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Aims We described the presence of Helicobacter pylori (HP) and estimated the prevalence of primary and secondary resistance using molecular detection in gastric biopsies of Ecuadorian patients. Methods and Results 66.7% (238/357) of the patients demonstrated the presence of HP using CerTest qPCR. Of these, 69.79% (104/149) were without previous HP eradication treatment and 64.42% (134/208) with prior HP eradication treatment. The mutation-associated resistance rate for clarithromycin was 33.64% (primary resistance) and 32.82% (secondary resistance), whereas that in levofloxacin the primary and secondary resistance was 37.38% and 42%, respectively. For tetracycline and rifabutin, primary and secondary resistance was 0%. Primary and secondary resistance for metronidazole and amoxicillin could not be evaluated by genotypic methods (PCR and sequencing). Conclusions The analysis of mutations in gyrA, 23S rRNA and 16S rRNA is useful to detect bacterial resistance as a guide for eradication therapy following failure of the first-line regimen. Significance and Impact of the Study This study carried out in an Ecuadorian population indicates that the resistance of HP to first-line antibiotics is high, which may contribute to the high rates of treatment failure, and other treatment alternatives should be considered.

Aims To explore the in vitro ability of alpha haemolytic streptococcus (AHS) and lactobacilli (LBs), from Indigenous Australian children, to inhibit the growth of respiratory pathogens (Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis), also from Indigenous Australian children. Methods and Results The bacterial interference of 91 isolates, from Indigenous Australian children both with and without otitis media (OM) or rhinorrhoea, was investigated using agar overlay and cell-free supernatant. Promising isolates underwent whole genome sequencing to investigate upper respiratory tract tropism, antibiotic resistance and virulence. Antibiotic susceptibility was examined for ampicillin, amoxicillin +clavulanic acid and azithromycin. Differences in the strength of bacterial inferences in relation to OM was examined using a case series of three healthy and three children with OM. LBs readily inhibited the growth of pathogens. AHS were less effective, although several isolates inhibited S. pneumoniae. One L. rhamnosus had genes coding for pili to adhere to epithelial cells. We detected antibiotic resistance genes coding for antibiotic efflux pump and ribosomal protection protein. LBs were susceptible to antimicrobials in vitro. Screening for virulence detected genes encoding for two putative capsule proteins. Healthy children had AHS and LB that were more potent inhibitors of respiratory pathogens in vitro than children with OM. Conclusions L. rhamnosus from remote Indigenous Australian children are potent inhibitors of respiratory pathogens in vitro. Significance and Impact of Study Respiratory/ear disease are endemic in Indigenous Australians. There is an urgent call for more effective treatment/prevention; beneficial microbes have not been explored. L. rhamnosus investigated in this study are potent inhibitors of respiratory pathogens in vitro and require further investigation.

The treatment of refractory Helicobacter pylori remains challenging in clinical practice. Factors that should be considered in the treatment of refractory H. pylori infection include treatment length, dosage of antibiotics and proton pump inhibitors (PPIs), number of drugs, and the selection of appropriate antibiotics. Extending the treatment length of triple therapy and non-bismuth quadruple therapy to 14 days may increase the eradication rate compared with a shorter period (7 or 10 days). The use of a higher dose of PPIs or vonoprazan may also increase the efficacy of triple therapy. Four-drug therapy, including bismuth or non-bismuth quadruple therapies, usually achieve higher eradication rates than triple therapy. The addition of bismuth or metronidazole to levofloxacin-amoxicillin-PPI therapy may also increase the eradication rate. Therefore, four-drug therapies containing a higher dose of PPIs for 14 days are recommended in the third-line treatment setting for refractory H. pylori infection. The selection of appropriate antibiotics may be guided by susceptibility testing or empirically by medication history. Tailored therapy guided by susceptibility testing or genotypic resistance is recommended whenever possible. However, properly designed empirical therapy based on prior medication history (i.e., avoid the reuse of clarithromycin or levofloxacin empirically) is an acceptable alternative to tailored therapy after considering accessibility, cost, and the preference of the patient.

A 179-day-old calf, which was weak and stunted, showed neurological signs and was euthanized. Postmortem examination revealed extensive and severe cloudy area in the meninges, and pleural pneumonia. Gram-positive cocci were isolated from systemic organs. Biochemical and 16S rRNA gene sequence analyses identified the isolate as Streptococcus gallolyticus, and its subspecies was suggested to be gallolyticus (SGG). The isolate was classified as a novel sequence type (ST115) by the multilocus sequence typing scheme for SGG and showed susceptibility to penicillin, ampicillin, amoxicillin, florfenicol, sulfamethoxazole-trimethoprim, and chloramphenicol. Histopathologically, suppurative meningoencephalitis and perineuritis were detected. As SGG has been isolated solely from a cow with mastitis in Japan, this is the first SGG infection in a calf with suppurative meningoencephalitis and perineuritis in this country.

Objectives The aim of this study was to investigate the genomic epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in China to identify predominant lineages and their associations with clinical data and antimicrobial resistance profiles. Methods We performed a national prevalence study of patients with S. aureus infections in 22 tertiary hospitals in China from 2015 to 2017. Clinical data from patients and the antimicrobial phenotypes were collected for each isolate. Genome sequencing was performed on a proportion of isolates and a phylogenetic analysis was undertaken. Genotypic and phenotypic β-lactam susceptibilities were compared. Results A total of 1900 patients with S. aureus infections were included, of which 40% involved MRSA. Community-associated MRSA (CA-MRSA) infections were 24% of the total isolates. Genomic data showed that more than three-quarters of the MRSA were from three dominant lineages CC239 (25%, 116/471), CC5 (21%, 96/471) and CC59 (33%, 154/471) with CC59 accounting for more than half of the CA-MRSA isolates. Penicillin susceptibility genomic features were observed in 53% (251/470) of MRSA, including almost all of the CC59 (152/154) lineage, and 96% (242/251) of these isolates demonstrated in vitro susceptibility to penicillin or amoxicillin combined with clavulanic acid. Phylogenetic analysis indicated that the CC59 lineage can be divided into six lineages with all Asian CC59 isolates likely arising from an ancestral Mainland China lineage. Conclusions This study showed a high prevalence of CA-MRSA in China, largely due to the widespread presence of CC59. As almost all isolates in this lineage possess genetic variants leading to increased β-lactam susceptibility, we suggest that to improve antibiotic stewardship combinations of penicillins and β-lactamase inhibitors should be included in the antibiotic susceptibility testing panels used to inform treatment decisions and research undertaken on this combination therapy.

The objective of this study was to evaluate the effectiveness of common antibiotics against different microorganisms in apparently healthy cattle in Shandong province and its suburb. A total of 220 nasal swab samples were collected and cultured for bacteriological evaluation. All the bacteria isolates after preliminary identification were subjected to antibiogram studies following disc diffusion method. It was found in the study that E. coli is the most commonly associated isolate (21%), followed by Klebsiella spp. (18%), Pseudomonas aeruginosa (13%), Salmonella spp. (15%), Shigella spp (12%), and Proteus spp (11%). While the antibiogram studies reveled that highest number of bacterial isolates showed resistance to Ampicillin (95%), followed by Augmentin (91%), Cefuroxime (85%) and Tetracycline (95%) of (Escherichia coli and Klebsiella spp). In the case of pseudomonas spp. and Salmonella the highest resistance was showed by Ampicillin (90%) followed by Amoxicillin + Clavulanic Acid (80%), Cefixime (90%), and Erythromycin (80%). In Shigella spp and Salmonella spp highest resistance was showed by Amoxicillin, Ceftazidime, Augmentin (60%), and Amoxicillin + Clavulanic Acid (50%). It is concluded that in vitro antibiogram studies of bacterial isolates revealed higher resistance for Ampicillin, Augmentin, Cefuroxime, Cefixime, Tetracycline, Erythromycin, and Amoxicillin + Clavulanic Acid. The high multiple Antibiotics resistance indexes (MARI) observed in all the isolates in this study ranging from 0.6 to 0.9. MARI value of >0.2 is suggests multiple antibiotic resistant bacteria and indicate presence of highly resistant bacteria. Resumo O objetivo deste estudo foi avaliar a eficácia dos antibióticos comuns contra diferentes microrganismos em bovinos aparentemente saudáveis na província de Shandong e seus subúrbios. Um total de 220 amostras de esfregaço nasal foi coletado e cultivado para avaliação bacteriológica. Todos os isolados de bactérias após identificação preliminar foram submetidos a estudos de antibiograma seguindo o método de difusão em disco. Verificou-se no estudo que E. coli é o isolado mais comumente associado (21%), seguido por Klebsiella spp. (18%), Pseudomonas aeruginosa (13%), Salmonella spp. (15%), Shigella spp (12%) e Proteus spp (11%). Enquanto os estudos de antibiograma revelaram que o maior número de isolados bacterianos apresentou resistência à Ampicilina (95%), seguido por Augmentin (91%), Cefuroxima (85%) e Tetraciclina (95%) de (Escherichia coli e Klebsiella spp). No caso de Pseudomonas spp. e Salmonella, a maior resistência foi apresentada pela Ampicilina (90%) seguida pela Amoxicilina + Ácido Clavulânico (80%), Cefixima (90%) e Eritromicina (80%). Em Shigella spp e Salmonella spp, a maior resistência foi demonstrada por Amoxicilina, Ceftazidima, Augmentina (60%) e Amoxicilina + Ácido Clavulânico (50%). Conclui-se que estudos de antibiograma in vitro de isolados bacterianos revelaram maior resistência para Ampicilina, Augmentina, Cefuroxima, Cefixima, Tetraciclina, Eritromicina e Amoxicilina + Ácido Clavulânico. Os altos índices de resistência a antibióticos múltiplos (MARI) observados em todos os isolados neste estudo variaram de 0,6 a 0,9. O valor MARI de > 0,2 sugere várias bactérias resistentes a antibióticos e indica a presença de bactérias altamente resistentes.

The genus Helicobacter contains more than 35 species, Gram- negative microaerophilic bacteria, which colonizes the gastrointestinal tracts of humans and different animals. aim of work transfer to end of introduction to determine the susceptibility of H. pylori isolates to several antimicrobial agents to overcome the H. pylori treatment failure. For this purpose, 25stool sample from dog, 20 stool samples from cat and 75 stool samples from their human owners were collected for H. pylori infection. H. pylori was detected by culture in 36%, 20% and 41.3% of dog, Cat and human samples, respectively. Antimicrobial resistance of H. pylori in human, dog and cat to ceftazidime is100% .to amoxicillin is 76%, 100% and 100% respectively, to bacitracin is 88%, 100% and 100% respectively, to erythromycin is 80%, 100% and 100% respectively, to trimethoprim sulphate is 48%, 50% and 50% respectively, to doxycycline is 40%, 50% and 50% respectively, to levofloxacin is 24%, 50% and 50% respectively, to nitrofurantoin is 44%, 50% and 50% respectively. 9 stool samples were collected from human, dog and cat examined for presence of specific16s rRNA gene for H. pylori by nested PCR. The positive samples were subjected to Helicobacter genus- specific 16s r RNA gene sequencing.

Introduction: The resistance to antibiotics of Helicobacter pylori (H. pylori) is the main factor that affects current therapeutic treatments. The main objective of this study is to describe the pattern of antibiotic resistances in children with an infection due to H. pylori. Patients and methods: An observational, retrospective study was conducted from 2014 to 2019, which included patients between 5 and 17 years old, on whom a gastroscopy, with a gastric biopsy culture positive for H. pylori, and an antibiotic sensitivity study was performed. The antibiotic sensitivity studies were performed using an epsilometer (E-test). The cut-off points to define the resistances were those proposed by the European Committee on Antimicrobial Susceptibility Testing — EUCAST. The eradication study was performed using the 13C-urea breath test or the H. pylori monoclonal test in faeces 6–8 weeks after finalising the treatment. Results: The study included 80 patients (63.8% females), with a mean age of 11.9 years (SD ± 2.7 DS). Over one-third (38.8%) of the patients had received previous treatment for H. pylori. In the endoscopy, peptic ulcer lesions were observed in 10% of patients. More than two-thirds (67.5%) had resistance to at least one drug. 16.3% presented double resistance. The primary resistances were: clarithromycin, 44.9%, metronidazole 16.3%, levofloxacine 7.9%, and amoxicillin 2%. Patients that received treatment according to the new ESPGHAN 2017 guidelines had significantly higher eradication rates compared to those that received treatment according to previous guidelines (80% vs. 55.8%, P = 0.04). Conclusions: The high rate of H. pylori resistances, and as a result, the low eradication rates, are still a very important cause for concern. The first line treatment, when this is indicated must be given following the antibiotic sensitivity studies, and in the cases where these cannot be done or are not available, at least in accordance with the regional resistance rates. The correct application of the new guidelines significantly improves the eradication rate. Resumen: Introducción: Las resistencias antibióticas de Helicobacter pylori (H. pylori) son el principal factor que afecta a la eficacia de los regímenes terapéuticos actuales. El objetivo principal del estudio es describir el patrón de resistencias antibióticas en ni˜nos con infección por H. pylori. Pacientes y métodos: Estudio observacional retrospectivo de 2014 a 2019 en el que se incluyen pacientes entre 5–17 años a los que se realizó gastroscopia, con cultivo de biopsia gástricapositivo para H. pylori y estudio de sensibilidad a antibióticos. Los estudios de sensibilidad antibiótica se realizaron mediante E-test. Los puntos de corte para definir las resistencias fueron los propuestos por el EUCAST. El estudio de erradicación se realizó con test del aliento con urea marcada con C 13 o test monoclonal de antígeno de H. pylori en heces a las 6–8 semanas de finalizar el tratamiento. Resultados: Ochenta pacientes (63,8% mujeres). Media de edad 11,9 años (±2,7 DS). Un 38,8% habían recibido tratamiento previo para H. pylori. Un 10% presentaron en la endoscopia lesiones ulcerosas pépticas. El 67,5% presentaba resistencia al menos a un fármaco. Un 16,3% presentaron doble resistencia. Las resistencias primarias fueron: claritromicina 44,9%, metronidazol 16,3%, levofloxacino 7,9% y amoxicilina 2%. Los pacientes que recibieron tratamiento acorde a las nuevas guías ESPGHAN 2017 presentaron tasas de erradicación significativamente superiores en comparación con los que recibieron tratamiento acorde a las guías previas (80% vs. 55,8% p = 0,04). Conclusiones: La alta tasa de resistencias de H. pylori y, en consecuencia, las bajas tasas de erradicación, siguen siendo una preocupación muy importante. El tratamiento de primera línea, cuando esté indicado debe hacerse guiado por estudios de sensibilidad antibiótica y en los casos en el que no se puedan realizar o no estén disponibles, al menos de acuerdo con las tasas regionales de resistencia. La aplicación correcta de las nuevas guías mejora de forma significativa el nivel de erradicación.

Background Non-bismuth containing quadruple therapy (concomitant therapy) is an alternative treatment for Helicobacter pylori (H. pylori) eradication with increasing clarithromycin-resistant strains over times. This study compared the efficacies of non-bismuth containing quadruple therapy (concomitant therapy) in the treatment of first-line anti-Helicobacter Pylori between two time intervals (January 2013 to June 2014 and June 2016 to December 2017). Methods H. pylori-infected patients were recruited in the intention-to-treat (ITT analysis) and divided into EACM-A group (enrolled from January 2013 to June 2014, N = 98) and EACM-B group (enrolled from June 2016 to December 2017, N = 99). Patients were prescribed with 7-day esomeprazole 40 mg bid., clarithromycin 500 mg bid., amoxicillin 1 g bid. and metronidazole 500 mg bid. Ninety patients and 93 patients were analyzed in the per protocol (PP) analysis (8 and 6 patients lost follow-up in each group). Urea breath tests were performed 4–8 weeks thereafter. Results The eradication rates for EACM-A and EACM-B groups were 87.8% (95% confidence interval [CI] = 79.7%–93.5%) and 84.8% (95% CI = 76.2%–91.2%) (p = 0.55) in intention-to-treat (ITT) analysis; 95.6% (95% CI = 89.1%–98.8%) and 90.3% (95% CI = 82.4%–95.5%) (p = 0.17) in per protocol (PP) analysis. The adverse event rates were 16.7% vs. 10.8% in the 2 groups (p = 0. 0.24). The antibiotic resistance rates between the 2 groups were amoxicillin (0%), tetracycline (0%); clarithromycin (11.8% vs. 17.8%, p = 0.46); metronidazole (32.4% vs. 33.3%, p = 0.93) and levofloxacin (14.7% vs. 37.8%, p = 0.02). Conclusion The success rate of 7-days concomitant therapy encountered an approximately 5% decrease across 4-year time interval (2013–2017) with the changes of clarithromycin resistance from 11.8% to 17.8% in Taiwan.

BACKGROUND: The drug resistance of Helicobacter pylori in children is gaining more and more attention. METHODS: Polymerase chain reaction-reverse dot blot was used to analyze main virulence genes and drug resistance of H. pylori. RESULTS: (1) The main H. pylori vacA virulence genotypes were s1/m1 and s1/m2 in Jilin, China. There was no significant difference in H. pylori virulence genotypes between children and adults. (2) The resistance rates of H. pylori to clarithromycin, metronidazole, and levofloxacin were high, the resistance rate to tetracycline and amoxicillin were relatively low. The drug-resistance rate of clarithromycin in children was significantly higher than that in adults. The single drug-resistance rate of metronidazole in adults was significantly higher than that in children. (3) The mutation sites of clarithromycin resistance in H. pylori were mainly A2143G of 23S rRNA gene, G616A of rdxA gene in metronidazole, N81K and D91G/N/Y of gyrA gene in levofloxacin, T556S and N562D/Y of PBP1 gene in amoxicillin, AGA926-928TTC and AG926-927GT of 16S rRNA gene in tetracycline. There was significant difference in D91Y of gyrA gene in levofloxacin between children and adults. (4) In different groups, the drug-resistance rate of clarithromycin in male children was higher than that in male adults. The drug-resistance rate of clarithromycin in children with peptic ulcers was higher than that in adults. CONCLUSION: There are some differences in drug resistance of H. pylori between children and adults, which indicated us to pay attention to the infection of H. pylori in children.

O índice da resistência antimicrobiana (RAM) cresce progressivamente no mundo e acaba limitando a eficácia de tratamento de doenças comuns, como a infecção do trato urinário (ITU). Além disso, na atualidade, a RAM é apontada como um dos principais problemas de saúde pública. Diante do exposto, o objetivo do presente estudo foi avaliar a resistência bacteriana frente aos antibióticos orais mais comumente utilizados para o tratamento das ITU em pacientes ambulatoriais, bem como a identificação das bactérias isoladas. Foi realizado um estudo observacional experimental com abordagem quantitativa no período de janeiro a maio de 2019, desenvolvido em um hospital privado de alta complexidade localizado na cidade do Recife, PE. Foram incluídas no estudo todas as uroculturas positivas de pacientes adultos atendidos no ambulatório do referido hospital, onde foi utilizado, para a identificação bacteriana, o equipamento MALDI – TOF (Matrix Associated Laser Desorption-Ionization – Time of Flight). Foram analisadas um total de 379 amostras positivas de uroculturas, das quais 16 (4,2%) representavam espécies sem interesse clínico, pois obtiveram uma porcentagem de frequência muito baixa, bem como 327 (86,3%) pertenciam a três espécies de bactérias Gram-negativas: Escherichia coli (72,8%), Klebsiella pneumoniae (16,2%) e Proteus mirabilis (11%). Enquanto nas 36 (9,5%) amostras foram identificadas duas espécies Gram-positivas: Staphylococcus saprophyticus (66,7%) e Enterococcus faecalis (33,3%). Foi possível observar que o antibiótico oral com maior percentual de resistência foi o sulfametoxazol + trimetoprima com 24,5% seguido da ciprofloxacina com 22,1%, cefuroxima (16,7%), amoxicilina + clavulanato (13,0%) e nitrofurantoína (8,1%). De acordo com recomendação, é excluído o uso de antibióticos que apresentarem resistência acima de 20%, desta forma os únicos antibióticos por via oral que possui perfil terapêutico adequado para o tratamento empírico dos pacientes adultos com ITU na região do presente estudo são cefuroxima, amoxicilina + clavulanato e nitrofurantoína.

The purpose of this study was to evaluate the probiotic characteristics and safety and to study the antifungal activity of C. amycolatum ICIS 9 and C. amycolatum ICIS 53 against Candida spp. The probiotic potential and safety properties were assessed by standard parameters. Both strains showed good survival at pH 3 for 3 h and high tolerance to 0.3% bile salts after 4 h of incubation. The indicators of hydrophobicity, autoaggregation, and surface tension for ICIS 9 were 89.43% (n-hexane) and 73.96% (xylene) and ranged from 13.13 to 39.86% and 34.27 mN/m, respectively. For ICIS 53, they were 59.95% (n-hexane) and 45.68% (xylene), from 35.58 to 51.53% and 32.40 mN/m, respectively. The strains ICIS 9 and ICIS 53 exhibited varying levels of coaggregation with all eight examined bacterial pathogens. The ICIS 9 strain was resistant to amikacin, amoxicillin, clarithromycin, chloramphenicol, ciprofloxacin, and gentamycin. ICIS 53 was resistant only to ciprofloxacin. The cell-free supernatant of strains ICIS 9 and ICIS 53 showed good antimicrobial and antibiofilm activity against 10 pathogenic vaginal and intestinal isolates of Candida spp. The CFS of ICIS 9 was more active against intestinal isolates, and the CFS of ICIS 53 showed good antimicrobial activity against vaginal isolates while inhibiting the growth of 2 out of 5 Candida spp. isolated from the intestine. Both of the strains were capable of reducing the biofilm formation of Candida fungi. In the case of the vaginal isolates of C. krusei V1, the results showed that the inhibition levels of ICIS 9 and ICIS 53 were 36.75 and 11.4%, respectively. In the case of C. albicans (V2, V3, V7, and V8), the inhibition of biofilm formation was no more than 7.07%. ICIS 9 and ICIS 53 also significantly inhibited biofilm formation of C. krusei 2613 intestinal isolates by 42.75 and 41.87%, respectively, with ICIS 9 inhibiting biofilm formation of C. albicans (2607, 2311, 2615, and 2615) from 3.38 to 15.69% and ICIS 53 from 5.95 to 23.48%. None of the strains showed DNase, haemolytic, or gelatinase activities. The results obtained revealed that ICIS 9 and ICIS 53 have safe properties and have the potential to be developed as probiotics.

Bats play a very important role in the transmission of zoonosis, including Salmonella. Salmonella are responsible for salmonellosis, which is a major public health concern. They are the cause of many hospitalizations and deaths worldwide. The objective of this study was to contribute to the im-provement of the control of zoonotic strains of Salmonella in Benin. To do so, a collection of 400 bats was made and after slaughter and dissection, bacteriological analyses were made on the gut to isolate and identify the different strains of Salmonella carried by these bats. The resistance profile and the presence of specific virulence gene such invA, spvR, spvC and stn were studied. The strain Salmonella Typhimurium ATCC 14028 was used as a positive control. Of the 400 bats slaughtered, 14 isolate of Salmonella spp were identified by API gallery. Therefore, the prevalence of Salmonella strains in bats was 3.5%. Salmonella spp strains isolated showed total re-sistance to amoxicillin, clavulanic acid and also to first and second genera-tions of cephalosporins. The stn and invA genes have been found in the DNA of all strains of Salmonella isolated. The consumption of bats being a com-mon practice in Benin, the risk of virulent Salmonella strains transmission must be taken very seriously and people must be sensitized to this in order to slow down the risk of infection.

Vonoprazan (VPZ), a new potassium-competitive acid blocker, has been approved and used for Helicobacter pylori eradication in Japan. To date, many studies, as well as several systematic reviews and meta-analyses (MAs), have compared VPZ-based 7-day triple therapy with proton pump inhibitor (PPI)-based therapy. An MA of randomized controlled trials (RCTs) comparing first-line VPZ- with PPI-based triple therapy, the latter featuring amoxicillin (AMPC) and clarithromycin (CAM), found that approximately 30% of patients hosted CAM-resistant H. pylori; however, the reliability was poor because of high heterogeneity and a risk of selection bias. VPZ-based triple therapy is superior to PPI-based triple therapy for patients with CAM-resistant H. pylori, but not for those with CAM-susceptible H. pylori. An MA of non-RCTs found that second-line VPZ-based triple therapies were slightly (~2.6%) better than PPI-based triple therapies (with AMPC and metronidazole). However, the reliability of that MA was also low because of selection bias, confounding variables and a risk of publication bias; in addition, it is difficult to generalize the results because of a lack of data on antibiotic resistance. VPZ-based triple therapy (involving AMPC and sitafloxacin) was more effective than PPI-based triple therapy in a third-line setting, but a confirmatory RCT is needed. Non-RCT studies indicated that VPZ-based triple therapy involving CAM and metronidazole may be promising. Any further RCTs must explore the antibiotic-resistance status when evaluating the possible superiority of a potassium-competitive acid blocker.

Background Current guidelines recommend either ampicillin plus ceftriaxone (AC) or amoxicillin/ampicillin plus gentamicin (AG) with an equivalent class IB recommendation in Enterococcus faecalis endocarditis. However, previous observational studies suggest that AC might be favourable in terms of adverse events. Objectives To investigate whether AC is non-inferior to AG, and if it is associated with less adverse events. Methods In June 2021, a systematic literature search using the databases PubMed/MEDLINE, CDSR, CENTRAL, CCAs, EBM Reviews, Web of Science and LILACS was conducted by two independent reviewers. Studies were considered eligible if (P) patients included were ≥ 18 years of age and had IE with E. faecalis, (I) treatment with AC was compared to (C) treatment with AG and (O) outcomes on in-hospital mortality, nephrotoxicity and adverse events requiring drug withdrawal were reported. Odds ratios and 95% confidence intervals were calculated using random-effects models with the Mantel–Haenszel method, the Sidik–Jonkman estimator for τ2 and the Hartung–Knapp adjustment. Results Treatment with AC was non-inferior to AG, as depicted by no significant differences in-hospital mortality, 3-month mortality, relapses or treatment failure. Furthermore, AC was associated with a lower prevalence of nephrotoxicity (OR 0.45 [0.26–0.77], p = 0.0182) and drug withdrawal due to adverse events (OR 0.11 [0.03–0.46], p = 0.0160) than AG. Conclusions Treatment with AC was non-inferior to treatment with AG, and it was associated with a reduced prevalence of nephrotoxicity and drug withdrawal due to adverse events. Thus, combination therapy with AC appears favourable over AG in patients with E. faecalis IE. Graphical abstract

Background Antimicrobial resistance (AMR) in Helicobacter pylori is a global concern. The AMR data to inform the Australian Therapeutic Guidelines is based upon data over 20 years old. Aims To evaluate the frequency of antimicrobial resistance in H. pylori isolates from gastric biopsy specimens received in our laboratory in Melbourne, Australia To review the literature on resistance rates in Australia and compare historic data. Methods A retrospective, observational study summarising AMR rates in all H. pylori isolates from our laboratory from 2015 to June 2020. Setting Microbiology laboratory in metropolitan Melbourne, Australia, receiving referrals from private hospitals, gastroenterology clinics, and endoscopy suites. Outcome measures Population minimum inhibitory concentration distributions and frequency of resistance to clarithromycin, amoxicillin, metronidazole, and tetracycline in H. pylori isolates. Results 386 H. pylori isolates with susceptibility testing data were identified. The frequency of resistance in this cohort was: clarithromycin 89.9%, amoxicillin 23.5%, metronidazole 66.1%, and tetracycline 4.4%. Comparison with historical data may suggest increasing AMR rates in Australia. Main limitation is lack of treatment history to correlate AMR results. Conclusions Definitive conclusions from this cohort cannot be made, but trends suggest rising levels of primary H. pylori AMR rates in Australia. This has important implications for empirical treatment decision making and treatment outcomes. Primary H. pylori AMR requires dedicated studies and current Australian therapeutic guideline recommendations may require re-evaluation. We propose considerations for improving the management of H. pylori in Australia. A centralised public health approach to H. pylori AMR surveillance should be established. This article is protected by copyright. All rights reserved.

O elefante é um dos maiores mamíferos terrestres, são carismáticos e bastante populares em jardins zoológicos. Um exemplar de elefante-asiático (Elephas maximus), fêmea, adulta, mantido sob cuidados humanos, com idade aproximada de 60 anos, pesando aproximadamente três toneladas, apresentava claudicação dos membros locomotores, relutância em se movimentar e com histórico de pododermatite em membros anteriores e posteriores. Foram observadas lesões na planta da pata com presença de secreção purulenta, hipequeratose, erosões e áreas de necrose. Com auxílio de swabs estéreis, amostras das lesões foram enviadas ao laboratório para cultura e antibiograma. O resultado laboratorial apontou o crescimento bacteriano de Klebsiella sp e Citrobacter sp. O antibiograma revelou sensibilidade para os antiobióticos: amoxicilina e ácido clavulônico, cefalexina, enrofloxacina, gentamicina, neomicina e sulfametoxazol e trimetoprim.

BACKGROUND AND AIM Vonoprazan has more potent and sustained acid inhibitory effects than proton pump inhibitors; therefore, Helicobacter pylori eradication rates are expected to improve with the use of vonoprazan-based regimens. To date, no randomized trial has compared the efficacy of 7-day vonoprazan-based triple therapy (7-VAC) with 14-day omeprazole-based triple therapy (14-OAC). This study aimed to compare the H. pylori eradication rates of 7-VAC and 14-OAC. METHODS This randomized clinical trial was performed at a tertiary hospital in Bangkok. Patients with active H. pylori infection who were naive to treatment were included and randomized (1:1) into either a 7-VAC group (vonoprazan 20 mg bid. pc., amoxicillin 1000 mg bid. pc., and clarithromycin 500 mg bid. pc.) or a 14-OAC group (omeprazole 20 mg bid. ac., amoxicillin 1000 mg bid. pc., and clarithromycin 500 mg bid. pc.). Eradication success was evaluated by urea breath test 4-6 weeks after completion of treatment. RESULTS A total of 122 subjects were randomized to receive 7-VAC (n = 61) or 14-OAC (n = 61). The H. pylori eradication rates of the 7-VAC and 14-OAC groups were 96.7% and 88.5% (P = 0.083), respectively, by intention-to-treat analysis and 98.3% and 93.1% (P = 0.159), respectively, by per-protocol analysis. All treatment-related adverse events were mild and not significantly different between the two groups. Common side effects included bitter taste, nausea, and dizziness. CONCLUSIONS The 7-VAC regimen was well tolerated and achieved similar eradication rates and side effects to those of 14-OAC; therefore, 7-VAC may be considered an alternative regimen for H. pylori treatment with the benefit of shorter duration.

BACKGROUND The black spiny-tailed iguana (Ctenosaura similis) is an endemic animal in Mesoamerica, whose meat is consumed by the local population. OBJECTIVES Because the black spiny-tailed iguana may be potential reservoirs of pathogens, this study aimed to isolate and characterise Salmonella spp. in their meat commercialised in markets of the city of Leon, Nicaragua. METHODS Thirteen specimens were analysed for the isolation of Salmonella spp., as well as their antimicrobial resistance patterns, including the presence of genes encoding extended-spectrum β-lactamases. RESULTS Salmonella spp. isolates were found in eight out of 13 samples, with S. enterica serovar Enteritidis being found in six out of eight samples. Moreover, eight Salmonella spp. isolates were resistant to amoxicillin plus clavulanic acid and cephalexin, but sensitive to other tested antibiotics. The blaSHV gene was detected in seven out of eight Salmonella spp. isolates, followed by the blaTEM (two out of eight) and blaCXT-M (one out of eight) genes. CONCLUSIONS These findings represent an important contribution to the implementation of appropriate strategies to prevent foodborne diseases.

Introduction. To analyze the association between antibiotic pressure and the risk of colonization/infection by Acinetobacter baumannii complex (AB), evaluating both the individual and general prescriptions of antibiotics. Methods. This is an analytical, observational, case-control study on patients admitted to an Intensive Care Unit (ICU) during an AB outbreak (14 months). A five-year time series was constructed with the monthly incidence of cases of infection/colonization with strains of AB resistant to each antibiotic administered and with the monthly consumption of these antibiotics in the ICU. Results. We identified 40 patients either infected (23) or colonized (17) by AB and 73 controls. We found an epidemic multidrug-resistant clone of AB in 75% of cases. Risk factors associated with the development of AB infection/colonization were: greater use of medical instruments, the presence of a tracheostomy, cutaneous ulcers, surgical lesions and prior antibiotic therapies. The regression analysis of individual use of antibiotics showed that prior treatment with ceftazidime, ceftriaxone, amoxicillin/clavulanate, imipenem, levofloxacin, linezolid, and vancomycin was a risk factor for acquiring AB. ARIMA models showed that the relationship were greatest and statistically significant when the treatment occurred between 6 months (ceftazidime) and 9 months (imipenem and levofloxacin) prior. Conclusions. The dynamic and aggregate relationship between the incidence of infection/colonization by multidrug-resistant strains of AB and prior antibiotic treatment was statistically significant for intervals of 6 to 9 months.

Helicobacter pylori (Hp) infection is a chronic gram-negative bacterial infection, that infects the epithelium of the stomach. This prevalence is very high and varies depending on factors such as geographical location, ethnicity, age, and socioeconomic. The key management of Hp infection is accurate diagnosis and treatment. The H. pylori diagnostic examination consists of non-invasive and invasive tests, the most common non-invasive tests are serological tests, urea breath tests (UBT), and stool antigen tests, while invasive tests are rapid urease tests, histopathology, culture, and PCR. The goal of H. pylori eradication is to heal peptic ulcers and reduce the risk of gastric cancer. Eradication therapy that is recommended worldwide and used in Indonesia is the triple drug combination therapy consisting of a PPI, clarithromycin and amoxicillin or metronidazole for 14 days. The success of eradication therapy is highly dependent on the choice of therapeutic regimen, patient compliance in taking multi-drugs with possible drug side effects, and the sensitivity of H. pylori strains to the antibiotics consumed.

Antimicrobial resistance (AMR) emergence in commensal and pathogenic bacteria is a global health issue. House flies (Musca domestica) are considered as biological and mechanical vectors for pathogens causing nosocomial infections, including methicillin-resistant Staphylococcus aureus (MRSA). However, the prevalence of antimicrobial resistance and the role of temperature on the occurrence of Staphylococcus aureus and MRSA in house flies in a hospital environment have not been studied. A total of 400 house flies were collected in winter and summer from four hospital-associated areas in Mymensingh, Bangladesh. Detection of S. aureus and MRSA in flies was done by culturing, staining, and PCR methods targeting nuc and mec genes (mecA and mecC), respectively. Disc diffusion test was used to detect resistance phenotype against six antimicrobials. Logistic regression models were constructed to assess the effect of temperature on the frequency of antimicrobial resistance, and on the presence of the nuc and mecA genes, and location of samples in and around a hospital environment. By PCR, S. aureus was detected in 208 (52%) samples. High frequencies of resistance (≥ 80% of isolates) to amoxicillin, azithromycin, and oxacillin were observed by disk diffusion test. Increase in temperature had a positive effect on the occurrence of S. aureus and MRSA isolates as well as on their resistance to individual and multiple antimicrobials. Among the study areas, hospital premises had increased odds of having S. aureus. Increased temperature of summer significantly increased the occurrence of MRSA in house flies in and around the hospital environment, which might pose a human and animal health risk.

Multidrug resistance among Escherichia coli causing urinary tract infections (UTIs) and diarrhea are major public health problem worldwide which cause difficulty in treating the infections caused by Escherichia coli due to the high resistances. The study is aimed to determine the phenotypic and molecular detection of multidrug resistant E. coli isolated from clinical samples of patients attending selected Hospitals in Damaturu, Yobe State-Nigeria. Methods: Two hundred (200) clinical samples were collected aseptically from patient diagnosed with (100 stool samples) and UTI’s (100 urine samples) using sterile universal container. The samples were processed using standard microbiological methods for identification of E. coli. Samples were cultured on MacConkey agar (stool) and Cystine lactose electrolyte deficient agar (urine). The resulting colonies of isolates were further subculture on Eosin methylene blue agar for confirmatory and followed by gram stain, biochemical identification at Microbiology laboratory unit of Yobe State Specialist and Yobe State Teaching Hospital respectively. The antimicrobial susceptibility patterns were determined using Kirby-Bauer disc diffusion techniques and the phenotypic expression of extended spectrum beta-lactamases (ESBLs) were determined using modified double disc synergy test (MDDST) and also the three (3) resistance genes (blaTEM, accC1 and qnrA) were detected using polymerase chain reaction. Results: One hundred and twenty-two (122) isolates were resistant to antibiotics. The highest level of resistance was against amoxicillin (90.2%) while the least resistance was against sparfloxacin (24.3%). Thirty-seven (37) E. coli isolates shows MDR; the highest MDR was (24.3%) while least MDR was (5.4%). The PCR amplification of resistant genes (blaTEM, accC1 and qnrA) were detected on E. coli that shows positive ESBL and the bands were separated using agarose gel electrophoresis. Conclusion: The findings of this study show augmentin, ciprofloxacin and sparfloxacin are the most effective antibiotics against E. coli isolated from patients attending the two hospitals in Damaturu; who are diagnose with UTI and diarrheic infection. The resistant genes include; blaTEM, accC1 and qnrA coding for beta-lactam, aminoglycoside and quinolones were present in E. coli isolated from patients attending selected Hospitals in Yobe State, Nigeria. Keywords: Multidrug resistant, Escherichia coli, extended spectrum beta lactamase, resistance-associated genes, urinary tract infections, diarrheic.

Antibiotic resistance causes serious health problems associated with an increase in hospitalization time, treatment cost, and mortality. In this study, the contamination levels of antibiotic resistant bacteria were determined in the Saigon River, which is impacted by different anthropogenic activities in Ho Chi Minh City. Five target antibiotics were supplemented to the R2A medium at the concentration of amoxicillin (9.6 µg/ml) / clavulanic acid (4.8 µg/ml), amikacin (19.2 µg/ml), cefixime (1.2 µg/ml), ciprofloxacin (1.2 µg/ml), and trimethoprim (2.4 µg/ml)/ sulfamethoxazole (45.6 µg/ml). As the results, the antibiotic resistant bacteria were found in all the sampling sites and at the highest concentration at the sites impacted by wastewater from both industrial and residential activities. Enterobacteriaceae was the most abundant family with 23.8% of total isolates of the antibiotic resistant bacteria. Human opportunistic pathogens and pathogens such as Klebsiella pneumoniae (6.74%), Enterobacter sp. (4.15%), Escherichia coli (6.63%), Stenotrophomonas maltophilia (3.11%), Aeromonas Caviae (4.66%) were identified in all surface water samples. Correlation analysis suggested that the pollutions of dissolved salt, organic matter, and wastewaters may facilitate the antibiotic resistant bacteria in the aquatic environments.

The article deals with the treatment of Helicobater pylori infection. We consider the regimens, which are currently recommended for use and matched the recent data of evidence-based medicine. According to a survey conducted in 2015 in Ukraine, first-line quadruple therapy with the inclusion of bismuth subcitrate showed the effectiveness of more than 90 % in the Eastern and Central regions of the country; the superiority of bismuth-containing regimen over the standard one (89 and 55 % of the successful eradications, respectively) has been also demonstrated. This paper presents the results of research on the effectiveness of first-line anti-Helicobacter pylori therapy consisting of a proton pump inhibitor, clarithromycin, amoxicillin with the addition of colloidal bismuth subcitrate (De Nol) in patients at high risk of developing resistance to clarithromycin. In the group of patients at high risk of resistance to clarithromycin, addition to the standard triple therapy of colloidal bismuth subcitrate has led to an increase in the effectiveness of eradication by 22.1 %, which indicates the feasibility of colloidal bismuth subcitrate (De Nol) inclusion into the treatment regimen for this category of patients.

Objectives: This study aims to investigate the prevalence and antibiogram of Staphylococcus aureus and methicillin-resistance S. aureus (MRSA) in rabbits, rabbit handlers, and rabbitry environments in Terengganu. Materials and Methods: Swab samples from 183 rabbits (183 oral and 183 ear swabs), 45 rabbit handlers (45 oral and 45 nasal), and environmental (n = 180) samples from rabbitries were collected from 10 rabbit farms in Terengganu. The associated S. aureus isolates from the swabs were isolated using phenotypic microbiology tests. The bacteria were confirmed by polymerase chain reaction targeting nuc (S. aureus) and mecA (MRSA) genes. The antibiogram of all S. aureus isolates was determined using the Kirby–Bauer test. Results: Staphylococcus aureus was detected in 19% of rabbits, 26.7% of rabbit handlers, and 8.8% of swabs from the rabbitry environment. However, MRSA (0%) could not be detected. Antibiotic susceptibility test revealed that S. aureus from rabbits showed low resistance (

Tesfaye Belachew,1 Eyuel Mulusew,2 Yonas Tolosa,2 Zerihun Asefa,3 Haileleul Negussie,4 Teshale Sori4 1Epidemiology Unit, Asella Regional Veterinary Laboratory, Asella, Oromia State, Ethiopia; 2Department of Biomedical Sciences, College of Veterinary Medicine and Agriculture, Addis Ababa University, Bishoftu, Oromia State, Ethiopia; 3Veterinary Teaching Hospital, College of Veterinary Medicine and Agriculture, Addis Ababa University, Bishoftu, Oromia State, Ethiopia; 4Department of Clinical Studies, College of Veterinary Medicine and Agriculture, Addis Ababa University, Bishoftu, Oromia State, EthiopiaCorrespondence: Teshale SoriDepartment of Clinical Studies, College of Veterinary Medicine and Agriculture, Addis Ababa University, P.O. Box 34, East Shewa Zone, Bishoftu, Oromia State, Ethiopia, Tel +251 911 363-637Email teshalesori2002@yahoo.com; teshale.sori@aau.edu.etPurpose: Salmonellosis is a foodborne zoonoses found worldwide. The main purpose of this study was to isolate and identify Salmonella and assess their antimicrobial susceptibility profiles from smallhold broilers supply chains and slaughterhouses in Bishoftu and Modjo, central Ethiopia.Methods: Four smallhold broiler farms under the auspices of Chico Meat were selected randomly. Feed, water, and water- and feed-trough samples were collected from broiler farms, while cecal contents were collected from slaughtered chicken at Chico Meat slaughterhouse. Conventional bacteriological techniques were used to isolate and identify Salmonella from the samples. Kirby–Bauer disk diffusion was employed to assess the antimicrobial susceptibility of the isolates.Results: Salmonella was isolated from 131 (24.3%, 95% CI 20.74– 28.15) of the 539 samples tested. Salmonella was found in 43 of the 250 samples collected from Bishoftu (22%, 95% CI 17.02%– 27.65%) and 76 of the 289 samples collected from Modjo (26.29%, 95% CI 21.32%– 31.77%). Salmonella was isolated from 26.46% of the cloacal samples, 21% of the cecal contents, 30.77% of the feed samples, 25% of the water samples, 22.22% of samples from feed troughs, and 20% of samples from water troughs. The highest level of resistance (80.81%) was observed against tetracycline, followed by kanamycin (71.72%), chloramphenicol and amoxicillin (67.68%), sulfamethazole–trimethoprim (61.62%), naldixic acid (63.64%), and streptomycin (59.60%), whereas most of the isolates were susceptible to gentamicin (69.70%). Resistance to more than two drugs was also observed.Conclusion: Salmonella was found in high prevalence in broilers, their feed, and their environment. Moreover, a majority of the isolates were resistant to most antimicrobials used in medical and poultry practices. This has significant implications for public health and antimicrobial resistance.Keywords: antimicrobials, broilers, central Ethiopia, resistance, Salmonella, smallhold farms

BACKGROUND Kingella kingae is an important cause of septic arthritis in young children, with modern laboratory methods leading to increased detection. Prevalence of this pathogen in New Zealand, where there are high rates of childhood infections due to Staphylococcus aureus and Streptococcus pyogenes, is not known. METHODS We conducted a retrospective review of children

Antibiotic-induced dysbiosis of the microbial community has been associated with several gastrointestinal symptoms. The impact of repeated administration of Lacticaseibacillus rhamnosus GG (CNCM-I-4798) (formerly known as Lactobacillus rhamnosus GG), Saccharomyces cerevisiae boulardii (CNCM-I-1079) and their combination (associated in Smebiocta/Smectaflora Protect®) in supporting recovery of gut microbiota functionality and composition during and following amoxicillin:clavulanic acid administration was evaluated in vitro. Antibiotic dosage negatively affected SCFA production, coinciding with detrimental effects on Bacteroidetes, Firmicutes and Bifidobacterium spp. in the simulated proximal colon, while Akkermansia muciniphila was significantly reduced in the distal colon. L. rhamnosus GG and S. boulardii were able to thrive in both colon regions upon dosing, with S. boulardii even showing protective effects on the survival of L. rhamnosus GG during antibiotic administration. The impact of the probiotic strains on microbiome recovery revealed that supplementation with L. rhamnosus GG and/or S. boulardii resulted in a stimulating effect on the most abundant bacterial groups within the bacterial community of each donor. For one of the donors tested, co-dosing of L. rhamnosus GG and S. boulardii resulted in superior short-chain fatty acid recovery accompanied by a stronger increase in abundance of Bifidobacteriaceae. Overall, the current study provides first evidence that combined supplementation of L. rhamnosus GG and S. boulardii might be an interesting candidate in limiting detrimental effects of amoxicillin:clavulanic acid on the human gut microbiome, though further studies are warranted to confirm these findings.

BACKGROUND Antibiotic resistance to Helicobacter pylori (H. pylori) infection, which ultimately results in eradication failure, has been an emerging issue in the clinical field. Recently, to overcome this problem, an antibiotic sensitivity-based tailored therapy (TT) for H. pylori infection has received attention. AIM To investigate the efficacy and safety profiles of TT for H. pylori infection treatment compared to a non-bismuth quadruple therapy, concomitant therapy (CT) regimen. METHODS We included patients (> 18 years) with an H. pylori infection and without a history of Helicobacter eradication who visited the Gil Medical Center between March 2016 and October 2020. After being randomly assigned to either the TT or CT treatment group in 1 to 1 manner, patient compliance, eradication success rate (ESR), and patient-reported side effects profiles were assessed and compared between the two groups. H. pylori infection was diagnosed using a rapid urease test, Giemsa stain, or dual priming oligonucleotide polymerase chain reaction (DPO-PCR). Tailored eradication strategy based through the presence of a 23S ribosomal RNA point mutation. For the TT group, a DPO-PCR test, which detected A2142G and/or A2143G point mutations, and a clarithromycin resistance test were performed. Patients in the clarithromycin-resistant group were treated with a bismuth-containing quadruple combination therapy, while those with sensitive results were treated with the standard triple regimen. RESULTS Of the 217 patients with a treatment naive H. pylori infection, 110 patients [mean age: 58.66 ± 13.03, men, n = 55 (50%)] were treated with TT, and 107 patients [mean age: 56.67 ± 10.88, men, n = 52 (48.60%)] were treated with CT. The compliance (TT vs CT, 100% vs 98.13%, P = 0.30), and follow-up loss rates (8.18% vs 9.35%, P = 0.95) were not significantly different between the groups. The ESR after treatment was also not statistically different between the groups (TT vs CT, 82.73% vs 82.24%, P = 0.95). However, the treatment-related and patient-reported side effects were significantly lower in the TT group than in the CT group (22.77% vs 50.52%, P < 0.001). CONCLUSION The DPO-based TT regimen shows promising results in efficacy and safety profiles as a first-line Helicobacter eradication regimen in Korea, especially when physicians are confronted with increased antibiotic resistance rates.

International audience; To characterize Lyme arthritis, with a focus on management, and outcome. Observational retrospective multicentre study in Western France, of all consecutive cases of Lyme arthritis, documented by Borrelia burgdorferi IgG on ELISA serological testing, confirmed by Western blot, with or without positive Borrelia PCR in synovial fluid, with no alternative diagnosis. We enrolled 52 patients (29 males), with a mean age of 43 +/- 19.4 years. Most patients had monoarthritis (n = 43, 82.7%), involving the knee (n = 51, 98.1%), with a median delay between symptoms onset and Lyme arthritis diagnosis of 5 months (interquartile range, 1.5-8). Synovial fluid analysis yielded median white cell count of 16,000/mm(3) (9230-40,500), and positive PCR in 16 cases (39%), for B. burgdorferi sensu stricto (n = 5), B. garinii (n = 5), B. afzelii (n = 3), and undetermined (n = 3). All patients received antibiotics, for a median duration of 28 days (21-30), with doxycycline (n = 44, 84.6%), ceftriaxone (n = 6, 11.5%), or amoxicillin (n = 2). Twelve patients (23.1%) also received intra-articular injection of glucocorticoids as first-line treatment. Of 47 patients with follow-up, 35 (74.5%) had complete resolution of Lyme arthritis. Lyme arthritis in Western Europe may be due to B. burgdorferi ss, B. afzelii, or B. garinii. Clinical presentation is similar to Lyme arthritis in North America (i.e. chronic knee monoarthritis), with low sensitivity of synovial fluid PCR (39%).

Objective. To characterize the profiles and genetic determinants of antibiotic resistance in pathogens of community-acquired urinary tract infections (UTI) in women of reproductive age in St. Petersburg (Russia).Materials and methods. The study included strains of microorganisms obtained from 145 women of reproductive age with diagnosed with a UTI. Antibiotic susceptibility was evaluated by disk diffusion method; the interpretation of the results was carried out in accordance with the EUCAST criteria. Strains of uropathogenic enterobacteria were tested by PCR for the presence of beta-lactamase genes: beta-lactamase genes encoding enzymes of the AmpC group (MOX, CMY, LAT, BIL, DHA, ACC, MIR, ACT, FOX), TEM, SHV, OXA‑1, ESBL genes of the CTX–M group, genes of carbapenemases (KPC, OXA‑48) and metal-beta-lactamases (VIM, IMP, NDM).Results. Most cases (81 %) of UTIs in women in St. Petersburg were due to enterobacteria, with Escherichia coli highly prevailing (66 %). Fosfomycin, meropenem and nitrofurantoin had the highest in vitro activity against uropathogenic Enterobacteriaceae. High rates of resistance to betalactam antibiotics were found (from 16 % to cefotaxime to 28 % to amoxicillin/clavulanic acid). The genes of TEM-beta-lactamases were found in 31 isolates (26.7 %), SHV – in 17 (14.6 %), CTX–M type – in 15 (12.9 %), DHA – in 2 (1.7 %). The other beta-lactam resistance genes (MOX, CMY, LAT, BIL, ACC, MIR, ACT, FOX, KPC group, OXA-like group, VIM, IMP, NDM) were not detected.Conclusion. Microbiological and molecular analysis of the structure of beta-lactam resistance is important for the effective of epidemiological control of antimicrobial resistance in pathogens causing urinary tract infections.

Aim. To study the efficacy and safety of a two-week bismuth-based quadruple of Helicobacter pylori (Hp) infection with the inclusion of a probiotic Bifiform. Materials and methods. An open prospective comparative randomized study included 68 Hp-positive patients: 22 with a confirmed diagnosis of peptic ulcer disease, 46 with chronic gastritis, gastroduodenitis and erosions in the pylorobulbar zone. The diagnosis and Hp infection were verified by the results of endoscopic and morphological studies, as well as using the 13C-urease breath test and determination of the Hp antigen in the feces. Depending on the therapy, the patients were randomized into 2 groups: the main group was taken 2 times a day for 14 days omeprazole 20 mg + amoxicillin 1000 mg + clarithromycin 500 mg + bismuth tripotassium dicitrate 240 mg + Bifiform 2 capsules 2 times a day; control similar therapy was carried out, but without the inclusion of Bifiform. Repeated testing for Нр was carried out one month after the termination of the course of treatment. Results. When using bismuth-containing quadruple, a high frequency of Hp eradication was noted, which in the ITT analysis was 86.1 and 68.8% (p0.05) and in the PP analysis it was 93.9 and 95.7% (p0.05) in patients of the main and control groups, respectively. Side effects of drug therapy were detected in 16.7 and 43.8% (p0.05), which was the reason for the early termination of therapy as a result of their development in 5.6 and 28% (p0.05) in patients of the main and control groups, respectively. The inclusion of the probiotic Bifiform in the eradication triple therapy of Hp infection reduced the frequency of detection of colonic dysbiosis from 27.8 to 3.6% and had a positive effect on the indices of local immunity (increased content of plasma cells in the inflammatory infiltrate and a stable level of secretory immunoglobulin A in coprofiltrate). Conclusion. A prospective, comparative, randomized study has shown that when using a two-week bismuth-based quadruple the eradication rate exceeds 90%. The inclusion of Bifiform in the eradication scheme dramatically reduces the frequency of adverse events and increases patient compliance, and also maintains the protective factors of the gastrointestinal mucosa at a higher level.

Background: Helicobacter pylori (H. pylori) infection is the most common cause of peptic ulcer disease and it can be associated with many complications, including malignancies. In clinical practice, some clinicians may use Clavulanic Acid (CA) in combination with amoxicillin or other beta-lactams as an addition to the standard treatment regimens. This practice may be done by habitual mistake, non-evidence based hypothetical assumptions, or by prescribing it as an alternative treatment. This review aims to expose the effect of CA against H. pylori infection and to review the possible mechanisms that may contribute to that effect. Methods: A PubMed and Google Scholar literature search was obtained on both pre-clinical and clinical studies related to CA and H.pylori infection. Results: Available clinical studies showed improvement in the eradication of H. pylori by about 10- 20% when CA was added to the treatment regimens. This effect for CA could be related to several mechanisms including inhibition of H. pylori growth by binding to Penicillin-Binding Proteins (PBPs), the transformation of H. pylori from the active filamentous form into coccoidal form, induction of the release of dopamine, modulation of immunological response towards H. pylori infection and its relationship with other microbiota. Randomized-controlled studies on patients with resistance to H. pylori are needed. Moreover, in vitro studies to evaluate the mechanisms by which CA may influence H. pylori are warranted. Conclusion: The presented literature suggests potential avenues for the use of CA in the management of peptic ulcer disease and H.pylori infection.

Background: Escherichia coli and Klebsiella pneumoniae are commonly implicated in urinary tract infections accounting for majority of the antimicrobial resistance encountered in hospitals. Objectives: To determine the prevalence and antimicrobial susceptibility of extended-spectrum beta-lactamases (ESBLs) producing E. coli and K. pneumoniae among patients in Anyigba, Nigeria. Methods: This hospital-based cross-sectional study was conducted using urine samples from 200 patients of Grimmard Catholic hospital and Maria Goretti hospital. Urine samples were processed to identify ESBL-producing E. coli and K. pneu- moniae using standard microbiological techniques. Isolates were then tested against antimicrobial agents. Results: A total of 156 bacterial isolates were recovered consisting 128 of E. coli and 28 of K. pneumoniae. Extended spec- trum beta-lactamases production was observed in 69% of E. coli and 31% of K. pneumoniae. These pathogens were resistant to 3 or more antibiotics. Of the antimicrobials tested, cefotaxime demonstrated the highest rates of resistance (100%) for both ESBL-producing E. coli and K. pneumoniae. Fifty-four isolates of ESBL-producing E. coli showed a high level of resist- ance to amoxicillin clavulanic acid (83.3%), ciprofloxacin (83.3%), and ceftazidime (79.6%). ESBL-positive K. pneumoniae iso- lates were highly resistant to ciprofloxacin (75%), and amoxicillin clavulanic acid (83.3%). Cefoxitin (62.5%) and gentamicin (66.7%) showed substantially higher rates of resistance against these isolates while all 24 strains were resistant to imipenem. Conclusion: This study indicated the prevalence of ESBL-positive Gram-negative pathogens in these study sites and also demonstrated their resistance to a few antibiotics. This highlights the need for new antimicrobials that are potent and im- proved policy on use of antibiotics. Keywords: Antibiotic resistance; ESBLs; Escherichia coli; Klebsiella pneumoniae; Anyigba.

We present the case of a patient with a voluminous cerebral abscess caused by Aggregatibacter aphrophilus and Actinomyces meyeri occurring a week post dental scaling. Both these bacteria are rarely involved in brain abscesses, and so far, cases of cerebral actinomyces have mostly been treated surgically and with intravenous (IV) antibiotics for 3–4 months, then put on oral antibiotic therapy with penicillin or amoxicillin for a further 3–12 months. Our patient underwent drainage through craniotomy and was subsequently put on intravenous ceftriaxone for 3 months accompanied by brain imaging control at the end of this period which showed complete regression of the abscess. Following parenteral treatment, no oral antibiotics were given since pharmacokinetic properties do not allow to attain high tissue concentration in the brain. This treatment gave excellent results.

Aim This study aimed to investigate the occurrence of antibiotic resistance phenotype and simultaneously understand its genetic basis in Escherichia coli isolated from the cloacal swabs of commercial chickens from north India. Methods and results Escherichia coli isolates were assessed for susceptibility to 14 different antibiotics using the disc-diffusion technique and were screened for the presence of 22 antibiotic resistance genes (ARGs) by employing PCR. Isolates were found to be highly resistant to fluoroquinolones (nalidixic acid 91%, norfloxacin 73% and ciprofloxacin 66%), tetracycline (71%), beta-lactams (ampicillin 49% and amoxicillin/clavulanic acid 37%), co-trimoxazole (48%), streptomycin (31%) and chloramphenicol (28%); and comparatively less resistant to cefazolin (13%), amikacin (10%), aztreonam (4%), gentamicin (4%) and ceftriaxone (3%). Sixty-three percent of isolates were resistant to more than four different drugs. Abundance of plasmid-borne ARGs like tetA (83%), sul3 (44%), aadA1 (44%), strA (43%), strB (41%), qnrS (38%), sul2 (28%) and aac(6)-Ib-cr (15%) was observed among the isolates. Forty-five percent of isolates possessed more than five different ARGs. Quinolone resistance-determining region (QRDR) mutations within gyrA and parC genes were found to be the major determiners of quinolone resistance. QRDR mutations included leu83, asn87 and gly87 within gyrase-A polypeptide and ile80 and lys84 within topoisomerase IV (encoded by parC). Conclusions Our findings suggest the abuse of antibiotics as feed additives and prophylactic drugs in Indian poultry sector. It also projects this industry as an active hotspot for the replication and selection of ARGs. Significance and impact of the study Our findings would provide evidence to the authorities for formulating effective strategies for restricting antibiotic usage as non-therapeutic agents in food animals. Occurrence of both plasmid-borne and chromosome-borne resistance towards quinolones can drive movement of resistance phenotype across bacterial species and vertical movement of resistance along the bacterial generations, respectively, which can pose mitigation challenges.

Purpose: This case report outlines the successful eradication of chronic Helicobacter pylori ( H. pylori) infection using a novel, “high-dose quad” salvage therapy approach. Gastroenterologists may consider using this approach for patients who have previously failed first- and second-line treatment regimens, as recommended by the American College of Gastroenterology (ACG). Summary: H. pylori infection is associated with multiple chronic gastrointestinal diseases, and patients who test positive for H. pylori should undergo treatment until eradication is achieved. Unfortunately, increasing antibiotic resistance to clarithromycin, metronidazole, and levofloxacin makes eradication of H. pylori challenging. This case describes an 84-year-old American woman with chronic H. pylori gastritis who failed two first-line treatment regimens (bismuth quadruple therapy and concomitant therapy), but responded to a novel, “high-dose quad” salvage regimen consisting of high-dose levofloxacin, amoxicillin, metronidazole, and high-dose acid suppression. Conclusion: This is the first time the “high-dose quad” regimen has been reviewed in the literature and is not FDA approved, but may be considered as an alternative salvage therapy in certain patients, based on the efficacy and safety observed in this case.

Aims Elimination of microorganisms and prevention of recurrence of infection from the complex root canal system of primary teeth requires an obturating material with broad antimicrobial activity. Hence, the purpose of the study is to assess and compare the antimicrobial efficacy of Triclosan, Amoxicillin and Eugenol individually and in combinations against a resistant microorganism viz., Enterococcus faecalis. Materials and methods A two-fold serial dilution method was used to check the minimum inhibitory concentration (MIC) of triclosan, amoxicillin and eugenol against thirty E. faecalis (isolated from oral lesions). The resistant strains were subjected to different combinations of three agents by modified checkerboard method. MIC was determined after incubation for 24 hours at 370°C. Then the three dilutions from MIC were inoculated on BHI agar plates and incubated overnight to determine minimum bactericidal concentration (MBC). Results The mean MIC and MBC of triclosan was 3.43 μg/mL and 3.75 μg/mL respectively. Whereas for amoxicillin, it was 3.43 μg/mL and 3.85 μg/mL. Eugenol did not show any inhibition up to a concentration of 3200 μg/mL. In combination, eugenol showed good synergistic effect with both triclosan and amoxicillin. In combination with triclosan, eugenol showed much promising result as compared with amoxicillin. But triclosan and amoxicillin combination showed inhibition at higher concentrations. Conclusion Triclosan and eugenol combination showed better effectiveness against E. faecalis in comparison to amoxicillin and eugenol. Triclosan and amoxicillin showed antagonism when used in combination against E. faecalis. How to cite this article Gowda J, Tavarageri A, Kulkarni R, et al. Comparative Assessment of the Antimicrobial Efficacy of Triclosan, Amoxicillin and Eugenol against Enterococcus faecalis. Int J Clin Pediatr Dent 2021;14(1):59-62.

Hemorrhagic gastroenteritis is a potentially fatal disease especially in untreated animals. Total samples of 202 rectal swabs collected from dogs and cats were subjected to bacteriological examination. One hundred four bacterial isolates were identified from the total 202 examined samples. The identified bacterial isolates were E. coli (46; 44.23%), Proteus species (22; 21.15%), Klebsiella species (9; 8.65%), C. perfringens (5; 4.80%), Enterobacter species (4; 3.84%), Pseudomonas aeruginosa (4; 3.84%), Salmonella species (3; 2.88%), Shigella species (3; 2.88%); Citrobacter species (2; 1.92%), Providencia rettgeri (2; 1.92%), Serratia liquefaciens (1; 0.96%), Hafnia species (1; 0.96%), C. bifermentans (1; 0.96%), C. putrefaciens (1; 0.96%). Serological identification for some E. coli isolates revealed that EHEC strains represent (12/26, 46.15%), EPEC (9/26, 34.61%), ETEC (4/26, 15.38%) and EIEC (1/26, 3.85%). Serotyping of Salmonella isolates detected S. Typhymurium, S. Heidelberg and S. Infantis. In case of canine E. coli isolates, resistance was recorded against amoxicillin/clavulanic acid, cephalexin, ceftriaxone, tetracycline, erythromycin and trimethoprim/sulphamethoxazole. Moderate resistance was recorded among feline E. coli isolates to amoxicillin/clavulanic acid, tetracycline and trimethoprim/ sulphamethoxazole. Salmonella isolates were highly resistant to amoxicillin/clavulanic acid, cephalexin, erythromycin, tetracycline and trimethoprim/sulphamethoxazole. In experimentally infected puppies with S. Typhymurium, histopathological examination showed necrosis in the tips of the villi and leukocytic infiltration in the submucosa of the jejunum, degeneration and fibrosis of the liver. In experimental salmonellosis in cats, histopathological examination showed coagulative necrosis in the tips of the villi of the jejunum and multifocal necrosis in the liver. In experimental E. coli infection in cats, histopathological examination showed ulceration and necrosis of the small intestine. The liver showed congestion of the blood vessels and fibrosis around the hepatic areas.

Background: The problem of antibiotic resistance has become worldwide health issue among hospitalized patients in developing countries, where the inappropriate usage of antibiotics is common. The widespread occurrence of multidrug resistant strains (MDRS) of Escherichia coli (E. coli) and klebsiella pneumoniae (K. pneumoniae) is currently considered avital medical challenge. The identification of ESβL genes and their MDRS in widely isolated uropathogens may provide a helpful tool for choosing effective antibiotic therapy and clinical improvement. Objective: The aim of this study is to determine the prevalence of (bla.TEM, bla.CTX-M, and bla.SHV) β-lactamase DNAs in E. coli and K. pneumoniae, and MDRS of uropathogens E. coli and k. pneumoniae isolated from patients urine UTI diagnosed who were admitted to the Urology & Nephrology Center. Methodology: Clinical E. coli and K. pneumoniae isolates were isolated from urine specimens of UTI diagnosed patients. Microbiological techniques were utilised to identify the isolates. Antibiotics susceptibility analysis was done utilising the Vitek2 system (bioMérieux, Marcy l’Etoile, France). The double disc diffusion technique (DDDT) was used for detecting phenotypic ESBL in isolates. Using the traditional PCR technique, the ESBL genes were identified. Results: Antibiotic resistance of E. coli’s isolates to commonly used antibiotics was high (88.2% resistant to Amoxicillin/clavulanate, 83.5 % were resistant to Trimethoprim-sulfamethoxazole) while minimum resistance appeared against Amikacin (AK) 10.5% and Imipenem (IP) 14%. For isolates of K. pneumoniae, the resistance was higher for nitrofurantoin, ceftazidime, cefotaxime, ciprofloxacin 96.6%, 83.3 %,83.3%, 80% respectively .In our study, out of 115 isolates, E. coli and K. pneumoniae isolates, 81 (70.43%) were phenotypically positive for ESβL by Combination Disc Test (CDT). The most commonly molecularly detected ESBL genes were TEM 80% of K. pneumoniae isolates and 77.6% of E. coli isolates .followed by SHV 70% of K. pneumoniae isolates and 34.1% of E. coli isolates and finally, CTXM 67% of isolates of E. coli and 63.3% of isolates of K. pneumoniae. Conclusions: The current study concluded that a high rate of resistance has been developed in uropathogens with empiric antibiotic treatment. It emphasized the alarming role of β-lactamases, especially ESßLs in antibiotic

Background: The utilization rate of different treatment regimens for Helicobacter pylori infection is believed to be high; however, the cost-effectiveness of these regimens has not been examined before. Therefore, the aim of this study was to examine the cost-effectiveness of the two commonly prescribed treatments for H. pylori infection. Methods: The data of an open-label, single-center, randomized trial that compared the efficacy of sequential therapy (SQT) (i.e., esomeprazole 20 mg twice daily for 10 days, amoxicillin 1000 mg twice daily for 5 days, then clarithromycin 500 mg and tinidazole 500 mg twice daily for 5 days) to standard triple therapy (STT) (i.e., esomeprazole 20 mg, amoxicillin 1000 mg, and clarithromycin 500 twice daily for 14 days) in the eradication of H. pylori, as confirmed by the negative urea breath test (UBT), were used. Propensity score matching bin bootstrapping, with 10,000 replications and bias correction was conducted to generate the 95% confidence limits. Moreover, probabilistic sensitivity analysis was conducted by varying both the eradication rates and the costs of treatment regimens. Results: There were 82 and 88 patients who were on SQT and STT, respectively. Patients' mean age was 47 years, and approximately 55% of them were females. The mean treatment costs were SAR 2,075.51 (USD 553.47) and SAR 2,629.26 (USD 701.14) for SQT and STT, respectively. The mean eradication rates for SQT and STT were 63.41% and 67.05%, respectively. The mean difference in costs and eradication rates for SQT versus STT were SAR − 550.75 (95% CI: −563.84- −537.69) and − 3.64% (95% CI: −6.98- 5.88). The use of SQT was more likely to be cost saving and more effective with 56.25% confidence level, in comparison to STT. Conclusion: The use of SQT in the treatment of H. pylori seems to be more cost-effective than STT.

Purpose To determine the efficacy of a potassium-competitive acid blocker (P-CAB)-based first-line eradication therapy with bismuth compared with that of proton pump inhibitor-based first-line therapy with bismuth. Materials and methods Eradication-naive H. pylori-infected patients were consecutively enrolled from January to November 2020. Before approval of the P-CAB-based eradication therapy, twice daily administration of a regimen containing lansoprazole 30 mg, amoxicillin 1 g, clarithromycin 500 mg, and bismuth potassium citrate 300 mg was prescribed for 7 days. After approval, lansoprazole was replaced with tegoprazan (50 mg). Clarithromycin resistance was examined in patients who underwent gastroscopic biopsy at our center. Efficacy was assessed via the 13C-urea breath test. Results Of the 381 eradication-naive patients, eradication was successful in 88.3% (151/171) treated with tegoprazan and 82.8% (140/169) treated with lansoprazole in per-protocol analysis (p=0.151). In intention-to-treat analysis, eradication rates were 78.8% (152/193) in the tegoprazan and 74.5% (140/188) in the lansoprazole group (p=0.323). Clarithromycin resistance was observed in 30 (20.1%) of the 148 patients (74 from each group), and only four of the 16 clarithromycin-resistant patients in the tegoprazan group achieved successful eradication. Clarithromycin resistance [odds ratio (OR)=42.1, 95% confidence intervals (CIs)=12.6-141.0] and poor patient compliance (OR=17.1, 95% CIs=1.6-189.1) were independent risk factors for eradication failure. Conclusion In eradication-naive patients, eradication success rates for 7-day first-line triple therapy regimen exceeded 82% with bismuth administration. In clarithromycin-resistant patients, neither tegoprazan 50 mg nor lansoprazole 30 mg achieved acceptable eradication rates when administered twice daily for 7 days.

Introduction Helicobacter pylori eradication therapy requires a complex prescribing schedule combining clarithromycin, amoxicillin, and a proton-pump inhibitor (PPI) or potassium-competitive acid blocker (P-CAB, vonoprazan). To reduce the burden of complex prescribing and increase adherence, a vonoprazan triple-drug blister pack comprising all three medications was launched in June 2016. This study aimed to assess the impact of the combination blister pack on eradication success rate in Japan immediately after launch. Methods We performed an interrupted time series analysis using a large administrative claims database of 7,300,000 insured individuals. We identified 36,570 patients who received first-line clarithromycin triple therapy from June 2015 to May 2016 (prelaunch) and 35,721 who received the same therapy from July 2016 to June 2017 (post-launch). The primary outcome was the success rate of clarithromycin triple therapy and the secondary outcomes were proportion of vonoprazan use and proportion of combination blister pack use. Results The success rate of clarithromycin triple therapy increased by 2.44% (95% confidence interval [CI] 1.36–3.52; P

Edwardsiella tarda is a common fish pathogen, causing significant septicemic diseases in fish. This study was carried out to investigate prevalence of E. tarda among Tilapia zilli at EL manzla lake, Dakahlia governorate and characterize the isolates phenotypically and genotypically in addition to detection of multi-drug resistance genes (B-lactames genes and plasmid-mediated quinolone resistant genes by PCR assay. Therefore, (100) samples of Tilapia zilli collected from different localities. Fish samples were subjected to clinical and post-mortem examination then bacteriological examination from liver, kidney and spleen. The suspected isolates were characterized by cultural and morphological characters, some conventional biochemical tests and API 20E system then by PCR assay. Eighteen % isolates were characterized as E. tarda. Furthermore, detection of antimicrobial resistance genes by PCR, the recovered isolates harbored blaSHV and blaOXA-1 with a prevalence of 50% and 25%, respectively with no detection of aac (6′)-Ib-cr and qepA genes in examined isolates. The results of antibiotics sensitivity showed resistance to Nalidixic acid, Lincomycin, Amoxicillin and Norfloxacin and most of isolate were found to be sensitive to Florfenicol and Neomycin.55.6% of recovered isolates showed resistance to three antibiotic classes and 27.7% of recovered isolates showed resistance to four antibiotic classes and considered as MDR. The emergence of MDR-strains represents a threat-alarm and PCR is very rapid method for identification of E. tarda isolates which may be helpful in control of Edwardsiellosis.

The study was applied on 175 random samples of milk and milk products collected from different shops (35 of each), at Kaliobia governorate, Egypt, for detection the propagation of Y. enterocoliticastrains in these samples, beside the phenotypic characterization and detection of some antibiotic resistant virulence genes in them.The results gained from these samples by bacteriological examination represent19 (10.9%) Y. enterocolitica biotypes 1Aand 1B only isolates from 175 samples, from milk and Kareish cheese samples (5/14.3% for each ),(4/11.4%)white cheese,(3/8.6%) ice cream, and(2/5.7%) from yoghurt samples.The antibiotic sensitivity profile showed that, the isolated Y. enterocoliticawere very high resistant for Penicillin-G followed by methicillin, ampicillin,oxytetracycline,amoxicillin, ampicillin, streptomycin and erythromycin. Meanwhile, they were highly sensitive to meropenem and norfloxacinfollowed by gentamycin,ciprofloxacin, cefotaximeand florphenicol. PCR declared thatblaTEM andtetAgenes were detected in all eight studied Y. enterocoliticaisolates. So, it was concluded that,the presence of antimicrobial resistant Y. enterocolitica strains in dairy products could be a public health concern for the consumers.

Antimicrobial resistance patterns among different Escherichia coli isolates in the Kingdom of Saudi Arabia. This study aimed to investigate the patterns of antimicrobial resistance in E. coli isolated from different samples, and to identify potential pathogenic isolates in Riyadh, Kingdom of Saudi Arabia (KSA). In total, 51 bacterial isolates were recovered from 113 samples of human urine, food (raw meat, raw chicken, raw egg surface, and fresh vegetables), water, and air. Twenty-four E. coli isolates were tested for susceptibility to 26 antibiotics. The air sample isolates were most resistant to amoxicillin, ampicillin, amoxicillin/clavulanic acid, amoxicillin/sulbactam, piperacillin/tazobactam, cefalotin, cefuroxime, cefoxitin, cefixime, nitrofurantoin, and trimethoprim/sulfamethoxazol. The isolates from vegetable samples were resistant to amoxicillin, ampicillin, amoxicillin/clavulanic acid, amoxicillin/sulbactam, cefalotin, cefuroxime, cefoxitin, and cefixime. By contrast, the isolates from the water samples were resistant only to amoxicillin and ampicillin. The isolates from the human urine samples were most frequently resistant to norfloxacin (80%) followed by amoxicillin and ampicillin (70%), trimethoprim/sulfamethoxazole (55%), ciprofloxacin and ofloxacin (50%), cefalotin (30%), cefuroxime, cefixime and cefotaxime (25%), ceftazidime, ceftriaxone, cefepime and aztreonam (20%), amoxicillin/clavulanic acid, piperacillin/tazobactam and gentamicin (10%), and amoxicillin/sulbactam and cefoxitin (5%). Almost all (23/25, 95.8%) (n = 23) of the isolates were multi-drug resistant (MDR) (i.e., resistant to 3 or more classes of antibiotics), and 16.7% (n = 4) of those were positive for extended spectrum β-lactamase (ESBL). Of the 4 ESBL-producers, 3 were positive for blaCTX-M-15 and blaCTX-M1group, 2 were positive for blaCMY-2, and 1 each was positive for blaCTX-M-2 group, blaSHV, and blaOXA-47. The quinolone resistance gene qnrS was detected in 25% (n = 6) of the E. coli strains isolated from urine (N = 5) and air (N = 1) samples. The considerable number of antimicrobial resistance genes detected among E. coli isolates tested here is alarming and should raise public health concern.

Background and aim Helicobacter pylori eradication can disrupt the gut microbiome. Here, we investigated the short-term impact of minimum antibiotic treatment-a 7-day vonoprazan and low-dose amoxicillin regimen (VA-dual therapy)-on gut microbiota and compared it with that of vonoprazan-based triple therapy (VAC-triple therapy). Methods Fifty-nine patients with H. pylori infection were recruited (UMIN000034140) from March to May 2019 and randomly assigned to the VAC-triple therapy or VA-dual therapy groups, according to the first-line H. pylori treatment received. Fecal samples were collected before treatment initiation and 1 and 8 weeks after eradication therapy completion. The composition ratios of the bacterial taxa and the alpha and beta diversities were evaluated in both groups via polymerase chain reaction amplification of the V3-V4 region of the 16S rRNA gene and sequencing using the MiSeq system. Results Nineteen patients were assigned to the VA-dual group and 24 to the VAC-triple group. Compared with baseline, the alpha diversity reduced significantly 1 and 8 weeks after VAC-triple therapy. However, for VA-dual therapy, the alpha diversities at 1 and 8 weeks after the treatment did not change significantly compared with those at baseline. Additionally, the beta diversity differed significantly between baseline and 1 and 8 weeks after VAC-triple therapy. VAC-triple therapy led to significant alteration in the relative abundance of Actinobacteria at the phylum level and Collinsella, Blautia, and Streptococcus at the genus level. Conclusions Compared with VAC-triple therapy, VA-dual therapy induced minimal changes in the diversity and relative abundance of gut microbiota.

Helicobacter pylori is one of the most common commensal microorganisms in the human body, colonizing up to 60% of the inhabitants on all continents. Some H. pylori strains have acquired virulent properties and their presence can significantly complicate the course of type B atrophic gastritis, gastric ulcer and duodenal ulcer, as well as gastric malignant diseases. In such situations, eradication therapy seems to be pathogenetically justified. In 1996, there were proposed the International Recommendations for standard first-line 7–10-day course triple eradication therapy, including a proton pump inhibitor (PPI), amoxicillin and clarithromycin. Until the beginning of the XXIth century, the International Recommendations has been actively and highly efficiently (up to 90%) used everywhere, but later reports started to emerge regarding a catastrophic decrease in therapeutic outcome (up to 60%). Later, it turned out that the effectiveness of the three-component (triple) therapy directly correlates with the resistance to clarithromycin substantially increased in recent decades, which necessitated generation of new schemes for H. pylori elimination. The results of various schemes for H. pylori eradication were analyzed, including variants of modified triple therapy associated with the inclusion of new drugs or prolonged duration of the therapeutic protocol. In particular, it was proposed to replace amoxicillin with metronidazole. However, further studies have shown that the combination of clarithromycin with amoxicillin seems to be preferable due to the high level of H. pylori resistance to metronidazole recorded in many countries. Attempts to use probiotics in parallel, particularly cultures of various Lactobacillus species, were analyzed, which increases the level of eradication during standard triple therapy from 61.5% to 81.6%, and significantly reduces the severity of side effects. It has been shown that a promising approach to increase the effectiveness of 7-day first-line therapy schemes with clarithromycin is to use modern effective PPIs (for example, esomeprazole or rabeprazole). The scheme of modified sequential therapy with the replacement of clarithromycin with tetracycline or levofloxacin, which has shown high efficiency has been considered. A variant of standard triple therapy modified into quadrotherapy by adding metronidazole or tinidazole was analyzed. It has been shown that the sequential therapy scheme is ineffective for eradication of multidrug-resistant strains. Ideally, the treatment of bacterial infections should be based on endoscopic sampling of gastric mucosa biopsies, followed by microbiological determination of in vitro antibacterial drug sensitivity in bacterial isolates.