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The most widespread ailments in dogs are urinary tract infections (UTIs) caused by bacterial species. It is necessary to recognize the prevailing bacterial pathogens and their susceptibility to antimicrobial agents to effectively treat UTIs. The present study aimed to classify the bacterial organism that causes UTIs in dogs and their patterns of antimicrobial resistance. A total of 141 urine samples were collected from diseased dogs in Veterinary Clinical Complex LUVAS in Hisar, India. Culture, biochemical and sensitivity testing were performed for each of the urine samples based on standard method. Of the total 141 urine samples from dogs, 21 (14.9%) isolates were identified as Klebsiella spp. The isolates were found to be highly resistant to ampicillin (100%), penicillin G (100%), oxytetracycline (100%), enrofloxacin (85.7%), chloramphenicol (80.6%), ceftriaxone (76.2%) and cloxacillin (71.4%), while susceptibility was observed against gentamicin (100%), amikacin (100%) and neomycin (90.5%). In the current study, 19 out of 21 identified isolates were found to be multidrug-resistant. This study indicates that dogs in the study area are found to harbor highly resistant Klebsiella spp. Therefore, when deciding on the antibiotic regimen for UTIs cases, Vets should consider resistance profile of chosen antibacterial agents before usage in order to discourage dissemination of resistant organisms in the study area.

Background and aims: The spread of antimicrobial resistance (AMR) is a serious public health threat complicating treatment and resulting in prolonged hospitalization. The prevalence of AMR threat is not well defined due to the dearth of appropriate surveillance systems. This study sought to assess the prevalence of AMR among bacterial isolates from sputum specimens obtained from patients with pneumonia presenting at two secondary healthcare facilities in Zaria from June 1 to August 31, 2018. Methods: Standard methodology was followed in processing sputum samples that met the acceptance criteria. The antibiotic susceptibility patterns of bacterial pathogens cultured from sputum specimens obtained from June 1 to August 31, 2018) were evaluated using the recommendation of the Clinical and Laboratory Standards Institute. Finally, data were analyzed using descriptive statistics. Results: Acinetobacter spp. were the predominant pathogens accounting for 32% of recovered isolates, followed by Staphylococcus spp. (18%) and Klebsiella spp. (17%), respectively. AMR was found in 91% of the isolates. Most isolates were resistant to erythromycin (ERY) (80%) and amoxicillin (83.3%). Eventually, the multiple antibiotic resistance index ≥0.3 was observed in 76% of the isolates. Conclusion: Based on the findings, AMR rates were observed to be high, and may display a serious therapeutic challenge to the management of community-acquired pneumonia. Concerted efforts are needed to combat the worrisome AMR trends revealed in this study.

Uncomplicated Enterobacteriaceae bacteremia is usually transient and may not require follow-up blood cultures (FUBC). This is a retrospective observational study conducted at a university-affiliated urban teaching hospital in Seattle, WA. All patients ≥ 18 years hospitalized between July 2014 and August 2019 with ≥ 1 positive blood culture for either Escherichia coli or Klebsiella species were included. The primary outcome was to determine the number and frequency of FUBC obtained, and the detection rate for positive FUBC. There were 335 episodes of E. coli and Klebsiella spp. bacteremia with genitourinary (54%) being the most common source. FUBC were sent in 299 (89.3%) patients, with a median of 3 (interquartile range (IQR): 2, 4) sets of FUBC drawn per patient. Persistent bacteremia occurred in 37 (12.4%) patients. In uncomplicated E. coli and Klebsiella spp. bacteremia, when the pre-test probability of persistent bacteremia is relatively low, FUBC may not be necessary in the absence of predisposing factors.

Aims: The study was carried out to determine organisms present during early onset of neonatal sepsis (EONNS), late onset of neonatal sepsis (LONNS) and their antimicrobial susceptibility pattern. Methodology: This study is a retrospective evaluation of 453 neonatal blood cultures. Two (2) ml of blood from these neonates was cultured in thioglycollate broth and tryptone soya broth. This was carried out in the Department of Microbiology and Parasitology of the University of Port Harcourt Teaching Hospital, Nigeria between January-December 2007. Results: Out of 453, 272(60.0%) neonates showed negative blood cultures, while 181(40.0%) neonates had positive bacterial cultures and 2 neonates (0.4%) were positive for Candida albicans. Overall, Klebsiella spp. was the most common pathogen, accounting for (37.8%) of the total isolates. Others were as follows; Staphylococcus aureus (28.4%), Escherichia coli (11.8%), unclassified coliforms 8.3%, Pseudomonas spp. 4.9%, Enterococcus spp. (2.9%), coagulase-negative Staphylococcus (CONS) (2.5%) and Proteus spp. (3.4%). Early onset neonatal sepsis (EONNS) and late onset neonatal sepsis (LONNS) had Klebsiella spp and Staphylococcus aureus as their common causes of neonatal sepsis respectively. Klebsiella spp. was susceptible to spafloxacin (87.0%) followed by ofloxacin (82.0%), amoxycillin-clavulanic acid (79.0%) and ceftazidime (65.0%) among the Gram-negative organisms. In the category of Gram-positive organisms, Staphylococcus aureus is highly sensitive to ofloxacin (81.0%) followed by spafloxacin (79.0%) and amoxicillin-clavulanic acid (71.0%). Conclusion: A viable antibiotic susceptibility surveillance programme coupled with good infection control practices and rational antibiotics use will reduce infection rate, ensure better therapeutic success and prolong the efficacy of available antimicrobials.

Introduction: Urinary Tract Infection (UTI) causes inflammation which is a common, painful and sometimes life-threatening condition as well. Despite high prevalence of bacteriuria, the information on biofilm forming bacteria is negligible. Objectives: This study aims at understanding the status of the biofilm forming nature of Klebsiella spp and Pseudomonas SPP and their drug resistance property with several class of antibiotics with a prime focus on resistance pattern against few penicillin based drugs to few empirical drugs in today's time. Methodology: Urine samples were analyzed and the isolates were biochemically identified. Then, the isolates were tested for several drugs so as to identify multidrug resistance nature of isolates by Kirby-Bauer Disc method. Biofilm forming nature was examined on Congo Red Agar. Results Out of 35 urine samples, 13 isolates (37.1%) were found to be positive with significant bacteriuria. Eight samples (22.8%) showed incidence of Klebsiella spp. and 5 samples (14.3%) showed P. aeruginosa. The prevalence of Klebsiella spp. (Klebsiella pneumoniae (46.2%) and K. oxytoca(15.4%)) and P. aeruginosa was found to be 61.4% and 38.6% respectively. 66.6% of K. pneumoniae and 50% K. oxytocawere biofilm forming pathogen.K. pneumoniae andK. oxytoca were resistant to amoxycillin, amoxycillin-clavulanate, and cefoxitin; while were sensitive to nitrofurantoin and azithromycin.P. aeruginosa were sensitive to azithromycin(100%), but showed 60% resistance to levofloxacin and ofloxacin. Eight (61.5%) isolates were found to be MDR. 100% of Klebsiella oxytoca (n=2), 66.7% of Klebsiella pneumoniae (n=4), and 40% of Pseudomonas aeruginosa (n=2)were multidrug resistant (MDR).Multiple antibiotic resistance (MAR) indices of bacteria revealed that all the 13 isolates were Multi-Antibiotics Resistance strains. Conclusion Biofilm forming nature is now much greater in Klebsiella spp; while most of the isolates like Klebsiella and Pseudomon as are multidrug resistant.

Background:Carbapenem-resistant Enterobacterales (CRE) are common causes of healthcare-associated infections and are often multidrug resistant with limited therapeutic options. Additionally, CRE can spread within and between healthcare facilities, amplifying potential harms.Objective:To better understand the burden, risk factors, and source of acquisition of carbapenemase genes in clinical Escherichia coli and Klebsiella spp isolates from patients in Washington to guide prevention efforts.Design:Multicenter prospective surveillance study.Methods:Escherichia coli and Klebsiella spp isolates meeting the Washington state CRE surveillance case definition were solicited from clinical laboratories and tested at Washington Public Health Laboratories using polymerase chain reaction (PCR) for the 5 most common carbapenemase genes: blaKPC, blaNDM, blaIMP, blaVIM, and blaOXA-48. Case patients positive by PCR were investigated by the public health department.Results:From October 2012 through December 2017, 363 carbapenem-resistant E. coli and Klebsiella spp isolates were tested. Overall, 45 of 115 carbapenem-resistant K. pneumoniae (39%), 1 of 8 K. oxytoca (12.5%), and 28 of 239 carbapenem-resistant E. coli (11.7%) were carbapenemase positive. Of 74 carbapenemase-positive isolates, blaKPC was most common (47%), followed by blaNDM (30%), blaOXA-48 (22%), and blaIMP (1%). Although all cases had healthcare exposure, blaKPC acquisition was associated with US health care, whereas non-blaKPC acquisition was associated with international health care or travel.Conclusions:We report that blaKPC, the most prevalent carbapenemase in the United States, accounts for nearly half of carbapenemase cases in Washington state and that most KPC-cases are likely acquired through in-state health care.

Amac: Tum dunyada oldugu gibi ulkemizde de nozokomiyal infeksiyon sikligi giderek artmaktadir. Bu calismada saglik bakim iliskili infeksiyonlardan izole edilen Gram negatif bakterilerin karbapenem direnc oranlarinin yillar icindeki degisiminin degerlendirilmesi amaclanmistir. Gerec ve Yontem: Calismamiz Ocak 2014-Aralik 2017 tarihleri arasinda retrospektif olarak yapilmistir. Hastane kayitlarindan Ocak 2014-Aralik 2017 tarihleri arasinda hastanemizde yatirilarak tedavi edilen, survayansi yapilan servislerden elde edilen ve Centers for Disease Control and Prevention (CDC) kriterlerine gore hastane infeksiyonu tanisi alan hastalarda ureyen Gram negatif etkenler incelenmistir. Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae ve Escherichia coli suslari degerlendirilmeye alinmistir. Bulgular: A. baumannii suslari arasinda 2014 yilinda %90,7 olan karbapenem direnci, 2017 yilinda %95,9, E. coli suslari arasinda 2014 yilindaki %4,1 olan karbapenem direnc orani 2017 yilinda %7,5, K. pneumoniae suslari arasinda 2014 yilinda %32,2 olan direnc orani 2017 yilinda %48,9, P. aeruginosa turleri arasinda ise yine 2014 yilinda %26,3 olan karbapenem direnc orani 2017 yilinda %38,4 olarak belirlenmistir. Sonuc: Calismamizda karbapenem direncinin Acinetobacter spp suslarinda cok yuksek duzeyde oldugu, Klebsiella spp suslarinda ise direnc oraninin yillar icinde dikkat cekici oranda yukseldigi tespit edilmistir. Bu verilerin bilinmesi ozellikle kritik yogun bakim hastalarinda hem ampirik antibiyotik ajanlarinin seciminde klinisyenler icin yol gosterici olacak, hem de direnc oranini azaltabilmek icin alinacak infeksiyon kontrol programlari ve antibiyotik kontrol programlarinin gelistirilmesi icin yonlendirici olacaktir.

Ventilator-associated pneumonia (VAP) is one of the most severe complications affecting mechanically ventilated patients. The condition is caused by microaspiration of potentially pathogenic bacteria from the upper respiratory tract into the lower respiratory tract or by bacterial pathogens from exogenous sources such as healthcare personnel, devices, aids, fluids and air. The aim of our prospective, observational study was to confirm the hypothesis that in the etiology of VAP, an important role is played by etiological agents from the upper airway bacterial microflora. At the same time, we studied the hypothesis that the vertical spread of bacterial pathogens is more frequent than their horizontal spread among patients. A total of 697 patients required mechanical ventilation for more than 48 h. The criteria for VAP were met by 47 patients. Clonality of bacterial isolates from 20 patients was determined by comparing their macrorestriction profiles obtained by pulsed-field gel electrophoresis (PFGE). Among these 20 patients, a total of 29 PFGE pulsotypes of Klebsiella spp. and Escherichia spp. strains were observed. The high variability of clones proves that there was no circulation of bacterial pathogens among hospitalized patients. Our finding confirms the development of VAP as a result of bacterial microaspiration and therefore the endogenous origin of VAP.

Klebsiella spp community-acquired meningitis caused by hypervirulent strains is well described as part of a distinct syndrome consisting of liver abscess and multiple septic metastatic lesions (Klebsiella pneumoniae invasive syndrome) occurring usually in diabetic, alcoholic, elderly or cancer patients, in Taiwan and other South-East Asian countries. In Western countries, these infections are very rare in natives and usually occur in patients of Asian origin. We report three cases of Filipino-origin patients, residents of Greece, with community-acquired invasive Klebsiella meningitis, who were treated in our ICU over a 10-year period. Learning points Community-acquired Klebsiella spp meningitis has a very bad prognosis.A physician must suspect an invasive Klebsiella infection in patients of Asian origin, even though they are residents of Western countries and have not visited their homeland recently.

Increases in hospital-onset Klebsiella spp. and Pseudomonas aeruginosa bacteraemia rates in England were observed between August 2020 and February 2021 to the highest levels recorded since the start of mandatory surveillance in April 2017. Cases were extracted from England's mandatory surveillance database for key Gram-negative bloodstream infections. Incidence rates for hospital-onset bacteraemia cases increased from 8.9 (N=255) to 14.9 (N=394) per 100,000 bed-days for Klebsiella spp. [incidence rate ratio (IRR) 1.7, P

Background: Blood cultures (BC) have a high clinical relevance and are a priority specimen for surveillance of antimicrobial resistance. Manual BC are still most frequently used in resource-limited settings. Data on automated BC performance in Africa are scarce. We implemented automated BC at a surveillance site of the African Network for improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA).Methods: Between June 2017 and January 2018, pairs of automated BC (BacT/ALERT®FA Plus) and manual BC (brain-heart infusion broth) were compared at a University hospital in Bouaké, Côte d'Ivoire. BC were inoculated each with a target blood volume of 10 ml from the same venipuncture. Automated BC were incubated for up to 5 days, manual BC for up to 10 days. Terminal subcultures were performed for manual BC only. The two systems were compared regarding yield, contamination, and turnaround time. For quality assurance, isolates were retested in a German routine microbiological laboratory.Results: BC sampling was increased from on average 24 BC to 63 BC per month. A total of 337 matched pairs of BC were included. Automated BC was positive in 36.5%, manual BC in 24.0% (p-value < 0.01), proportion of contamination was 47.9 and 43.8%, respectively (p-value = 1.0). Turnaround time of positive BC was shortened by 2.5 days with automated compared to manual BC (p < 0.01). Most common detected pathogens in both systems were Klebsiella spp. (26.0%) and Staphylococcus aureus (18.2%). Most contaminants were members of the skin flora. Retesting of 162 isolates was concordant in 79.6% on family level.Conclusions: Implementing automated BC in a resource-limited setting is possible and improves microbiological diagnostic performance. Automated BC increased yield and shortened turnaround times. Regular training and mentorship of clinicians has to be intensified to increase number and quality of BC. Pre-analytical training to improve diagnostic stewardship is essential when implementing a new microbiological method. Retesting highlighted that manual identification and antimicrobial susceptibility testing can be of good quality and sustainable. The implementation of automated tools should be decided individually according to economic considerations, number of samples, stable supply chain of consumables, and technical sustainability.

Microbial transmission, on the surface of any currency note, can either be through direct (hand-to-hand contact) or indirect (food or other inanimate objects) means. To ascertain the degree of bacterial load enumerated during the handling of money and food items, particularly on currency note by denominations, should be of public health importance. Despite the available literature regarding microbial contamination of Nigerian currency notes, there is still paucity of information about how microbial contamination/load differ across the denominations specific to different food vendors. In this context, therefore, the current study investigated bacterial contamination of Nigerian currency notes via a comparative study of different denominations (₦1,000, ₦500, ₦200, ₦100, ₦50, ₦20, and 10, and ₦5) recovered from local food vendors. Specifically, the different food handlers/vendors included fruit, meat, vegetable, fish, and grain/cereal sellers. All emergent data from 8 × 5 factorial design of experiment were of duplicate measurements. To consider the currency denominations and food vendor type, a one-factor-at-a-time analysis of variance (ANOVA) was conducted. Results showed that about 81.7% of currency notes were contaminated with eitherEscherichia coli,Klebsiellaspp. orStaphylococcusspp. in varying degrees. The higher denominations of ₦500, ₦200, and ₦100 note, with the exception of ₦1,000 note, recorded increased degree of contamination over the lower denominations of ₦50, ₦20, ₦10, and ₦5 note. Based on the total viable count (TVC), the ₦100 currency note appeared the most contaminated (1.32 × 105cfu/ml) whereas ₦5 note appeared the least contaminated (1.46 × 104cfu/ml). The frequency of isolated bacteria on currency notes from vegetable, meat, and fish sellers were significantly higher (p< 0.05) compared to other food vendors. The degree of bacterial contamination of the current work appears chiefly dependent on the food vendor type and currency denomination(s). This work calls for increased awareness and education among food vendors and ready-to-eat food sellers. Doing this would help mitigate the possible cross-contamination between currency notes and foodstuff. Through this, consumers would know more about the potential health risks such simultaneous activities (of handling currency notes and foodstuff) do pose on food safety.

COMBATING foodborne pathogens in hospitals is a growing concern. A major aspect is a safe nutrition for patients in hospitals. It is still a hot topic concerning patients, media, and politicians. In Libya, it is a rising trend to inspect food and surfaces' safety aspects to assure hospital hygiene regulations. In this study, a survey of the general microbiological quality of food and surfaces in a General Teaching Hospital was undertaken in Alshatii, Libya. Fifty food and forty surface samples were cultured on different kinds of selective culture media. Significant colonies were counted and identified via microscopic and biochemical examinations. This study reported satisfactory levels of Escherichia coli, Staphylococcus aureus, Enterobacter spp., Klebsiella spp. and Listeria spp. when compared with guidelines for the published microbiological quality of ready-to-eat food. No detectable levels of Salmonella spp. were recorded in our study. We identified 9 out of 40 surface samples with unsatisfactory levels. Listeria spp. were isolated from eight surface samples that indicate improper hygiene compared with data on the general microbiological quality of surfaces. Food samples from the General Hospital in Libya was of relatively accepted microbiological quality but surface hygiene needs an improved strategy to prevent cross-contamination that causes public health problems. This inspection acts as a hygiene alert to improve the management of hospital cleaning and it will have a positive impact on the public health of Libyan society.

Urinary tract infections (UTIs) are highly prevalent worldwide [1]. Urinary tract infections (UTIs) are the inflammatory disorders...

Locally fried plantains (Dodo Ikire) which are local snacks for both indigenes and travelers are always packed inside a transparent nylon bag which may pose public health risks to consumers. Samples were collected from major production and hawking hotspots for microbiological analysis. This study aimed to isolate and determine microbial load of Dodo Ikire using standard microbiological procedures. Analysis of the fried plantain revealed total bacterial count ranging from 3.0 × 102cfu/ml (Bacillus cereus) to 4.0 × 108 cfu/ml (Staphylococcus aureus). Mean coliform count ranged from 2.6 × 106cfu/ml (Klebsiella spp) to 6.0 × 103cfu/ml (Escherichia coli), and fungal count ranged from 3.0 × 104cfu/ml (Penicillium marneffei) to 3.0 × 108cfu/ml (Yeast). The isolated microorganisms includes fungi, enterobactericae and gram positive bacteria. The coliform has the highest counts (≥ 102) in most samples; this can be due to post production contamination as the entire food samples involved use of heat during manufacturing. This study concluded that fried plantain (Dodo Ikire) posed a risk to Nigerian people due to high microbial load and it is a read-made food that most travelers usually consume.

Objetivo: El propósito de la investigación fue el aislamiento de microorganismos del género Staphylococcus y Bacilos Gram negativos posterior a dos técnicas de lavado de manos, durante las prácticas de laboratorio de los estudiantes de Enfermería. Metodología: La investigación fue de tipo correlacional y transversal, realizada en mayo de 2018; los participantes fueron 40 estudiantes distribuidos en dos grupos (Grupos control y experimental). Las muestras se tomaron por hisopado de las manos recientemente lavadas. Se aplicó el lavado de manos clínico (LMC) de 11 pasos en el grupo control y el LMC de 3 tiempos en el grupo experimental, previa capacitación. El aislamiento, identificación y recuento microbiano se efectuó en medios de cultivos adecuados y selectivos. Los datos se procesaron en el programa Excel, mediante pruebas de significación estadística y estadísticos descriptivos. Resultados: Se aisló Staphylococcus cuagulasa negativo en un 40 % del total de participantes; según el tipo de lavado se encontró este microorganismo en un 50% de participantes que aplicaron el LMC de 11 pasos, y en un 30% de participantes tras el LMC de 3 tiempos. Respecto a la búsqueda de bacilos Gram negativos, se encontró Klebsiella spp en un 5% del total de participantes en el LMC de 3 tiempos. Los recuentos bacterianos fueron más bajos en el LMC de 3 tiempos y se obtuvo diferencia estadísticamente significativa de p=0.033 (p≤0.05) al comparar ambas técnicas de lavado. Conclusiones: Hubo diferencia entre las dos técnicas de lavado de manos en los recuentos bacterianos, hallándose mayor crecimiento tras el LMC de 11 pasos, y menor crecimiento en el LMC de 3 tiempos. El microorganismo más frecuente fue Staphylococcus cuagulasa negativo y en un mínimo de muestras, Klebsiella spp.

Many articles have been published on resistant microorganisms isolated from humans, animals, foods and the environment in Ghana. However, there are no reviews that summarize the information on the isolates and antibiotics tested so far in the country. This literature review was completed through “PubMed” and “Google Scholar” searches. We included publications from the period 1975-2015 with a laboratory-based methodology to determine antibiotic resistance of strains isolated in Ghana. In total, 60 articles were included in the analysis with 10% of the articles carrying out nationwide research on antibiotic resistance. The regions of Ghana with the highest published articles were Greater Accra (40%), Ashanti (21.7%) and Northern Region (10%). Most of the studies (86.7%) were related to isolates collected from human samples followed by environmental (5%), animal (3%) and food samples (2%). Ten different bacteria genera were observed in the studies. The most common was Escherichia coli, followed by Staphylococcus spp., Mycobacterium spp. and Streptococcus spp. The highest mean resistance rate was encountered in Escherichia coli (62.2%) followed by Klebsiella spp. (60.4%) and Pseudomonas spp. (52.1%). High resistance rates have been found in Ghana, however, the data are skewed and some regions of the country have been neglected. There is a need for higher quality research to establish and monitor resistance patterns in Upper West, Brong-Ahafo, Volta and Eastern Regions of Ghana.

Las infecciones intrahospitalarias constituyen un problema de salud pública por la carga de morbimortalidad y el incremento en el costo hospitalario, el cual llega a ser de hasta cuatro veces el valor generado cuando no se pre- senta infección. Muchas son las causas que se han considerado: higiene del paciente, higiene hospitalaria, esteri- lización, tiempo quirúrgico, y cuidados durante el lavado de manos por los cirujanos y el personal que interviene al paciente, siendo este último un factor muy importante para que la infección del sitio operatorio contribuya con un 38% del total de las infecciones postquirúrgicas. Entre los agentes etiológicos de estas infecciones se destacan Klebsiella spp y Staphylococcus aureus. Este artículo pretende promover la práctica de la Guía de Higiene de Ma- nos de la OMS, que consiste en higienizarse antes y después de todo contacto con el paciente y la instalación de dispensadores cercanos a él, evitando la colonización bacteriana.

Objective. Despite the international data available on healthcare-associated infections in selected groups of patients, there is a lack of large and good quality studies. Pediatric studies focusing on healthcare infections in this type of patients should be done in order to deepen our understanding on associated risk factors and possible intervention areas. Methods. The descriptive retrospective epidemiological study of Acinetobacter spp. and Klebsiella pneumoniae cases in children's departments of health care was performed in Kemerovo regions (2012-2017). Results. A total of 129,430 patient treatment outcomes were studied, in 1380 K. pneumoniae and 201 Acinetobacter spp. were isolated. The incidence of Acinetobacter spp. in adults, 3.2 times higher than in children. The risk of Klebsiella ssp. infection was in 13 times higher than Acinetobacter spp. infection. Conclusions. We revealed decreasing trend in colonization Klebsiella spp. and Acinetobacter spp. incidence. Patients who were treated by intensive care medical technologies were under at the highest risk of infections, especially in case of invasive and noninvasive respiratory constant positive airway pressure support by combination

Aim: Community and hospital acquired urinary tract infections (UTI) are the most common bacterial infections in all age groups. In this study, the women diagnosed UTI, which complicated and uncomplicated, were referred to outpatient clinics between 2011 and 2015 were selected. The suitability of empirical antimicrobial therapy prescribed with resistance patterns of Gram negative bacteria isolated from these patients was investigated. Methods: UTI complaining and urine culture ≥10⁵ cfu / ml of bacteria that women aged 18-65 were comprised the study group. HIS (Hospital Information System Software) was scanned for these patients and uncomplicated and complicated UTI distinction was made according to the criteria set by Infectious Diseases Society of America (IDSA, 2016). Of the 2180 patients studied, 836 were complicated and 896 were noncomplicated. Identification of Gram negative isolates in urine culture; Conventional methods and Matrix-Assisted Laser Desorption and Ionization Time-Of-Flight Mass Spectrometry (MALDI-TOF MS), (Biotyper, Bruker, Germany) systems were used. The antimicrobial susceptibilities of the isolated strains from 2011 to 2014 were determined according to the Clinical Laboratory Standards Institute (CLSI) and the isolated strains in 2015 were determined according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST). Results: The distribution of 2180 female patients (18 to 65 years old) was urology polyclinic (68%), family medicine, infectious disease and physical medicine and rehabilitation polyclinics (19.1%), and emergency medicine polyclinic (12.6%). E. coli (84%), K. pneumonia / oxytoca (7%) and Enterobacter spp (2.6%) were the most frequently detected agents in the uncomplicated UTIs, while complicated UTI E. coli (91%), K. pneumonia / oxytoca (5.7%) and P. aeruginosa (1%) were found to be the first, second and third in the patients. Quinolones were prescribed 18.2%, phosphomycin 16.7%, nitrofurantoin 15.6%, nitrofurantoin and phosphomycin combined 16.3%, second generation oral cephalosporins 9.6% and third generation oral cephalosporins 10.7%. Resistance to quinolones, the most commonly prescribed antibiotic, was found in 19% of E. coli, 21% of Klebsiella spp., 13% of Enterobacter spp. and 9% of Proteus spp. Conclusion: When these prescriptions were compared with the results of antimicrobial susceptibility, it was observed that 38 (14%) were incompatible with the sensitivity results. It was found that 42% of cefuroxime prescriptions, 28% of quinolone prescriptions and 17% of ceftriaxone prescriptions were incompatible with the antibiogram results., Amaç: Toplum ve hastane kaynaklı üriner sistem enfeksiyonları (ÜSE), tüm yaş gruplarında en sık karşılaşılan bakteriyel enfeksiyonlardır. Bu çalışmada 2011-2015 yılları arasında polikliniklere ÜSE şikayetiyle başvuran hastalardan izole edilen Gram negatif bakterilerin direnç paternleri ile bu hastalara reçetelenen ampirik antimikrobiyal tedavinin uygunluğunun araştırıldı.Yöntemler: ÜSE şikayetiyle başvuran ve idrar kültüründe ≥10⁵ kob/ml bakteri üremesi olan 18-65 yaş arası kadın hastalar çalışma grubunu oluşturdu. HBYS (Hastane Bilgi Yazılım Sistemi)’nden bu hastaların dosyası taranarak Infectious Diseases Society of America (IDSA, 2016) tarafından belirlenen kriterler doğrultusunda komplike olmayan ve komplike ÜSE ayrımları yapıldı. Buna göre 2180 hastanın 836’sı komplike ÜSE tanısı alırken, 896’sının nonkomplike ÜSE tanısı aldığı tesbit edildi. İdrar kültüründe izole edilen Gram negatif izolatların identifikasyonu; konvansiyonel yöntemler ve Matrix-Assisted Laser Desorption and İonization Time-Of-Flight Mass Spectrometry (MALDI-TOF MS), (Biotyper, Bruker, Almanya) sistemleri ile yapıldı. İzole edilen suşların antimikrobiyal duyarlılıkları 2011-2014 yılları için Clinical Laboratory Standards Institute (CLSI), 2015 yılı için ise The European Committee on Antimicrobial Susceptibility Testing (EUCAST) önerilerine göre belirlendi. Bulgular: ÜSE şikayetiyle çalışmaya alınan 18-65 yaş arası 2180 kadın hastanın poliklinik dağılımı; %68 Üroloji, %19,1 Aile Hekimliği pol., Enfeksiyon pol ve Fizik Tedavi ve Rehabilitasyon pol. ve %12,6 Acil pol. idi. Komplike olmayan ÜSE’lerde 1., 2. ve 3. sırada en çok tespit edilen etken sırasıyla E. coli (%84), K. pneumoni/oxytoca (%7) ve Enterobacter spp (%2,6) iken, komplike ÜSE’li hastalarda 1., 2. ve 3. sırada E. coli (%91), K. pneumoni/oxytoca (%5,7) ve P. aeruginosa (%1) tespit edildi. Hastalara reçete edilen antimikrobiyallere bakıldığında; kinolonların %18,2 oranında, fosfomisin %16,7, nitrofurantoin %15,6, nitrofurantoin ve fosfomisin kombine olarak %16,3 oranında, 2. kuşak oral sefalosporinlerin %9,6 ve 3. kuşak oral sefalosporinlerin ise %10,7 oranında reçetelendiği saptandı. Ayaktan tedavi edilen hastalara en sık reçete edilen antibiyotik olan kinolonlara direnç, E.coli’de %19, Klebsiella spp.’de %21, Enterobacterspp.’de %13, Proteus spp’de % 9 olarak bulundu. Sonuç: Bu reçetelerin antimikrobiyal duyarlılık sonuçları ile uyumuna bakıldığında ise, 38(%14)’inin duyarlılık sonuçları ile uyumsuz olduğu gözlendi. Sefuroksim reçetelerinin %42, kinolon reçetelerinin %28, seftriakson reçetelerinin ise %17 oranında antibiyogram sonucu ile uyumsuz olduğu saptandı.

Irina Netsvyetayeva,1 Wojciech Marusza,2 Romuald Olszanski,3 Kamila Szyller,2 Aneta Krolak-Ulinska,2 Ewa Swoboda-Kopec,1 Janusz Sierdzinski,4 Zachary Szymonski,5 Grazyna Mlynarczyk1 1Department of Microbiology, Medical University of Warsaw, Poland; 2Academy of Face Sculpturing, Warsaw, Poland; 3Military Institute of Health Services, Warsaw, Poland; 4Department of Medical Informatics and Telemedicine, Medical University of Warsaw, Poland; 5Department of Zoology, Magdalen College, University of Oxford, Oxford, UK Introduction: Cross-linked hyaluronic acid (HA) gel is widely used in esthetic medicine. Late bacterial infection (LBI) is a rare, but severe complication after HA augmentation. The aim of this study was to determine whether patients who underwent the HA injection procedure and developed LBI had qualitatively different bacterial flora on the skin compared to patients who underwent the procedure without any complications. Methods: The study group comprised 10 previously healthy women with recently diagnosed, untreated LBI after HA augmentation. The control group comprised 17 healthy women who had a similar amount of HA injected with no complications. To assess the difference between the two groups, their skin flora was cultured from nasal swabs, both before and after antibiotic treatment in the study group. Results: A significant increase in the incidence of Staphylococcus epidermidis was detected in the control group (P=0.000) compared to the study group. The study group showed a significantly higher incidence of Staphylococcus aureus (P=0.005), Klebsiella pneumoniae (P=0.006), Klebsiella oxytoca (P=0.048), and Staphylococcus haemolyticus (P=0.048) compared to the control group. Conclusion: The bacterial flora on the skin differed in patients with LBI from the control group. The control group’s bacterial skin flora was dominated by S. epidermidis. Patients with LBI had a bacterial skin flora dominated by potentially pathogenic bacteria. Keywords: hyaluronic acid, late bacterial infection, bacterial biofilm, skin bacterial flora, S.epidermidis, S. aureus, Klebsiella spp.

Many etiologies have been proposed to predispose neutropenic fever, and infections have been reported in less than one-third of the reported cases. However, etiologies might have a significant impact on the prognostic, and can even lead to mortality. In this literature review, the aim to discuss the different microbiological etiologies of neutropenic fever, and the management approaches of such conditions, including the proper assessment and evaluation of patients. Additionally, the goal of this literature review to discuss the appropriate treatment and prophylaxis measures based on the assessment results. Many bacterial pathogens could be isolated from patients suffering from neutropenic fever, including both the gram-positive and negative organisms, such as pseudomonas aeruginosa, E. coli, Klebsiella spp, actinobacteria spp, in addition to many other bacteria such as staph. Nevertheless, Aureus was commonly isolated from the infected patients, and it has been reported with increased morbidity and mortality rates. Assessment of the severity of the condition and identification of the microbiological activity can significantly lead to enhance management of the infected patients. Detailed information about the etiology and management are provided within the main text of this study. Further efforts are needed to increase awareness related to the hazards of the inadequate and incomplete assessments of patients with neutropenic fever, which might lead to delayed or inadequate management and worsened prognosis.

Introduction Lower respiratory tract infections (LRTIs) are a major cause of morbidity and death. Because of changes in how LRTIs are defined coupled with the increasing prevalence of drug resistance, there is a gap in knowledge regarding the current burden of antimicrobial use for Centers for Disease Control and Prevention (CDC)-defined LRTIs. We describe the infection characteristics, antibiotic consumption, and clinical and economic outcomes of patients with Gram-negative (GN) LRTIs treated in intensive care units (ICUs). Methods This was a retrospective, observational, cross-sectional study of adult patients treated in ICUs at two large academic medical centers in metropolitan Detroit, Michigan, from October 2013 to October 2015. To meet the inclusion criteria, patients must have had CDC-defined LRTI caused by a GN pathogen during ICU stay. Microbiological assessment of available Pseudomonas aeruginosa isolates included minimum inhibitory concentrations for key antimicrobial agents. Results Four hundred and seventy-two patients, primarily from the community (346, 73.3%), were treated in medical ICUs (272, 57.6%). Clinically defined pneumonia was common (264, 55.9%). Six hundred and nineteen GN organisms were identified from index respiratory cultures: P. aeruginosa was common (224, 36.2%), with 21.6% of these isolates being multidrug resistant. Cefepime (213, 45.1%) and piperacillin/tazobactam (174, 36.8%) were the most frequent empiric GN therapies. Empiric GN therapy was inappropriate in 44.6% of cases. Lack of in vitro susceptibility (80.1%) was the most common reason for inappropriateness. Patients with inappropriate empiric GN therapy had longer overall stay, which translated to a median total cost of care of $79,800 (interquartile range $48,775 to $129,600) versus $68,000 (interquartile range $38,400 to $116,175), p = 0.013. Clinical failure (31.5% vs 30.0%, p = 0.912) and in-hospital all-cause mortality (26.4% vs 25.9%, p = 0.814) were not different. Conclusion Drug-resistant pathogens were frequently found and empiric GN therapy was inappropriate in nearly 50% of cases. Inappropriate therapy led to increased lengths of stay and was associated with higher costs of care.

Background A study to evaluate the microbial quality of goat carcasses at Chinsapo-2 and Chigwirizano slaughter slabs in Lilongwe District, Malawi, was conducted in June 2014. A total of 154 swab samples were collected from 34 carcasses for identification of the isolates and bacterial total viable counts (TVCs). Cotton swab samples were also collected from clothes, knives and hands of butchers and water used in the slaughter process. Results The study found that predominant bacterial isolates at Chinsapo-2 were E. coli (29%), followed by Bacillus spp. (18%), Proteus spp. (15%) and Klebsiella spp. (13%). On the other hand, bacterial isolates from Chigwirizano were E. coli (38%), followed by Bacillus spp. (23%), Proteus spp. (13%) and Klebsiella spp. (5%). The mean bacterial TVC before treatment (washing hands, clean knives with hot water and provision of working gear) for Chinsapo-2 were 6.74 ± 0.38, 6.38 ± 0.38 and 8.26 ± 0.38, while Chigwirizano had 9.48 ± 0.50, 9.48 ± 0.50 and 8.24 ± 0.50 log10 CFU/cm2. After treatment, Chinsapo-2 recorded 8.03 ± 0.38, 7.67 ± 0.38 and 7.30 ± 0.38 log10 CFU/cm2 on hands, knives and clothes while Chigwirizano had 7.12 ± 0.50, 8.84 ± 0.50 and 8.73 ± 0.50 log10 CFU/cm2, respectively. Washing hands with tap water before slaughter significantly (P 4.3 log CFU/cm2. Therefore, further studies should be conducted to reduce the bacterial contamination. Graphical abstract Relative frequencies at Chinsapo and Chigwirizano slaughter slabs

Aim: The majority of clinical specimens infected can be by Klebsiella species. Furthermore the incidence of drug resistant Klebsiella is increasing, therefore drug resistance sensitivity test it seems necessary before prescribing antibiotics. The aim of this research was to determine the pattern of antimicrobial resistance of Klebsiella species from clinical.Methods: The present research was performed on 300 specimens of Klebsiella collected from hospitalized patients between 2016 and 2017. Identification was carried out according to standard procedure, and drug sensitivity test was determined by Kirby-Bauer method.Results: The frequency rates of the isolated Klebsiella species were: pneumonia (94%), oxytoca (4%), ozaenae (1%), and rhinoscleromatis (1%). The collected samples in order of frequency were: urine, sputum, vagina, scar, stool, and blood respectively. The percentage rates of resistance were as follows: Ampicillin (97%), amoxycillin (97%), cephalothin (39%), gentamicin (30%), colistin (55%), nalidixic acid (2%), chloramphenicol (26%), kanamycin (17%), tetracycline (28%), nitrofurantoin (44%), ceftazidime (2%), and amikacin (0%).Conclusion: The lowest resistance rate obtained with amikacin in all tested Klebsiella; which can be recommended as the most effective antibiotic., Amaç: Klinik örneklerin çoğu Klebsiella türleri ile enfekte olabilmektedir. Ayrıca ilaca dirençli Klebsiella insidansı artmaktadır, bu nedenle antibiyotik reçete edilmeden önce ilaç direnci duyarlılık testi gerekli görünmektedir. Bu araştırmanın amacı Klebsiella türlerinin antimikrobiyal direncini klinik olarak belirlemektir.Yöntemler: Bu araştırma, 2016 ve 2017 yılları arasında hastanede yatan hastalardan toplanan 300 Klebsiella örneği üzerinde gerçekleştirilmiştir. Tanımlama standart yönteme göre gerçekleştirilmiş ve ilaç duyarlılık testi Kirby-Bauer yöntemi ile belirlenmiştir.Bulgular: İzole Klebsiella türlerinin sıklık oranları: pnömoni (% 94), oksitoka (% 4), ozaenae (% 1) ve rinososikromatis (% 1). Sıklık sırasına göre toplanan örnekler: idrar, balgam, vajina, skar, dışkı ve kan idi. Rezistans yüzdesi şöyledir: Ampisilin (%97), amoksilin (%97), cefalotin (%39), gentamisin (%30), kolistin (%55), nalidiksik asit (%2), kloramfenikol (%26), kanamisin (%17), tetrasiklin (%28), nitrofurantoin (%44), seftazidim (%2) ve amikasin (%0).Sonuç: Test edilen Klebsiella türlerinde en düşük direnç oranı Amikasin ile elde edilmiştir ve en etkili antibiyotik olarak önerilebilir.

RESUMO As infecções cruzadas na assistência à saúde são reconhecidas como o evento adverso que mais ocorre durante o processo de internação de pacientes em hospitais; assim a adoção de medidas preventivas é legalmente recomendada pela Norma Regulamentadora 32, que estabelece a necessidade de higienização das mãos e a proibição do uso de adornos pelos trabalhadores de saúde, inclusive anéis. Objetivo: Sumarizar as evidências científicas sobre as características microbiológicas das mãos e anéis de trabalhadores de saúde e o risco de infecção cruzada. Material e Método: Revisão integrativa da literatura estruturada nas etapas: questão norteadora, busca, categorização dos estudos, avaliação, interpretação dos resultados e síntese do conhecimento. Foram selecionados artigos originais e revisões, publicados em inglês, português, espanhol e francês, em revistas indexadas nas principais bases de dados internacionais da área da Saúde, por meio dos descritores aplicados de acordo com as particularidades de cada base de dados e obtidos por consulta nos Descritores de Ciências em Saúde (DeCS) e Medical Subject Headings (MeSH). Resultados: Sete estudos foram analisados e evidenciaram que os principais microrganismos encontrados nas mãos e anéis de profissionais de saúde foram S. aureus, Enterococcus spp, S. epidermides, Klebsiella spp e E. colli. Conclusão: A contaminação das mãos com e sem anel ocorreu de modo semelhante, não podendo dizer com exatidão se o uso de anéis foi o responsável pelo aumento na quantidade de microrganismos encontrados e se essa prática interfere na infecção cruzada.

&beta, Lactam-resistant Klebsiella isolates continue to cause multidrug resistance infections worldwide. This study aimed to describe the geographical distribution of extended spectrum &beta, lactamase (ESBL), AmpC &beta, lactamase (AmpC), and carbapenemase production among 139 Klebsiella isolates recovered from patients at major referral health facilities in Ghana. The phenotypic methods of combined disc diffusion test, modified three-dimensional test, modified Hodge test (MHT), and combined disc test were performed for each isolate to detect ESBL, AmpC, carbapenemase, and metallo-&beta, lactamase (MBL) producers, respectively. Except for MBL, all other &beta, lactam resistance mechanisms were highest in the healthcare facilities situated in the northern belt of Ghana. Significant regional difference of ESBL producers was observed between the northern and middle belts as well as the northern and southern belts. Genotypic detection with polymerase chain reaction (PCR) revealed the presence of bla TEM 36/139 (25.9%), bla SHV 40/139 (28.8%), bla CTX-M 37/139 (26.6%), bla OXA-48 3/139 (2.16%), and bla NDM 1/139 (0.72%) genotypes. In conclusion, there were variations in &beta, lactam resistance among Klebsiella spp. from health facilities situated in the northern, middle, and southern belts of Ghana. The study provides preliminary evidence that emphasizes the need to direct more attention to antimicrobial resistance control, especially in the northern belt of Ghana. Findings from this study may be critical for creating and fine-tuning effective antimicrobial resistance control strategies and for informing accurate antibiotic prescription by practitioners.

Background Qnr genes are known to confer a low-level resistance to fluoroquinolone in Enterobacteriaceae. They are often found on the same resistance plasmids as extended spectrum β-lactamase (ESBL) and constitute the most common antibiotic resistance mechanism. This study aimed to detect the presence of qnr genes in ESBL-producing E. coli and Klebsiella spp. Methods From May 2013 to July 2015, 91 E. coli and 64 Klebsiella spp. strains with phenotypic resistance to quinolone were collected from several specimens and analyzed for the detection of qnrA, qnrB, qnrS genes and the β-lactamase resistance genes (blaCTX-M, blaTEM, blaSHV) using simplex and multiplex PCR. Results In the present study, 107 (69%; 61 E. coli and 46 Klebsiella spp.) of 155 bacterial strains tested were found harboring at least one qnr gene consisting of 74 (47.74%) qnrB, 73 (47.10%) qnrS and 4 (2.58%) qnrA. Of the 107 strains encoding qnr genes, 102, 96 and 52 carried CTX-M1, TEM and SHV type ESBL respectively. Conclusion This study identified quinolone resistance (qnr) gene in ESBL-producing E. coli and Klebsiella spp. in Togo. These finding which suggest a possible resistance to quinolone are of high interest for better management of patients and control of antimicrobial resistance in Togo. Electronic supplementary material The online version of this article (10.1186/s13756-019-0552-0) contains supplementary material, which is available to authorized users.

In this cohort of Escherichia coli and Klebsiella spp hospital-onset bacteremia, isolated fluoroquinolone resistance had a larger relative impact on mortality than other phenotypic resistance patterns. This finding may support stewardship efforts targeting unnecessary fluoroquinolone use and increased attention from infection prevention and control departments.

Background Urinary tract infection is an infection affecting infants and children. The aim of this study was to determine the etiology of urinary tract infection along with their antimicrobial resistance. Methods This cross-sectional study was conducted from June 2015 to January 2016 at Siddhi Memorial Hospital, Bhaktapur, Nepal. Urine samples were first cultured on cystine lactose electrolyte deficient agar and blood agar by semi-quantitative technique, and then incubated aerobically for 18–24 h at 37 °C. The identified bacterial isolates were tested for antimicrobial susceptibility by Kirby Bauer disc diffusion technique. Results Of 1599 urine samples, 12.3% samples showed significant bacterial growth. E. coli (58.7%) was the most common pathogen, followed by Klebsiella pneumoniae (22.5%). Most of the isolates were resistant to ampicillin and co-trimoxazole, while least were resistant to amikacin and nitrofurantoin. Higher multi-drug resistance (61.9%) was observed among isolates. Conclusions E. coli and Klebsiella spp. were predominant cause of pediatric urinary tract infection in children. Higher susceptibility observed against aminoglycosides and nitrofurans make these drugs suitable in emergency.

Objectives Healthcare-associated infections (HCAI), which are important causes of mortality and morbidity, are high cost but preventable infections. This study aimed to determine hospital infections and isolates in Sisli Hamidiye Etfal Training and Hospital and to determine our local data. The changes in the distribution of the isolates in this process were evaluated by comparing the data of 1995 and today. Methods Materials sent to the microbiology laboratory of our hospital in 1995 and 2017 from the patients hospitalized in the period between June 1-December 31 were evaluated concerning hospital infection. The standard manual methods were used in 1995, while in 2017, MALDI-TOF MS was used for identification and BD Phoenix automated system for antibiotic susceptibility. Results In 1995, in total, 100 bacteria were isolated from pediatric and adult patients, of which 48 Pseudomonas aeruginosa (48/100), 37 Klebsiella spp (37/100). In 2017, Acinetobacter baumannii causing an important resistance problem was found to be increased in number. The main hospital infection causes were Acinetobacter baumannii (37/179), Klebsiella spp (41/179). In 2017, bacterial diversity was also increased. Conclusion Isolated strains, as in the past, are gram-negative bacteria, Pseudomonas spp decreased in 2017, and Acinetobacter spp increased. The findings suggest that the automated systems used in microbiology laboratories may have a role in the detection of bacterial diversity.

Introducción. La infección del tracto urinario (ITU) es la complicación médica más frecuente durante el embarazo y se asocia con desenlaces materno-perinatales negativos. Objetivos. Determinar la prevalencia de ITU en gestantes en condiciones de vulnerabilidad social de Bucaramanga, Colombia, y realizar una caracterización de los casos de ITU. Además, identificar los factores asociados al desarrollo de esta complicación y el perfil de resistencia antibiótica de los microorganismos causantes de la infección. Materiales y métodos. Se llevó a cabo un análisis secundario de los datos obtenidos en un estudio principal que incluyó 838 gestantes atendidas en la red pública de atención de Bucaramanga. La prevalencia de ITU se estimó considerando el número de gestantes con reporte de urocultivo (n=648). Se realizó un análisis descriptivo de las características de la muestra y un análisis bivariado para evaluar las diferencias en el diagnóstico de ITU. Finalmente, se estimaron los factores asociados a ITU mediante un modelo de regresión log binomial. Resultados. La prevalencia de ITU durante el embarazo fue del 14.51% (n=94). Se observó que por cada año de aumento en la edad materna hubo una reducción del 6% en la prevalencia de ITU (RP: 0.94, IC95%: 0.90-0.98, p=0.005); además, se encontró una asociación entre tener antecedentes de ITU y desarrollar esta complicación durante la gestación (RP: 3.6, IC95%: 1.81-7.08, p

BACKGROUND Multi-drug resistant strains of Klebsiella as a result of the production of β lactamases like ESBL and AmpC β lactamases pose a big problem. The aim of the study is to detect ESBL and AmpC β lactamases among Klebsiella spp. and to evaluate the risk factors associated with acquiring these beta lactamases. MATERIALS AND METHODS ESBL detection was done by the method advocated by the CLSI and AmpC production by the modified three-dimensional test. A detailed history was taken; therapeutic details and outcome were assessed. Statistical analysis was done by χ2 test. Settings and Design- The isolates from samples of patients attending outpatient departments and admitted to wards and ICU of a tertiary care centre were included in study. RESULTS Among our isolates 104 (69.3%) were ESBL producers and 13 (8.6%) AmpC producers. Both ESBL and AmpC β lactamase production was seen in twelve isolates. There was significant association between hospital stay of more than 5 days, treatment with broad-spectrum antibiotics, admission to ICU/NICU and ESBL production. CONCLUSIONS The present study revealed a high rate of ESBL production and the coexistence of ESBL and AmpC. There is a need to devise and standardise more simple and reliable methods to detect them.

Background: Extended Spectrum b -Lactameses Producing Organisms (ESBLs) are increasing in number and causing more severe infections because of their continuous mutation and multidrug resistance property with limited therapeutic option.Aims and Objectives: Present study was undertaken to detect the prevalence of the ESBLs producing bacteria in wound infection, so as to provide a base line data in treating them & prevent unnecessary use of antibioticsMethods: Isolated gram-negative bacteria initially screened by Minimum Inhibitory Concentration (MIC) ESBLs breakpoints. Then suspected ESBLs producers were confirmed by Phenotypic confirmatory test. Results: 105 (One hundred five) (91.30%) bacterial strains were isolated from 115 samples of wound swab & pus from different patients were studied of which 84(80.00%) were Gram-negative and 21(20.00%) were Gram-positive. Among the isolated Gram-negative bacteria 79(94.05%) were found suspected ESBLs producers of which 54(68.35%) were found as confirmed ESBL producers. The prevalence of ESBLs producing organisms in the present study were found to be 64.29% and Klebsiella spp as most prevalent ESBLs producers.Conclusion: It is essential to report ESBL production along with routine sensitivity reporting, which will help the clinician in prescribing the proper antibiotics.Chatt Shi Hosp Med Coll J; Vol.15 (1); Jan 2016; Page 26-30

infections were E. coli 425 (54.9%), S. aureus 68 (24.9%), Klebsiella spp. 3 (23%), P. aeruginosa 110 (26.9%), and S. aureus 30 (20.4%) respectively. The overall prevalence of resistance to the antimicrobial agents tested in various clinical specimens is discussed in this study. Conclusion: The high resistance rate was observed in our study to most used antibiotics. Therefore, setting up a comprehensive surveillance system is need to evaluate the distribution of organisms isolated and their drug resistance pattern over different period of time and place of Iran.

ObjectivesTo provide an overview of the most frequent aetiologies found in febrile episodes of children under 5 years from sub-Saharan Africa. MethodsMEDLINE and EMBASE were searched for publications in English and French on non-malaria fever episodes in African children under 5 years of age, which were published between January 1990 and July 2015. Case reports and conference abstracts were excluded. ResultsIn total, 3851 titles and abstracts were reviewed, and 153 were selected for full screening of which 18 were included in the present review. Bloodstream infection (BSI) was most commonly investigated (nine of 18) followed by urinary tract infection (UTI) (four of 18) and respiratory tract infection (RTI) (two of 18). Few studies investigated BSI and UTI in the same children (two of 18), or BSI and gastrointestinal infection (GII) (one of 18). As for BSI, the most frequently isolated bacteria were E. coli (four of 12), Streptococcus pneumonia (four of 12), Salmonella spp (three of 12) and Staphylococcus aureus (two of 12) with a positive identification rate of 19.7-33.3%, 5.2-27.6%, 11.7-65.4% and 23.5-42.0%, respectively. As for UTI, the main bacteria isolated were E. coli (six of six) and Klebsiella spp (six of six) with a positive rate of 20.0-72.3% and 10.0-28.5%, respectively. No bacterium was isolated in RTI group, but Human influenzae A and B were frequently found, with the highest positive identification rate in Tanzania (75.3%). Dengue virus (two of 12) was the most frequently reported viral infection with a positive identification rate of 16.7-30.8%. Finally, only rotavirus/adenovirus (69.2% positive identification rate) was found in GII and no bacterium was isolated in this group. ConclusionsThe high prevalence of treatable causes of non-malaria fever episodes requires a proper diagnosis of the origin of fever followed by an appropriate treatment, thereby reducing the under-5 mortality in sub-Saharan Africa and preventing the overprescription of antibiotics and thus circumventing the rise of antibiotic resistance. ObjectifsFournir un apercu des etiologies les plus frequemment trouvees dans les episodes febriles chez les enfants de moins de 5 ans en Afrique subsaharienne. MethodesMedline et Embase ont ete recherchees pour les publications en anglais et en francais sur les episodes de fievre non paludique chez les enfants africains de moins de 5 ans, qui ont ete publiees entre janvier 1990 et juillet 2015. Les rapports de cas et les resumes de conferences ont ete exclus. ResultatsAu total, 3851 titres et resumes ont ete examines, et 153 ont ete selectionnes pour le l'analyse complete, dont 18 ont ete inclus dans la presente etude. L'infection sanguine (IS) a ete la plus souvent investiguee (9/18), suivie par l'infection des voies urinaires (IVU) (4/18) et l'infection des voies respiratoires (IVR) (2/18). Peu d'etudes ont ivestigue l'IS et l'IVU chez les memes enfants (2/18), ou L'IS et l'infection gastrointestinale (IGI) (1/18). En ce qui concerne l'IS, les bacteries les plus frequemment isolees etaient E. coli (12/04), Streptococcus pneumonia (12/04), Salmonella spp (12/03) et Staphylococcus aureus (12/02) avec un taux d'identification positive de 19,7 a 33,3%, de 5,2 a 27,6%, de 11,7 a 65,4% et de 23,5 a 42,0%, respectivement. Quant aux IVU, les principales bacteries isolees etaient E. coli (6/6) et Klepsiella spp (6/6) avec un taux d'identification positive de 20,0 a 72,3% et de 10,0 a 28,5%, respectivement. Aucune bacterie n'a ete isolee dans le groupe IVR, mais influenzae A et B humains ont ete frequemment retrouves, avec le taux d'identification positive le plus eleve en Tanzanie (75,3%). Le virus de la dengue (2/12) etait l'infection virale la plus frequemment rapportee avec un taux d'identification positive de 16,7 a 30,8%. Enfin, seuls les rotavirus/adenovirus (69,2% de taux d'identification positive) ont ete retrouves dans les IGI et aucune bacterie n'a ete isolee dans ce groupe. ConclusionsLa prevalence elevee de causes traitables d'episodes de fievre non-paludique exige un bon diagnostic de l'origine de la fievre, suivi d'un traitement approprie, afin de reduire la mortalite des moins de 5 ans en Afrique subsaharienne et d'empecher la prescription excessive d'antibiotiques, evitant ainsi l'augmentation de la resistance aux antibiotiques. ObjetivosProveer una vision general de las etiologias mas frecuentemente encontradas en episodios febriles de ninos menores de 5 anos en africa subsahariana. MetodosSe realizaron busquedas en Medline y Embase, de publicaciones en Ingles y Frances, sobre episodios de fiebre no malarica en ninos Africanos menores de 5 anos, que hubiesen sido publicados entre Enero de 1990 y Julio del 2015. Se excluyeron informes de casos y resumenes de conferencias. ResultadosEn total se revisaron 3851 titulos y resumenes. Se seleccionaron 153 para una revision completa, y de estos se han incluido 18 en la revision. La sepsis (IS) era la infeccion mas comun (9/18), seguida por la infeccion del tracto urinario (ITU) (4/18) y la infeccion del tracto respiratorio (ITR) (2/18). Pocos estudios investigaban IS e ITU en los mismos ninos (2/18), o IS e infeccion gastrointestinal (IGI) (1/18). En lo que a la IS se refiere, la bacterias mas frecuentemente aislada eran E. coli (4/12), Streptococcus pneumonia (4/12), Salmonella spp (3/12) y Staphylococcus aureus (2/12) con una tasa de identificacion positiva del 19.7-33.3%, 5.2-27.6%, 11.7-65.4% y 23.5-42.0%, respectivamente. En cuanto a la ITU, las principales bacterias aisladas eran E. coli (6/6) y Klebsiella spp (6/6), con una tasa positiva de 20.0-72.3% y 10.0-28.5% respectivamente. No se aislo ninguna bacteria en el grupo ITR, pero se hallaban a menudo los virus influenzae humana A y B, con la tasa de identificacion positiva mas alta en Tanzania (75.3%). El virus del dengue (2/12) era la infeccion viral mas frecuentemente reportada, con una tasa de identificacion positiva del 16.7-30.8%. Finalmente, solo se encontro rotavirus/adenovirus (tasa de identificacion positiva del 69.2%) en IGI y no se aislo ninguna bacteria en este grupo. ConclusionesLa alta prevalencia de causas tratables de fiebre no-malarica requiere de un buen diagnostico del origen de la fiebre, seguido por un tratamiento apropiado, reduciendo asi la mortalidad en menores de 5 anos en africa subsahariana y la prevencion de la prescripcion excesiva de antibioticos, evitando el aumento de la resistencia a los mismos

Introducao : A sepse e um problema de saude publica e e uma das principais causas de morte nos hospitais. Objetivos deste estudo foi classificar e descrever o perfil dos pacientes e adesao da equipe de saude ao protocolo institucional correlacionando o impacto na taxa de letalidade por sepse e choque septico. Metodos : Foi realizado um estudo retrospectivo dos casos de sepse e choque septico no Pronto Socorro Central da Santa Casa de Misericordia de Sao Paulo, Brasil, de 2013 a 2016. Foram analisadas as variaveis: idade, sexo, origem, fatores de risco, apresentacao clinica, foco infeccioso, achados microbiologicos, tempo de internacao, tipo de infeccao, adesao ao protocolo institucional, exames laboratoriais, culturas, administracao de antimicrobiano empirico e desfecho. Resultados: Foram incluidos um total de 434 pacientes com sepse. O predominio foi do genero masculino (57,6%), com predominio de infeccoes comunitarias (91,6%) com idade media de 57 anos, com tempo medio de permanecia hospitalar de 15 dias e o tempo medio para o desfecho obito foi 13 dias. Quanto ao foco primario da infeccao dos pacientes incluidos no protocolo 73,2% eram casos de sepse 26,8% de choque septico. Os principais focos foram de origem pulmonar (60,4%). A Escherichia coli foi o agente infeccioso mais prevalente (24,3%) dos casos seguido por Staphylococcus aureus (18,7%), Klebsiella spp (13,9%) e Pseudomonas spp (13,1%). O numero de notificacoes e a aderencia aos pacotes da sepse foram significantes. Houve uma reducao na taxa de letalidade de 37% nos ultimos tres anos. Conclusoes : O protocolo institucional mostrou se eficaz, otimizando as acoes praticas e melhoria da qualidade, como a deteccao precoce e tratamento em tempo habil dos pacientes com sepse e o impacto nas intervencoes. O processo de desenvolvimento e adesao ao protocolo foi associado ao aumento das notificacoes de casos e ao declinio da taxa de letalidade por sepse apos a adocao das ferramentas do protocolo. Palavras chave : Sepse, Protocolos, Mortalidade ABSTRACT Background : Sepsis is a public health problem and is one of the leading causes of death in hospitals. The objective of this study was to classify and describe the profile of the patients and adherence of the health team to the institutional protocol correlating the impact on the rate of lethality due to sepsis and septic shock. Methods: A retrospective study of sepsis and septic shock in the Central Emergency Room of Santa Casa de Misericordia, Sao Paulo, Brazil, was carried out from 2013 to 2016. The following variables were analyzed: age, gender, origin, risk factors, presentation clinical, infectious outbreak, microbiological findings, hospitalization time, type of infection, adherence to the institutional protocol, laboratory exams, cultures, empiric antimicrobial administration and outcome. Results : A total of 434 patients with sepsis were included. The predominance was male (57.6%), with a predominance of community- -based infections (91.6%), with a mean age of 57 years, with an average length of hospital stay of 15 days, and the mean time to death was 13 days. As for the primary focus of infection of the patients included in the protocol 73.2% were cases of sepsis 26.8% of septic shock. The main foci were of pulmonary origin (60.4%). Escherichia coli was the most prevalent infectious agent (24.3%) followed by Staphylococcus aureus (18.7%), Klebsiella spp (13.9%) and Pseudomonas spp (13.1%). The number of reports and adherence to sepsis packages were significant. There has been a reduction in the lethality rate of 37% in the last three years. Conclusions: The institutional protocol proved 2 of 6 Santana SP, Berezin EN, Arnon MV, Massaia IDFS, Sprovieiri SRS. Avaliacao da aderencia ao protocolo de tratamento de sepse em um hospital universitario brasileiro. Arq Med Hosp Fac Cienc Med Santa Casa Sao Paulo. 2020; 65:e43. to be effective, optimizing practical actions and improving quality, such as the early detection and timely treatment of sepsis patients and the impact on interventions. The process of protocol development and adherence was associated with an increase in case reports and a decline in sepsis lethality after the adoption of protocol tools. Keywords: Sepsis, Protocols, Mortality

Urinary tract infections (UTIs) are among the most common human infections with the distribution of etiological agents and antibiotic resistance patterns varying from region to region and from time to time. The aims of this study were to ascertain the prevalence and antibiotic resistance profiles of common Gram-negative uropathogens among patients attending a Tertiary Care Hospital in Ekiti State, Nigeria. One hundred and fifty clean-catch midstream urine specimens were obtained and cultured within 2 hours of collection for the detection of Gram-negative uropathogens. The isolated organisms were identified by standard microbiological methods. Of the total 150 urine specimens analyzed, 82 (54.67%) specimens were positive for Gram-negative uropathogen with significant bacteriuria of which 34 (41.46%) were males and 48 (58.54%) were females. Klebsiella spp. 38 (46.34%) and Escherichia coli 32 (39.02%) were the most frequently isolated Gram-negative uropathogens, followed by Proteus mirabilis 10 (12.20%) while the least occurring uropathogen was observed to be Pseudomonas aeruginosa 2 (2.44%). All the isolated uropathogens were observed to be highly resistant to the commonly prescribed antibiotics. Emerging resistance to carbapenems was also observed. Nevertheless, carbapenems showed highest susceptibility compared to other tested antibiotics. Conclusively, high levels of resistance of uropathogens to antibiotics exist in our setting. This therefore calls for continuous antibiotic surveillance and improved antibiotic stewardship.

Background Infections caused by third generation cephalosporin-resistant Enterobacteriaceae (3GCREB) are an increasing healthcare problem. We aim to describe the 3GCREB infection incidence and compare it to prevalence upon admission. In addition, we aim to describe infections caused by 3GCREB, which are also carbapenem resistant (CRE). Methods In 2014–2015, we performed prospective 3GCREB surveillance in clinically relevant patient specimens (screening specimens excluded). Infections counted as hospital-acquired (HAI) when the 3GCREB was detected after the third day following admission, otherwise as community-acquired infection (CAI). Results Of 578,420 hospitalized patients under surveillance, 3367 had a 3GCREB infection (0.58%). We observed a similar 3GCREB CAI and HAI incidence (0.28 and 0.31 per 100 patients, respectively). The most frequent pathogen was 3GCR E. coli, in CAI and HAI (0.15 and 0.12 per 100 patients). We observed a CRE CAI incidence of 0.006 and a HAI incidence of 0.008 per 100 patients (0.014 per 1000 patient days). Conclusions Comparing the known 3GCREB admission prevalence of the participating hospitals (9.5%) with the percentage of patients with a 3GCREB infection (0.58%), we conclude the prevalence of 3GCREB in university hospitals to be about 16 times higher than suggested when only patients with 3GCREB infections are considered. Moreover, we find the HAI and CAI incidence caused by CRE in Germany to be relatively low.

With the increasing incidence of multidrug-resistant organisms, there is a need for newer antibiotics. However, due to the lack of new antimicrobial agents, it is necessary to re-evaluate the older agents like minocycline which is a second-line antimicrobial agent. In this study, minocycline susceptibility testing was performed for 693 Escherichia coli, 316 Klebsiella spp. and 89 Acinetobacter spp. Among extended spectrum beta-lactamase producing E. coli and Klebsiella spp. percentage susceptibility to minocycline were 76 and 85, respectively. Among the carbapenem resistant E. coli, Klebsiella spp. and Acinetobacter spp. minocycline susceptibility were 52%, 55% and 42%, respectively. Based on the susceptibility profile, minocycline can be considered for treatment of infections by multidrug-resistant organisms.

Background: Extended spectrum beta-lactamase (ESBL) producing organisms causing urinary tract infections are increasing in incidence and becoming a serious health problem due to their resistance to large number of antibiotics. Objectives: To investigate the ESBL prevalence of Escherichia coli and Klebsiella spp. which are isolated from urine samples for both in and outpatients with their resistance profiles. Methods: From 2004 to 2012, a total of 13975 isolates (12897 E. coli, 1078 Klebsiella spp.) were included in this study. The antibiotic susceptibility was tested using Kirby–Bauer disk diffusion method and Vitek2 System (bioMerieux, France) according to CLSI. Results: Our data showed a significant increasing in ESBL prevalence from 12.5% to 44.7% (P < 0.001) for inpatients; from 9.6% to 22.8% (P < 0.001) for outpatients in E. coli and from 25% to 60.5% (P < 0.003) for inpatients; from 12% to 25% (P < 0.095) for outpatients in Klebsiella spp. For E. coli, the increase was significantly high in both of males and females (P < 0.001). However, for Klebsiella spp. it was significantly high in male patients (P < 0.001). The resistance rates of antibiotics for the ESBL producing E. coli, and Klebsiella spp. showed a significant increase. These rates were higher than 70% for fluoroquinolones, amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole. Even carbepenem resistance reached to 7% in the outpatients and 15% in inpatients for ESBL producing Klebsiella spp. Conclusions: Our study demonstrated a significant increase in the prevalence of ESBL producing E. coli and Klebsiella spp. and a remarkable carbapenem resistance trend in the ESBL producing Klebsiella spp. isolated from urine samples.

Background/aim: The aim of this study was to determine the prevalence of fecal carriage of extended-spectrum beta-lactamase (ESBL)-producing bacteria, enzyme types, and risk factors affecting colonization. Materials and methods: A total of 576 stool samples from outpatients were examined between October 2012 and May 2013. Screening was done with selective EMB plates. ESBL were detected by double-disk synergy and confirmed agar strip gradient methods. Enzyme types were determined by PCR. Results: The prevalence of fecal carriage was found as 30% (173 of 576). Recent use of antibiotics, hospitalization and surgical operation, diabetes, crowded household populations, and old age were associated with higher carriage rates. Of the ESBL-producing bacteria, 87.5% were positive for blaCTX-M genes. Of the blaCTX-M gene-positive isolates, 95.2% were positive for blaCTX-M-1 genes; among these, 82.2% were positive for blaCTX-M-3 and 67.7% were positive for blaCTX-M-15 genes while 62.5% isolates were positive for both blaCTX-M-3 and blaCTX-M-15 genes Conclusions: A high rate (30%) of fecal carriage of ESBL bacteria was found in an adult population. The predominant beta-lactamase enzyme types were CTX-M-3 and CTX-M-15. © TÜBİTAK, 2012.20.00.17, This study was funded by the B?lent Ecevit University Scientific Research Fund (project number: 2012.20.00.17). We thank the technical staff of the laboratory for their help with the media preparation and bacterial identification, and we also thank Eldan Suba?? for her help with the PCR reactions.

International audience; Extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) are endemic pathogens worldwide. Infection with ESBL-PE may be associated with inadequate antibiotic therapy and a poor outcome. However, risk factors for ESBL-PE community-acquired infections are ill-defined. An observational multicentre study was performed in 50 hospitals to identify the prevalence of and risk factors for community-acquired ESBL-PE bacteraemia. All patients presenting with community-onset Enterobacteriaceae bacteraemia were recorded over a 2-month period (between June and November 2013). Risk factors and 14-day outcomes of patients were investigated. Among 682 Enterobacteriaceae bacteraemia episodes recorded, 58 (8.5%) were caused by ESBL-PE. The most frequent species isolated were Escherichia coli (537; 76.7%) and Klebsiella spp. (68; 9.7%), of which 49 (9.1%) and 8 (11.8%), respectively, were ESBL-producers. Most ESBL-PE episodes were healthcare-associated, and only 22 (38%) were apparently community-acquired. The main risk factor for community-acquired ESBL-PE bacteraemia was a prior hospital stay of ≥5 days within the past year. The overall 14-day survival was 90%; only 4 (6.9%) of 58 patients with ESBL-PE bacteraemia died. Inadequate initial antibiotic therapy was administered to 55% of patients with ESBL-PE bacteraemia but was not associated with increased 14-day mortality. Although many patients had community-onset ESBL-PE bacteraemia, almost two-thirds of the episodes were actually healthcare-associated, and true community-acquired ESBL-PE bacteraemia remains rare. In our essentially non-severely ill population, inappropriate initial therapy was not associated with a higher risk of mortality.

Background: Extended spectrum beta-lactamases (ESBLs) are group of bacteria producing enzymes which can destroy one or more antibiotics. ESBL producing organisms are resistant to many types of antibiotics which would normally be used to treat such infections thus considered as multi-drug resistant (MDR). The emergence and spread of ESBL is a public health threat as it is usually associated with an increase of morbidity, mortality and healthcare costs. Aim of the work: Detecting the prevalence of nosocomial infections caused by ESBL-producing E.coli and Klebsiella species among patients treated at Minia University Hospitals. Methods: Eighty-five isolates from nosocomial infections at Minia university hospital due to E.coli and Klebsiella species were screened for ESBL production phenotypically and by PCR Results: Out of 85 isolates causing nosocomial infections at Minia university hospitals during the period of April 2014 - April 2015, the prevalence of E.coli was 52 isolates (61.1%) while Klebsiella spp. was 33 isolates (38.9%). The prevalence of ESBL among all the isolates of E.coli and Klebsiella species was 32.8% (28/85); with a prevalence of 16.4% among E.coli and 16.4% among Klebsiella spp. Isolates. Conclusions: The prevalence of ESBL in Minia University Hospitals was 32.8% among the nosocomial infections. The predictors for the nosocomial acquired ESBL-EK infections were; old age, long hospital stay, mechanical ventilation, diabetes mellitus and prior antibiotics intake.