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Background:Diabetic foot ulcers (DFUs) are severe complications of diabetes, leading to osteomyelitis, gangrene, and limb amputation. These outcomes increase mortality risk and bacterial resistance in surviving patients. The selection of the most effective antibiotics for DFUs remains a growing challenge. Objectives:The study aimed to identify risk factors, bacterial pathogens, and drug resistance in DFU patients, and explore the correlation between interleukin-6 (IL-6), vascular endothelial growth factor (VEGF) levels, and DFUs. Materials and Methods:Sixty isolates of bacteria were isolated aerobically from 100 samples of DFU (30 isolates from Pseudomonas aeruginosa and 30 isolates from Staphylococcus aureus). All isolates were identified by biochemical tests, then confirmation diagnosis was done by using VITEK-2. Determination multiple drug resistance isolates by susceptibility tests, then estimation of the activity of silver nanoparticles (AgNPs) as antibacterial with different concentrations were done. VEGF and IL-6 levels were determined by using Enzyme-linked immunosorbent assay (ELISA) technique. Results:The study revealed that many bacteria-resistant antibiotics, but AgNPs significantly inhibit multi-drug resistant bacteria, suggesting their potential as an alternative treatment. VEGF and IL-6 levels were significantly higher (P-value < 0.001) in DFU patients, with IL-6 negatively correlating with VEGF. Conclusion:Diabetic foot infections, caused by various bacteria, require understanding of antibiotic sensitivity for effective treatment. AgNPs showed strong antimicrobial effects against common bacteria, suggesting potential as an alternative treatment. The study also found elevated VEGF and IL-6 levels in DFU patients, with IL-6 potentially inhibiting VEGF, thus impairing healing.

Background: ESKAPE “(Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter sp.)” pathogens are commonly found in infections affecting the skin and underlying tissues. ESKAPE pathogens often exhibit widespread multidrug resistance in hospitals, contributing significantly to Hospital-acquired infections. ESKAPE pathogen prevalence can combat the vast challenge of Antibiotic Resistance (ABR). Materials and Methods: “The microbiological statistics of ESKAPE infections and sensitivity between January 2020 and October 2022 were extracted from the laboratory records and analysed for the bacterial profile and antibiotic sensitivity pattern”. Results: Out of the 2037 pathogens isolated from Skin and soft tissue infection, 1308 were ESKAPE pathogens accounting for a prevalence of 64.2%. Staphylococcus aureus (n=340/1308; 25.99%) was the predominant pathogen followed by Pseudomonas aeruginosa (n=332/1308; 25.38%). Among Gram-negative isolates, 29.43% exhibited multidrug resistance (MDR). Carbapenemase was found to be a frequent mechanism of resistance, highest among Acinetobacter species (n=99; 64.7%), followed by Klebsiella pneumoniae (n=109; 37.07%). Amp C production was seen most commonly in Enterobacter species (n=93; 61.2%), followed by Klebsiella pneumoniae (n=172; 58.5%) whereas ESBL production was seen in Enterobacter species (n=46; 30.03%). Conclusion: ESKAPE pathogens are critical etiologic agents of Skin and soft infections. Regular studies are vital for evaluating bacterial susceptibility and highlighting the importance of policies to reduce hospital infections and enhance antibiotic prescription oversight. Understanding virulence and resistance markers is critical for tailoring treatment strategies based on local antibiograms and managing related infections.

Background: Methodology: A retrospective study was conducted using the Medical Microbiology Laboratory records of the Lagos State University Teaching Hospital. The study reviewed the in vitro antibiotic susceptibility patterns of urinary bacterial isolates from April 2020 to March 2021, focusing on Enterococcus spp. Bacteria were isolated and identified from routine urine samples using standard bacteriological methods and the Analytical Profile Index (API). Antibiotic susceptibility tests (AST) were performed using the modified Kirby-Bauer disk diffusion method, with susceptibility breakpoints determined by the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results: A total of 82 patients (5 outpatients and 77 inpatients) with Enterococcus-associated UTIs were identified. The species distribution was 70.7% E. faecalis and 29.3% E. faecium. E. faecium exhibited greater resistance to levofloxacin and tetracycline but greater sensitivity to amoxicillin compared to E. faecalis. Both species showed high sensitivity to tigecycline, meropenem, and fosfomycin. Conclusion: The prevalence of Enterococcus-associated UTIs in this study was 3.6% (82/2253), with hospital-acquired Enterococcus spp. accounting for 3.4% (77/2253). E. faecium isolates were significantly more resistant to levofloxacin and tetracycline than E. faecalis. The high rate of multidrug resistance (MDR) in both species underscores the importance of promoting rational antibiotic use to prevent the emergence of resistant organisms.

An agent that contributes to hospital acquired illnesses is Klebsiella pneumoniae. In community-acquired infections and illnesses of the urinary tract, it is the primary and most frequent causal agent. The strains were detected by using Analytical Profile Index (Api-20 E) and 16s rRNA techniques, fifteen trains of K. pneumoniae were obtained from eighteen urine samples collected from patients in Al-Hussein Hospital, Thi-Qar Governorate, Iraq. This research sought to identify the antibiotic resistance of K. pneumoniae to Aztreonam, Ceftriaxone, Trimethoprim, Amikacin, Ciprofloxacin, Meropenem, and Piperacillin, the resistance was high and ranged between (86.6-100)%. The multidrug resistance percentage was 100%, in addition the investigation aimed to detect some virulence genes, (i.e. HtrA and MrkA gene) in K. pneumoniae. The HtrA and MrkA genes were found using the PCR method, which revealed that 6 (40%) of the isolates had the HtrA gene and that all strains under study lacked the MrkA gene.

Abstract Overuse of antibiotics during coronavirus disease 2019 (COVID-19) in an attempt to reduce COVID-19 mortality in the short term may have contributed to long-term mortality from antimicrobial resistance (AMR). The aim of this study was to evaluate the impact of the COVID-19 pandemic on AMR in Egypt and map the distribution of multidrug-resistant (MDR) and extensive drug-resistant (XDR) across Egypt. Through a multicenter cross-sectional study 2430 culture results were collected in 2019 and 2022 pre and post-COVID-19 pandemic in Egypt, including 400 Klebsiella pneumoniae, 760 Escherichia coli, 650 Acinetobacter baumannii, and 620 Methicillin-resistant staphylococcus aureus (MRSA) culture results. MDR and XDR culture results distribution across Egypt was highlighted through the geographic information system. Mixed effect logistic regression models and sub-group analysis were performed according to the type of specimens to test the impact of COVID-19 on resistance. Adjusted analysis demonstrated K. pneumoniae resistance has increased against quinolones and carbapenems (P

Background: Microorganisms are turning out to be greatly resistant to existing antibiotics, specifically gram-negative rods which shows resistance to currently accessible antibiotics. Beta-lactam antibiotics are the main therapeutic option to treat infections of gram-negative microorganisms i.e., ESBL and Carbapenemase producers. Saussurea lappa herb is a medicinal herb use since many times. Basically, the roots of S. lappa herb were used as medicines. Current study was conducted to find out activity of various fractions of S. lappa herb against multidrug resistant gram-negative rods. Methods: Crude extracts of ethanol, methanol and water and fractions of n-hexane, chloroform, and methanol from S. lappa herb were used. Total of sixty multidrug resistant organisms were included in which thirty were ESBL and thirty were carbapenemase producing organisms. Mean MIC and comparative analysis of various extracts and fractions have been evaluated. Results: The mean MIC value of crude extracts of ethanol, methanol, n-hexane, chloroform and methanol fractions and water extract from S. lappa against ESBL producing organisms were 109.33± 6.915 mg/ml, 154.67± 5.164 mg/ml, 150.00± 5.345 mg/ml, 55.33±5.164 mg/ml, 178.00±6.103 mg/ml, 64.00± 7.701 mg/ml respectively. Similarly, the mean MIC value against carbapenemase producing organisms were 100.67± 8.683 mg/ml, 158.67± 3.519 mg/ml, 150.67± 5.936 mg/ml, 54.67±5.164 mg/ml, 176.67±14.223 mg/ml, 64.33± 9.353 mg/ml respectively. Conclusion: This study suggests that extracts and fractions of S. lappa herb can form the basis to develop novel broad-spectrum formulation for antimicrobial drugs as it contains compounds that has novelty to perform its action against multi-resistant mechanisms.

Introduction and aim of study: Chronic wounds are increasingly challenging global healthcare. These wounds, which take over 3 months to heal, are complicated by untreated infections and the formation of biofilm, hindering healing and antibiotic effectiveness. To tackle these issues, new treatments like bacteriophage therapy are being explored. Bacteriophages, viruses that target bacteria, offer promise in overcoming antibiotic resistance. However, their use presents challenges that need to be addressed. Material and methods: Our review is based on the analysis of materials collected in Pubmed, Elsevier and other scientific articles using keywords: “chronic wound”, “chronic wounds infection”, “biofilms”, “MDR”, “bacteriophage”, “phage therapy”. Conclusions: The rise of chronic wounds due to resistant infections poses a significant challenge for patients and healthcare systems. Multidrug-resistant bacteria, often forming biofilm, evade current treatments, urging the search for alternatives. Phage therapy, showing efficacy against various stubborn infections, including those from surgery or diabetes, gains attention. Advanced delivery systems enhance targeted treatment, while phage cocktails improve effectiveness, especially against multiple resistant strains. Safety is generally observed, but larger trials are needed. Though not a replacement for antibiotics, phage therapy offers hope, needing robust clinical validation. While challenges exist, its societal, commercial, and economic benefits suggest a promising future beyond clinical use.

Background: Helicobacter pylori is the most frequent human bacterial infection worldwide; it is prevalent in approximately half of the world's population. H.pylori poses a major health risk because it possesses distinct virulence factors and highly resistant to antibiotics. Multidrug resistance (MDR) and single-drug resistance are two distinct resistance profiles. Chromosome mutations influence antibiotic activity via target-mediated pathways. Inadequate drug absorption, efflux pumps activity, biofilm development, and cocci formation represent supplementary biological mechanisms by which H.pylori acquires drug resistance. The overexpression of efflux pumps genes in mutant isolates is readily detectable in post-therapy courses. Objective: Characterization of the biological and molecular mechanisms contributing to the development of antibiotic resistance in H.pylori. Conclusion: An alarming rate of drug-resistant H.pylori is on the rise. Primary and acquired resistance to clarithromycin and metronidazole has increased globally. Bacterial factors including biofilms, efflux pumps, and molecular mechanism are in association with H.pylori resistance. It is important to continue to monitor the resistance profiles of H.pylori isolates.

The swine production chain can be a reservoir of antimicrobial-resistant Escherichia coli, which transfers resistance genes to other bacteria, serving as an important biomarker in the One Health approach. This study aimed to identify the frequency and antimicrobial resistance profile of E. coli in the swine production chain, assess the presence of extended-spectrum beta-lactamases (ESBL), and compare resistance profiles across different sample types. A total of 622 samples of swine carcasses from various points of the slaughter process (n = 400), swine feces (n = 100), commercial cuts (n = 45), environment (n = 67), and feces from employees (n = 10) of a pig slaughterhouse certified by the Federal Inspection Service, located in São Paulo state, Brazil, were collected. A total of 1260 E. coli isolates were obtained from the samples, with 73.6% of the samples testing positive. The agar disk diffusion test was performed with 10 different classes of antimicrobials. To confirm the production of ESBLs, the isolates were submitted to a double-disk synergism test using cefotaxime, ceftazidime, and amoxicillin with clavulanic acid. Of the total isolates, 80.71% were multidrug resistant. All ESBL-producing isolates were multidrug resistant and resistant to amoxicillin, tetracycline, and chloramphenicol. Isolates from human feces samples had less chance of being multidrug resistant than samples from other sources. The diversity of resistance profiles was verified in the samples, not clustering according to the sources, except for human feces isolates that clustered, evidencing lower antimicrobial resistance variability of these samples. Antimicrobial resistance is significantly present in the pork production chain, necessitating a comprehensive multidisciplinary approach to effectively mitigate risks within the One Health framework.

The dissemination of resistant pathogens through food supply chains poses a significant public health risk, spanning from farm to fork. This study analyzed the distribution of Shiga toxin-producing Escherichia coli (STEC) across various sources within the animal-based food supply chain. A total of 500 samples were collected from livestock, poultry, the environment, fisheries, and dairy. Standard microbiological procedures were employed to isolate and identify E. coli isolates, which were further confirmed using MALDI-TOF and virulence-associated genes (VAGs) such as stx1, stx2, ompT, hylF, iutA, fimH, and iss. The phenotypic resistance patterns of the isolates were determined using the disc diffusion method, followed by molecular identification of antibiotic resistance genes (ARGs) through PCR. STEC were subjected to PCR-based O typing using specific primers for different O types. Overall, 154 (30.5%) samples were confirmed as E. coli, of which 77 (50%) were multidrug-resistant (MDR) E. coli. Among these, 52 (67.53%) isolates exhibited an array of VAGs, and 21 (40.38%) were confirmed as STEC based on the presence of stx1 and stx2. Additionally, 12 out of 52 (23.07%) isolates were identified as non-O157 STEC co-harbouring mcr-1 and blaNDM-1. O26 STEC was found to be the most prevalent among the non-O157 types. The results suggest that the detection of STEC in food supply chains may lead to serious health consequences, particularly in developing countries with limited healthcare resources.

The persistence of non-typhoidal Salmonella and Campylobacter in chicken meat is a considerable public health risk and a future challenge. This study aimed to determine the prevalence of Salmonella and Campylobacter in poultry processing lines where different chlorine concentrations were used in the chill tank. The samples were collected from four types of processing plants in Sri Lanka, considering the chlorine concentration used in the chill tank, which ranged from 2 ppm to 50 ppm. Salmonella and Campylobacter were isolated from whole carcass washings, neck skin, and cecal samples. Subsequently, an antimicrobial susceptibility test was performed for the isolates. The results revealed the overall prevalence of Salmonella and Campylobacter was 78.25% and 63.5%, respectively. Positive percentages of Salmonella and Campylobacter were high in the carcasses compared to the neck skin and ceca. The Campylobacter counts on the whole carcasses were significantly low (p < 0.001), at higher chlorine concentrations ranging from 20 to 30 ppm and 40 to 50 ppm. The pathogen prevalence in the whole carcasses was 84.7% Campylobacter coli, 39.1% Campylobacter jejuni, 71.1% Salmonella Typhimurium, and 28.8% Salmonella Infantis. The highest resistance was observed for tetracycline (63.8%) in Salmonella, while it was for gentamicin (87.8%) in Campylobacter. The prevalence percentage of multidrug-resistant Campylobacter was 51.2%, while it was 2.12% for Salmonella. The persistence of multidrug-resistant Salmonella and Campylobacter on the post-chill carcasses was highlighted in the present study as a significant public health threat that has to be addressed urgently.

Few data are available on incidence of multidrug-resistant organism (MDRO) colonization and infections in mechanically ventilated patients, particularly during the COVID-19 pandemic. We retrospectively evaluated all patients admitted to the COVID-19 intensive care unit (ICU) of Hub Hospital in Milan, Italy, during October 2020‒May 2021. Microbiologic surveillance was standardized with active screening at admission and weekly during ICU stay. Of 435 patients, 88 (20.2%) had MDROs isolated ≤48 h after admission. Of the remaining patients, MDRO colonization was diagnosed in 173 (51.2%), MDRO infections in 95 (28.1%), and non-MDRO infections in 212 (62.7%). Non-MDRO infections occurred earlier than MDRO infections (6 days vs. 10 days; p

The worldwide incidence of multi-drug-resistant tuberculosis (MDR-TB) is rapidly increasing, and it has emerged as a pressing public health issue in Iran. Nevertheless, there is a scarcity of up-to-date research on the prevalence of MDR-TB in individuals with pulmonary TB in the country. In this cross-sectional study, we gathered a total of 1216 respiratory samples, each corresponding to a unique patient, from five distinct regional TB laboratories in Iran. We identified clinical isolates as Mycobacterium tuberculosis using the IS6110-based PCR assay and Xpert MTB/RIF. Drug susceptibility testing (DST) was conducted using the conventional proportion method. Out of the collected specimens, 448 tested positive for M. tuberculosis. Among these isolates, 445 (99.4%) exhibited susceptibility to the tested drugs, while 3 (0.6%) were found to be MDR. The findings from this recent study indicate that the prevalence of MDR in Iran stands at 0.6%. The absence of recently approved treatment protocols in various regions of Iran, along with inadequately equipped laboratories lacking DST capabilities, could contribute significantly to the rise in TB/MDR-TB prevalence in Iran. Therefore, the implementation of enhanced treatment management strategies and the adoption of innovative technologies are essential steps towards improving the current situation.

Background. The coronavirus disease 2019 (COVID-19) pandemic placed an unprecedented strain on intensive care units (ICUs) in South Africa. Infection prevention and control (IPC) strategies were highlighted to minimise the risk to healthcare workers and for the protection of patients from contracting hospital-acquired infections (HAIs). During the third wave, our institution adopted a shift system to address severe burnout among ICU personnel. We noted an upstroke in the occurrence of HAIs, specifically carbapenem-resistant Enterobacterales (CRE) and multidrug-resistant (MDR) Acinetobacter baumannii. Objectives. To report these outbreaks, compare the rate of CRE and A. baumannii infections with the first COVID-19 wave and to analyse its impact on patient outcomes. Method. We retrospectively analysed data from a prospectively collected registry involving all adult patients with severe COVID-19 admitted to the dedicated COVID-19 ICU from May 2021 to September 2021. Information from the admission database, including the patients’ demographics, comorbidities, laboratory results and length of ICU stay were extracted. Results. Ninety patients were admitted with severe COVID-19 during the third wave. There was an outbreak of both CRE (the majority Klebsiella pneumoniae) and A. baumannii. Furthermore, 18 patients cultured the same CRE organism, and 25 patients cultured the environmental organism A. baumannii. The HAI rate was significantly higher compared with the first wave published data: 59/90 (65.6%) v. 73/363 (20.1%, p

Objective To investigate the expression and significance of progesterone X receptor (PXR), multidrug resistant protein 1 (MDR1), cytochrome P450 3A5 (CYP3A5), and cytochrome P450 2B6 (CYP2B6) in high-grade serous ovarian cancer (HGSOC). Methods A total of 56 patients with HGSOC admitted to the Department of Gynecology, Qingdao Municipal Hospital from September 2019 to December 2021 were included in the experimental group. The patients were further divided into drug resistant group (24 cases) and sensitive group (32 cases) according to their resistance to platinum chemotherapy drugs. The control group included 16 patients with uterine fibroids admitted during the same period. The expression of PXR, MDR1, CYP3A5, and CYP2B6 in HGSOC and normal fallopian tubes were determined by immunohistochemistry, real-time quantitative PCR, and Western blotting. Results Compared with the control group, the positive expression rates of PXR, MDR1, CYP3A5, and CYP2B6 were significantly increased in the experimental group (χ2=12.879-17.174,P0.05). Conclusion PXR, MDR1, CYP3A5, and CYP2B6 are highly expressed in HGSOC, which may be involved in its occurrence and development. The detection of PXR, MDR1, CYP3A5, and CYP2B6 expression can be used to determine the sensitivity of HGSOC to chemotherapy, which is helpful to provide guidance for postoperative chemotherapy.

Background: Staphylococcus aureus, especially those that are multidrug-resistant, constitute a public health problem worldwide. It has been represented as the most common causative agent of skin infections, wound infections, and bacteremia. Objective: The purpose of the current study was to determine the incidence of S. aureus antibiotic resistance through bacteria collection from various clinical locations in a number of hospitals in the Babylon province. Materials and Methods: During the research, 429 clinical samples were collected from hospitals in the Babylon Health Directorate between July 2022 and February 2023. The samples were cultured in routine selective media, and the bacterial isolates were found according to different testing biochemically. The disc diffusion method was used in an antibacterial sensitivity test. Results: Of 429 different specimens, 284 (66.2%) showed bacterial growth. After using manual methods to identify species, 171 (60.21%) of 284 isolates are Staphylococcus spp. From 171 Staph species, 61 (35.67%) were S. aureus. These isolates award a maximum rate of sensitivity to nitrofurantoin (90%) and chloramphenicol (95%) and showed a maximum ratio of resistance to penicillin (91%) and cefoxitin (85%). Conclusion: High prevalence of S. aureus 61 (35.67%) from 171 Staphylococcus species. Antibiotics indicated a high ratio of sensitivity to nitrofurantoin (90%) and chloramphenicol (95%) and indicated a high ratio of resistance to penicillin (91%) and cefoxitin (85%). The purpose of the current study was to determine the incidence S. aureus antibiotic resistance through bacteria collection from various clinical locations in a number of hospitals in the Babylon province.

Abstract Background Resistance to different antimicrobial classes by Salmonella species has generated a global public health concern. The spread of extended-spectrum β-lactamases (ESBLs) bla CTX gene variants is also increasing. This study aimed to investigate the antibiotic resistance and the carriage of bla CTX-M-9 and bla CTX-M-15 as well as the quinolone resistance gene (qnrB19) among Salmonella species from hospitalised patients in Lagos, Nigeria. Methods In this cross-sectional study from April 2021 to August 2021, a total of 508 samples were collected from hospitalised patients. The samples were subjected to standard microbiological investigation. All the isolates were identified using API 20E kits and real-time polymerase chain reaction (RT-PCR). The in vitro antibiotic susceptibility testing (AST) was investigated using the disk diffusion method. Detection of antibiotic resistance and virulence gene makers was conducted using RT-PCR. Results In total, 24 Salmonella species were identified. All the isolates were non-typhoidal Salmonella isolates. None of the isolates screened was S. Typhi and S. Paratyphi. Most of the isolates were susceptible to imipenem, ciprofloxacin, ofloxacin and gentamycin, while a high level of resistance to all cephalosporins, penicillin, and some carbapenems was observed. In total, 79.2% (19/24) of the Salmonella isolates harboured the bla CTX-M variant including 54.2% (13/24) bla CTX-M-9 and 12.5% (3/24) bla CTX-M-15, while co-habitation of bla CTX-M-9 and bla CTX-M-15 was observed in 12.5% (3/24) of the isolates, respectively. None of the isolates harboured quinolone-resistant qnrB19 gene and virulence gene stn. However, invA gene was present in 66.7% (16/24) of all isolates. Conclusions This study is considered the first report of bla CTX-M-9 and bla CTX-M-15 variants in Salmonella species in Nigeria. The continued existence of cefotaximase (CTX-M)-producing Salmonella within our environment calls for the prudent use of cephalosporins.

Staphylococcus pseudintermedius is an emergent zoonotic agent associated with multidrug resistance (MDR). This work aimed to describe the antibacterial activity of four essential oils (EOs) and silver nanoparticles (AgNPs) against 15 S. pseudintermedius strains isolated from pyoderma. The four EOs, namely Rosmarinus officinalis (RO), Juniperus communis (GI), Citrus sinensis (AR), and Abies alba (AB), and AgNPs were used alone and in combination to determine the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC). All strains were MDR and methicillin-resistant. Among the antibiotic cohort, only rifampicin, doxycycline, and amikacin were effective. EOs’ chemical analysis revealed 124 compounds belonging to various chemical classes. Of them, 35 were found in AR, 75 in AB, 77 in GI, and 57 in RO. The monoterpenic fraction prevailed over the sesquiterpenic in all EOs. When EOs were tested alone, AB showed the lowest MIC followed by GI, AR, and RO (with values ranging from 1:128 to 1:2048). MBC increased in the following order: AB, AR, GI, and RO (with values ranging from 1:512 to 1:2048). MIC and MBC values for AgNPs were 10.74 mg/L ± 4.23 and 261.05 mg/L ± 172.74. In conclusion, EOs and AgNPs could limit the use of antibiotics or improve the efficacy of conventional therapies.

A wide range of comorbidities, especially in multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis (XDR-TB) patients, markedly complicates selecting effective treatment of tuberculosis (TB) and preventing the development of adverse events. At present, it is impossible to assess the severity of comorbid pathologies and develop indications for the administration of accompanying therapy in TB patients. The aim of this study was to identify the difference in the range of comorbidities between patients with MDR-TB and XDR-TB and assess the impact of comorbidities on TB treatment. Materials and Methods: A retrospective, prospective study was conducted where 307 patients with MDR-TB and XDR-TB pulmonary tuberculosis aged 18 to 75 years who received eTB treatment from 2016 to 2021 in St. Petersburg hospitals were analyzed. The analysis showed that the comorbidity level in MDR-TB and XDR-TB patients with TB treatment success and treatment failure was comparable with the use of the Charlson Comorbidity Index (CCI). The CCI demonstrated declining data in terms of TB treatment outcome period in both groups. A slight predominance of CCI score (3 to 4 points) in XDR-TB (22.7%) vs. MDR-TB (15.4%) patients was found. In the case of an TB treatment failure, the CCI level in MDR-TB vs. XDR-TB patients was characterized by a significantly higher rate of low magnitude (ranging from 1 to 2 points) in 21.1% vs. 4.5% (p < 0.05), which was higher in XDR-TB patients (ranging from 4 to 5 points, in 10.0% vs. 0, χ2 = 33.7 (p < 0.01)). Chronic viral hepatitis B and C infection, cardiovascular pathology, chronic obstructive pulmonary disease, and chronic alcoholism were found to be significant comorbidity factors that influenced the TB treatment success. Conclusions: It is evident that XDR-TB patients comprise a cohort with the most severe disease course due to comorbidities impacting TB treatment efficacy. The obtained data pointed to the need to determine comorbidity severity in patients with drug-resistant Mbt prior to administering TB treatment schemes.

The increasing disparity between antimicrobial resistance (AMR) and the development of new antimicrobials continues to pose a significant global health concern. However, plant extracts have shown promise in combating this issue either through their inherent antimicrobial activity or by serving as potential reservoirs of effective antimicrobial compounds. These compounds have the ability to target pathogenic biofilms and inhibit the production of extended-spectrum β -lactamases (ESBLs). However, there is limited research available on the antibacterial properties of goldenrod extract. Thus, the objective of this study was to investigate the impact of S. virgaurea (SV) extract on the viability and ability to form biofilms of ESBL-Pseudomonas aeruginosa (P. aeruginosa). A cross-sectional study was conducted from August 2022 to March 2023. The broth microdilution method was employed to determine the minimum inhibitory concentration (MIC) of the (SV) extract. Subsequently, the minimum bactericidal concentration (MBC) was determined based on the MIC values obtained. The antibiotic susceptibility of bacteria was evaluated using the Kirby disk diffusion assay and an Antimicrobial Susceptibility Testing (AST) card in conjunction with the Vitek-2 compact system. Biofilm formation was evaluated using Congo red and a 96-well Elisa plate, while the presence of extended-spectrum β-lactamases (ESBLs) was estimated by measuring the reduction of nitrocefin at a wavelength of 390 nm. In addition, treatment of biofilm and ESBL activity with SV extract using 96-well Elisa plate and nitrocefin hydrolyzing, respectively. The resistance rates of P. aeruginosa isolates to the tested antibiotics were as follows: Levofloxacin 33%, Ciprofloxacin 40%, Amikacin 49%, Meropenem 50%, Cefepime 70%, Ceftazidime 75%, Cefotaxime 85%, Piperacillin-Tazobactam 90%, Amoxiclav 97%, Ampicillin 99%, Ceftriaxone 100%. The prevalence of MDR-P. aeruginosa, XDR-P. aeruginosa, PDR-P. aeruginosa and non-MDR-PA were 40% (n = 40), 7% (n = 7), 3% (n = 3) and 50% (n = 50), respectively. From the GC–MS results, it was observed that the presence of Octadecane, Clioquinol, Glycerol tricaprylate, hexadecanoic acid, cis-13-octadecenoic acid, oleic acid and Propanamide were the major components in the Solidago extract. In the determination of plant crude extracts, the values ranged between 0.25 and 64 mg/mL against bacteria. The resulting activity of the extract showed a significant statistical relationship at a p-value ≤ 0.01 against ESBL production and biofilm formation in P. aeruginosa. The S. virgaurea extract exhibited effectiveness in inhibiting biofilm formation and combating P. aeruginosa strains that produce extended-spectrum β-lactamases (ESBLs).

Context: Tuberculosis is a major health problem in India .Accurate and also fast diagnosis of tuberculosis has remained a challenge and we determined the impact of CBNAAT on notification of tuberculosis cases in Rajasthan. Aims: The Aim of the present Study was use of CBNAAT in tuberculosis and impact on rate of detection of TB and MDR and XDR TB in Rajasthan. Methods and Material: We did a retrospective study of notified tuberculosis cases registered in government and private hospital from 2015 to 2018.comaprison was done for these 4 years Results: There was a total increase of 57 percent over the period of 4 years from 2015 to 2018 in no of tuberculosis notified cases and during the same time there was a 51 percent and 66 percent increase in the number of MDR and XDR tuberculosis cases respectively. Conclusion: Use of CBNAAT significantly increases the no of notified cases of tuberculosis along with MDR and XDR cases .as we recommend that it should be widely adopted and expanded

Product development in medical technology is largely governed by Regulatory Affairs. In contrast, for consumer products Human-Centred Design (HCD) is the guiding principle. Both approaches are laid down in international standards and overlap many aspects such as procedure, applied methodologies and development activities. For medical devices patient safety and therefore risk management is the guiding development goal. In HCD the focus lies on User Experience (UX), a positive experience throughout the entire product life cycle. The question arises whether UX could play a more important role in medical device development, particularly considering the similarities of the two development processes

Background Surveillance of antimicrobial resistance (AMR) among veterinary pathogens is necessary to identify clinically relevant patterns of AMR and to inform antimicrobial use practices. Streptococcus equi subsp. zooepidemicus and Rhodococcus equi are bacterial pathogens of major clinical importance in horses and are frequently implicated in respiratory tract infections. The objectives of this study were to describe antimicrobial resistance patterns and identify predictors of AMR and multidrug resistance (MDR) (resistance to three or more antimicrobial classes) among equine S. zooepidemicus and R. equi isolates. Methods Antimicrobial susceptibility data from equine specimens submitted to the University of Kentucky Veterinary Diagnostic Laboratory between 2012 and 2017 were used in the study. Temporal trends in AMR and MDR were assessed using the Cochran-Armitage test. Logistic regression was used to identify associations between patient characteristics and the following outcomes: (a) MDR among S. zooepidemicus isolates, and (b) resistance to macrolides and ansamycins (rifampin) among R. equi isolates. Logistic regression was also used to investigate whether resistance of S. zooepidemicus and R. equi isolates to an antimicrobial class could be predicted by resistance to other drug classes. Results The vast majority of S. zooepidemicus (99.6%) and R. equi isolates (83%) were resistant to at least one antimicrobial agent, but no significant temporal trends in AMR were observed. Approximately half (53.3%) of the S. zooepidemicus isolates were multidrug-resistant, and there was a significant (p

An emerging multidrug-resistant pathogenic yeast called Candida auris has a high potential to spread quickly among hospitalized patients and immunodeficient patients causing nosocomial outbreaks. It has the potential to cause pandemic outbreaks in about 45 nations with high mortality rates. Additionally, the fungus has become resistant to decontamination techniques and can survive for weeks in a hospital environment. Nanoparticles might be a good substitute to treat illnesses brought on by this newly discovered pathogen. Nanoparticles have become a trend and hot topic in recent years to combat this fatal fungus. This review gives a general insight into the epidemiology of C. auris and infection. It discusses the current conventional therapy and mechanism of resistance development. Furthermore, it focuses on nanoparticles, their different types, and up-to-date trials to evaluate the promising efficacy of nanoparticles with respect to C. auris.

Multidrug resistance (MDR) is one of the most problematic issues in chemotherapeutic carcinoma therapy. The ABCB1 transporter, a drug efflux pump overexpressed in cancer cells, has been thoroughly investigated for its association with MDR. Thus, discovering ABCB1 inhibitors can reverse the MDR in cancer cells. In the current work, a molecular docking technique was utilized for hunting the most prospective ABCB1 inhibitors from the Toxin and Toxin-Target Database (T3DB). Based on the docking computations, the most promising T3DB compounds complexed with the ABCB1 transporter were subjected to molecular dynamics (MD) simulations over 100 ns. Utilizing the MM-GBSA approach, the corresponding binding affinities were computed. Compared to ZQU (calc. −49.8 kcal/mol), Emamectin B1a (T3D1043), Emamectin B1b (T3D1044), Vincristine (T3D4016), Vinblastine (T3D4017), and Vindesine (T3D2479) complexed with ABCB1 transporter demonstrated outstanding binding affinities with ΔGbinding values of −93.0, −92.6, −93.8, −92.2, and −90.8 kcal/mol, respectively. The structural and energetic investigations confirmed the constancy of the identified T3DB compounds complexed with the ABCB1 transporter during the 100 ns MD course. To mimic the physiological conditions, MD simulations were conducted for those identified inhibitors complexed with ABCB1 transporter in the presence of a POPC membrane. These findings revealed that Emamectin B1a, Emamectin B1b, Vincristine, Vinblastine, and Vindesine are promising ABCB1 inhibitors that can reverse the MDR. Therefore, subjecting those compounds to further in-vitro and in-vivo investigations is worthwhile.

Objectives. Classification on multiple criteria of Gram-negative bacilli (GNBs) according to antibiotic resistance. Material and method. Retrospective study (January 2017-December 2018) carried out in the Infectious Diseases Clinic from Craiova; GNBs were identified using the Vitek 2 automated system, which subsequently established their sensitivity to antimicrobials; GNBs were classified based on an arbitrary score from 1 (minimum) to 5 (maximum) based on the multiple antibiotic resistance index (MAR), the percentage of multidrug resistant strains (MDR) and the percentage of extended resistance strains (XDR). The final classification represents the sum of the points awarded for each category considered. Results. The following GNBs were considered: Escherichia coli (n = 720), Klebsiella pneumoniae (n = 335), Pseudomonas aeruginosa (n = 139), Proteus mirabilis (n = 60) and Acinetobacter baumannii (n = 29). MAR values are: Acinetobacter baumannii (Ab) – 0.6, Proteus mirabilis (Pm) – 0.52, Pseudomonas aeruginosa (Pa) – 0.51, Klebsiella pneumoniae (Kp) - 0.37 and Escherichia coli (Ec) – 0.23. The percentage of MDR strains is: Pm – 76.67%, Kp – 68.86%, Pa - 58.71%, Ec – 51.94% and Ab – 51.72%; XDR strains were identified for Ab - 17.24% and Pa – 6.47%. The final classification of GNBs is as follows: Pa – 12p, Ab - 11 p, Pm – 7p, Kp – 6p, Ec – 3p. Conclusions. Depending on the resistance profile on multiple criteria, the classification of the studied Gram-negative bacteria is as follows: Pa, Ab, Pm, Kp, Ec.

Introduction: Urinary tract infection is one of the most common bacterial infections in humans, and Escherichia coli is one of the most important factors. Therefore, the present study aimed to evaluate the diversity of Europathogenic E. coli genotypes based on iucA, iucB, iucC, and iucD genes. Materials & Methods: In this study, plates containing a positive culture of urinary tract infection of E. coli were collected from four treatment centers in Shiraz, Iran. After determining phenotypic and genotypic identity, 100 isolates of E. coli were isolated. The bacterial genome was extracted using a kit. After genetic confirmation of the isolates using 16S rRNA, antibiotic resistance and susceptibility were performed for 10 antibiotics out of 9 classes using the disk diffusion method according to the CLSI standard. Frequency investigation of the virulence factors (iuc gene) was performed through the PCR molecular method and specific primers. Findings: The prevalence rates of iucA, iucB, iucC, and iucD genes were estimated at 95%, 60%, 72%, and 92%, respectively. The amount of resistance of 10 antibiotics of azithromycin, ampicillin, cefotaxime, nalidixic acid, tetracycline, trimethoprim-sulfamethoxazole, cefepime, aztreonam, gentamicin, and nitrofurantoin were also determined at 95%, 86%, 68%, 66%, 65%, 64%, 51%, 46%, 44%, and 14%. In addition, 98% of the isolates had multidrug resistance. Discussions & Conclusions: The present study showed that the high prevalence of the iuc gene among E. coli strains indicated the importance of this gene in the pathogenesis and genetic diversity of this bacterium.

Background and aim: One of the worst complications of diabetes mellitus is diabetic foot infections (DFI). A varied presentation is reported for both the causative bacterial species and their drug resistance patterns. We intended to evaluate the prevalence of drug-resistant strains among aerobic bacterial profile of DFI -as there was no regional data available to implement a rational antibiotic therapy for better management. Materials and methods: This cross-sectional observational study included 102 DFI cases attending this hospital with Wagner grade-1 or above ulcers. Wound swabs were taken from the base of the ulcers after a thorough cleaning. They were inoculated in blood agar, and MacConkey agar and drug sensitivity were performed Kirby Bauer disc diffusion method following the guidelines by the Clinical and Laboratory Standards Institute (CLSI) antimicrobial susceptibility testing standards. Results: Altogether, 135 bacterial isolates were reported with an average of 1.32 bacteria per ulcer with Gram-negative bacilli in 63.7% and Gram-positive cocci in 36.3% cases. However, when individual isolates were considered, Staphylococcus aureus was the commonest species, followed by Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii complex, and Pseudomonas aeruginosa. Drug resistance was rampant, with 69.1% multi-drug resistant organisms (MDRO) among them. Methicillin-resistant Staphylococcus aureus (MRSA) was 81.3%, MRCONS 66.7%, and extended-spectrum β-lactamase (ESBL)- producer Gram-negative Bacteria (GNB) 47.3%. Conclusion: In this scenario, Vancomycin and linezolid were the only effective drugs against GPC. Piperacillin-tazobactam and imipenem were effective for GNB in general except ESBL or Metallo-beta-lactamase (MBL) producing Acinetobacter and Pseudomonas species, which showed a dangerous inclination for treatment failure.

Objective(s): Emergence of multidrug resistance has reduced the choice of antimicrobial regimens for UTIs. To understand the association of phenotype and genotype among uropathogens.Materials and Methods: Six hundred and twenty-eight (628) urine samples were collected and analyzed. Antibiotic sensitivity pattern was determined by the Kirby-Bauer Disc Diffusion Method and minimum inhibitory concentration (MIC) was tested by the E test. Fluoroquinolone resistant mutations in QRDR of gyrA and ParC, phylogenetic groups, and PAIusp subtype were detected by PCR.Results: Most prevalent uropathogens were Escherichia coli (53.2%) followed by Klebsiella pneumoniae (21%). Multidrug- resistance was observed in > 50% cases for third-generation cephalosporins and ciprofloxacin and lowest in meropenem. E. coli (66.2%) and K. pneumonia (64.4%) were extended-spectrum β-lactamases (ESBLs) producers. MIC to trimethoprim-sulfamethoxazole was highest in E. coli (>1024 µg/ml). In 80 (24%) of the 334 E. coli isolates analyzed in detail, 54 fluoroquinolones (FQ) resistant isolates carried mutations (S83L, D87N, S80I, E84V) in QRDR of gyrA and ParC. Out of 54 FQ-resistant isolates, 43 (79.6%) isolates belonged to the phylogenetic group B2, and 11(20.4%) belonged to group D. Isolates belonged to group B2, 38 (88.4%) of the 43 isolates carried PAIusp subtype IIa and high frequency of mutation E84V in ParC was detected in 37 (97.4%). Other mutations, such as S80I, S83L in gyrA and D87N in ParC were found in all resistant isolates.Conclusion: Correlations between phenotype and genotype provided a basis to understand the resistance development in uropathogens, and PAIusp subtyping indicated that E. coli belonged to the B2 group.

Global dispersion, hospital outbreaks, and lineage relationships between emerging antibiotic-resistant strains such as Klebsiella pneumoniae are of public health interest. This study aimed to isolate and identify K. pneumoniae clones from third-level healthcare hospitals in Mexico to establish their multidrug-resistant phenotype, phylogeny, and prevalence. Biological and abiotic surface samples were used to isolate K. pneumoniae strains and to test their antibiotic susceptibility to classify them. The housekeeping genes: gapA, InfB, mdh, pgi, phoE, ropB, and tonB were used for multilocus sequence typing (MLST). Phylogenetic networks were constructed with 48 strains. Isolated strains (93) were mainly from urine and blood, 96% were resistant to ampicillin as expected, 60% were extended-spectrum β-lactamases (ESBL), 98% were susceptible to ertapenem and meropenem and 99% were susceptible to imipenem, 46% were multi-drug resistant (MDR), 17% were extensively-drug resistant (XDR), 1% were pan-drug resistant (PDR), and 36% were not classified. The tonB, mdh, and phoE genes were the most variable, and the InfB gene showed positive selection. The most prevalent sequence types (STs) were ST551 (six clones), ST405 (six clones), ST1088 (four clones), ST25 (four clones), ST392 (three clones), and ST36 (two clones). ST706 was PDR, and ST1088 clones were MDR; neither of these STs has been reported in Mexico. The strains analyzed were from different hospitals and locations; thus, it is important to maintain antibiotic surveillance and avoid clone dissemination to prevent outbreaks, adaptation to antibiotics, and the transmission of antibiotic resistance.

Entomopathogenic bacteria are obligate symbionts of entomopathogenic nematode (EPN) species. These bacteria biosynthesize and release non-ribosomal-templated hybrid peptides (NR-AMPs), with strong, and large-spectral antimicrobial potential, capable of inactivating pathogens belonging to different prokaryote, and eukaryote taxa. The cell-free conditioned culture media (CFCM) of Xenorhabdus budapestensis and X. szentirmaii efficiently inactivate poultry pathogens like Clostridium, Histomonas, and Eimeria. To learn whether a bio-preparation containing antimicrobial peptides of Xenorhabdus origin with accompanying (in vitro detectable) cytotoxic effects could be considered a safely applicable preventive feed supplement, we conducted a 42-day feeding experiment on freshly hatched broiler cockerels. XENOFOOD (containing autoclaved X. budapestensis, and X. szentirmaii cultures developed on chicken food) were consumed by the birds. The XENOFOOD exerted detectable gastrointestinal (GI) activity (reducing the numbers of the colony-forming Clostridium perfringens units in the lower jejunum. No animal was lost in the experiment. Neither the body weight, growth rate, feed-conversion ratio, nor organ-weight data differed between the control (C) and treated (T) groups, indicating that the XENOFOOD diet did not result in any detectable adverse effects. We suppose that the parameters indicating a moderate enlargement of bursas of Fabricius (average weight, size, and individual bursa/spleen weight-ratios) in the XENOFOOD-fed group must be an indirect indication that the bursa-controlled humoral immune system neutralized the cytotoxic ingredients of the XENOFOOD in the blood, not allowing to reach their critical cytotoxic concentration in the sensitive tissues.

AbstractBackground Bloodstream infections (BSIs) caused by multidrug-resistant (MDR)-Pseudomonas aeruginosa are associated with poor clinical outcomes, at least partly due to delayed appropriate antimicrobial therapy. The characteristics of MDR-P. aeruginosa bloodstream isolates have not been evaluated in Qatar. Our study aimed to examine in vitro susceptibility, clinical and molecular characteristics, and mechanisms of resistance of MDR-P. aeruginosa bloodstream isolates from Qatar.Materials and methods We included all MDR-P. aeruginosa isolated from blood cultures taken between October 2014 and September 2017. Blood cultures were processed using BD BACTEC™ FX automated system. BD Phoenix™ was used for identification, Liofilchem® MIC Test Strips for MIC determination. Whole-genome sequencing was performed using the Illumina-HiSeq-2000.Results Out of 362 P. aeruginosa bloodstream isolates, 16 (4.4%) were MDR. The median patient age was 55 years (range 43–81) and all patients presented with septic shock. Most patients received meropenem (12/16) and/or colistin (10/16). Clinical response was achieved in eight patients, and five patients died within 30-days. MDR-P. aeruginosa isolates belonged to 13 different sequence types. All isolates were non-susceptible to cefepime and ciprofloxacin. The most active agents were colistin (16/16) and aztreonam (10/16). Seven isolates produced blaVIM, and four possessed genes encoding extended-spectrum β-lactamases. Aminoglycoside modifying enzymes were present in 15/16, transferable qnr-mediated quinolone resistance gene was detected in 3/16, and the novel ciprofloxacin modifying enzyme CrpP-encoding gene in one isolate.Conclusion MDR-P. aeruginosa BSIs are relatively uncommon in Qatar but are highly resistant, harbour multiple resistance genes, and are commonly associated with unfavourable clinical outcomes. Colistin was the only agent with consistent activity against the study isolates.Key messagesMDR-P. aeruginosa constituted

Abstract Objective The current study aims to explore the bacteriology of sputum of tuberculosis (TB) suspected patients. A cross-sectional study was carried out in the sputum samples of 150 TB suspected patients visiting District Public Health Office, Bharatpur, Nepal. The samples were subjected to cultural, microscopic and biochemical analyses for the identification of the isolates. In addition, antibiotic susceptibility tests were carried out with a special focus on ESBL and MBL production following Clinical and Laboratory Standard Institute guidelines. Results Bacterial growth was recovered in 47% (71/150) of the TB suspected patients of which 12.66% (19/150) had pulmonary TB infection. Streptococcus spp. (9%) and Pseudomonas aeruginosa (9%) were the most frequently isolated bacteria. Enterobacteriaceae accounted for 35% of the total isolates. Occurrence of bacterial pathogens was more in males (69%) than in females (31%).The incidence of bacterial pathogen was seen associated with gender of the patients and with the TB infection (p 0.05). Tetracycline was effective against Streptococcus spp. whereas gentamicin was effective against Bacillus species. Imipenem and co-trimoxazole were effective drugs for Gram-negative isolates. Among 83 isolates, 35 were multi-drug resistant, 9 were ESBL producers and 4 were MBL producers.

Background and purpose: The prevalence of antibiotic resistance in Acinetobacter baumannii is increasing worldwide, causing significant clinical problems. This study aimed to determine the antibiotic resistance pattern of clinical A. baumannii isolated from different different wards in Sari hospitals. Materials and methods: This study was performed on 100 clinical A. baumannii isolated from Sari hospitals, north of Iran, 2018. The clinical isolates were identified by biochemical tests, while identification of the blaOXA-51 gene was performed by PCR for the final confirmation of the isolates. Antibiotic susceptibility pattern of the isolates was determined by the disk agar diffusion method. Data were analyzed in SPSS applying Chi-square test. Results: Among 100 clinical isolates of A. baumannii, the lowest resistance rate (75%) was detected against imipenem, while the highest resistance rate (100%) was observed against ciprofloxacin. Resistance rates to meropenem, doripenem, levofloxacin, cefotaxime, ceftazidime, cefepime, piperacillin, piperacillin/ tazobactam, and trimethoprim/sulfamethoxazole were 97, 96, 93, 93, 76, 92, 86, 78, and 92%, respectively. In this study, the highest and lowest cases of MDR and XDR isolates were found in urine and blood samples, respectively, while the highest and lowest cases of MDR and XDR in terms of hospital departments were found in ICU and surgery, respectively. Conclusion: Due to the high prevalence of multidrug resistant isolates, using antibiogram prior to antibiotic administration and proper use of antibiotics for the treatment of infections caused by Acinetobacter baumannii should be seriously considered.

According to the European Medical Device Directive (MDR (EU) 2017/745), medical products of all risk classes are obliged to be labelled with Unique Device Identification Codes (UDI). In order to meet the requirements of the MDR, a novel method of identification for additively manufactured metallic products was developed at the Fraunhofer Institute for Machine Tools and Forming Technology (IWU). The method provides a product traceability within its production process and during the whole product lifespan, and also functions as a counterfeit protection. This paper shows the integration of a unique identification during an additive manufacturing process for a titanium part. The readout of the integrated identification was executed using ultrasonic and eddy current methods, as well as micro computed tomography. Obtained results are discussed in the paper.

Escherichia coli sequence type (ST) 131 is of concern because it can acquire antimicrobial resistance and cause extraintestinal infections. E. coli ST131-H22 sublineage appears capable of being transmitted to humans through poultry. We report on multidrug-resistant ST131-H22 poultry isolates in Brazil closely related to international human and poultry isolates.

Abstract Objective The present study aimed to investigate the frequency and antibiotic susceptibility pattern of Gram-negative bacteria (GNB) isolated from surgical site infections (SSIs) in the North of Iran. Results This cross-sectional study conducted over a two-year period during 2018–2020 on all cases of SSIs who had a positive culture for a GNB. Standard microbiological tests were followed for the bacterial isolation and identification. Antimicrobial susceptibility profiles were determined using disk diffusion method. During the study period, a total of 78 nonduplicated GNB isolated from SSIs. The most prevalent surgical procedures were fracture fixation (37.2%), and tissue debridement (23.1%). Klebsiella isolates showed the highest isolation rate (29.5%) followed by Enterobacter (28.2%), and Acinetobacter (16.7%). Antibiotic susceptibility results showed that Acinetobacter isolates were almost resistant to all of the tested antibiotics, except gentamicin, co-trimoxazole, and meropenem. Enterobacteriaceae isolates showed the lowest resistance against amikacin, co-trimoxazole, and imipenem. Overall, 49 (62.8%) of isolates were multiple drug-resistant (MDR). In summary, a remarkable rate of MDR isolates which showed an increasing trend during recent years is a serious alarm for the management of SSIs caused by GNB. Moreover, the results of regional assessments, provide good epidemiological background for comparing our situation with other regions.

Abstract Objective Klebsiella pneumoniae (K. pneumoniae) involves both community-acquired and nosocomial infections. It is responsible for a wide variety of infections, including infections of the urinary tract, pneumonia, bacteremia, meningitis, wound infection and purulent abscesses. We constructed this study to detect several carbapenems resistant and virulence genes in classical and hyper-virulent strains of K. pneumoniae isolated from hospitalized neonates and adults in Khartoum state. Results Seventy percent of the isolates were resistant to ceftazidime, 18(30%) to ciprofloxacin, 23(38.3%) to chloramphenicol, 24(40%) to gentamicin and 8% to imipenem, 35% were multidrug-resistant, and 7% extensively drug-resistant, all blood isolates (n = 14) were resistant to ceftazidime. entB was the most predominant virulence gene (93.3%), followed by mrkD (78.3%), kfu (60%), K2 (51.7%), magA (18.3%) and rmpA (5%). bla OXA-48 was the most predominant carbapenem-resistant gene (68.3%), followed by bla NDM (10%), bla KPC (8.3%), and bla IMP (3.3%). Eight hyper-virulent strains were positive for bla OXA-48 and two for bla NDM genes.

A multidrug-resistant Salmonella enterica serotype Anatum strain reported in Taiwan was isolated in the United States from patients and from seafood imported from Asia. Isolates harbored 11 resistance determinants, including quinolone and inducible cephalosporin resistance genes. Most patients had traveled to Asia. These findings underscore the need for global One Health resistance surveillance.

Pathogen-based factors associated with tuberculosis (TB) in eastern Sudan are not well defined. We investigated genetic diversity, drug resistance, and possible transmission clusters of Mycobacterium tuberculosis complex (MTBC) strains by using a genomic epidemiology approach. We collected 383 sputum specimens at 3 hospitals in 2014 and 2016 from patients with symptoms suggestive of TB; of these, 171 grew MTBC strains. Whole-genome sequencing could be performed on 166 MTBC strains; phylogenetic classification revealed that most (73.4%; n = 122) belonged to lineage 3 (L3). Genome-based cluster analysis showed that 76 strains (45.9%) were grouped into 29 molecular clusters, comprising 2–8 strains/patients. Of the strains investigated, 9.0% (15/166) were multidrug resistant (MDR); 10 MDR MTBC strains were linked to 1 large MDR transmission network. Our findings indicate that L3 strains are the main causative agent of TB in eastern Sudan; MDR TB is caused mainly by transmission of MDR L3 strains.

Abstract Objectives The pediatric urinary tract infection (UTI) often remains under-diagnosed or neglected owing to non-specific clinical presentations, patients failing to describe the actual situation and of clinical practice in diagnosis. The study was aimed to determine the etiologies of UTI in children with enhanced quantitative urine culture (EQUC) technique. Results Of enrolled 570 pediatric urine samples, the significant growth positivity was higher in EQUC 92 (16.15%) compared to standard urine culture (SUC) 73 (12.80%) technique. 20.6% of the significant isolates as detected with EQUC were missed on the SUC technique. The age group, in range 1–4 years, was more prone to the infection, where E. coli was the commonest pathogen. EQUC detected, probably all isolates, contributing UTI i.e. multidrug-resistant (MDR), extensive drug-resistant (XDR), and extended-spectrum β-lactamase (ESBL) producers, as some of them skipped on the SUC technique. Of total organisms isolated from EQUC, 46% were ESBL producer, 56.5% were MDR, and 1.4% were XDR. However, 40.5% ESBL, 44% MDR but no XDR detected on SUC. Hence a simple modification on conventional culture protocol could be a crucial modification for the detection of etiologies, contributing UTI, and hence to reduce inapt antimicrobial burden.

Abstract Background Klebsiella pneumoniae is a leading cause of bloodstream infection (BSI). Strains producing extended-spectrum beta-lactamases (ESBLs) or carbapenemases are considered global priority pathogens for which new treatment and prevention strategies are urgently required, due to severely limited therapeutic options. South and Southeast Asia are major hubs for antimicrobial-resistant (AMR) K. pneumoniae and also for the characteristically antimicrobial-sensitive, community-acquired “hypervirulent” strains. The emergence of hypervirulent AMR strains and lack of data on exopolysaccharide diversity pose a challenge for K. pneumoniae BSI control strategies worldwide. Methods We conducted a retrospective genomic epidemiology study of 365 BSI K. pneumoniae from seven major healthcare facilities across South and Southeast Asia, extracting clinically relevant information (AMR, virulence, K and O antigen loci) using Kleborate, a K. pneumoniae-specific genomic typing tool. Results K. pneumoniae BSI isolates were highly diverse, comprising 120 multi-locus sequence types (STs) and 63 K-loci. ESBL and carbapenemase gene frequencies were 47% and 17%, respectively. The aerobactin synthesis locus (iuc), associated with hypervirulence, was detected in 28% of isolates. Importantly, 7% of isolates harboured iuc plus ESBL and/or carbapenemase genes. The latter represent genotypic AMR-virulence convergence, which is generally considered a rare phenomenon but was particularly common among South Asian BSI (17%). Of greatest concern, we identified seven novel plasmids carrying both iuc and AMR genes, raising the prospect of co-transfer of these phenotypes among K. pneumoniae. Conclusions K. pneumoniae BSI in South and Southeast Asia are caused by different STs from those predominating in other regions, and with higher frequency of acquired virulence determinants. K. pneumoniae carrying both iuc and AMR genes were also detected at higher rates than have been reported elsewhere. The study demonstrates how genomics-based surveillance—reporting full molecular profiles including STs, AMR, virulence and serotype locus information—can help standardise comparisons between sites and identify regional differences in pathogen populations.

This study was planned to estimate the proportion of confirmed multi-drug resistance pulmonary tuberculosis (TB) cases out of the presumptive cases referred to DTC (District Tuberculosis Center) Jodhpur for diagnosis; to identify clinical and socio-demographic risk factors associated with the multidrug-resistant pulmonary TB and to assess the spatial distribution to find out clustering and pattern in the distribution of pulmonary TB with the help of Geographic Information System (GIS). In the Jodhpur district, 150 confirmed pulmonary multi-drug resistant tuberculosis (MDR-TB) cases, diagnosed by probe-based molecular drug susceptibility testing method and categorized as MDR in DTC's register (District Tuberculosis Center), were taken. Simultaneously, 300 control of confirmed non-MDR or drug-sensitive pulmonary TB patients were taken. Statistical analysis was done with logistic regression. In addition, for spatial analysis, secondary data from 2013-17 was analyzed using Global Moran's I and Getis and Ordi (Gi*) statistics. In 2012-18, a total of 12563 CBNAAT (Cartridge-based nucleic acid amplification test) were performed. 2898 (23%) showed M. TB positive but rifampicin sensitive, and 590 (4.7%) showed rifampicin resistant. Independent risk factors for MDR TB were ≤60 years age (AOR 3.0, CI 1.3-7.1); male gender (AOR 3.4, CI 1.8-6.7); overcrowding (AOR 1.6, CI 1.0-2.7); using chulha (smoke appliance) for cooking (AOR 2.5, CI 1.2-4.9), past TB treatment (AOR 5.7, CI 2.9-11.3) and past contact with MDR patient (AOR 10.7, CI 3.7-31.2). All four urban TUs (Tuberculosis Units) had the highest proportion of drug-resistant pulmonary TB. There was no statistically significant clustering, and the pattern of cases was primarily random. Most of the hotspots generated were present near the administrative boundaries of TUs, and the new ones mostly appeared in the area near the previous hotspots. A random pattern seen in cluster analysis supports the universal drug testing policy of India. Hotspot analysis helps cross administrative border initiatives with targeted active case finding and proper follow-up.

Objectives: E. cloacae is an opportunistic organism that causes serious infections, particularly in immuno-compromised and hospitalized patients, along with the emergence of resistance traits. The COVID-19 pandemic has impacted the epidemiological pattern and resistance traits of E. cloacae infections as well as those of other bacteria. The study aims to assess the epidemiological patterns, resistance characteristics and clinical outcomes of E. cloacae in Saudi Arabia and the impact of the COVID-19 pandemic. Methods: King Fahad Medical City in Riyadh provided the data between January 2019 and December 2021 for the retrospective study of 638 isolates of E. cloacae. The clinical outcome of an E. cloacae infection was also determined by collecting and statistically analyzing the clinical records of 153 ICU patients. Results: The total percentage of resistant E. cloacae isolates decreased from 48.36% in 2019 to 38% in 2020 and 37.6% in 2021. The overall mortality rate among ICU patients was 40.5%, with an adult age group having a substantial relative risk value of 1.37. Conclusion: E. cloacae is a prevalent nosocomial infection in which adult age is a significant risk factor for mortality. Moreover, this study emphasizes the importance of comparing E. cloacae resistance trends before and throughout the pandemic period in order to better understand the bacteria’s behaviour.

Objective(s): Plasmid-mediated quinolone resistance (PMQR) determinants and integrons have a considerable contribution to bacterial drug resistance in Gram-negative pathogens. We studied the prevalence of PMQR genes and integron carriage in multidrug-resistant community isolates of Klebsiella spp.Materials and Methods: Two hundred and fifty Klebsiella spp. isolates were collected from outpatient specimens between August 2015 and October 2017 in Yazd central Laboratory, Iran. Antibiotic susceptibility was determined against 17 antibiotics and minimum inhibitory concentration (MIC) of ciprofloxacin was measured by E-test. Polymerase chain reaction (PCR) was employed for detection of qnrA, qnrB, qnrS, aac(6’)-Ib-cr, oqxAB and qepA genes. Results: Disc diffusion results showed that 17 isolates (6.8%) were multidrug resistant (MDR), two of which were Klebsiella oxytoca and 15 were Klebsiella pneumoniae. MIC measurements revealed 11 ciprofloxacin-resistant isolates (including the two K. oxytoca), three intermediately-resistant and three ciprofloxacin-susceptible isolates. All ciprofloxacin-resistant and intermediately-resistant isolates carried at least one and up to four PMQR genes. The most prevalent PMQR gene was oqxAB (93.75%) followed by aac(6’)-ib-cr (50.0%), qnrB (25.0%) and qnrS (18.75%) but qnrA and qepA were not detected. Class 1 integron was observed in 14 (82.3%) isolates including nine ciprofloxacin-resistant, two intermediately-resistant, and three susceptible isolates. Class 2 and 3 integrons were not observed. Conclusion: Presence of MDR, multiple PMQR determinants as well as class 1 integron in community isolates of Klebsiella spp. can be an important source of transmission of these opportunistic pathogens.

The formation of a protective biofilm by Pseudomonas aeruginosa (PA) is one of the hallmarks of their survival both in vivo and in harsh environmental conditions, thus, biofilm-eradication has relevance from therapeutic perspectives and for infection control. The aim of our study was to investigate the possible relationship between antibiotic resistance, biofilm-forming capacity and virulence factors in n = 166 PA isolates of environmental origin. Antimicrobial susceptibility testing and the phenotypic detection of resistance determinants were carried out using standard protocols. The biofilm-forming capacity of PA was tested using a standardized crystal violet microtiter plate-based method. Motility (swimming, swarming, and twitching) and siderophore production of the isolates were also assessed. Resistance rates were highest for ciprofloxacin (46.98%), levofloxacin (45.18%), ceftazidime (31.92%) and cefepime (30.12%); 19.28% of isolates met the criteria to be classified as multidrug-resistant (MDR). Efflux pump overexpression, AmpC overexpression, and modified Hodge-test positivity were noted in 28.31%, 18.07% and 3.61%, respectively. 22.89% of isolates were weak/non-biofilm producers, while 27.71% and 49.40% were moderate and strong biofilm producers, respectively. Based on MDR status of the isolates, no significant differences in biofilm-production were shown among environmental PA (non-MDR OD570 [mean ± SD]: 0.416 ± 0.167 vs. MDR OD570: 0.399 ± 0.192; p > 0.05). No significant association was observed between either motility types in the context of drug resistance or biofilm-forming capacity (p > 0.05). 83.13% of isolates tested were positive for siderophore production. The importance of PA as a pathogen in chronic and healthcare-associated infections has been described extensively, while there is increasing awareness of PA as an environmental agent in agriculture and aquaculture. Additional studies in this field would be an important undertaking to understand the interrelated nature of biofilm production and antimicrobial resistance, as these insights may become relevant bases for developing novel therapeutics and eradication strategies against PA.

We decreased antimicrobial drug consumption in an intensive care unit in Lebanon by changing to colistin monotherapy for extensively drug-resistant Acinetobacter baumanii infections. We saw a 78% decrease of A. baumanii in sputum and near-elimination of blaoxa-23-carrying sequence type 2 clone over the 1-year study. Non–A. baumanii multidrug-resistant infections remained stable.

Abstract Objective This study was aimed to determine prevalence and resistance pattern like multidrug resistant (MDR) or ESBL nature of E. coli and Klebsiella spp. from various sewage drain samples with an idea to deliver baseline information that could be utilized for defining guidelines for the treatment of hospital sewages. Results Of 10 sewage samples analyzed, 7 (70%) contained E. coli while 6 (60%) contained Klebsiella. Except one sample, all positive samples contained both E. coli and Klebsiella spp. E. coli isolates were resistant to ampicillin, amoxicillin, cefoxitin, cefuroxime, and cefpodoxime; while 85.7% were resistant to amoxicillin/clavulanate, ceftazidime, cefotaxime and ceftriaxone. 71.4%, 57.1%, 42.9%, and 28.6% were resistant to aztreonam, trimethoprim/sulfamethoxazole, nitrofurantoin, and gentamicin. Most were sensitive to chloramphenicol, ofloxacin, ciprofloxacin, and azithromycin. 85.7% and 57.1% of E. coli were MDR and ESBL isolates, respectively. Klebsiella were resistant to ampicillin, amoxicillin, and amoxicillin/clavulanate. 83.4% of Klebsiella were resistant to cefoxitin. 66.7% of strains were resistant to cefuroxime, ceftazidime, cefotaxime, ceftriaxone, and cefpodoxime. Klebsiella showed 50% resistant to aztreonam and trimethoprim/sulfamethoxazole, while 33.3% were resistant to chloramphenicol, nitrofurantoin, ofloxacin, and ciprofloxacin. Klebsiella were sensitive to azithromycin and gentamicin. 66.7% and 33.3% of Klebsiella were MDR and ESBL isolates, respectively.

Important achievements such as the discovery of penicillin increased life expectancy in the 19th century. At the beginning of the 20th century, the influence of technical equipment and biomedical research led to a further leap in life expectancy. The use of computer devices with sophisticated software also improved the quality of life. This is linked to the fact that all these achievements have now led to the emergence of one of the largest import and export markets in the USA, alongside the european union (EU), which is an association of European states. In order to guarantee a uniform quality of this abundance of different products and therapies, there are worldwide corresponding regulations, to which all manufacturers must adhere. The entry into force of these regulations, with the associated approval and testing obligations for each individual medical device, ensures that a consistently high quality of products is used on patients. Of course, high quality as well as high functionality and safety levels of medical products are a must. However, the implementation of these regulations is realized differently in the various markets, as there is no global harmonization. This work focuses on approval procedures for medical devices in Europe (EU) and the USA and compares significant differences in the approval procedures, which are shown as a graphical comparison. An example is an approval of medical devices by the U.S. Food and Drug Administration (FDA), which is an US government agency. In Europe (EU) there is a manufacturer’s declaration of conformity for the approval.

Introduction: Tuberculosis is still a major health concern around the world, especially in developing countries with very large populations. Diabetes may be responsible for the progression of Mycobacterium tuberculosis infection. According to the research of some authors, the development of an active form of tuberculosis is associated with the earlier development of diabetes, which is called the epidemic of the 21st century due to the very large number of patients around the world and worrying predictions of the incidence of diabetes for the upcoming years. Diabetes May also predispose to drug-resistant tuberculosis as well as worse and slower anti-tuberculosis treatment effects. In European countries where the prevalence of drug-resistant and TB is Lower than in developing countries, most cases of tuberculosis have been reported among immigrants. The aim of the study is to analyze the current epidemiological situation of tuberculosis, multi-drug resistant tuberculosis and diabetes in Great Britain (with particular attention directed to England) and in India in correlation with the influx of migrants from India to Great Britain. Materials and method: The data used in this analysis come from the Global Tuberculosis Reports published by The World Health Organization and National Diabetes Audit Reports published by The Health and Social Care Information Center, as well as from Rother publications made available in 2001-2019. Results: There has been a significant increase in the incidence of diabetes in England and India in recent years, the incidence of tuberculosis in England Has been decreasing, while in India it Has remained more or less stable. An increase in the incidence of drug-resistant tuberculosis was observed in the population of India and in the population of migrants of Hindu origin in England, while the Total number of MDR cases in England Romains more or less stable with a downward trend in 2011-2014 and slightly rising in 2015-2017. Conclusions: Due to the strong association between diabetes and tuberculosis, the probable association of diabetes and multi-drug resistant tuberculosis, and the increasing incidence of diabetes, the control of TB incidence may be disturbed, and there is a risk of an increase in the incidence of MDR tuberculosis. This phenomenon can threaten not only developing countries, where tuberculosis is more common than in other regions of the world, but also highly developer countries that akcept large numbers of migrants.