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Serratia marcescens previously was thought to be a low pathogenic bacterium but has recently being recognized as a nosocomial pathogen. In May 2007, patients with nosocomial septicemia caused by S. marcescens were identified in a neonatal intensive care unit (NICU) at a tertiary-teaching hospital. The objective of this report is to highlight the rare source of the S. marcescens outbreak. Here, we describe the investigations and outcomes of this outbreak. Case subject was defined as any neonate receiving medical care at the NICU, from one week before the index patient became symptomatic and onwards, with clinical signs and symptoms of sepsis, with or without a positive blood culture, which yielded S. marcescens. Chart reviews were conducted for case subjects. Various samples from the NICU were sent for sterility testing including medications, solutions, used and freshly prepared total parenteral nutrition (TPN) from the NICU and the pharmacy unit. The specimens were processed and positive isolates were identified as S. marcescens using standard microbiological methods. S. marcescens isolates were subjected to pulsed field gel electrophoresis for molecular typing and source identification. S. marcescens were isolated from five neonates, used TPN and freshly prepared TPN of different batches in pharmacy. None of the environmental samples and medications grew S. marcescens. Analysis of macrorestriction patterns of genomic DNA by pulsed field gel electrophoresis demonstrated indistinguishable patterns. This outbreak was related to bacterial contamination of TPN. This report points at a rare source of S. marcescens outbreak. However, targeted investigations and immediate active interventions enabled the managing team to control the outbreak in the NICU.

Ultraviolet-A (UVA) radiation is present in sunlight and have been associated with various types of human skin cancers. In this study, rubber-grade zinc oxide (ZnO) powder was used as the targeted materials to study its UVA photoresponse as well as its antibacterial function. ZnO powder was synthesized using French process. The morphological structures of the samples were investigated using field emission scanning electron microscopy and transmission electron microscopy. The dominant morphology of the sample was micro/nanoplate. The optical bandgap of the ZnO sample is 3.19 eV based on the UV-Visible measurement. Current-voltage measurement was conducted to study the effect of UVA (390 nm) illumination on the photoconductivity of the ZnO pellet. Photoconductivity was observed to increase significantly under UVA exposure due to light absorption on the surface of ZnO to raise the electrons across the bandgap. The current response of the UVA-induced also revealed the small persistent photoconductivity after the UVA light was turned off. Besides, higher voltage bias would lead to higher current flow under the same intensity of UVA exposure. According to the antibacterial test towards Staphylococcus aureus, the percentage inhibition of the bacterial after 24 h incubation increase when the concentration of ZnO suspension increases. The UVA illumination had improved the inhibition of the bacterial growth. This is due to the excitation of ZnO and increasing of free charge carriers in the solution, leading to potential distortion to the membrane surface of the bacteria. ZnO powder performed high absorption of UVA and they are not only can be used to block the UVA sunlight, but also have higher antibacterial capability under UVA excitation.

The antibacterial responses of zinc oxide (ZnO) structures against Staphylococcus aureus, Pseudomonas aeruginosa, and Streptococcus pyogenes were investigated. Two ZnO powder samples, one with rod-like (ZnO-1) and the other with plate-like (ZnO-2) structures, were characterized for their morphological, structural, and optical properties. The rods were 30–120 nm in diameter, and the plates were 40–100 nm thick. XRD results revealed the wurtzite crystallinity of ZnO with average crystallite sizes of 33.72 (ZnO-1) and 39.25 (ZnO-2) nm. ZnO-2 possessed a relatively higher green photoluminescence than that of ZnO-1, suggesting a relatively higher amount of oxygen vacancies in ZnO-2 structures. Optical density measurements showed that both ZnO samples inhibited the growth of S. aureus, P. aeruginosa, and S. pyogenes by 29–98% after 24 h of treatment. The most dramatic growth inhibition was observed in S. pyogenes with 96% and 98% inhibition for ZnO-1 and ZnO-2, respectively, leading to a probable bactericidal phenomenon. The toxicological effect on S. pyogenes was probably due to the absence of catalase, making the bacteria vulnerable to the harmful reactive oxygen species (ROS) released by ZnO. ZnO-1 induced higher inhibition toward S. aureus and P. aeruginosa than that of ZnO-2 because of the smaller particle size of rod structures compared to plate and slab structures. The adhesion of ZnO particles on the membrane of bacteria could be the underlying cause of zinc toxicity effect towards the bacteria. ZnO-1 possessed larger surface area and provided higher amount of zinc atom, thereby inducing higher level of toxicity toward the bacteria. Two possible mechanisms were proposed to explain the inhibition of bacteria, namely, ROS toxicity toward cellular constituents and interaction of zinc with bacteria membrane through adhesion of ZnO particle. Several ZnO morphological-antibacterial correlations were presented in this work.

The effects of surface modification of zinc oxide (ZnO) powder and UVA illumination on the powder towards Escherichia coli and Staphylococcus aureus were investigated. FESEM-EDS results showed that oxygen annealing increased the O:Zn ratio on the surface of ZnO-rod and ZnO-plate samples. Surface conductances of ZnO-rod and ZnO-plate pellets were reduced from 1.05 nS to 0.15 nS and 1.34 nS to 0.23 nS, respectively. Meanwhile, UVA illumination on the surface of the ZnO-rod and ZnO-plate samples was found to improve surface conductance to 7.08 nS and 6.51 nS, respectively, due to the release of charge carrier. Photoluminescence results revealed that oxygen annealing halved the UV emission intensity and green emission intensity, presumably caused by oxygen absorption in the ZnO lattice. The antibacterial results showed that oxygen-treated ZnO exhibited slightly higher growth inhibition on E. coli and S. aureus compared with unannealed ZnO. UVA illumination on ZnO causes the greatest inhibition toward E. coli and S. aureus. Under the UVA excitation, the inhibition of E. coli increased by 18% (ZnO-rod) and 13% (ZnO-plate) while the inhibition of S. aureus increased by 22% (ZnO-rod) and 21% (ZnO-plate). Release of reactive oxygen species were proposed in antibacterial mechanisms, which were aided by surface modification and UVA photoactivation. The reactive oxygen species disrupted the DNA and protein synthesis of the bacterial cell, causing bacteriostatic effects toward E. coli and S. aureus.

In this study, we study the physical property and antibacterial bioactivity of ZnO nanopowder towards Staphylococcus Aureus. Transmission electron microscopy (TEM), field emission scanning electron microscopy (FESEM), FTIR, Raman spectroscopy and UV-Vis were used to characterize the ZnO nanopowder. The major morphology consists of nanorods which have length 70-200 nm and width 30-120 nm. FTIR spectra performed a well-synthesis of ZnO that has Zn-O stretching bond (482 cm-1). UV-Vis absorption spectra showed an intense UV absorption at 387 nm, corresponding to optical bandgap 3.24 eV. Raman spectroscopy exhibited a prominent peak in E2high mode located at 435 cm-1. The antibacterial response of ZnO was performed toward Staphylococcus aureus. Higher concentration of ZnO had caused higher inhibition of the bacteria. Besides, the increment of capability of ZnO towards the bacteria was observed under UV radiation. It was believed that the irradiation had induced oxygen to be released from the surface of the ZnO and caused the increasing of reactive oxygen species, which enhance the bacteria inhibition.

AIMS: In Malaysia, Shigella spp. is the third most common bacterial agent responsible for childhood diarrhoea. This study was conducted to determine the prevalence and antimicrobial susceptibility patterns of Shigella spp. isolated from patients admitted to the Hospital Universiti Sains Malaysia from January 2001 to December 2009. SUBJECTS AND METHODS: A hospital-based retrospective study was used. Stool samples from patients were cultured using a standard culture method. Shigella spp. isolates were identified by biochemical and serological methods, and the antimicrobial susceptibility pattern was evaluated using the Kirby-Bauer disc-diffusion method. RESULTS: A total of 138 Shigella spp. were isolated from a total of 14,830 routine stool specimens, yielding an isolation rate of 0.93% that corresponded to 9.99% of the 1,381 bacterial pathogens isolated. Of these isolates, S. sonnei was the predominant species, followed by S. flexneri and S. boydii. Seasonal variation was noticed, and no significant differences were detected in the demographic data for S. flexneri and S. sonnei. The susceptibility of all isolated Shigella strains was tested against seven antibiotics. Ceftriaxone (99.1%), ciprofloxacin (98.4%), and nalidixic acid (93.8%) were effective against the Shigella strains, whereas tetracycline and trimethoprim-sulfamethoxazole exhibited high frequencies of resistance (58.4% and 53.8%, respectively). CONCLUSION: This study is important for public health education aimed at reducing the morbidity and mortality associated with Shigella spp. infection. Our results also will be helpful for paediatricians and microbiologists in the selection of appropriate antibiotics for the management of diarrhoea.

In this study, we report the structural morphology of a zinc oxide (ZnO) sample and antibacterial application of the ZnO structures in calamine lotion. Antibacterial activities of the calamine lotion towards Staphylococcus aureus and Pseudomonas aeruginosa were investigated. The structural morphology of ZnO sample was studied using a transmission electron microscope (TEM) and a field-emission scanning electron microscope (FESEM). The morphologies of the ZnO structure consisted of many rod and spherical structures. The particle sizes of the sample ranged from 40 nm to 150 nm. A calamine lotion was prepared through mixing the ZnO structures with other constituents in suitable proportion. The energy-dispersive x-ray spectroscopy (EDS) revealed the presence of large amount of ZnO structures whiles the X-ray diffraction (XRD) results showed a good crystalline property of ZnO in the calamine lotion mixture. The morphological structures of ZnO were found to remain unchanged in the calamine lotion mixture through FESEM imaging. In the antibacterial test, prepared calamine lotion exhibited a remarkable bacterial inhibition on Staphylococcus aureus and Pseudomonas aeruginosa after 24 h of treatment. The bactericidal capability of calamine lotion was largely due to the presence of ZnO structures which induce high toxicity and killing effect on the bacteria.

Background Clostridum difficile (C. difficile) infection is increasingly seen among hospitalised patients with type 2 diabetes mellitus but its rate and associated risk factors are not known. We aimed to determine the rate and characteristics of hospital-acquired C. difficile infection in subjects with type 2 diabetes mellitus admitted into acute medical wards. Methods Our prospective cross-sectional study involved 159 patients with established type 2 diabetes mellitus admitted into acute medical wards who developed a hospital-acquired C. difficile infection. Stools were tested for C. difficile toxins using a toxin A/B kit and a toxin A kit. Clinical features, laboratory findings, types of antibiotics, and use of a proton pump inhibitor were examined for their association with the infection. Results Thirteen subjects were positive for toxin A and one for toxin B. Using univariable analysis, we found that patients with type 2 diabetes mellitus and hospital acquired C. difficile infection were younger (mean 53.8 years, p=0.02), had diarrhoea and abdominal pain (p=0.001) but no fever. Sepsis (p=0.02) and use of a proton pump inhibitor (p=0.01) were more commonly implicated as the cause of the infection. Of the various types of antibiotics prescribed, carbapenem (28.6% vs 4.1%, p=0.01) and metronidazole (42.9% vs 19.3%, p=0.04) were significantly associated with hospital acquired C. difficile infection. Conclusions Patients with type 2 diabetes mellitus admitted into acute medical wards and who developed hospital-acquired C. difficile infection have distinct characteristics.

This study describes the prevalence of Clostridium difficile toxin (CDT) in loose stool samples from inpatients aged more than two years of a tertiary hospital. A total of 175 samples that had been examined were from stool samples that were sent to the Medical MicrobiologyParasitology Laboratory for various clinical indications. The toxin was detected by a commercial immunochromatograhic test, and the patients' demography, clinical features, treatment and outcomes were analyzed from their medical records. Clostridium difficile toxin was positive in 24 (13.7%) of the stool samples. Male and female were 11 (45.8%) and 13 (54.2%) respectively, with the majority of them aged more than 50 years. Most were from medical wards (n = 21, 87.5%), with the rest from surgical wards (n = 2, 8.3%) and intensive care units (n = 1, 3.4%). All the CDT positive patients had history of prior antibiotic usage within 6 weeks before the detection of the toxin. The mean duration of antibiotics usage was 17.75 (+/- 13.75) days, while the mean duration of diarrhea was 5.21((+/- 5.85) days. Eighteen patients had underlying medical illnesses that were diabetes mellitus, chronic renal disease, hypertension, ischaemic heart disease, cerebrovascular disease and malignancy; with seven of them being CDT positive while on chemotherapy. Stool occult blood test was positive in 15 patients whereas presence of pus cells in the CD positive stool samples were detected in 21 patients. The duration of hospitalization among the patients was 27.96 (+/- 23.22) days.

Acinetobacter spp is a known nosocomial pathogen causing a wide range of clinical diseases such as pneumonia, wound infection and bloodstream infections (BSI). The clinical outcomes of acinetobacter BSI were determined by a 1:1 case control study involving 58 confirmed cases of acinetobacter BSI who were compared to other gram-negative infections. The crude mortality of acinetobacter BSI was 47.2%, which was significantly greater than other gram-negative BSI (OR 1.89, 95% CI 1.10-3.24) but there were no significant differences in attributed mortality between the two groups. We found that patients treated in intensive care units (ICU), who had longer ICU stays, who presented with shock or coagulopathy, had prior exposure to carbapenems, had mechanical ventilation, were on a ventilator for longer periods, had a nasogastric tube, had an arterial catheter or had parenteral nutrition at a significantly greater risk of mortality due to acinetobacter BSI. Patients presenting with septic shock (OR 17.95, 95% CI 3.36-95.84) or having a central venous catheter (OR 12.48, 95% CI 1.09-142.68) were independently at higher risk for mortality. Appropriateness of therapy reduced the mortality attributes of acinetobacter BSI (OR 0.197, 95% CI 0.040-0.967) but did not significantly reduce crude mortality in acinetobacter BSI patients. This study shows the importance of preventing acinetobacter BSI and the appropriate use of antimicrobial agents to reduce mortality.

Background : Antibiotic resistance among Enterobacteriaceae posts a great challenge to the health care service. The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) is attracting significant attention due to its rapid and global dissemination. The infection is associated with significant morbidity and mortality, thus creating challenges for infection control and managing teams to curb the infection. In Southeast Asia, there have been limited reports and subsequent research regarding CRKP infections. Thus, the study was conducted to characterize CRKP that has been isolated in our setting. Methods : A total of 321 K. pneumoniae were included in the study. Each isolate went through an identification process using an automated identification system. Phenotypic characterization was determined using disk diffusion, modified Hodge test, Epsilometer test, and inhibitor combined disk test. Further detection of carbapenemase genes was carried out using polymerase chain reaction and confirmed by gene sequence analysis. Results : All together, 13 isolates (4.05%) were CRKP and the majority of them were resistant to tested antibiotics except colistin and tigercycline. Among seven different carbapenemase genes studied ( bla KPC , bla IMP , bla SME , bla NDM , bla IMI, bla VIM , and bla OXA ), only two, bla IMP4 (1.87%) and bla NDM1 (2.18%), were detected in our setting. Conclusion : Evidence suggests that the prevalence of CRKP in our setting is low, and knowledge of Carbapenem-resistant Enterobacteriaceae and CRKP has improved and become available among clinicians. Keywords: carbapenem-resistant Enterobacteriaceae; carbapenemase ; Klebsiella pneumoniae; Modified Hodge test (Published: 10 March 2015) Citation: Emerg Health Threats J 2015, 8 : 26011 - http://dx.doi.org/10.3402/ehtj.v8.26011

Background Antibiotic resistance of bacteria is on the rise, thus the discovery of alternative therapeutic agents is urgently needed. Honey possesses therapeutic potential, including wound healing properties and antimicrobial activity. Although the antimicrobial activity of honey has been effectively established against an extensive spectrum of microorganisms, it differs depending on the type of honey. To date, no extensive studies of the antibacterial properties of tualang (Koompassia excelsa) honey on wound and enteric microorganisms have been conducted. The objectives of this study were to conduct such studies and to compare the antibacterial activity of tualang honey with that of manuka honey. Methods Using a broth dilution method, the antibacterial activity of tualang honey against 13 wound and enteric microorganisms was determined; manuka honey was used as the control. Different concentrations of honey [6.25-25% (w/v)] were tested against each type of microorganism. Briefly, two-fold dilutions of honey solutions were tested to determine the minimum inhibitory concentration (MIC) against each type of microorganism, followed by more assays within a narrower dilution range to obtain more precise MIC values. MICs were determined by both visual inspection and spectrophotometric assay at 620 nm. Minimum bactericidal concentration (MBC) also was determined by culturing on blood agar plates. Results By visual inspection, the MICs of tualang honey ranged from 8.75% to 25% compared to manuka honey (8.75-20%). Spectrophotometric readings of at least 95% inhibition yielded MIC values ranging between 10% and 25% for both types of honey. The lowest MBC for tualang honey was 20%, whereas that for manuka honey was 11.25% for the microorganisms tested. The lowest MIC value (8.75%) for both types of honey was against Stenotrophomonas maltophilia. Tualang honey had a lower MIC (11.25%) against Acinetobacter baumannii compared to manuka honey (12.5%). Conclusion Tualang honey exhibited variable activities against different microorganisms, but they were within the same range as those for manuka honey. This result suggests that tualang honey could potentially be used as an alternative therapeutic agent against certain microorganisms, particularly A. baumannii and S. maltophilia.