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Between 2016 and 2019, the proportion of Escherichia coli bloodstream infection (BSI) with resistance to at least one antibiotic increased nationally. Public health interventions implemented in response to the COVID-19 pandemic changed population contact patterns and healthcare systems, with consequent effects on epidemiological trends of numerous pathogens. We investigated the impact of COVID-19 restrictions on epidemiological trends of E. coli BSI antimicrobial resistance (AMR) across South West England. We undertook a retrospective ecological analysis utilizing routine surveillance data of E. coli BSI cases reported to the UK Health Security Agency between 2016 and 2021. We analysed AMR trends for antimicrobial agents including amoxicillin–clavulanate, ciprofloxacin, piperacillin–tazobactam, gentamicin, third-generation cephalosporins and carbapenems before and after the implementation of COVID-19 restrictions (23 March 2020) using Bayesian segmented regression. We identified 19 055 cases. A total of 50.2% were male. Median age was 76 (interquartile range, 65–85 years). Piperacillin–tazobactam (–2.90% [95% highest density interval {HDI} –4.51%, –0.48%]) and ciprofloxacin (–2.40% [95% HDI –4.35%, 0.48%]) resistance demonstrated immediate step changes at the implementation of COVID-19 restrictions. Gentamicin (odds ratio [OR] 0.92 [95% HDI 0.76, 1.12]) and third-generation cephalosporins (OR 0.95 [95% HDI 0.80, 1.14]) exhibited decreasing annual resistance trends after the implementation of COVID-19 restrictions, with moderate evidence for a lower OR after restrictions as compared to the period before (gentamicin Bayes Factor = 5.10, third-generation cephalosporins Bayes Factor = 6.67). COVID-19 restrictions led to abrupt and longer term changes to E.coli BSI AMR. The immediate effects suggest altered transmission, whereas changes to resistant E. coli reservoirs may explain trend effects. [ABSTRACT FROM AUTHOR]

Objective: An increase in antimicrobial resistance (AMR) is observed worldwide, partly due to the overuse and misuse of antibiotics, which are ineffective in certain population subgroups. This negatively impacts both the healthcare system and patients. Our study aimed to investigate the current AMR profiles for the most commonly used antibiotics in treating urinary tract infections (UTIs) caused by gram-negative bacteria (GNB) across different age and gender subpopulations. By doing so, we provide valuable information for doctors managing prophylactic and empiric therapeutic treatments. Materials and Methods: We retrospectively analysed over 650,000 urine cultures collected in the Microbiology Department of a referral university hospital in Southern England from January 2014 to December 2022. A population-based analysis for subgroups was performed to rule out differences in AMR patterns. Our report was recorded at UHS as an internal audit (UHS7670). Results: 146,867 cultures were found positive for GNB growth. Nitrofurantoin showed the best sensitivity patterns for all age subgroups (0.93% for patients aged ≤ 18; 1.22% for patients aged 19–40; 2.17% for patients aged 40–60; and 3.48% for patients aged > 60), regardless of gender (male: 6.37%, female: 2.59%). Ampicillin/amoxicillin and trimethoprim showed a poor AMR profile for all age groups (>55% and >28%, respectively) and genders (>60% and >28%, respectively). All the other tested antibiotics (cefalexin, cefotaxime, ceftazidime, ciprofloxacin, co-amoxiclav, gentamicin) showed an overall good profile for GNB resistance across all subgroups. For all antibiotics except trimethoprim, the risk of developing AMR was significantly higher in the male population. We also found that people aged over 60 had a higher risk of AMR compared to the other age groups for all antibiotics, with the exception of cefotaxime and co-amoxiclav. Conclusions: With an overall rise in resistance patterns for GNB-related UTIs, certain antibiotics—particularly ampicillin/amoxicillin and trimethoprim—now exhibit very poor sensitivity profiles. However, antibiotics such as nitrofurantoin and gentamicin remain excellent options for empirically treating UTIs. It is important to note that AMR can vary across different populations, with higher resistance often found in elderly and male patients. Clinicians must stay informed about current guidelines and research to provide the best treatment options while minimizing the risk of further AMR development. [ABSTRACT FROM AUTHOR]

Background: Sepsis neonatorum, or neonatal sepsis, is a clinical illness brought on by the pathophysiologic consequences of a systemic or localized infection. It includes systemic illnesses such as meningitis, pneumonia, arthritis, osteomyelitis, and urinary tract infections and affects babies under one month of age. Neonates are immune-compromised and resist weakly to bacterial infections. Aim and Objectives: To study bacteriological profile of neonatal sepsis and to study the antibiotic sensitivity pattern of different bacterial pathogens isolated. Materials and methods: A total of 180 neonates with suspected sepsis were included in the study based on inclusion and exclusion criteria. 2-3 mL of blood was collected from each patients by the nursing personnel under aseptic precautions and inoculated immediately into 20 mL of glucose citrate broth with 0.025% of sodium polyanethol sulphonate as anticoagulant (HI media, a commercial firm). The broths were sub cultured on 5% sheep blood agar and Mac-Conkey agar after overnight incubation. A negative result was followed-up by examining the broth daily and doing a final subculture at the end of the seventh day. Positive growth was identified by Gram staining and antimicrobial susceptibility test was performed by Kirby-Bauer disk diffusion method as per NCCLS guidelines. Discussion and Conclusion: Neonatal septicemia is an life threatening emergency and rapid treatment with antimicrobial agent is highly essential for favorable outcome. For the effective management of the cases with neonatal septicemia, the study of microbiological profile with their antibiotic sensitivity pattern always plays a significant role. In our study, the prevalence of neonatal sepsis was found to be 33.3% and the prevalence was higher in males compared to females. Among the neonates 56.7% had early onset sepsis and 43.3% had late onset sepsis. The clinical presentation was studied in all the patients, it was found that the most common clinical symptom was respiratory distress and pneumonia was more common in early onset sepsis. Among neonates gram negative septicemia was more common compared to gram positive septicemia. Staph aureus was most common among gram positive and pseudomonas was more common among gram negative isolates. Antibiotic susceptibility showed that the gram positive organisms were highly sensitive to vancomycin, linezolid, teicoplanin and also sensitive to amoxycillin and clindamycin and were least sensitive to penicillin and ampicillin. Antibiotic susceptibility showed that the gram negative organisms were highly sensitive to colistin, tigecycline, meropenem and imipenem, and sensitive to ampicillin and gentamycin. An antibiotic policy should be formulated in our hospital and depending upon antibiotic sensitivity pattern of the isolated pathogen, antibiotic should be used. [ABSTRACT FROM AUTHOR]

To evaluate the safety and efficacy of switching from intravenous (IV) to oral antimicrobial therapy in patients with Enterobacterales bacteraemia, after completion of 3–5 days of microbiologically active IV therapy. A multicentre, open-label, randomized trial of adults with monomicrobial Enterobacterales bacteraemia caused by a strain susceptible to ≥1 oral beta-lactam, quinolone, or trimethoprim/sulfamethoxazole. Inclusion criteria included completion of 3–5 days of microbiologically active IV therapy, being afebrile and haemodynamically stable for ≥48 hours, and absence of an uncontrolled source of infection. Pregnancy, endocarditis, and neurological infections were exclusion criteria. Randomization, stratified by urinary source of bacteraemia, was to continue IV (IV Group) or to switch to oral therapy (Oral Group). Agents and duration of therapy were determined by the treating physicians. The primary endpoint was treatment failure, defined as death, need for additional antimicrobial therapy, microbiological relapse, or infection-related re-admission within 90 days. Non-inferiority threshold was set at 10% in the 95% CI for the difference in the proportion with treatment failure between the Oral and IV Groups in the modified intention-to-treat population. The protocol was registered at ClinicalTrials.gov (NCT04146922). In the modified intention-to-treat population, treatment failure occurred in 21 of 82 (25.6%) in the IV Group, and 18 of 83 (21.7%) in the Oral Group (risk difference –3.7%, 95% CI –16.6% to 9.2%). The proportions of subjects with any adverse events (AE), serious AE, or AE leading to treatment discontinuation were comparable. In patients with Enterobacterales bacteraemia, oral switch, after initial IV antimicrobial therapy, clinical stability, and source control, is non-inferior to continuing IV therapy. [ABSTRACT FROM AUTHOR]

Biofilm-associated bacterial infections are the major reason for treatment failure in many diseases including burn trauma infections. Uncontrolled inflammation induced by bacteria leads to materiality, tissue damage, and chronic diseases. Specialized proresolving mediators (SPMs), including maresin-like lipid mediators (MarLs), are enzymatically biosynthesized from omega-3 essential long-chain polyunsaturated fatty acids, especially docosahexaenoic acid (DHA), by macrophages and other leukocytes. SPMs exhibit strong inflammation-resolving activities, especially inflammation provoked by bacterial infection. In this study, we explored the potential direct inhibitory activities of three MarLs on Gram-positive (Staphylococcus aureus) and Gram-negative (Pseudomonas aeruginosa and Escherichia coli) bacteria in their biofilms that are leading bacteria in burn trauma-related infections. We also examined the effects of MarLs on the bactericidal activities of a typical broad-spectrum antibiotic, carbenicillin (carb), on these bacteria in their preformed biofilms. The results revealed that MarLs combined with carbenicillin can inhibit the survival of Gram-positive and Gram-negative bacteria in their biofilms although MarLs alone did not exhibit bactericidal activity. Thus, our findings suggest that the combination of MarLs and carbenicillin can lower the antibiotic requirements to kill the bacteria in preformed biofilms. [ABSTRACT FROM AUTHOR]

Brevundimonas species are aerobic, non fermenting Gram negative bacilli. Brevundimonas diminuta (B. diminuta) is not believed to be a significant pathogen, and its virulence is generally low, being rarely isolated from clinical samples. Only a few clinical cases of serious opportunistic infections, particularly in patients with compromised immunity, have been reported for B. diminuta. All known species of Brevundimonas spp. show strong resistance to most antibiotics, according to the Centers for Disease Control and Prevention (CDC). Here, a case of B. diminuta infection in an eight-year-old female child is described. The patient also had a minor Patent Ductus Arteriosus (PDA) and a known congenital Atrial Septal Defect (ASD). Following isolation from the blood sample, the VITEK 2 compact system identified B. diminuta. [ABSTRACT FROM AUTHOR]

Background - Surgical site infections (SSI), one of the most common causes of healthcare associated infections are a common complication associated with surgery. The importance of wound infections, in both economic and human terms, should not be underestimated. Materials and Method - This study aims to find out common bacterial isolate and their antibiotic resistance pattern, the incidence of ESBL producers and MRSA in wound infections. Wound swabs from 578 patients were analyzed in the study. Discussion and Results - The predominant isolate was found to be Gram positive bacteria than Gram negative bacteria. However Staphylococcus aureus was seen as the most common bacterial pathogen followed by Klebsiella pneumoniae and Pseudomonas aeruginosa. Conclusion - By employing standard microbiological techniques meticulously the causative agents can be isolated and antimicrobial sensitivity can be assessed for proper management of wound infection. [ABSTRACT FROM AUTHOR]

Background -. The prevalence incidence and characteristics of secondary infection in patients infected with Covid-19 is not well understood and has been raised as an important knowledge gap. Critically ill patients are susceptible for the development of secondary bacterial infections. Due to a combination of virus- and drug-induced immunosuppression, these patients may even have a higher risk of developing a secondary infection. These secondary infections can increase the severity of illness and raise the risk of death. Further research on secondary infections in COVID-19 patients is essential. Therefore, the objective of this study objective of this study was to investigate the incidence of secondary bacterial infections and to assess the impact of secondary infections on the outcome of critically ill patients infected with SARS-CoV-2. Material & Methods - The present study was undertaken among Covid-19 patients admitted in ICU of Gandhi Medical College and Hamidia Hospital, Bhopal. Blood and urine samples of patients was taken on the day of admission in ICU and repeated on 3rd day if feasible and was sent for bacterial and fungal culture to determine the presence of secondary infection, causative organism and all patients were followed till discharge/death to determine the effect of secondary infection on outcome. All the data analysis was performed using appropriate statistical software (Epi Info Version-6). Results Positive growth in blood was seen in 18 (54.5%) of the patients with secondary infection, while urine culture was positive in 11 (32.3%) patients. Both blood and urine culture were positive in 12.1% of the patients. Among the 40 isolates obtained from 33 patients with secondary infection, 8 (20.0%) patients had gram positive infections. Among 33 patients with secondary infection, 5 (15.2%) succumbed while in patients without secondary infection, 9 (13.4%) deaths were observed. Among the 5 deaths happened in 33 patients with secondary infection. All 5 (100.0%) were due to gram negative organisms. Conclusion -. Gram negative infections were common among the patients admitted in ICU. These data were captured when the COVID-19 cases were on the rise. Those with secondary infections had a longer stay in ICUs and the most common organisms leading to mortality in such patients were gram negative in nature. [ABSTRACT FROM AUTHOR]

Introduction: Gram-negative rod (GNR) bacterial ventriculitis is a rare complication of shunt-dependent hydrocephalus, often requiring an extended and invasive treatment course. Accumulation of purulent material, as well as empyema and septation formation, limits circulation of antibiotics and infection clearance. Supplementation of standard care with neuroendoscopic-guided intraventricular lavage with lactated Ringer solution and fenestration of septations may facilitate infection clearance and simplify the eventual shunt construct required. Here, the utility of serial lavage for ventriculitis is described in a population of shunt-dependent neonates and infants at high risk for morbidity and mortality. Methods: Five infants with shunt-dependent hydrocephalus and subsequent GNR ventriculitis were treated with standard care measures with the addition of serial neuroendoscopic lavage. A retrospective chart review was performed to collect patient characteristics, shunt dependency, and shunt revisions within a year of ventriculitis resolution. Results: Patients demonstrated a mean 74% decrease in cerebrospinal fluid (CSF) protein following each neuroendoscopic lavage and trended toward a shorter time to infection clearance in comparison to previously published literature. Patients required 0–2 shunt revisions at 1-year follow-up following hospitalization for shunt-related ventriculitis (mean 0.8 +/− 0.8). Conclusions: Serial neuroendoscopic lavage is an effective technique, used alone or in combination with fenestration of septations, to reduce the CSF protein and bacterial load in the treatment of ventriculitis, decreasing time until eradication of infection. Serial lavage may reduce the risk of future shunt malfunction, simplify the future shunt construct, and decrease duration of infection. [ABSTRACT FROM AUTHOR]

Immune checkpoints play an important role in maintaining the balance of the immune system and in the development of autoimmune diseases. A central checkpoint molecule is the programmed cell death protein 1 (PD-1, CD279) which is typically located on the surface of T cells. Its primary ligand PD-L1 is expressed on antigen presenting cells and on cancer cells. Several variants of PD-L1 exist, among these soluble molecules (sPD-L1) present in serum at low concentrations. sPD-L1 was found elevated in cancer and several other diseases. sPD-L1 in infectious diseases has received relatively little attention so far and is therefore subject of this study. sPD-L1 serum levels were determined in 170 patients with viral infections (influenza, varicella, measles, Dengue fever, SARS-CoV2) or bacterial sepsis by ELISA and compared to the levels obtained in 11 healthy controls. Patients with viral infections and bacterial sepsis generally show significantly higher sPD-L1 serum levels compared to healthy donors, except for varicella samples where results do not reach significance. sPD-L1 is increased in patients with impaired renal function compared to those with normal renal function, and sPD-L1 correlates significantly with serum creatinine. Among sepsis patients with normal renal function, sPD-L1 serum levels are significantly higher in Gram-negative sepsis compared to Gram-positive sepsis. In addition, in sepsis patients with impaired renal function, sPD-L1 correlates positively with ferritin and negatively with transferrin. sPD-L1 serum levels are significantly elevated in patients with sepsis, influenza, mesasles, Dengue fever or SARS-CoV2. Highest levels are detectable in patients with measles and Dengue fever. Also impaired renal function causes an increase in levels of sPD-L1. As a consequence, renal function has to be taken into account in the interpretation of sPD-L1 levels in patients. [ABSTRACT FROM AUTHOR]

Background: In the management of Gram‐negative bloodstream infection (GN‐BSI), short antimicrobial courses have been increasingly demonstrated to be non‐inferior to prolonged therapy, with lower risk of Clostridioides difficile infection (CDI) and emergence of multi‐drug resistant (MDR) organisms. However, immunocompromised hosts were excluded from these studies. We investigated outcomes of short (≤10 days), intermediate (11–14 days), and prolonged (≥15 days) antimicrobial durations for GN‐BSI in neutropenic patients. Methods: A retrospective cohort study was conducted on neutropenic patients with monomicrobial GN‐BSI between 2018 and 2022. The primary outcome was a composite of all‐cause mortality and microbiologic relapse within 90 days after therapy completion. The secondary outcome was a composite of 90‐day CDI and development of MDR‐GN bacteria. Cox regression analysis with propensity score (PS) adjustment was used to compare outcomes between the three groups. Results: A total of 206 patients were classified into short (n = 67), intermediate (n = 81), or prolonged (n = 58) duration. Neutropenia was predominantly secondary to hematopoietic stem cell transplantation (48%) or hematologic malignancy (35%). The primary sources of infection included intra‐abdominal (51%), vascular catheter (27%), and urinary (8%). Most patients received definitive therapy with cefepime or carbapenem. No significant difference in the primary composite endpoint was observed for intermediate versus short (PS‐adjusted hazard ratio [aHR] 0.89; 95% confidence interval [95% CI] 0.39–2.03) or prolonged versus short therapy (PS‐aHR 1.20; 95% CI 0.52–2.74). There was no significant difference in the secondary composite endpoint of CDI or MDR‐GN emergence. Conclusion: Our data suggest that short antimicrobial courses had comparable 90‐day outcomes as intermediate and prolonged regimens for GN‐BSI among immunocompromised patients with neutropenia. [ABSTRACT FROM AUTHOR]

The cell envelope is a multilayered structure that insulates the interior of bacterial cells from an often chaotic outside world. Common features define the envelope across the bacterial kingdom, but the molecular mechanisms by which cells build and regulate this critical barrier are diverse and reflect the evolutionary histories of bacterial lineages. Intracellular pathogens of the genus Brucella exhibit marked differences in cell envelope structure, regulation, and biogenesis when compared to more commonly studied gram-negative bacteria and therefore provide an excellent comparative model for study of the gram-negative envelope. We review distinct features of the Brucella envelope, highlighting a conserved regulatory system that links cell cycle progression to envelope biogenesis and cell division. We further discuss recently discovered structural features of the Brucella envelope that ensure envelope integrity and that facilitate cell survival in the face of host immune stressors. [ABSTRACT FROM AUTHOR]

‘Candidatus Liberibacter solanacearum’ (Lso) is a phloem-limited pathogen associated with devastating diseases in members of the Solanaceae and Apiaceae and vectored by several psyllid species. Different Lso haplotypes have been identified, and LsoA and LsoB are responsible for diseases in Solanaceae crops. Our efforts are aimed at identifying pathogenicity factors used by this bacterium to thrive in different hosts. Bacterial secreted proteins can play a role in host colonization or the manipulation of the host immune responses; these proteins are called effectors. In this study, we identified six LsoB-specific proteins with a conserved secretion motif as well as a conserved N-terminal domain in the mature protein. These proteins had different expression and secretion patterns but a similar subcellular localization in Nicotiana benthamiana leaves, suggesting that they play different roles regardless of their conserved secretion motif. One of these proteins, CKC_04425, was expressed at high levels in the insect vector and the host plant, indicating that it could play a role in both the plant and insect hosts, whereas the others were mainly expressed in the plant. One protein, CKC_05701, was able to efficiently suppress programmed cell death and reactive oxygen species production, suggesting that it may have a virulence role in LsoB-specific pathogenesis. [ABSTRACT FROM AUTHOR]

Aims: To isolate and identify the bacteria in open fractures and determine the antimicrobial susceptibility pattern of isolates. Methods: A prospective study was carried out in a tertiary care hospital of rural India. The study was carried out on 100 patients of all age groups presenting with open fractures at Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana between March 2021 and September 2022. Two wound swabs, (one for culture and other for microscopy) and tissue specimens were collected to isolate and identify the bacteria causing infection in open fractures. All the bacterial isolates were then subjected to antibiotic sensitivity. Results: The results were statistically analyzed using SPSS version 17.0. Significant growth was reported in 46% of the debridement samples. Staphylococcus aureus was the most common organism isolated in 30% of cultures, followed by Pseudomonas aeruginosa in 22% of the cultures. In the post operative follow up period, 40 % of the patients reported significant growth. Pseudomonas aeruginosa was the most common organism isolated in 28% of cultures in follow up period. Among gram positive organisms, Staphylococcus aureus was 77% susceptible to Amikacin & 68% susceptible to Erythromycin. Gram negative organisms like Enterobacteriaceae were 100% susceptible to Imipenem, 71% susceptible to Amikacin and 71% to ciprofloxacin. Conclusion: Initial contamination in open fractures is by both gram positive and gramnegative organisms with Staphylococcus aureus being commonest. Broad spectrum antibiotics like ciprofloxacin along with amikacin form cornerstone therapy for prevention of infection. [ABSTRACT FROM AUTHOR]

The Gram-negative bacteria were isolated from various samples and antibiotic susceptibility testing were performed. The strains were screened by PCR for class 1 integron, virulence and antibiotic resistance genes. blaOXA-23 and blaOXA-51 genes positive samples were cloned into the pGEM-T vector and the plasmids were sent for DNA sequence analysis. The isolates were showed resistance to quinolone, cephalosporin, aminoglycoside, carbapenem and penicillin group antibiotics. Virulence factor genes were identified in 121 strain. The most common virulence gene was determined to be aer (29.78%), followed by sfa (28.19%), afa (27.12%), cnf (21.27%), pap (12.76%) and hly (12.76%). In addition, 34 different virulence patterns were observed. Plasmid-mediated quinolone resistance genes were detected 15 of67 quinolone-resistant isolates. Among carbapenem resistant strains, blaOXA-23 gene was detected in 16 and blaOXA-51 gene in 19 isolates. The strains producing OXA-23 and OXA-51 were Klebsiella oxytoca, Acinetobacter baumannii, E.coli and P.mirabilis. In this study, clinical isolate K. oxytoca carrying both blaOXA-23 and blaOXA-51 genes were identified first time from Türkiye. A high predominance (88.82%) of class 1 integron was detected. In addition, determined that 46.27% of the isolates had the ability to form biofilms. In conclusion since the limited treatment options of antibiotic-resistant Gram-negative pathogens that cause serious infections are an important problem in terms of public health it is important to investigate antibiotic resistance, virulence factor genes and biofilm formation in these pathogens. [ABSTRACT FROM AUTHOR]

Background: Bacteriophages (phages) are one of the most promising alternatives to traditional antibiotic therapies, especially against multidrug-resistant bacteria. Klebsiella pneumoniae is considered to be an opportunistic pathogen that can cause life-threatening infections. Thus, this study aims at the characterization of a novel isolated phage vB_Kpn_ZC2 (ZCKP2, for short). Methods: The phage ZCKP2 was isolated from sewage water by using the clinical isolate KP/08 as a host strain. The isolated bacteriophage was purified and amplified, followed by testing of its molecular weight using Pulse-Field Gel Electrophoresis (PFGE), transmission electron microscopy, antibacterial activity against a panel of other Klebsiella pneumoniae hosts, stability studies, and whole genome sequencing. Results: Phage ZCKP2 belongs morphologically to siphoviruses as indicated from the Transmission Electron Microscopy microgram. The Pulsed Field Gel Electrophoresis and the phage sequencing estimated the phage genome size of 48.2 kbp. Moreover, the absence of lysogeny-related genes, antibiotic resistance genes, and virulence genes in the annotated genome suggests that phage ZCKP2 is safe for therapeutic use. Genome-based taxonomic analysis indicates that phage ZCKP2 represents a new family that has not been formally rated yet. In addition, phage ZCKP2 preserved high stability at different temperatures and pH values (-20 − 70 °C and pH 4 – 9). For the antibacterial activity, phage ZCKP2 maintained consistent clear zones on KP/08 bacteria along with other hosts, in addition to effective bacterial killing over time at different MOIs (0.1, 1, and 10). Also, the genome annotation predicted antibacterial lytic enzymes. Furthermore, the topology of class II holins was predicted in some putative proteins with dual transmembrane domains that contribute significantly to antibacterial activity. Phage ZCKP2 characterization demonstrates safety and efficiency against multidrug-resistant K. pneumoniae, hence ZCKP2 is a good candidate for further in vivo and phage therapy clinical applications. [ABSTRACT FROM AUTHOR]

Background: Bacteriophages (phages) are one of the most promising alternatives to traditional antibiotic therapies, especially against multidrug-resistant bacteria. Klebsiella pneumoniae is considered to be an opportunistic pathogen that can cause life-threatening infections. Thus, this study aims at the characterization of a novel isolated phage vB_Kpn_ZC2 (ZCKP2, for short). Methods: The phage ZCKP2 was isolated from sewage water by using the clinical isolate KP/08 as a host strain. The isolated bacteriophage was purified and amplified, followed by testing of its molecular weight using Pulse-Field Gel Electrophoresis (PFGE), transmission electron microscopy, antibacterial activity against a panel of other Klebsiella pneumoniae hosts, stability studies, and whole genome sequencing. Results: Phage ZCKP2 belongs morphologically to siphoviruses as indicated from the Transmission Electron Microscopy microgram. The Pulsed Field Gel Electrophoresis and the phage sequencing estimated the phage genome size of 48.2 kbp. Moreover, the absence of lysogeny-related genes, antibiotic resistance genes, and virulence genes in the annotated genome suggests that phage ZCKP2 is safe for therapeutic use. Genome-based taxonomic analysis indicates that phage ZCKP2 represents a new family that has not been formally rated yet. In addition, phage ZCKP2 preserved high stability at different temperatures and pH values (-20 − 70 °C and pH 4 – 9). For the antibacterial activity, phage ZCKP2 maintained consistent clear zones on KP/08 bacteria along with other hosts, in addition to effective bacterial killing over time at different MOIs (0.1, 1, and 10). Also, the genome annotation predicted antibacterial lytic enzymes. Furthermore, the topology of class II holins was predicted in some putative proteins with dual transmembrane domains that contribute significantly to antibacterial activity. Phage ZCKP2 characterization demonstrates safety and efficiency against multidrug-resistant K. pneumoniae, hence ZCKP2 is a good candidate for further in vivo and phage therapy clinical applications. [ABSTRACT FROM AUTHOR]

Natural bioactive compounds represent a new frontier of antimicrobial molecules, and the marine ecosystem represents a new challenge in this regard. In the present work, we evaluated the possibility of changes in the antibacterial activity of protamine-like (PL) proteins, the major nuclear basic protein components of Mytilus galloprovincialis sperm chromatin, after the exposure of mussels to subtoxic doses of chromium (VI) (1, 10, and 100 nM) and mercury (1, 10, and 100 pM) HgCl2, since these metals affect some properties of PL. After exposure, we analyzed the electrophoretic pattern of PLs by both acetic acid-urea polyacrylamide gel electrophoresis (AU-PAGE) and SDS-PAGE and determined the MIC and MBC of these proteins on different gram+ and gram– bacteria. PLs, particularly after mussels were exposed to the highest doses of chromium and mercury, showed significantly reduced antibacterial activity. Just at the highest doses of exposure to the two metals, changes were found in the electrophoretic pattern of PLs, suggesting that there were conformational changes in these proteins, which were confirmed by the fluorescence measurements of PLs. These results provide the first evidence of a reduction in the antibacterial activity of these proteins following the exposure of mussels to these metals. Based on the results, hypothetical molecular mechanisms that could explain the decrease in the antibacterial activity of PLs are discussed. [ABSTRACT FROM AUTHOR]

Background: Bacteriophages (phages) are one of the most promising alternatives to traditional antibiotic therapies, especially against multidrug-resistant bacteria. Klebsiella pneumoniae is considered to be an opportunistic pathogen that can cause life-threatening infections. Thus, this study aims at the characterization of a novel isolated phage vB_Kpn_ZC2 (ZCKP2, for short). Methods: The phage ZCKP2 was isolated from sewage water by using the clinical isolate KP/08 as a host strain. The isolated bacteriophage was purified and amplified, followed by testing of its molecular weight using Pulse-Field Gel Electrophoresis (PFGE), transmission electron microscopy, antibacterial activity against a panel of other Klebsiella pneumoniae hosts, stability studies, and whole genome sequencing. Results: Phage ZCKP2 belongs morphologically to siphoviruses as indicated from the Transmission Electron Microscopy microgram. The Pulsed Field Gel Electrophoresis and the phage sequencing estimated the phage genome size of 48.2 kbp. Moreover, the absence of lysogeny-related genes, antibiotic resistance genes, and virulence genes in the annotated genome suggests that phage ZCKP2 is safe for therapeutic use. Genome-based taxonomic analysis indicates that phage ZCKP2 represents a new family that has not been formally rated yet. In addition, phage ZCKP2 preserved high stability at different temperatures and pH values (-20 − 70 °C and pH 4 – 9). For the antibacterial activity, phage ZCKP2 maintained consistent clear zones on KP/08 bacteria along with other hosts, in addition to effective bacterial killing over time at different MOIs (0.1, 1, and 10). Also, the genome annotation predicted antibacterial lytic enzymes. Furthermore, the topology of class II holins was predicted in some putative proteins with dual transmembrane domains that contribute significantly to antibacterial activity. Phage ZCKP2 characterization demonstrates safety and efficiency against multidrug-resistant K. pneumoniae, hence ZCKP2 is a good candidate for further in vivo and phage therapy clinical applications. [ABSTRACT FROM AUTHOR]

Elizabethkingia meningoseptica is an uncommonly encountered multidrug-resistant gram-negative bacterium that causes infections primarily among vulnerable hosts. A true opportunistic pathogen, its ability to cause severe sepsis and complicated infection in selected patients has been noted. Very limited preclinical and clinical data exist with regard to suitable therapeutic options. In this study, we present the case of prolonged bloodstream and central nervous system infection due to E. meningoseptica treated with dose-optimized combination antibiotic therapy, with evidence of microbiological (including development of adaptive resistance mechanisms) and clinical failure. [ABSTRACT FROM AUTHOR]

Background -. The prevalence incidence and characteristics of secondary infection in patients infected with Covid-19 is not well understood and has been raised as an important knowledge gap. Besides systemic effects of COVID-19 itself, the presence of secondary infections in such patients may have an adverse effect on patient's outcome and duration of stay in ICU. This study was hence planned to fill the knowledge gaps in regards to secondary infection in patients in COVID-19 ICU-their incidence, aetiology and effect on outcome. Material & Methods - The present study was undertaken among Covid-19 patients admitted in ICU of Gandhi Medical College and Hamidia Hospital, Bhopal. Blood and urine samples of patients was taken on the day of admission in ICU and repeated on 3rd day if feasible and was sent for bacterial and fungal culture to determine the presence of secondary infection, causative organism and all patients were followed till discharge/death to determine the effect of secondary infection on outcome. All the data analysis was performed using appropriate statistical software (Epi Info Version-6). Results Out of 100 patients, 50.0% were females and 34.0% of the patients belonged to the age group of 56-70 years. 20 (80%) were males, while the rest 5 were females. Positive growth in blood was seen in 18 (54.5%) of the patients with secondary infection, while urine culture was positive in 11 (32.3%) patients. Both blood and urine culture were positive in 12.1% of the patients. Among the 40 isolates obtained from 33 patients with secondary infection, 8 (20.0%) patients had gram positive infections. Conclusion -. Gram negative infections were common among the patients admitted in ICU. All efforts should be made to improve infection control practices. Strict practice of antimicrobial stewardship will help in reducing drug pressure, which is a key driver of drug resistance. [ABSTRACT FROM AUTHOR]

Genes encoding endolysins were identified and cloned from three different Escherichia coli bacteriophages, 10-24(13), PBEC30, and PBEC56. Putative antimicrobial peptide (AMP)-like C-terminal alpha helix structures with amphipathic natures were predicted from the three endolysins. Each gene was cloned and expressed as hexahistidine-tagged forms, and the products were purified and characterized. The purified endolysins exhibited antibacterial activities against a variety of Gram-negative bacteria including Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella pneumonia. Their antibacterial activities were improved by N-terminal fusion with an antimicrobial peptide, cecropin A. Minimum inhibitory concentrations (MIC) were as low as 4 μg/mL, depending on the targeted strain. The endolysins' enzymatic activities were not affected by changes in pH at ranges from 5 to 10 and were stable at temperatures between 4 and 65 °C. The in vivo efficacies of the three endolysins were also demonstrated using Galleria melonella for infection models. [ABSTRACT FROM AUTHOR]

Purpose To compare rates of treatment failure for patients with bloodstream infections (BSIs) due to Escherichia coli , Klebsiella pneumoniae , or Proteus mirabilis who received oral step-down antibiotic therapy with either a fluoroquinolone (FQ) or trimethoprim/sulfamethoxazole (SXT) to rates for those who received an oral β-lactam (BL). Methods This retrospective, multicenter, cohort study included 397 unique adult hospitalized patients with a BSI due to E. coli , K. pneumoniae , or P. mirabilis at 6 hospitals in central Texas between July 11, 2016, and July 11, 2018. The primary outcome was a composite of treatment failure comprising 30-day readmission due to recurrence, 30-day all-cause mortality, and change in oral antibiotic. Secondary outcomes included 90-day development of Clostridioides difficile infection, 90-day colonization with a multidrug-resistant organism, 90-day all-cause readmission, hospital length of stay, and the individual components of the primary outcome. Results Of the 397 patients included, 200 received oral step-down therapy with a BL while 197 received an FQ or SXT. Most patients had an infection due to E. coli (82.8%) and a urinary source of infection (85%). Median total duration of therapy was 14 days in both groups. No difference in treatment failure was identified between the groups treated with a BL and FQ/SXT (7% vs 5.8%, P = 0.561). Median hospital length of stay was the only secondary endpoint in which there was an observed difference (6 vs 5 days, P = 0.04). Conclusion We observed no difference in treatment failure rates for patients receiving an oral BL compared to an oral FQ or SXT for step-down therapy of BSIs due to E. coli , K. pneumoniae , and P. mirabilis. [ABSTRACT FROM AUTHOR]

Introduction: Melioidosis is an infectious disease of humans and animals caused by an environmental saprophyte Burkholderia pseudomallei. Although the organism is associated with soil and water, environmental isolation is rarely successful which could be due to the existence of viable but non culturable forms. Aim: To isolate B. pseudomallei from the soil to detect the environmental presence of this organism in and around Puducherry, India. Materials and Methods: A descriptive cross-sectional study was carried out from July 2018 to January 2021 at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. A total of 473 soil samples were collected from areas surrounding the residence and workplaces of seven culture-proven melioidosis cases, from Puducherry and three districts of Tamil Nadu (Cuddalore, Nagapattinam and Villupuram) during the dry and wet seasons. Soil samples were enriched in Ashdown's broth and cultured on Ashdown's agar. The plates were incubated at 37°C and examined daily for seven days with a further extended period of incubation till the tenth day for samples that did not show growth. Suspected isolates were subjected to Vitek 2 system for biochemical identification. Confirmation of the isolates was carried out by antigen detection and Polymerase Chain Reaction (PCR). Results: From 473 soil samples processed, bacteria with colony morphology similar to B. pseudomallei were isolated in 56 (11.83%) samples. Only one isolate, which was detected on the tenth day of incubation was confirmed as B. pseudomallei using antigen detection and PCR. This sample was collected during the wet season (December 2020) from Endur, in the Villupuram district of Tamil Nadu, India. Conclusion: The study findings highlight the importance of extended incubation of culture plates at 37°C for up to ten days to improve the chances of isolation from the soil. [ABSTRACT FROM AUTHOR]

Background This is a "proof-of-concept" study aiming to evaluate the impact of a multistep bundles intervention in the management and outcomes of patients with gram-negative bloodstream infections (GN-BSIs). Methods This was a single-center, quasi-experimental design study. In the pre-phase (January 2019 to May 2020), patients were retrospectively enrolled. During the post-phase (June 2020 to September 2021), all patients were prospectively enrolled in a nonmandatory 3-step bundles intervention arm including (i) step 1: imaging to detect deep foci of infection, follow-up blood cultures and procalcitonin monitoring; (ii) step 2: early targeted antibiotic treatment and surgical source control; (iii) step 3: discontinuation of antibiotics within 7–10 days in case of uncomplicated BSI. Patients were followed up to 28 days from BSI onset. The primary outcome was 28-day mortality. Results A total of 271 patients were enrolled: 127 and 144 in the pre- vs post-phase, respectively. Full application of step 1 (67% vs 42%; P <.001), step 2 (83% vs 72%; P =.031), and step 3 (54% vs 2%; P <.001) increased in the post-phase. Overall, the intervention reduced 28-day mortality (22% vs 35%, respectively; P =.016) and the median duration of total (11 vs 15 days; P <.001) and targeted (8 vs 12 days; P =.001) antibiotic therapy. Finally, the multivariate Cox regression confirmed the independent protective effect of adherence to step 1 (adjusted hazard ratio [aHR], 0.36; 95% CI, 0.20–0.63) and step 2 (aHR, 0.48; 95% CI, 0.29–0.81) on risk of 28-day mortality. Conclusions Clinical management and outcomes of patients with GN-BSIs may be improved by providing a pre-established multistep bundles intervention. [ABSTRACT FROM AUTHOR]

Background Antimicrobial susceptibility testing (AST) is often needed prior to antimicrobial optimization for patients with gram-negative bloodstream infections (GN-BSIs). Rapid AST (rAST) in combination with antimicrobial stewardship (AS) may decrease time to administration of narrower antibiotics. Methods This was a prospective, nonblinded, randomized trial evaluating the impact of a phenotypic rAST method vs conventional AST (cAST) in hospitalized patients with GN-BSI and source control. The primary outcome was time to narrowest effective therapy. Results Two hundred seventy-four patients were randomized and 205 underwent analysis (97 cAST, 108 rAST). Median (interquartile range [IQR]) time to susceptibility results was 23 hours shorter in the rAST group (cAST: 62 [59–67] hours vs rAST: 39 [IQR, 35–46] hours; P  < .001). Median (IQR) time to narrowest effective therapy was similar between groups (cAST: 73 [44–138] hours vs rAST: 64 [42–92] hours; P  = .10). Median (IQR) time to narrowest effective therapy was significantly shorter in a prespecified subgroup of patients not initially on narrowest therapy and during AS working hours (cAST: 93 [56–154] hours vs rAST: 62 [43–164] hours; P  = .004). Significant decreases were observed in median (IQR) time to oral therapy (cAST: 126 [76–209] hours vs rAST: 91 [66–154] hours; P  = .02) and median (IQR) length of hospital stay (cAST: 7 [4–13] days vs rAST: 5 [4–8] days; P  = .04). Conclusions In patients with GN-BSI, rAST did not significantly decrease time to narrowest effective therapy but did decrease time to oral antibiotics and length of hospital stay. Rapid AST using existing microbiology platforms has potential to optimize patient outcomes. [ABSTRACT FROM AUTHOR]

• Polymicrobial and monomicrobial bloodstream infections were compared. • Polymicrobial infections were correlated with increased mortality. • Imaging studies led to surgical drainage in 20-27 % of patients in both groups. • Performance of imaging studies was correlated with better outcomes. : Appropriate antimicrobial therapy and surgical drainage, improve survival in patients with Gram negative bloodstream infections (BSI). Data about the yield of imaging studies in polymicrobial BSI is sparse. The aim of the study was to assess the need for imaging studies and surgical drainage among patients with polymicrobial compared to monomicrobial BSI. : In a retrospective cohort study of adult patients with Gram negative BSI, 135 patients with monomicrobial BSI were compared to 82 with polymicrobial BSI. Imaging studies were performed in 56.3 % of patients with monomicrobial BSI and in 50 % of polymicrobial BSI (p=0.4), surgical drainage was performed in 20.1 % of patients with monomicrobial BSI and 27.2 % of polymicrobial BSI (p=0.25). Surgical drainage was performed in 26.2 % of patients who survived vs. 11.8 % of patients who died (p=0.035). : There is no difference in the diagnostic approach to monomicrobial and polymicrobial Gram-negative BSI. Surgical drainage is associated with decreased mortality. [ABSTRACT FROM AUTHOR]

Introduction Contemporary emergence of multidrug resistance (MDR) urges regular updates on circulating pathogens and their antimicrobial resistance profiles. We aimed to identify the burden of MDR and World Health Organization (WHO) priority Gram negative pathogens among patients admitted with febrile illness to Abbassia Fever Hospital, a major Public Fever Hospital in Egypt. The carbapenemase- and extended spectrum beta-lactamases (ESBLs)-encoding genes carried by the isolates were also identified. Methods A total of 9602 clinical specimens were collected from febrile patients during 2018 and 2019. The recovered bacterial isolates were examined for antimicrobial susceptibility using disk diffusion test. Susceptibility to colistin was tested using E-test. ESBLs production was phenotypically and genotypically analyzed. Results A total of 790 bacterial isolates (612 Gram negative and 178 Gram positive) were recovered. A percentage of 77.6%, and 62.9% of the Gram negative and positive isolates showed MDR phenotype, respectively. WHO priority pathogens were abundant, including carbapenem-resistant (CR) Enterobacterales (105/187; 56.1%) and CR glucose non-fermenters (82/187; 43.8%) such as: A. baumannii (55; 29.4%), P. aeruginosa (27; 14.4%). Carbapenemase- and ESBLs-encoding genes were detected in 56.1% and 30.8% of Enterobacterales and in 43.8% and 46.3% of glucose non-fermenters, respectively. Antimicrobials such as fosfomycin and chloramphenicol retained good activities against MDR Gram negative pathogens. Conclusions This study highlights the regional burden of MDR and priority Gram negative pathogens. The obtained data are of relevant medical importance for implementation of evidence-based antimicrobial stewardship programs and for tailoring the existing empirical treatment guidelines. [ABSTRACT FROM AUTHOR]

Background and Objectives: Anaerobic bacteria are a common cause of endogenous infections, some of which can be life threatening. These bacteria are not easily cultured and isolated and often cannot even found from infected sites. Delayed or inappropriate treatment of these microorganisms can lead to failure in eradicating these infections. The purpose of this study was to determine the diversity of anaerobic bacteria at present and their pattern of sensitivity to several antibiotics. Materials and Methods: A retrospective study was conducted over a period of two years on various specimens. Specimens derived from body fluids are inoculated on a BacT/Alert (bioMérieux). Anaerobic isolates were identified by Gram staining and continued identification using Vitek 2® automated system. Antibiotic sensitivity examination was carried out using ATBTM ANA (bioMérieux). Results: A total of 440 specimens were received in microbiology laboratory for anaerobic culture from patients with multiple infections from 13 hospitals in Jakarta. Our research was able to identify 18 species on anaerobic bacteria, consisting 52.5% Gram positive and 47.5% Gram negative bacteria. The most common bacteria found were Clostridium perfringens (15%) from Gram positive and Provetella bivia (10%) from Gram negative. The sensitivity pattern shows that antibiotic piperacilline-tazobactam is 100% effective against anaerobic bacteria, while metronidazole as the drug of choice is only 75% effective. Against Gram positive, several antibiotics such as piperacilline-tazobactam, ticarcilin-clavunic acid, cefoxitin, cefotetan, imipenem and chloramphenicol were 100% effective, however metronidazole occupied the lowest position (61.9%). Meanwhile against Gram negative antibiotics piperacilline-tazobactam is 100% effective and chloramphenicol in the second position (94.75%). Conclusion: Clostridium perfringens and Provetella bivia are the most common bacteria found. The antibiotics piperacilline-tazobactam is 100% effective against both Gram positive and negative. The accuracy of specimen management, isolation, identification and sensitivity examination will determine the successful microbiological investigations. [ABSTRACT FROM AUTHOR]

• GN-BSI patients have poor long-term mortality in comparison to a matched cohort • The underlying cause of death was due to infection only within the first 90 days • Sepsis was the contributory cause of death for one year after GN-BSI Understand the long-term mortality, risk of readmission for sepsis and cause of death following a gram-negative bloodstream infection (GN-BSI). This was a propensity-matched study using data linkage of Queensland hospital data, Australia. GN-BSIs were collected from 2005 to 2010 and matched 1:1 to hospital admissions without BSI for age, gender, year of culture collection, frequency of admissions in the prior year and Charlson-Deyo Comorbidity score and each comorbidity within the Charlson-Deyo score. Readmissions for sepsis, mortality and causes of death were evaluated. Cases of GN-BSI were propensity-matched 1:1 to culture-negative hospital admissions (n = 14016). Readmissions for sepsis were higher in the GN-BSI cohort from 91 to 365 days (P < 0.001) and in the four subsequent years (P < 0.001). The five-year survival in the GN-BSI cohort was 52% versus 65% in the culture-negative cases (P < 0.001). Infection was only a common underlying cause of death within the first 90 days. Sepsis was the most common contributing cause of death (CCOD) for the two years following index culture in the GN-BSI cohort. Compared to a similarly vulnerable group of hospital attendees, GN-BSI had higher mortality and demonstrated a persistent long-term risk of readmission for sepsis and sepsis as a CCOD. [ABSTRACT FROM AUTHOR]

Objective: To determine the emerging antibiotic resistance pattern of adult patients of MDR UTI cases caused by E.Coli. Study Design: Retrospective Data. Setting: Departments of Medicine and Obstetrics & Gynecology, Madinah Teaching Hospital / University Medical and Dental College, Faisalabad. Period: August 2016 to Sep 2018. Material & Methods: This retrospective study included 187 patients meeting the operational definition of multi-drug resistance cases of urinary tract infection caused by E. coli. All cases either male or female of age above 15 years with positive reports of urine culture and sensitivity for E.coli were included in the study. Along with the demographic variables urine WBC's, results of urine culture and sensitivity were noted. Antibiotic sensitivity pattern of all the E.coli resistant UTI cases was analyzed. After identification of the microbe, antimicrobial sensitivity was accessed using Kirby-Bauer disc diffusion method on the Mueller-Hinton agar. The antimicrobial susceptibility test was performed against E. coli strains by using the following antibiotics: Piperacilin, Amoxicilin- Calvulanic, Pipmedic Acid, Cefipime, Ceftrixone, Cefuroxime, Cefoperazone-sulbactam, Ceftazidime, Cephradine, Ciprofloxacin, Ofloxacin, Levofloxacin, ofloxacin, Nitrofurantoin, Amikacin, Tombramycin, Gentamicin, Linezolid, Doxycycline, Sulphamethoxazole, Imipenem, Meropenem, Aztreonam in order to obtain an antibiogram. Results: In our data, 66.8% (n=125) were MDR UTI, and more than half of these cases were 63.2% (n=79) were females. Among the total 187 cases, 97.3% patients were resistant to most of the beta-lactam antibiotics, 95.7% were resistant to most of the quinolones and 68.4% were resistant to most of the aminoglycosides. Conclusion: This increasing antibiotic resistance is very alarming and steps should be taken to reduce the misuse of antibiotics. Studies should be done to control the risk factors leading to E. coli UTI. By following proper pharmacological guidelines, principles to use antibiotics and manage outpatient cases of UTIs, the incidence of MDR UTI can be controlled. [ABSTRACT FROM AUTHOR]

Background The Democratic Republic of the Congo (DRC) has one of the highest neonatal death rates (between 14% and 28%) in the world. In the DRC, neonatal sepsis causes 15.6% of this mortality, but data on the bacterial etiology and associated drug susceptibility are lacking. Methods Hemocultures of 150 neonates with possible early-onset neonatal sepsis (pEOS) were obtained at the Hôpital Provincial Général de Référence de Bukavu (Bukavu, DRC). The newborns with pEOS received an empirical first-line antimicrobial treatment (ampicillin, cefotaxime, and gentamicin) based on the synopsis of international guidelines for the management of EOS that are in line with World Health Organization (WHO) recommendations. Isolates were identified using matrix-assisted laser desorption/ ionization time-of-flight mass spectrophotometry. Antibiotic resistance was assessed using the disk diffusion method. Results Fifty strains were obtained from 48 patients and identified. The 3 most prevalent species were Enterobacter cloacae complex (42%), Klebsiella pneumoniae (18%), and Serratia marcescens (12%). Enterobacter cloacae isolates were resistant to all first-line antibiotics. All K. pneumoniae and S. marcescens isolates were resistant to ampicillin, and the majority of the K. pneumoniae and half of the S. marcescens isolates were resistant to both cefotaxime and gentamicin. All E. cloacae complex strains, 89% of K. pneumoniae , and half of S. marcescens had an extended-spectrum ß-lactamase phenotype. Conclusions The most prevalent pathogens causing EOS in Bukavu were E. cloacae complex, K. pneumoniae , and S. marcescens. Most of these isolates were resistant to the WHO-recommended antibiotics. [ABSTRACT FROM AUTHOR]

Background: Reduced cholesterol levels are associated with increased organ failure and mortality in sepsis. Cholesterol levels may vary by infection type (gram negative vs positive), possibly reflecting differences in cholesterol-mediated bacterial clearance. Methods: This was a secondary analysis of a combined data set of 2 prospective cohort studies of adult patients meeting Sepsis-3 criteria. Infection types were classified as gram negative, gram positive, or culture negative. We investigated quantitative (levels) and qualitative (dysfunctional high-density lipoprotein [HDL]) cholesterol differences. We used multivariable logistic regression to control for disease severity. Results: Among 171 patients with sepsis, infections were gram negative in 67, gram positive in 46, and culture negative in 47. Both gram-negative and gram-positive infections occurred in 11 patients. Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and HDL cholesterol (HDL-C) levels were lower for culture-positive sepsis at enrollment (TC, P < .001; LDL-C, P < .001; HDL-C, P = .011) and persisted after controlling for disease severity. Similarly, cholesterol levels were lower among culture-positive patients at 48 hours (TC, P = .012; LDL-C, P = .029; HDL-C, P = .002). Triglyceride (TG) levels were lower at enrollment (P = .033) but not at 48 hours (P = .212). There were no differences in dysfunctional HDL. Among bacteremic patients, cholesterol levels were lower at enrollment (TC, P = .010; LDL-C, P = .010; HDL-C, P ≤ .001; TG, P = .005) and at 48 hours (LDL-C, P = .027; HDL-C, P < .001; TG, P = .020), except for 48 hour TC (P = .051). In the bacteremia subgroup, enrollment TC and LDL-C were lower for gram-negative versus grampositive infections (TC, P = .039; LDL-C, P = .023). Conclusion: Cholesterol levels are significantly lower among patients with culture-positive sepsis and bacteremia. [ABSTRACT FROM AUTHOR]

Introduction Sepsis is a serious inflammatory clinical syndrome with poor outcome, triggered mostly by Gramnegative infections. Dysregulated Toll-like receptor-4 (TLR4)- mediated innate responses play a role in the pathogenesis of sepsis. Aim of work This study aimed to evaluate the levels of expression of TLR4 on neutrophils and monocytes in patients with different degrees of sepsis, to estimate serum levels of soluble TLR4 (sTLR4), tumor necrosis factor (TNF)-α and Creactive protein (CRP) in these patients and to compare these results with those of controls and to correlate the results with disease severity and outcome. Patients and methods Ninety individuals were included. Forty five patients were classified into 2 groups (35 with sepsis and 10 with septic shock); all patients were selected from among systemic inflammatory syndrome (SIRS) patients admitted to the Intensive Care Unit after positive blood culture for Gram-negative bacilli. A total of 45 healthy controls were also recruited. All participants were subjected to the following investigations: evaluation of expression of TLR4 on neutrophils and monocytes (by flow cytometry) and determination of serum levels of sTLR4 and TNF-α (by enzyme-linked immunosorbent assay) and quantitative CRP (qCRP; by turbidimetry). Results were correlated with disease severity and outcome. Results The most common isolated organism was Klebsiella pneumoniae (40%). Among all the isolated organisms, 56.6% were multi-drug resistant. The most common primary site of infection was the lower respiratory tract. Out of the 45 patients studied, 30 patients died. In both patient subgroups, compared with the controls, the following was observed: a significant increase in TLR4 expression on neutrophils and monocytes (P<0.001), increased levels of sTLR4 (P<0.001), qCRP (P<0.001), and a non-significant difference in TNF-α (P=0.128). Conclusion Increased levels of sTLR4 are accompanied by reduced levels of TNF-α, but not qCRP, in patients with sepsis. TLR4 and sTLR4 may be useful diagnostic markers for identifying patients with sepsis among SIRS patients. [ABSTRACT FROM AUTHOR]

Background Rapid blood culture diagnostics are of unclear benefit for patients with gram-negative bacilli (GNB) bloodstream infections (BSIs). We conducted a multicenter, randomized, controlled trial comparing outcomes of patients with GNB BSIs who had blood culture testing with standard-of-care (SOC) culture and antimicrobial susceptibility testing (AST) vs rapid organism identification (ID) and phenotypic AST using the Accelerate Pheno System (RAPID). Methods Patients with positive blood cultures with Gram stains showing GNB were randomized to SOC testing with antimicrobial stewardship (AS) review or RAPID with AS. The primary outcome was time to first antibiotic modification within 72 hours of randomization. Results Of 500 randomized patients, 448 were included (226 SOC, 222 RAPID). Mean (standard deviation) time to results was faster for RAPID than SOC for organism ID (2.7 [1.2] vs 11.7 [10.5] hours; P  < .001) and AST (13.5 [56] vs 44.9 [12.1] hours; P  < .001). Median (interquartile range [IQR]) time to first antibiotic modification was faster in the RAPID arm vs the SOC arm for overall antibiotics (8.6 [2.6–27.6] vs 14.9 [3.3–41.1] hours; P  = .02) and gram-negative antibiotics (17.3 [4.9–72] vs 42.1 [10.1–72] hours; P  < .001). Median (IQR) time to antibiotic escalation was faster in the RAPID arm vs the SOC arm for antimicrobial-resistant BSIs (18.4 [5.8–72] vs 61.7 [30.4–72] hours; P  = .01). There were no differences between the arms in patient outcomes. Conclusions Rapid organism ID and phenotypic AST led to faster changes in antibiotic therapy for gram-negative BSIs. Clinical Trials Registration NCT03218397. [ABSTRACT FROM AUTHOR]

All the serotypes of Salmonella enterica subsp. enterica are parasites for human being and mammals, while the other subspecies and Salmonella bongori are met preponderant in birds and animals with cold blood. On usual media, liquid or solid, they form colonies of S or R type, also common to the other enterobacteriaceae. On agar-blood it usually doesn’t determine hemolysis. On selective lactin media they form lactase-negative colonies, some with the black center due to the production of H2S, and on the Wilson-Blair medium a high selective medium for salmonella, they form black colonies with black halo and metallic gloss. Yersinia is gram-negative bacilli or coccobacilli, pleomorphous, non sporulated, with tendency of bipolar coloration. The choleric vibrio is a gram negative bacillus very mobile, with characteristic aspect of comma, due to polar flagella. It grows on selective culture media, supplemented with biliary salts. [ABSTRACT FROM AUTHOR]

Background and aims. Meropenem (Mer) and vaborbactam (Vab) is a combination of a carbapenem and a new ß-lactamase inhibitor used in adults to treat different types of infections caused by Gram-negative bacteria. This combination is chosen as an alternative in infections caused by Gram-negative bacteria when carbapenem-only therapies are unsatisfactory. Materials and methods. Based on this, we report our assessment of such meropenem/vaborbactam association through the E-test and the Microscan routine automated system. This evaluation was performed on 22 samples, carbapenem-resistant strains of Gram-negative bacteria isolated from different types of biological material. Five E. coli and 1 P. mirabilis were respectively susceptible to both carbapenems and Mer/Vab, 6 P. aeruginosa and 2 A. baumannii were respectively resistant to both carbapenems and Mer/Vab and out of 8 K. pneumoniae which were resistant to carbapenems only one was resistant to the Mer/Var combination. Results and conclusions. From the data obtained, it can be seen that resistance to carbapenems is 72%, and drops to 36% with the combined use of Mer/Vab. However, this combination cannot be used in the treatment of patients with diseases caused by P. aeruginosa and Acinetobacter spp., resistant to meropenem. [ABSTRACT FROM AUTHOR]

Background: Kidney transplant recipients (KTRs) are at increased risk of infections. Methods: The aims of this study were to describe the incidence of bloodstream infections (BSIs) by gram‐negative bacteria in a cohort of KTRs, the risk factors for BSI due to multi‐drug–resistant (MDR) gram‐negative bacteria, and the predictors for unfavorable outcome, defined as death or nephrectomy or return to dialysis, within 30 days from BSI. We conducted a retrospective cohort study at the renal transplant unit of a tertiary care hospital in Athens, Greece. Results: In a total of 1962 KTRs, we recorded 195 BSI episodes in 182 single patients (male/female = 97/85), with a median (interquartile range) age of 57.2 (44‐64.9) years. The incidence was 1.393/100 patient‐years. The most common source of infection was urinary tract (70.9%), and Escherichia coli (63.7%) was the most common pathogen. 19.2% of the infecting organisms were MDR; previous antibiotic use (OR 8.2; CI 2.1‐32.9) and previous stay in the intensive care unit (OR 34.2; CI 1.6‐730.2) were associated with MDR BSIs. 6% of patients died, and 2.2% underwent nephrectomy, while no patients had to return to dialysis. Diabetes mellitus (OR 8.1; 95% CI 1.3‐50.3), Pseudomonas aeruginosa BSI (OR 46.1; 95% CI 3.9‐552.3), and septic shock (OR 46.7; 95% CI 1.7‐1304.9) were independent predictors of unfavorable outcome. Conclusion: Bloodstream infections in KTRs have a significant impact on allograft and patients outcome. [ABSTRACT FROM AUTHOR]

Six newly synthesized acid dye derivatives were evaluated for their in vitro antimicrobial activity against four (04) Gram positive (Staphylococcus aureus, Staphylococcus lugdunensis, Streptococcus pneumoniae and Bacillus subtilis) and six (06) Gram negative (Pseudomonas aeruginosa, Acinetobacter baumannii, Citrobacter freundii, Klebsiella pneumoniae,Pseudomonas fluorescens and Shigella sonnei) bacterial strains. The dyes were synthesized using substituted aryl amines and substituted amino hydroxy sulfonic acid as diazo and coupling components, respectively. The antimicrobial activity was explored by Agar-Well Diffusion method using 100 mg/ml dye concentration. The results demonstrated that the dyes possess varying degrees of activities against the bacterial strains tested and the structure of the dye molecules was found to have considerable influence on their antimicrobial activity. [ABSTRACT FROM AUTHOR]

Plants used in traditional medicines contain a vast array of substances that can be used to treat chronic and infectious diseases and the present study was carried out with the same intent to appraise the possible medicinal value of Polypodium decumanum a medicinal plant found mainly in Sikkim, Kamau region and in Western Ghats found. The antimicrobial assay was carried out by Disc diffusion method. The crude plant extracts of leaves part exhibited antimicrobial activity on majority of test organisms. The antimicrobial results revealed that the Ethyl acetate, Ethanol & Aqueous leaves extract of Polypodium decumanum among the selected reference bacterial strains tested, the zone of inhibition was seen in concentration dependent manner on the two different Gram positive and two-gram negative strains. [ABSTRACT FROM AUTHOR]

Aim To evaluate the bactericidal effects of ozone Nano-bubble water (NBW3) in different pathogenic bacteria. Methodology 0.1 mL volume of bacteria suspension containing approximately 1 x 107 CFUs/ mL (McFarland standard) of each test bacterium added to each 10 mL of serial dilution of ozone nanobubbles water, 0.9% NaCl with standard strains of bacteria (as negative control) used. Following the incubation (for 2, 5, and 10 min, at 37 °C). The 0.9% NaCl control bacterial suspensions incubated and treated in the same manner. Aliquots removed from each tube at each time point and serial 10-fold dilutions prepared in sterile physiological saline. Next, 0.1 mL aliquots of each dilution aseptically inoculated on plate of agar medium and incubated at 37 °C for overnight. Colonies then be counted, and the number of CFUs/mL be plotted against time for each bacterium tested. Results Ozone had an antibacterial effect on both gram positive and gram-negative bacteria those suspended in first 2 delusion, but little effect in third one. Its antibacterial efficacy was not comparable with that of NaCl under the test conditions used. Ozone-Nano effect on gram negative and gram-positive bacteria. Conclusion Ozone-Nano-bubbles water has bactericidal effect on different strains of gram negative and gram-positive bacteria. [ABSTRACT FROM AUTHOR]

We examined factors associated with follow-up blood cultures (FUBCs) in patients with monomicrobial Gram-negative (GN) bloodstream infection (BSI) and investigated the impact of FUBCs on therapeutic management and patient outcome. A retrospective cohort analysis was conducted of adult patients diagnosed with GN-BSI at a tertiary-care university hospital during 2013–2016. FUBCs performed between 24 hours and 7 days after index BCs was the exposure variable. Risk factors for 30-day mortality were analysed by multivariate Cox analysis on the overall cohort, including FUBCs as a time-varying covariate and on 1:1 matched patients according to Sequential Organ Failure Assessment (SOFA) score and time to FUBC. In 278 (17.6%) of 1576 patients, FUBCs were performed within a median of 3 and 2 days after index BCs and active antibiotic therapy initiation. Persistent BSI was found in 107 (38.5%) of 278 patients. FUBCs were performed in more severely ill patients, with nonurinary sources, difficult-to-treat pathogens and receipt of initial inappropriate therapy. Source control and infectious disease consultation rates were higher among patients with preceding FUBCs and was associated with longer treatment duration. Thirty-day mortality was 10.4%. Independent risk factors for mortality were Charlson comorbidity index (hazard ratio (HR) 1.12) SOFA (HR 1.11), septic shock (HR 2.64), urinary source (HR 0.60), central venous catheter source (HR 2.30), complicated BSI (HR 2.10), carbapenem resistance (HR 2.34), active empiric therapy (HR 0.68), source control (HR 0.34) and FUBCs (HR 0.48). Association between FUBCs and lower mortality was confirmed in the 274 matched pairs. FUBCs were performed in more severe GN-BSIs, yielding a high rate of persistent BSI. In this context, FUBCs were associated with lower mortality. [ABSTRACT FROM AUTHOR]

Urinary tract infections (UTIs) are a major burden to the health care as it is estimated that around 150 million UTIs occur yearly worldwide. Enterobacteriaceae are the most common agent causing serious urinary tract infections; and multi drug resistent (MDR) cases are increasing day by day. Objectives: To determine the frequency and patient demographics of multidrug resistant urinary tract isolates of Escherichia Coli in a Tertiary Care Hospital. Study Design: Retrospective cross sectional study. Setting: Department of Medicine, Madinah Teaching Hospital / The University of Faisalabad, Faisalabad. Period: May 2016 to Sep 2018. Material & Methods: 187 patients of age 15 to 90 years with positive E. coli on urine culture and sensitivity were included in this retrospective cross sectional study. All those patients with history of dysuria (pain during urination) or frequent urination (more than 7 times per day) were advised urine complete analysis and those with >5 WBCs or pus cells /HPF or having positive for leukocyte esterase and/or nitrite, were advised urine culture and sensitivity. Main outcome variable was the frequency of MDR cases among the culture positive E. coli UTI patients. Results: Among all the cases of E. coli UTI, frequency of MDRE UTI was 66.8% (n=125) and rest 33.2% (n= 62) cases were not MDR UTI. 97.3% patients were resistant to lactam antibiotics, 95.7% were resistant to quinolones and 68.4% were resistant to aminoglycosides. Conclusion: With the rise in the microbe’s resistance to multiple drugs, new therapeutic strategies are to be designed after analyzing our population’s susceptibility pattern. It is not less than a challenge for physicians of a developing nation like Pakistan to treat MDR E.coli UTI cases while taking care of the cost of treatment and controlling the disease burden at the same time. [ABSTRACT FROM AUTHOR]

Plants used in traditional medicines contain a vast array of substances that can be used to treat chronic and infectious diseases and the present study was carried out with the same intent to appraise the possible medicinal value of Inula racemosa Hook and Phytolacca accinosa Roxb a threatened medicinal plant of Kashmir valley. The antimicrobial assay was carried out by Disc diffusion method. The crude plant extracts of root part exhibited antimicrobial activity on majority of test organisms. The antimicrobial results revealed that the hydroalcoholic root extract of Inula racemosa and Phytolacca accinosa among the selected reference bacterial strains tested, the zone of inhibition was seen in concentration dependent manner on the four different Gram positive and four-gram negative strains. [ABSTRACT FROM AUTHOR]

Introduction: Cytokines and granulocyte elastase produced in sepsis cleave a disintegrin and metalloprotease with thrombospondin type I motif 13 (ADAMTS13) and deplete its levels. By this mechanism, sepsis results in microangiopathic hemolytic anemia (MAHA) with thrombocytopenia. Hence, the hypothesis is that plasmapheresis may help in sepsis-induced thrombotic microangiopathy (sTMA), by removing the factors responsible for low levels of ADAMTS13. In tropical countries like India, the contribution of sepsis to intensive care unit (ICU) mortality is high; and hence, it is essential to look out for newer modalities of sepsis treatment. There is abundant literature on the use of plasmapheresis in sepsis but data on its use in sTMA are limited, thus necessitating further research in this field. Case description: This case series studies the outcomes of five patients admitted with sTMA in the ICU and attempts to evaluate the effectiveness of plasmapheresis in improving their outcomes. All patients diagnosed with sTMA and treated with plasmapheresis, between January 2016 and August 2018 at our tertiary care center, were selected for the study. The diagnosis of sepsis was based on sepsis-3 definition. Results: Four different gram-negative organisms were found to have caused MAHA, with the commonest source being either urinary tract infection (UTI) or lower respiratory tract infection. Three of five patients required hemodialysis and two had disseminated intravascular coagulation (DIC). All five had good outcome and recovered well from the acute episode post plasmapheresis. Discussion: In two of five patients, the initial smear was negative and hence the need for repeated examination of the peripheral blood smear should be kept in mind in cases of sTMAs. The median of the number of plasmapheresis sessions required in sTMA is six, which is lesser than that required for primary thrombotic thrombocytopenic purpura (TTP). Hence, the duration of central line placement and the risk of catheter-related complications are low. Based on the observations made in this case study, further exploratory studies are required to evaluate the efficacy of plasmapheresis in sTMA secondary to tropical infections. [ABSTRACT FROM AUTHOR]

Multidrug-resistant (MDR) extended-spectrum beta-lactamase (ESBL)-producing bacterial isolates have emerged as a global threat to human health. Little is known about the overall prevalence of multidrug resistance profile and ESBL-producing gram-negative bacilli (GNB) in Ethiopia. Therefore, this meta-analysis was performed to produce proportional estimates of multidrug resistance and ESBL-producing GNB in Ethiopia. A web-based search was conducted in PubMed, Google Scholar, Research Gate, Scopus and other databases. Articles published till 2019 on the prevalence and antimicrobial resistance profiles of ESBL-producing GNB in Ethiopia were included in the study. Relevant data were extracted and statistical analysis was performed using comprehensive meta-analysis version 3.3.0 software. Publication bias was analyzed and presented with funnel plots. In this meta-analysis, the overall proportional estimate of ESBL-producing GNB was 48.9% (95% confidence interval [CI]: 0.402, 0.577). The pooled proportional estimates of ESBL-producing Klebsiella pneumoniae, Escherichia coli and other GNB were 61.8%, 41.2% and 42.9%, respectively. Regarding antimicrobial resistance profiles against selected drugs, the pooled proportional estimates of resistance against amoxicillin-clavulanic acid, trimethoprim-sulfamethoxazole, cefotaxime, ceftazidime, tetracycline, gentamicin and ciprofloxacin was 79.0%, 78.4%, 78.0%, 72.4%, 72.7%, 58.9% and 43.8%, respectively. The pooled proportional estimates of MDR isolates were found to be 82.7% (95% CI: 0.726, 0.896), which are relatively high as compared to other countries. This highlights a need for active surveillance systems which can help understand the actual epidemiology of ESBL, aid in formulating national guidelines for proper screening of ESBL and support developing standardized approaches for managing patients colonized with ESBL. [ABSTRACT FROM AUTHOR]

The child population is exposed to multiple bacterial germs, one of these is Helicobacter Pylori. This bacterium (microaerophilic Gram-negative) is responsible for the presence of primary gastritis, duodenitis, gastric ulcers, and upper digestive bleeding in children. The objective of this study is to determine the prevalence of Helicobacter pylori in children's feces from between the ages of 1 and 12 at Maritza Rivas neighborhood from Juigalpa-Chontales, using an indirect method to detect antigens. It has a descriptive, prospective cross-sectional methodological design, with a quantitative approach. The population consists of 217 minors, by means of the non-probabilistic sampling or for convenience, a sample of 30 children was obtained, both sexes presented in 50%. The data was collected by means of surveys applied to parents, protecting the confidentiality of the data; it was processed in SPSS 21 and Excel 2013. Among the main results of the investigation, the prevalence of infection by Helicobacter pylori is 66.6% with 20 positive cases from the total sample. In general, it was found that the average age of minors is 6 years. Regarding the symptoms described by the parents, it was found that 36.7% have epigastric pain, 20% heartburn, 46.7% colic, 13.7% vomiting, 20% urticaria and 16.7% weight loss. She suggests implementing public health measures, which would contribute to a decrease in the prevalence of gastric cancer in our country. [ABSTRACT FROM AUTHOR]

Objective: We aimed to determine antibiotic susceptibility patterns of ESBL- and non-ESBL bacteria isolated from pregnant women with UTI in antenatal wards in Khartoum State, Sudan. Methods: This cross-sectional study was conducted during April-July 2016 at different hospitals in Khartoum State. Mid-stream urine samples were obtained from 150 hospitalized pregnant women and cultured on CLED (Cystine Lactose Electrolyte Deficient) agar. Microorganisms were identified using standard microbiological procedures. Isolated Gram-negative bacteria were tested for antibiotic susceptibility and ESBL screening using modified Kirby-Bauer method and Double Disc Synergy Test (DDST) respectively. Results: Urine culture revealed positive results in 33/150 (22%) and the most prevalent isolates were Gram negative bacteria (18/33, 54.5%). Among gram-negative bacteria, isolates of E. coli were the most prevalent accounting 66.6% (12/18) followed by K. pneumoniae (4/18, 22.2%) and K. oxytoca (2/18, 11.1%). ESBL was detected in 8/18 (44.4%) of the Gram-negative isolates. Of note, imipenem was the most susceptible antibiotic for ESBL-producer and non-ESBL producer Gram negative isolates, accounting 100% susceptibility for both bacterial groups. Overall susceptibility rates were also high for ciprofloxacin (13/18, 72.2%). In other hand, co-trimoxazole and amoxicillin showed high resistance pattern for ESBL-producer and non-ESBL producer isolates; 27.8%, 44.4% and 38.9%, 38.9% susceptibility rates of co-trimoxazole and amoxicillin for ESBL-producer and non-ESBL producer isolates, respectively. Conclusions: Imipenem remains the most powerful option for ESBL- and non-ESBL bacteria causing UTIs in pregnant women. However, due to tremendous increase of antibiotic-resistant, antibiotic-susceptibility testing is recommended as a routine investigation for admitted pregnant women. [ABSTRACT FROM AUTHOR]

The article presents a study which described trends in etiologies and susceptibility patterns of bloodstream infections (BSI) in hospitalized children in Malawi from 1998 to 2017. Topics discussed include the decline in child mortality in Malawi in the last 20 years due to multiple interventions, decrease in minimum incidence rates of pediatric BSI over 20 years, and pathogen etiology.

Background: Nosocomial bacteria are bacteria that cause diseases acquired from the hospital environments. Aim: This study looked into profile of bacterial pathogens associated with nosocomial infections in hospitals within Makurdi metropolis. Result: A total of 71 bacterial pathogens were encountered from 240 samples analysed from three hospitals in Makurdi metropolis. Of the 71 isolates, 46(64.8%) were Gram positive and 25(35.2%) were Gram negative. The Gram positive constituting S. aureus (50.70%) and staphylococcus spp (14.08%) while the Gram negative constituting E. coli (15.50%), klebsiella spp (7.04%) and P. aeruginosa (12.68%). Out of 21(29.58%) isolates cultured from hand swabs, the bacterial pathogens from hand swab at F M C was the highest 12(57.14%) followed by C H M 5(23.81%) while B M M C has the least profile of 4(19.05%). With regards to hospital air, the highest profile of nosocomial bacteria was also from F M C 8(61.54%), followed by B M M C 4(30.77%) while C H M had just only one isolate 1(7.69%). Of 21(29.58%) isolates from B M M C; 10(47.62%) S. aureus, 4(19.05%) Staphylococcus spp, 2(9.52%) P. aeruginosa and 5(23.81%) Escherichia coli were obtained. In C H M, out of 18(25.35%) bacterial pathogens evolved constituting 12(66.67%) S. aureus, 2(11.11%) Staphylococcus spp, 1(5.56%) P. aeruginosa and 3(16.67%) E. coli. Whereas, the profile of 32(45.07) isolates in Federal Medical Centre Makurdi constituting 14(43.75%) S. aureus, 4(12.50%) Staphylococcus spp, 6(18.75%) P. aeruginosa, 3(9.38%) E. coli and 5(15.63%) Klebsiella spp were obtained. The antibiotic susceptibility pattern to Staphylococcus spp reveals that the highest level of sensitivity were demonstrated by Cloxacillin and Ofloxacin with 50%, followed by Augumentin and Cefuroxime with 40%, Gentamicin (30%), Erythromycin (20%) and least sensitivity with Ceftriazone (10%) while Ceftazidime has the highest resistance recorded 0% sensitivity. E. coli has the highest sensitivity on Ceftazidime having 81.8% and Gentamicin 63.6%, Ofloxacin also displayed a high level of sensitivity to isolates tested with 63.6% sensitive, follow by Cefuroxime (45.5%). Conclusion: This study showed that nosocomial bacterial pathogens particularly, S. aureus, P. aeruginosa, Staphylococcus spp and enteric bacteria, E. coli and Klebsiella spp are the predominant pathogens associated with infections acquired in hospital environment. So, information on resistance patterns of isolates encountered in this study will assist the clinicians in making improvement in management of nosocomial infections. [ABSTRACT FROM AUTHOR]