens. This study describes the preparedness of ambulatory care facilities in Zhytomyr oblast, Ukraine, to provide good quality ambulatory care. Methods This is a retrospective analysis of routinely collected programme data. Before discharge of every patient from the hospital, MSF teams assess services available at outpatient facilities using a standardised questionnaire. The assessment evaluates access, human resources, availability of medicines, infection control measures, laboratory and diagnostic services, and psychosocial support. Results We visited 68 outpatient facilities in 22 districts between June 2018 and September 2019. Twenty-seven health posts, 24 TB-units, 13 ambulatories, two family doctors and one polyclinic, serving 30% of DR-TB patients in the oblast by September 2019, were included. All facilities provided directly observed treatment, but only seven (10%) provided weekend-services. All facilities had at least one medical staff member, but TB-training was insufficient and mostly limited to TB-doctors. TB-treatment and adequate storage space were available in all facilities, but only five (8%) had ancillary medicines. HIV-positive patients had to visit a separate facility to access HIV-care. Personal protective equipment was unavailable in 32 (55%) facilities. Basic laboratory services were available in TB-units, but only four (17%) performed audiometry. Only ten (42%) TB-units had psychosocial support available, and nine (38%) offered psychiatric support. Conclusion Outpatient facilities in Zhytomyr oblast are not yet prepared to provide comprehensive care for DR-TB patients. Capacity of all facilities needs strengthening with trainings, infection control measures and infrastructure. Integration of psychosocial services, treatment of co-morbidities and adverse events at the same facility are essential for successful decentralisation. The health reform is an opportunity to establish quality, patient-centred care.

Introduction and objective Infections due to multidrug-resistant (MDR) Enterobacteriaceae are an ongoing global threat in their management. The aim of the study was to investigate the antiimicrobial resistance (AMR) and virulence gene profiles of MDR Gram-negative isolates in Sokoto, north-west Nigeria. Material and methods A total of 578 clinical samples were collected from patients. Suspected Gram-negative bacteria were isolated from these clinical samples: vaginal swab, pus, stool, blood, wound swab and urine, using Gram-staining and conventional biochemical reactions. These isolates were further identified with an identification kit (Microgen-GN-A), and tested against a panel of 11 antibiotics. A single polymerase chain reaction (PCR) assay targeting 13 virulence gene related to adhesion ( fim H, pap C, and sfa S), iron chelation ( iut A, and fyu A), toxins ( ast A, stx 1, stx 2, and eae A), biofilm ( bss S), and serum resistance ( tra T, iss , and kaps MTII) encoding genes were evaluated. Results A total of 276 Gram-negative isolates were identified using the Gram stain and biochemical reactions. These organisms were further confirmed with identification kit. Of the 276 isolates, 36 organisms of interest (23 Escherichia coli , 4 Klebsiella pneumoniae and 9 Proteus mirabilis ) were identified. Other Gram-negative isolates accounted for the remaining 86.9%. The majority of the isolates were resistant to cefixime (100%) and partially resistant to amikacin (19.4%).The virulence genes bssS (58.3%), fim H (44.4%), and iut A (44.4%) were the most prevalent, whereas kaps MTII (5.6%) and stx 2 (2.8%) were least detected, while ast A was not detected in any of the isolates. Conclusions The study elucidated the prevalence of antibiotic resistance and virulence genes in Gram-negative bacteria from clinical isolates in Sokoto, north-western Nigeria. The majority of the isolates were MDR, thereby posing a public health risk.

Abstract Background Access to antibiotics without a prescription from retail pharmacies has been described as a major contributor to anti-microbial resistance (AMR) globally. In the context of high rates of AMR, the Chinese government has recently introduced strict policies regarding hospital antibiotic use, but the existing ban on antibiotic sales without prescription in retail pharmacies has not been strongly enforced. In 2016, a goal of prescription-only antibiotics by 2020 was announced. The objective of the study was to determine progress towards the 2020 goal, through estimating the proportion of retail pharmacies selling antibiotics without prescription across the three regions of mainland China. Methods Using the Simulated Patient method, we conducted a cross-sectional survey across purposively-sampled retail pharmacies in urban and rural areas of 13 provinces in eastern, central and western China. Medical students presented a scenario of a mild upper respiratory tract infection, following a strict three-step protocol. They recorded the pharmacy characteristics, and details of their experience, including at which step antibiotics were offered. Results Complete data were obtained from 1106 pharmacies. Antibiotics were obtained in 925 (83.6, 95% CI: 81.5, 85.8%) pharmacies without a prescription, 279 (25.2%) at Stage 1 (symptoms only described), 576 (52.1%) at stage 2 (asked for antibiotics), and 70 (6.3%) at Stage 3 (asked for penicillin or cephalosporins). There were significant differences between provinces, with antibiotic access (at any stage) ranging from 57.0% (57/100) in Zhejiang (81/82) to 98.8% in Guizhou. However, there were no significant differences in access to antibiotics by level of city, county, township or village (P = 0.25), whether the pharmacy was part of a chain or independent (P = 0.23), whether a licensed pharmacist was attending (P = 0.82) or whether there was a sign saying that prescriptions were required for antibiotics (P = 0.19). Conclusions It is easy to obtain antibiotics without a prescription in retail pharmacies in China, despite the fact it is against the law. This must be addressed as part of the wider anti-microbial stewardship effort which could include intense enforcement of the existing law, supported by a public education campaign.

Michele Stella Majoumouo,1,2 Nicole Remaliah Samantha Sibuyi,2 Marius Belmondo Tincho,2 Michele Mbekou,1 Fabrice Fekam Boyom,1 Mervin Meyer2 1Antimicrobial & Biocontrol Agents Unit, Laboratory for Phytobiochemistry and Medicinal Plants Studies, Department of Biochemistry, University of Yaoundé 1, Yaoundé, Cameroon; 2Department of Science and Technology (DST)/Mintek Nanotechnology Innovation Centre, Biolabels Node, Department of Biotechnology, University of the Western Cape, Bellville, South AfricaCorrespondence: Mervin MeyerUniversity of the Western Cape, Department of Biotechnology, New Life Science Building, Robert Sobukwe Road, Bellville 7535, South AfricaTel +27 21 9592032Fax +27 21 9593505Email memeyer@uwc.ac.zaBackground: The global increase in outbreaks and mortality rates associated with multi-drug-resistant (MDR) bacteria is a major health concern and calls for alternative treatments. Natural-derived products have shown potential in combating the most dreadful diseases, and therefore serve as an effective source of bioactive compounds that can be used as anti-bacterial agents. These compounds are able to reduce metal ions and cap nanoparticles to form biogenic nanoparticles (NPs) with remarkable anti-bacterial activities. This study explores the use of Terminalia mantaly (TM) extracts for the synthesis of biogenic silver NPs (TM-AgNPs) and the evaluation of their antibacterial activity.Methods: TM-AgNPs were synthetized by the reduction of AgNO3 with aqueous and methanolic TM extracts. UV–visible (UV-vis) spectrophotometry, Dynamic Light Scattering (DLS), Transmission Electron Microscopy, and Fourier Transform Infrared (FTIR) analyses were used to characterise the TM-AgNPs. Anti-bacterial activity of the TM extracts and TM-AgNPs was evaluated against eight bacterial strains using the broth microdilution assay. The growth inhibitory kinetics of the bio-active TM-AgNPs was assessed on susceptible strains for a period of 8 hrs.Results: Polycrystalline biogenic AgNPs with anisotropic shapes and diameter range of 11 to 83 nm were synthesized from the TM extracts. The biogenic TM-AgNPs showed significant antibacterial activity compared to their respective extracts. The MIC values for TM-AgNPs and extracts were 3 and 125 μg/mL, respectively. Biogenic AgNPs synthesised from the aqueous TM leaf extract at 25°C (aTML-AgNPs-25°C) showed significant antibacterial activity against all the bacterial strains tested in this study. Their bactericidal effect was particularly higher against the Streptococcus pneumoniae and Haemophilus influenzae.Conclusion: This study demonstrated the ability of TM extracts to synthesize biogenic AgNPs. The NPs synthesized from the aqueous TM extracts demonstrated higher antibacterial activity against the tested microorganisms compared to the methanolic extracts. Studies are underway to identify the phytochemicals involved in NP synthesis and their mechanism of action.Keywords: antimicrobial resistance, green synthesis, nanotechnology, Terminalia mantaly, antibacterial activity

We present a case of recurrent multidrug-resistant Candida auris ( C . auris ) in a patient who required multiple hospitalizations. The patient's case was complicated by interval admissions to the intensive care unit for septic and hypovolemic shock for 12 months to manage C . auris fungemia. Despite adequate isolation precautions and appropriate antifungal treatment, this case demonstrates the profound implications of this emerging pathogen, specifically regarding invasive infections. Moreover, C . auris is rapidly becoming known as a multidrug-resistant organism, which limits treatment options and thus contributes to high mortality., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Griffith et al.)