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

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

Multidrug-resistant (MDR) Pseudomonas aeruginosa has been declared a serious threat by the United States Centers for Disease Control and Prevention. Here, we used whole genome sequencing (WGS) to investigate recurrent P. aeruginosa bloodstream infections in a severely immunocompromised patient. The infections demonstrated unusual, progressive increases in resistance to beta lactam antibiotics in the setting of active treatment with appropriate, guideline-directed agents. WGS followed by comparative genomic analysis of isolates collected over 44 days demonstrated in host evolution of a single P. aeruginosa isolate characterized by stepwise acquisition of two de-novo genetic resistance mechanisms over the course of treatment. We found a novel deletion affecting the ampC repressor ampD and neighboring gene ampE, which associated with initial cefepime treatment failure. This was followed by acquisition of a porin nonsense mutation, OprD, associated with resistance to carbapenems. This study highlights the potential for in-host evolution of P. aeruginosa during bloodstream infections in severely immunocompromised patients despite appropriate antimicrobial therapy. In addition, it demonstrates the utility of WGS for understanding unusual resistance patterns in the clinical context.

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

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

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

This investigation aimed to determine the prevalence and biofilm-forming potentials of bacterial uropathogenic among primary school pupils in Yola North, Adamawa State. A total of 120 clean mid-stream urine samples were collected from apparently healthy children to determine the antimicrobial susceptibility of the isolated pathogen by the Kirby and Bauer disc diffusion method while the biofilm-forming potential by the standard methods. The result showed 26 % of the samples had significant bacteria growth with the Gram-negative as the highest. The infectivity pattern among the age group showed 8-10 had the highest infectivity percentage (35%) followed by 5-7 and 11-13 with 22.5% and 20% respectively. Six bacteria pathogens were isolated which are E. coli (41.9%) which is the most prevalent isolate followed by Staphylococcus aureus (29.0%), Pseudomonas sp. (9.7%), Klebsiella sp. (9.7%), Enterobacter sp. (6.5%), Proteus sp. (3.3%). The antibiotic sensitivity test showed an alarming resistance level to nearly all the tested antibiotics showing multi-drug resistant strains. The Biofilm-forming potentials depict E. coli with the strongest potential followed by S. aureus. A high occurrence of asymptomatic UTIs and antimicrobial resistance observed poses a public health concern. Thus, routine diagnostic exercise is recommended for early detection and prompt treatment of the pathogens.

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

The development of novel antagonistic nanoparticles requires information about the factors that influence the antibacterial and anti-biofilm activity. Even though antibacterial studies relating size and shape of metallic nanoparticles were reported earlier we attempted to comprehend the parameters that control the antibacterial and anti-biofilm efficacy of bimetallic Au/Ag nanoparticles prepared by femtosecond laser ablation. The synthesis of bimetallic nanoparticles was done according to our previous article. Absorption spectra and transmission electron microscopy (TEM) validated the buildup of bimetallic nanoparticles. The samples were investigated for antibacterial activity against Gram negative (Pseudomonas aeruginosa) and Gram positive (Bacillus pumilus, Staphylococcus aureus) microorganisms by agar disc diffusion. Anti-biofilm studies were conducted and the biofilm inhibition percentage was calculated. SEM images clearly support the biofilm inhibition occurring to the microorganisms after the treatment with the nanoparticles. It was observed that the antibacterial and anti-biofilm efficacy of the samples increased with the size, concentration, and composition of the nanoparticles. Considering the morphological aspect, the nanoalloy structure showed better activity compared to the core shell structure. Thus it can be concluded that the size, concentration, composition and morphology are key factors that govern the antibacterial and anti-biofilm effectiveness of the synthesized bimetallic Au/Ag nanoparticles. To our knowledge and belief, this is the first work of its kind discussing all the controlling parameters together. This information could be incorporated while synthesizing nanoparticles for medical applications as coating substances.

Background: Many studies reported the effects of antibiotic exposure on E. coli bacterial growth and cell modification. However, scarce descriptive information on ultrastructural effects upon exposure of commercial antibiotics. Methods: This study described the morphological and ultrastructural alterations caused by selected antibiotics (amoxicillin-clavulanate, ceftriaxone, polymyxin B, colistin, gentamicin, and amikacin) that targeted cell wall, plasma membrane, and cytoplasmic density, and also proteins synthesis. We determined extracellular morphological changes of exposure through scanning electron microscopy (FESEM) and intracellular activities through transmission electron microscopy (TEM) investigation. Results: FESEM and TEM micrograph of E. coli exposed with selected antibiotics shows ultrastructural changes in beta-lactam class (amoxicillin-clavulanate, ceftriaxone) elongated the cells as the cell wall was altered as it inhibits bacterial cell wall synthesis, polymyxin class (polymyxin B, colistin) had plasmid and curli-fimbriae as it breaking down the plasma/cytoplasmic membrane, and aminoglycoside class (gentamicin, and amikacin) reduced ribosome concentration as it inhibits bacterial protein synthesis by binding to 30 s ribosomes. Conclusion: Morphological and ultrastructural alterations of E. coli’s mechanism of actions were translated and depicted. This study could be reference for characterization studies for morphological and ultrastructural of E. coli upon exposure to antimicrobial agents.

BackgroundPrevious studies show an increasing incidence of gram-negative organisms in surgical site infections after spine surgery. This study is looking for the association of the post-operative prophylactic use of Bactrim and the gram-negative surgical site infection after lumbar spine surgery.MethodsPatients who underwent lumbar spine surgery between August 2010 and December 2019 at the institution were retrospectively reviewed.ResultsThere were 11 infections out of 511 cases where no oral antibiotics were given (2.2%). There were 2 infections out of 84 cases where Bactrim was given (2.4%). This was not statistically significant (P=0.89). The organisms cultured from the no oral antibiotic group were 8 cases of methicillin sensitive Staphylococcus aureus (MSSA), 1 case of E. coli, 1 case of Pseudomonas aeruginosa, 1 case of MRSA. The organisms cultured from the Bactrim group were 1 case of MRSA, and 1 case of combined Citrobacter freundii and methicillin sensitive Staphylococcus aureus (MSSA).ConclusionThere was no statistically significant difference in SSIs when Bactrim was given for two weeks after surgery. However, two subjects who developed infection from the Bactrim group were paradoxically affected by gram-negative and antibiotic resistant organisms. So, clinicians should be judicious in their use of oral antibiotics after spine surgery. Level of Evidence: III.

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

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

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

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

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

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

BackgroundRapid blood culture diagnostics are of unclear benefit for patients with gram-negative bacilli (GNB) bloodstream infections (BSIs). We conducted a multicenter, randomized, controlled trial comparing outcomes of patients with GNB BSIs who had blood culture testing with standard-of-care (SOC) culture and antimicrobial susceptibility testing (AST) vs rapid organism identification (ID) and phenotypic AST using the Accelerate Pheno System (RAPID).MethodsPatients with positive blood cultures with Gram stains showing GNB were randomized to SOC testing with antimicrobial stewardship (AS) review or RAPID with AS. The primary outcome was time to first antibiotic modification within 72 hours of randomization.ResultsOf 500 randomized patients, 448 were included (226 SOC, 222 RAPID). Mean (standard deviation) time to results was faster for RAPID than SOC for organism ID (2.7 [1.2] vs 11.7 [10.5] hours; P

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

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

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

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

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

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

Abstract The crop is the part of the chicken's digestive tract that is more likely to break during processing. This research aimed to isolate Salmonella sp. from crop in local chickens and broiler from the Peunayong Chicken Market in Banda Aceh. Samples were swab contents of crop from 15 crops of local chickens and 15 crops of broiler. This research is a Cross sectional study with Carter method, starts with a swab of crop contents and then is inserted into the Selenite Cystine Broth (SCB) media, if the color of the media becomes orange, then followed by streaking bacteria on Salmonella Shigella Agar (SSA) media. Then observed the morphology that grew on SSA media including size, shape, surface, elevation, edges, aspects and colony color, followed by Gram stain to observe bacterial morphology microscopically. The research data were analyzed descriptively, displayed in figures and tables. The results of the isolation showed that 7 from 15 samples (46%) of local chicken cropping and 15 from 15 samples (100%) of broiler were positive for Salmonella sp. Therefore, it can be concluded that Salmonella sp. can be isolated from local chicken and broiler, Salmonella sp. prevalence is higher in broiler than in local chicken. Keywords : Eviserasi; Food borne disease; Gram negatif; Zoonotic disease Abstrak Tembolok merupakan bagian saluran pencernaan ayam yang lebih mungkin pecah selama pemrosesan. Penelitian ini bertujuan untuk mengisolasi Salmonella sp. pada tembolok ayam buras dan ayam ras yang berasal dari Pasar Ayam Peunayong Kota Banda Aceh. Sampel berupa swab isi tembolok dari 15 tembolok ayam buras dan 15 tembolok ayam ras. Penelitian ini merupakan Cross sectional dengan metode Carter dimulai dari swab isi tembolok kemudian dimasukkan kedalam media Selenite Cystine Broth (SCB), apabila warna media menjadi orange dilanjutkan dengan penanaman bakteri pada media Salmonella Shigella Agar (SSA). Kemudian diamati morfologi yang tumbuh pada media SSA meliputi ukuran, bentuk, permukaan, elevasi, tepi, aspek dan warna koloni, dilanjutkan dengan pewarnaan Gram untuk mengamati morfologi bakteri secara mikroskopis. Data hasil penelitian dianalisis secara deskriptif, ditampilkan dalam bentuk gambar dan tabel. Hasil isolasi didapatkan bahwa pada 7 dari 15 (46%) sampel tembolok ayam buras dan 15 dari 15 sampel (100%) sampel tembolok ayam ras positif terdapat Salmonella sp. Oleh sebab itu, dapat disimpulkan bahwa Salmonella sp. dapat disolasi dari tembolok ayam buras dan ayam ras, prevalensi Salmonella sp. lebih tinggi pada ayam ras dibandingkan ayam buras. Kata kunci : Eviserasi; Food borne Disease; Gram negative; Zoonotic disease

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

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

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

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

Multidrug-resistant (MDR) Pseudomonas aeruginosa has been declared a serious threat by the United States Centers for Disease Control and Prevention. Here, we used whole genome sequencing (WGS) to investigate recurrent P. aeruginosa bloodstream infections in a severely immunocompromised patient. The infections demonstrated unusual, progressive increases in resistance to beta lactam antibiotics in the setting of active treatment with appropriate, guideline-directed agents. WGS followed by comparative genomic analysis of isolates collected over 44 days demonstrated in host evolution of a single P. aeruginosa isolate characterized by stepwise acquisition of two de-novo genetic resistance mechanisms over the course of treatment. We found a novel deletion affecting the ampC repressor ampD and neighboring gene ampE, which associated with initial cefepime treatment failure. This was followed by acquisition of a porin nonsense mutation, OprD, associated with resistance to carbapenems. This study highlights the potential for in-host evolution of P. aeruginosa during bloodstream infections in severely immunocompromised patients despite appropriate antimicrobial therapy. In addition, it demonstrates the utility of WGS for understanding unusual resistance patterns in the clinical context.

The Arcobacteraceae family groups Gram-negative bacterial species previously included in the family Campylobacteraceae. These species of which some are considered foodborne pathogens, have been isolated from different environmental niches and hosts. They have been isolated from various types of foods, though predominantly from food of animal origin, as well as from stool of humans with enteritis. Their different abilities to survive in different hosts and environments suggest an evolutionary pressure with consequent variation in their genome content. Moreover, their different physiological and genomic characteristics led to the recent proposal to create new genera within this family, which is however criticized due to the lack of discriminatory features and biological and clinical relevance. Aims of the present study were to assess the Arcobacteraceae pangenome, and to characterize existing similarities and differences in 20 validly described species. For this, analysis has been conducted on the genomes of the corresponding type strains obtained by Illumina sequencing, applying several bioinformatic tools. Results of the present study do not support the proposed division into different genera and revealed the presence of pangenome partitions with numbers comparable to other Gram-negative bacteria genera, such as Campylobacter. Different gene class compositions in animal and human-associated species are present, including a higher percentage of virulence-related gene classes such as cell motility genes. The adaptation to environmental and/or host conditions of some species was identified by the presence of specific genes. Furthermore, a division into pathogenic and non-pathogenic species is suggested, which can support future research on food safety and public health.

Objectives: To evaluate the correlation between patient characteristics, operative variables and the risk of blood stream infection as well as the association of primary blood stream infection and adverse outcomes. Methods: Clinical records of 6500 adult patients who underwent open heart surgery between February 2008 and October 2020 were analyzed. The microbiological pattern of the primary BSI and its association with adverse events, such as mortality and major cardiovascular events, were evaluated. Results: Primary bloodstream infection was diagnosed in 1.7% (n = 108) of patients following cardiac surgery with the application of cardiopulmonary bypass. Most isolated bacteria were gram-negative bacillus groups, such as the Enterobacteriaceae family with Serrata marcescens in 26.26%, followed by the Enterococcaceae family with the Enterococcus faecalis in 7.39% and Enterococcus faecium in 9.14% as the most frequently identified bacteria. The postprocedural mortality, stroke rate p 120 min, OR 2.31 95%CI 1.34 to 3.98, perfusion time >120 min, OR 2.45 95%CI 1.63 to 3.67, and duration of the intervention >300min, OR 2.78 95%CI 1.47 to 5.28, were significantly related to the primary BSI. Conclusion: The gram-negative bacillus was the most common microorganism identified in BSI after cardiovascular operations using cardiopulmonary bypass. Patients on dialysis prior to cardiac surgery are at higher risk for having BSI. Enteric bacterial translocation after prolonged cardiopulmonary bypass is a possible mechanism of early primary bloodstream infection in these patients. In patients at high risk, prophylactic use of an antibiotic regimen with broader gram-negative bacteria coverage should be considered, especially in those with prolonged cardiopulmonary bypass and intervention time.

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

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

There is paucity of data describing the impact of COVID-19 pandemic on antimicrobial resistance. This review evaluated the changes in the rate of multidrug resistant gram negative and gram positive bacteria during the COVID-19 pandemic. A search was conducted in PubMed, Science Direct, and Google Scholar databases to identify eligible studies. Studies that reported the impact of COVID-19 pandemic on carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Enterobacteriaceae (CRE), extended-spectrum beta-lactamase inhibitor (ESBL)-producing Enterobacteriaceae , vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Pseudomonas aeruginosa (CPE) were selected. Studies published in English language from the start of COVID-19 pandemic to July 2022 were considered for inclusion. Thirty eligible studies were selected and most of them were from Italy (n = 8), Turkey (n = 3) and Brazil (n = 3). The results indicated changes in the rate of multidrug resistant bacteria, and the changes varied between the studies. Most studies (54.5%) reported increase in MRSA infection/colonization during the pandemic, and the increase ranged from 4.6 to 170.6%. Five studies (55.6%) reported a 6.8–65.1% increase in VRE infection/colonization during the pandemic. A 2.4–58.2% decrease in ESBL E. coli and a 1.8–13.3% reduction in ESBL Klebsiella pneumoniae was observed during the pandemic. For CRAB, most studies (58.3%) reported 1.5–621.6% increase in infection/colonization during the pandemic. Overall, studies showed increase in the rate of CRE infection/colonization during the pandemic. There was a reduction in carbapenem-resistant E. coli during COVID-19 pandemic, and an increase in carbapenem-resistant K. pneumoniae. Most studies (55.6%) showed 10.4 – 40.9% reduction in the rate of CRPA infection during the pandemic. There is an increase in the rate of multidrug resistant gram positive and gram negative bacteria during the COVID-19 pandemic. However, the rate of ESBL-producing Enterobacteriaceae and CRPA has decrease during the pandemic. Both infection prevention and control strategies and antimicrobial stewardship should be strengthen to address the increasing rate of multidrug resistant gram positive and gram negative bacteria. [ABSTRACT FROM AUTHOR]

The aim of this paper was to assess the microbiologic quality of air in broiler houses. The number of bacteria (mesophile, staphylococci, streptococci and gram-negatives) and fungi was determined in 6 broiler houses with chicken of different ages (1-6 weeks old) through specific methods. The results were statistically processed by using the SPSS software, version 17. The number of bacteria and fungi varied in the 6 broiler houses, ranging from 2.25 x 105 to 2.17 x 106 for the total number of mesophilic bacteria, between 3.5 x 104 – 1.27 x 106 for staphylococci, 7.4 x 104 – 5.01 x 105 for streptococci, 3.5 x 103 – 1.53 x 104 for gram-negatives and from 1.67 x 104 to 8.13 x 104 for fungi, respectively. The number of bacteria and fungi were significantly lower for the younger chicken (p < 0.05). The proportions of groups with hygienic significance within the total mesophilic bacteria number were: 15.7% - 68.6% staphylococci, 6.7% - 45.6% streptococci and 0.2% - 4.5% gram-negatives. The comparative appraisal of the microbiologic quality in the broiler houses showed better air quality in the youngest chicken’s house (one week of age). The obtained results indicate the necessity for increased ventilation and for air disinfection during the chicken’s fattening period.

Objectives: Understand the long-term mortality, risk of readmission for sepsis and cause of death following a gram-negative bloodstream infection (GN-BSI). Methods: This was a propensity-matched study using data linkage of Queensland hospital data, Australia. GN-BSIs were collected from 2005 to 2010 and matched 1:1 to hospital admissions without BSI for age, gender, year of culture collection, frequency of admissions in the prior year and Charlson-Deyo Comorbidity score and each comorbidity within the Charlson-Deyo score. Readmissions for sepsis, mortality and causes of death were evaluated. Results: Cases of GN-BSI were propensity-matched 1:1 to culture-negative hospital admissions (n = 14016). Readmissions for sepsis were higher in the GN-BSI cohort from 91 to 365 days (P

ABSTRACT The test performance and potential clinical utility of the ePlex blood culture identification Gram-negative (BCID-GN) panel was evaluated relative to matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) mass spectrometry on bacterial isolates and conventional antimicrobial susceptibility testing. The majority (106/108, 98.1%) of GN bacteria identified by MALDI were on the BCID-GN panel, and valid tests (107/108, 99.1%) yielded results on average 26.7 h earlier. For all valid tests with on-panel organisms, the positive percent agreement was 102/105 (97.2%) with 3 false negatives and the negative percent agreement was 105/105. Chart review (n = 98) showed that in conjunction with Gram stain results, negative pan-Gram-positive (GP) markers provided the opportunity to discontinue GP antibiotic coverage in 63/98 (64.3%) cases on average 26.2 h earlier. Only 8/12 (66.7%) Enterobacterales isolates with resistance to third-generation cephalosporins harbored the CTX-M gene. In contrast, 8/8 CTX-M+ samples yielded a resistant isolate. Detection of 1 Stenotrophomonas maltophilia (18 h), 1 OXA23/48+ Acinetobacter baumannii (52.4 h), and 3 CTX-M+ Enterobacterales isolates on ineffective treatment (47.1 h) and 1 on suboptimal therapy (72.6 h) would have additionally enabled early antimicrobial optimization in 6/98 (6.1%) patients. IMPORTANCE The GenMark Dx ePlex rapid blood culture diagnostic system enables earlier time to identification of antimicrobial-resistant Gram-negative bacteria causing bloodstream infections. Its ability to rule out Gram-positive bacteria enabled early discontinuation of unnecessary antibiotics in 63/98 (64.3%) cases on average 26.2 h earlier. Detection of bacteria harboring the CTX-M gene as well as early identification of highly resistant bacteria such as Stenotrophomonas maltophilia and Acinetobacter baumannii enabled optimization of ineffective therapy in 6/98 (6.1%) patients. Its implementation in clinical microbiology laboratories optimizes therapy and improves patient care.

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

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

Background: Gram-negative bloodstream infections are associated with significant morbidity and mortality in children. Increasing antimicrobial resistance (AMR) is reported globally, yet efforts to track pediatric AMR at a national level over time are lacking., Methods: The Australian Group on Antimicrobial Resistance (AGAR) surveillance program captures clinical and microbiological data of isolates detected in blood cultures across Australia. EUCAST 2022 was used for MIC interpretation and the AMR package in R for data analysis., Results: Over a nine-year period, there were 3,145 bloodstream infections with 3,266 gram-negative isolates reported in hospitalized children aged <18 years; 21.0% were from neonates. The median length of stay was 9 days, and 30-day all-cause mortality was 5.2%. A greater odds of death was observed in those with a multi-drug resistant organism (aOR: 2.1, 95%CI: 1.3, 3.3, p: 0.001). Escherichia coli (44.5%) and Klebsiella pneumoniae complex (12.6%) were the two most frequently reported organisms. Overall resistance in Enterobacterales to gentamicin/tobramycin was 11.6%, to ceftazidime/ceftriaxone was 12.9%, and 13.2% to ciprofloxacin. Resistance increased over time.Of 201 Pseudomonas aeruginosa isolates reported, 19.7% were resistant to piperacillin-tazobactam, 13.1% resistant to cefepime/ceftazidime and 9.8% to ciprofloxacin. Of 108 Acinetobacter spp. isolates, one was resistant to meropenem, and two were resistant to ciprofloxacin. Resistance did not increase over time., Conclusion: AMR in gram-negative organisms causing bloodstream infections in Australian children is increasing which should be considered when updating guidelines and empiric treatment regimens. Ongoing pediatric-specific national surveillance with pediatric reporting must remain a priority to strengthen antimicrobial stewardship and infection control programs., (© The Author(s) 2024. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

The COVID-19 pandemic has raised concerns beyond the viral infection itself. Bacterial co-infections, particularly those involving Acinetobacter baumannii, have become a significant worry in critically ill COVID-19 patients. A. baumannii is an opportunistic pathogen that can cause nosocomial infections, especially in patients with compromised immune systems. This study investigated 36 A. baumannii isolates obtained from COVID-19 patients during a concurrent outbreak. The isolates were collected over two years through routine medical requests sent to the Clinical Microbiology laboratory. Identification of the strains was confirmed through biochemical tests, the Phoenix BD® Automated Microbiology System, and MALDI-TOF Mass Spectrometry. The study assessed the antimicrobial sensitivity of the isolates, with a specific focus on resistance to the beta-lactam group as well as aminoglycosides. The presence of specific antibiotic resistance genes (bla OXA-23 , -24 , -51 and -58 , bla KPC , bla SHV , bla IMP , bla VIM , aac(6')-Ib, ant(3″)-Ia, and aph(3')-Ia) was investigated using PCR and Sanger DNA sequencing. Biofilm-forming capabilities of the isolates were also evaluated. The findings revealed diverse resistance profiles, with a high prevalence of resistant strains, including resistance to carbapenems. Genetic analysis suggested potential clonal spread of certain strains within the hospital setting. Moreover, a significant proportion of the isolates demonstrated strong biofilm-forming abilities, which can enhance persistence and antibiotic resistance. In conclusion, this study highlights the need for vigilant monitoring and targeted interventions to address bacterial co-infections in COVID-19 patients. The diversity in resistance patterns, potential clonal spread, and robust biofilm-forming abilities among A. baumannii isolates underscore the importance of addressing this issue to better manage and treat critically ill COVID-19 patients., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financialinterestsor personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)