Academic literature on the topic 'Antimicrobial resitance'

The COVID-19 pandemic led to tremendously use of antimicrobial due to the lack of proper treatment strategies, raising concerns about emergence of antimicrobial resistance (AMR). This study aimed at determining the prevalence and antibiotic resistance pattern of selected bacteria isolates in 02 referral health facilities in Yaoundé before and during the COVID-19 pandemic era. We conducted a retrospective study over a period of 03 years (from 1 January 2019 to 31 December 2021) in the bacteriology units of the Central and General Hospitals of Yaoundé, Cameroon. Data on bacteria genera (Streptococcus, Staphylococcus, Neisseria meningitidis and Enterobacteriaceae) as well as their corresponding specifics antibiotics: Cefixime, azythromycin and erythromycin were obtained from laboratory records. The global resistance rate of bacteria as well as their correlation with antibiotics according to COVID-19 pandemic era was determined and compared. For p < 0.05, the difference was statistically significant. In all, 426 bacterial strains were included. It appeared that the highest number of bacteria isolates and lowest rate of bacterial resistance were recorded during the pre-COVID-19 period in 2019 (160 isolates vs. 58.8% resistance rate). Conversely, lower bacteria strains but greater resistance burden were recorded during the pandemic era (2020 and 2021) with the lowest bacteria amount and peak of bacteria resistance registered in 2020, the year of COVID-19 onset (120 isolates vs. 70% resistance in 2020 and 146 isolates vs. 58.9% resistance in 2021). In contrast to almost all others groups of bacteria where the resistance burden was quite constant or decreasing over years, the Enterobacteriaceae exhibited greater resistance rate during the pandemic period [60% (48/80) in 2019 to 86.9% (60/69) in 2020 and 64.5% (61/95) in 2021)]. Concerning antibiotics, unlike erythromycin, azythromycin related resitance increased during the pandemic period and the resistance to Cefixim tends to decrease the year of the pandemic onset (2020) and re-increase one year therafter. A significant association was found between resistant Enterobacteriaceae strains and cefixime (R = 0.7; p = 0.0001) and also, between resistant Staphylococcus strains and erythromycin (R = 0.8; p = 0.0001). These retrospective data showed a herogeneous MDR bacteria rate and antibiotic resistance pattern over time before and during the COVID-19 pandemic era suggesting that antimicrobial resistance needs to be more closely monitored.

Antimicrobial resistance continues to pose serious public health challenges. OqxA and OqxB are multidrug resistance genes that confer Escherichia coli and Klebsiella pneumoniae resistance to more than one antibiotics. The purpose of this study was to detect OqxA in Escherichia coli and OqxB in Klebsiella pneumoniae from clinical samples isolated from Niger Delta University, Yenagoa. A total of 50 samples were collected. The bacterial isolates were identified using a standard bacteriological technique, the genes were detected using Polymerase Chain Reaction while the antibiotic susceptibility testing was done by disc diffusion. Of the 50 clinical isolates, 9(18%) were positive for E. coli while 15(30%) were positive for Klebsiella pnuemoniae. The total number of isolates were 18(36%) from male and 32(64%) from females. The susceptibility pattern of the isolates revealed that Escherichia coli exhibited the highest resistance of 100% to Cefuroxime and Augmentin, followed by Gentamycin and Ofloxacin (.55%) and Ciprofloxacin (11.11%) while Klebsiella pneumoniae Nalidixic Acid, Augmentin Cephalexin and Sulfamethoxazole shows 100% resistance respectively. Of the 9 that were E.coli isolates, 8(88.9%) harboured OqX A while of the 15 that were Klebsiella pneumoniae isolates, 13 (86.7%) harboured the OqxB genes. There was 100% resistance to Nalidixic acid, cefuroxime and sulfamethoxazole, with lowest resitance to meropenem (46.7%) and ciprofloxacin (60%). The report clearly demonstrates an urgent need for surveillance against these bacteria especially as they are pathogens of public health concerns to minimize the increasing pace of multidrug resistance conferred on these bacteria by OxAB genes.

IntroductionDespite the increasing importance of infections due to multidrug-resistant organisms (MDROs), there is a lack of comprehensive information about the burden of disease and outcomes of key infections caused by these pathogens. The aim of the ABOUT-MDRO (A systematic review on the burden and outcomes of infections due to multidrug resitant organisms) project is to provide estimations of the burden of some key infections and their outcomes caused by the target MDROs.Methods and analysisA systematic literature search will be performed using MEDLINE/PubMed, Elsevier’s SCOPUS, Cochrane library, Clinical trials and Web of Science, as well as the Surveillance Systems from Public Health Institutions and Scientific Societies for Antimicrobial Resistance and Healthcare-Associated Infections in Europe database of European surveillance systems, for data on prevalence/incidence, mortality and length of stay of target infections in hospitalised patients (including ventilator-associated pneumonia, hospital-acquired pneumonia, complicated intra-abdominal infections, complicated urinary tract infections, skin and soft tissue infections and bloodstream infections) and in specific populations (children, hospital wards, neutropenic patients) caused by cephalosporin-resistant or carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa and Acinetobacter spp., methicillin-resistant Staphylococcus aureus, and vancomycin-resistant Enterococcus spp. The information retrieved will be tabulated and pooled estimates and 95% CIs calculated of rates and outcomes, using random effects models. Relationships between rates and outcomes in randomised control trials and epidemiological studies, and data of proportions and incidence/prevalence rates will also be analysed. The information collected in this study will be useful for identifying gaps in our knowledge in terms of incidence/prevalence and clinical outcomes of infections caused by MDROs, and for informing priorities in infection control and the research and design of appropriate studies.Ethics and disseminationThis study will be based on published data so we did not require ethical approval. Formal consent is not required. The results of this review will be reported according to the Preferred Reporting Items for Systematic Review and Meta-Analyses statement. Data will be presented at international conferences and published in peer-reviewed journals.Registration detailsPROSPERO (https://www.crd.york.ac.uk/prospero/) (CRD42019124185).

Abstract Background The modern advances in the fields of Medicine and Surgery depend entirely on our ability to treat and prevent infections. However, the rising incidence of antimicrobial resitance in both community and hospital settings has proved to be increasingly challenging. In 2017, WHO published a list of ‘priority pathogens’; antibiotic-resistant bacteria which posed the greatest threat to human health. Among them, A. baumannii was recognized as a critical priority pathogen due to its significant role in nosocomial infections. There was a growing call for new avenues in antimicrobial therapy. One such endeavour was to revisit an old therapeutic option against MDRO, viz. bacteriophage therapy. Numerous instances of successful phage therapy have already been published, with many more becoming available each day. Methods A total of fifty (50) multidrug resistant isolates of A. baumannii were collected. We attempted to isolate bacteriophages from hospital sewage water, against these collected strains, using standard procedure. Then the host range of the isolated phages were analysed against those 50 collected isolates. The lytic activity was confirmed using spot and plaque assays, following the techniques used by Newase et al, with some modifications. The isolated phages were then purified and stained following methods of Ellis et al, with some modifications, and visualised by a ThermoScientific Talos L120C transmission electron microscope (TEM). Graphical Workflow This depicts the workflow of the study. Created with BioRender.com Results A total of three (3) bacteriophages were isolated from the hospital sewage, and their lytic activity against A. baumannii strains were confirmed by the spot assay which showed clear zones on bacterial lawns. The phages, named vB_AbaS_SRNAIIMS002, vB_AbaS_SRNAIIMS008 and vB_AbaP_SRNAIIMS010, showed central clear zones surrounded by halos, in the plaque assay. Finally, all 3 bacteriophages were visualised by TEM, and two of them had morphology suggestive of siphoviridae family, with long tails, while the third had a short stubby tail, characteristic of the podoviridae family. Conclusion The study concludes that 3 novel bacteriophages were isolated from sewage water, all of which were active against MDR A. baumannii strains. This provides impetus to further research towards phage therapy as a novel therapeutic option against MDROs. Disclosures All Authors: No reported disclosures.

Abstract Background Between January and April 2022, an audit of surveillance data revealed five cases of bloodstream Acinetobacter baumannii infection in intensive care unit (ICU) patients in a large general hospital. Bacterial infections such as Acinetobacter baumannii contribute to significant mortality and complications of treatment in ICU patients. We aimed to describe bacterial pathogens and their resistance profile among ICU patients to inform infection prevention and control programs. Methods We conducted a cross-sectional study of patients admitted to the ICU of a large general hospital in Kazakhstan from January to April 2022. The study included all patients ≥ 18 years old diagnosed with a bacterial infection as detected in blood, urine or sputum samples. Demographic, clinical, and laboratory data were abstracted from medical records. Results Among 65 patients identified, 54% were male, mean age 64 years (range 20-93). Majority (35%) were admitted directly to the ICU, 15% had been transferred to the ICU from the infectious surgery department, 14% from the stroke department, and 5% from the gynecology department. Sixty-eight percent (44/65) of patients had surgery prior to transfer to the ICU. The most frequent pathogen in the study patients was Acinetobacter baumannii 63% (n=41). Of which, 15% was detected in blood, 41% in urine, and 44% in sputum. The hospital only tests for drug-resistance for the prescribed antibiotic, and 63% (26/41) of strains tested were resistant to their prescribed medicines. Klebsiella pneumoniae was detected in 22% (n=15) patients. Of which, 60% was detected in sputum, 20% in urine and 20% in blood. Also, 60% were drug-resistant. Staphylococcus aureus was detected in 11% of patients. Of which, 57% was drug-resistant in sputum. Overall 60% (39/64) of pathogens tested had resistance for the antibiotic prescribed, but there was no evidence that prescribed antibiotics changed based on resistance results. Antimicrobial resitance and antibiotics prescribed to patients in an ICU of a large general hospital (n=65), Kazakhstan, 2022 Map of bacterial infection in ICU patients admitted from different wards in a large general hospital, Kazakhstan, 2022 Conclusion The identification of infectious pathogens with demonstrated drug resistance reinforces the need for improved basic infection control practices and the need for improved antimicrobial stewardship. Increased surveillance and reporting of hospital-acquired infections is needed. Disclosures All Authors: No reported disclosures

Abstract Background The quantitative relationship between antimicrobial agent consumption and rise or fall of antibiotic resistance has rarely been studied. We began all admission surveillance testing for methicillin-resistant Staphylococcus aureus (MRSA) in August 2005 with subsequent contact isolation and decolonization using nasally applied mupirocin ointment for those colonized. In October 2012, we discontinued decolonization of medical (nonsurgical service) patients. Methods We conducted a retrospective study from 2007 through 2014 of 445680 patients; 35235 were assessed because of mupirocin therapy and positive test results for MRSA. We collected data on those patients receiving 2% mupirocin ointment for decolonization to determine the defined daily doses (DDDs). A nonparametric regression technique was used to quantitate the effect of mupirocin consumption on drug resistance in MRSA. Results Using regressive modeling, we found that, when consumption was consistently &gt;25 DDD/1000 patient-days, there was a statistically significant increase in mupirocin resistance with a correlating positive rate of change. When consumption was ≤25 DDD/1000 patient-days, there was a statistically significant decrease in mupirocin resistance with a correlating negative rate of change. The scatter plot of fitted versus observed mupirocin resistance values showed an R2 value of 0.89—a high correlation between mupirocin use and resistance. Conclusions Use of the antimicrobial agent mupirocin for decolonization had a threshold of approximately 25 DDD/1000 patient-days that separated a rise and fall of resistance within the acute-care setting. This has implications for how widely mupirocin can be used for decolonization, as well as for setting consumption thresholds when prescribing antimicrobials as part of stewardship programs.

Abstract Background Colistin is a last-resort antibiotic used in extreme cases of multi-drug resistant (MDR) Gram-negative bacterial infections. Colistin resistance has increased in recent years and often goes undetected due to the inefficiency of predominantly used standard antibiotic susceptibility tests (AST). To address this challenge, we aimed to detect the prevalence of colistin resistance strains through both Vitek®2 and broth micro-dilution. We investigated 1748 blood, tracheal aspirate, and pleural fluid samples from the Intensive Care Unit (ICU), Neonatal Intensive Care Unit (NICU), and Tuberculosis and Respiratory Disease centre (TBRD) in an India hospital. Whole-genome sequencing (WGS) of extremely drug-resitant (XDR) and pan-drug resistant (PDR) strains revealed the resistance mechanisms through the Resistance Gene Identifier (RGI.v6.0.0) and Snippy.v4.6.0. Abricate.v1.0.1, PlasmidFinder.v2.1, MobileElementFinder.v1.0.3 etc. detected virulence factors, and mobile genetic elements associated to uncover the pathogenecity and the role of horizontal gene transfer (HGT). Results This study reveals compelling insights into colistin resistance among global high-risk clinical isolates: Klebsiella pneumoniae ST147 (16/20), Pseudomonas aeruginosa ST235 (3/20), and ST357 (1/20). Vitek®2 found 6 colistin-resistant strains (minimum inhibitory concentrations, MIC = 4 μg/mL), while broth microdilution identified 48 (MIC = 32–128 μg/mL), adhering to CLSI guidelines. Despite the absence of mobile colistin resistance (mcr) genes, mechanisms underlying colistin resistance included mgrB deletion, phosphoethanolamine transferases arnT, eptB, ompA, and mutations in pmrB (T246A, R256G) and eptA (V50L, A135P, I138V, C27F) in K. pneumoniae. P. aeruginosa harbored phosphoethanolamine transferases basS/pmrb, basR, arnA, cprR, cprS, alongside pmrB (G362S), and parS (H398R) mutations. Both strains carried diverse clinically relevant antimicrobial resistance genes (ARGs), including plasmid-mediated blaNDM-5 (K. pneumoniae ST147) and chromosomally mediated blaNDM-1 (P. aeruginosa ST357). Conclusion The global surge in MDR, XDR and PDR bacteria necessitates last-resort antibiotics such as colistin. However, escalating resistance, particularly to colistin, presents a critical challenge. Inefficient colistin resistance detection methods, including Vitek2, alongside limited surveillance resources, accentuate the need for improved strategies. Whole-genome sequencing revealed alarming colistin resistance among K. pneumoniae and P. aeruginosa in an Indian hospital. The identification of XDR and PDR strains underscores urgency for enhanced surveillance and infection control. SNP analysis elucidated resistance mechanisms, highlighting the complexity of combatting resistance.

Qualifiée de pandémie silencieuse, l'antibiorésistance constitue un défi majeur pour la santé publique, en ville comme à l'hôpital. Les infections nosocomiales à bactéries sensibles ou résistantes aux antibiotiques constituent, quant à elles, une menace pour la qualité et la sécurité des soins.La surveillance de la résistance aux antibiotiques et des infections nosocomiales est primordiale. Une connaissance approfondie de ces deux fléaux est en effet indispensable à la formulation de stratégies préventives efficaces. Leur surveillance, au sens épidémiologique, permet de participer à l'information, et également de comparer les établissements, en y intégrant des données macroscopiques comme la consommation des antibiotiques, ou des solutés hydroalcooliques, ainsi que les informations individuelles des patients.Ce travail de thèse a été mené pendant la pandémie COVID-19 au sein de l'Assistance Publique - Hôpitaux de Paris (APHP), plus grand centre hospitalier universitaire d'Europe. En entrainant une augmentation massive des activités de réanimation et de consommation d'antibiotiques, elle nous a conduit à une réorientation de nos objectifs vers l'évaluation des effets collatéraux de la pandémie sur les infections bactériennes nosocomiales et l'antibiorésistance au sein de nos hôpitaux. Nous sous sommes concentrés sur les bactériémies en exploitant les données des hémocultures, disponibles dans les laboratoires de bactériologie de l'AP-HP.Nous avons montré que cette période s'est accompagnée, non seulement d'une augmentation de l'incidence des bactériémies, mais aussi de la résistance aux antibiotiques chez les entérobactéries. En revanche, nous avons observé une diminution des infections invasives à streptocoque A et pneumocoque, espèces bactériennes dont la transmission est maitrisée par le port d'un masque. Une revue d'une épidémie à bactéries hautement résistantes émergentes (BHRe) au sein d'un service de réanimation fortement impacté par la pandémie complète ces études.Dans un deuxième temps, nous avons exposé l'hétérogénéité des taux d'infections nosocomiales et d'antibiorésistance au sein de l'AP-HP. Cette hétérogénéité n'est pas simplement due à une différence de consommation en antibiotiques. En travaillant sur de nouveaux indicateurs de résistance ou d'infections, nous avons identifié des facteurs structuraux et organisationnels expliquant une plus grande fréquence de ces phénomènes.Il est probable que des facteurs individuels, à l'échelle des malades, comme la gravité de la maladie (case-mix) soient également liés à un plus grand risque. Cela fera l'objet de nos travaux futurs dans lesquels sera utilisé l'entrepôt de données de santé (EDS) de l'AP-HP.La systématisation dans le temps de ce système de surveillance permettra d'identifier les axes prioritaires, ainsi que le pilotage des politiques de prévention et des actions ciblées mises en place
Considered as a silent pandemic, antimicrobial resistance (AMR) is a major public health issue, that, combined with hospital-acquired infections (HAIs) threaten the quality and safety of hospital care. Monitoring antibiotic resistance and nosocomial infections is one of the cornerstones of preventing these phenomena. Surveillance programs are key in bringing a comprehensive knowledge of the current situation, essential for an effective implementation of prevention strategies. Surveillance of these phenomena can also be used for comparisons between facilities if we take care to take into account other factors of importance such as antibiotic and alcohol-based hand rub consumptions, and individual patient data.This thesis was conducted at the Assistance Publique - Hôpitaux de Paris (AP-HP), Europe's largest university hospital centre, during the COVID-19 pandemic. The significant rise in intensive care activities and antibiotic consumption has prompted us to redirect our objectives to assess the COVID-19 impacts on HAIs and AMR in our hospitals. Our study focused on bloodstream infections, by using data on blood cultures, collected from AP-HP bacteriology laboratories.We have demonstrated that this period was accompanied not only by an increase in the incidence of bacteraemia, but also in AMR among Enterobacteriales.Of interest, we have observed a decrease in invasive infections induced by Streptococcus pneumoniae and Streptococcus pyogenes, bacterial types which transmission can be controlled by wearing a mask.A review of a carbapenemase-producing Enterobacteriaceae (CPE) outbreak in an intensive care unit heavily impacted by the pandemic completes these studies.Additionally, we explore the irregularity of HAI and AMR rates within the AP-HP. This inconsistency cannot solely be attributed to variations in antibiotic consumption. Through the development of new indicators for resistance and infections, we have identified structural and organisational factors that are linked to a higher frequency of these phenomena.Individual patient factors, such as the severity of illness (case-mix), are likely to be associated with an increased risk of resistance. We will investigate this further in our future research using the AP-HP Clinical Data Warehouse.The systematisation of this surveillance over time will make it possible to identify priority areas and steer prevention policies and targeted actions