Bacterial Exofactors Modulate Biofilm Growth and Resistivity to Antimicrobial Drugs

Some bacteria have the ability to co-exist, proliferate and survive in a multicellular community, biofilm. Each participating bacteria can form its colonies and encases itself by a self-produced insoluble extracellular matrix substance (EPS). Microcolonies within biofilm are held together by interactions and bonding of the substances present in the EPS with their separation from the water channels. Similar to insoluble EPS, bacterial microcolonies release soluble exofactors that have direct impacts on the survivability, growth and antibacterial resistivity of other microcolonies made of single- or multi-species bacteria in the same biofilm. How the exofactors of microcolonies of one-type bacteria impact on microcolonies of other-type bacteria is still unclear. We studied about the role of exofactors released from Escherichia coli, Staphylococcus aureus and Pseudomonas aeruginosa, which are common biofilm-forming pathogenic bacteria. Exofactors facilitate to transform the microenvironment where bacteria can acquire alternative lifestyle with a long survival period and resistivity to certain antimicrobial drugs.

Profile of Multidrug Resistant Bacteria in Bukavu Hospitals and Antimicrobial Susceptibility to Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis and Staphylococcus aureus

Objective: To evaluate the spread of Multidrug-Resistant (MDR) bacterial infections in Bukavu hospitals and test antimicrobial susceptibility patterns of some isolates to usual marketed antibiotics. Methods: The prevalence of MDR strains was determined by using general antimicrobial susceptibility data collected from 3 hospital laboratories. The susceptibility of some isolates to usual antibiotics was processed by agar diffusion method with standard E. coli ATCC8739 and standard antibiotics discs as controls. The tested antibiotics were ampicillin, ceftriaxone, gentamicin, chloramphenicol and ciprofloxacin. Results: At the 3 hospitals, 758 tests were realized in urine, pus, stool, FCV, blood, LCR, split and FU specimens;46 strains were unidentified and 712 strains were identified. Of 712 identified strains, 223 (31.4%) were MDR or XDR strains including Escherichia coli, Klebsiella pneumoniae, Enterobacter, Proteus mirabilis, Salmonella enterica, Pseudomonas aeruginosa, Citrobacter freundii, Morganella morganii, Enterococcus faecalis and E. faecium, Neisseria gonorrohoae, Staphylococcus aureus, coagulase-negative, staphylococci, Streptococcus pneumoniae and Streptococcus pyogenes. Of the infected patients, 36 (21.5%) children were under 16 years and 188 (78.5%) adults were predominately women (58.5%). The susceptibility test showed that all strains but S. aureus were resistant to ampicillin and amoxicillin and ciprofloxacin. Gentamicin, ceftriaxone, and chloramphenicol remain partially active (27% - 80%) against P. mirabilis, E. coli and P. aeruginosa. The resistance is more likely related to strain mutation than to pharmaceutical quality of the antibiotics prescribed. Conclusion: Both data from hospital laboratories and in vitro post-testing findings confirmed the ongoing elevated prevalence of MDR strains in Bukavu. The causes of antibiotic misuse and socio-economic determinants of the phenomenon of resistance should be scrutinized in order to take adequate strategies in the prospective of establishing an effective control system against this threat to overall health. The results of this work on MDR profiles have various implications for the management of infectious diseases. It provides indicators for the surveillance of antimicrobial resistance, practical guidelines for antibiotic susceptibility testing in biomedical laboratories, and guidance for antibiotic therapy.

A comparative study on antimicrobial susceptibility of uroculturome of humans in health and urinary tract infections

Background:The uroculturome indicates the profile of culturable microbes inhabiting the urinary tract,and it is often required to do a urine culture to find an effective antimicrobial to treat urinary tract infections(UTIs).Methods:This study targeted to understand the profile of culturable pathogens in the urine of apparently healthy(128)and humans with clinical UTIs(161)and their antimicrobial susceptibility.All the urine samples were analyzed to quantify microbial load and determine the diversity and antimicrobial susceptibility of microbes following standard microbiological methods.Results:In urine samples from UTI cases,microbial counts were 1.2×10^(4)±6.02×10^(3) colony-forming units(cfu)/mL,while in urine samples from apparently healthy humans,the average count was 3.33±1.34×10^(3) cfu/mL.In eight samples(six from UTI cases and two from apparently healthy people,Candida(C.albicans 3,C.catenulata 1,C.krusei 1,C.tropicalis 1,C.parapsiplosis 1,C.gulliermondii 1)and Rhizopus species(1)were detected.Candida krusei was detected only in a single urine sample from a healthy person and C.albicans was detected both in urine of healthy and clinical UTI cases.Gram-positive(G+ve)bacteria were more commonly(Odds ratio,1.98;CI99,1.01-3.87)detected in urine samples of apparently healthy humans,and Gram-negative(G−ve)bacteria(Odds ratio,2.74;CI99,1.44-5.23)in urines of UTI cases.From urine samples of 161 UTI cases,a total of 90 different types of microbes were detected and,73 samples had only a single type of bacteria.In contrast,49,29,3,4,1,and 2 samples had 2,3,4,5,6 and 7 types of bacteria,respectively.The most common bacteria detected in urine of UTI cases was Escherichia coli(52 samples),in 20 cases as the single type of bacteria,other 34 types of bacteria were detected in pure form in 53 cases.From 128 urine samples of apparently healthy people,88 types of microbes were detected either singly or in association with others,from 64 urine samples only a single type of bacteria was detected while 34,13,3,11,2 and 1 sample yielded 2,3,4,5,6 and seven types of microbes,respectively.In the urine of apparently healthy humans too,E.coli was the most common bacteria,(10 samples)followed by Staphylococcus haemolyticus(9),S.intermedius(5),and S.aureus(5),and similar types of bacteria also dominated in cases of mixed occurrence,E.coli was detected in 26,S.aureus in 22 and S.haemolyticus in 19 urine samples,respectively.G+ve bacteria isolated from urine samples’irrespective of health status were more often(P<0.01)resistant than G−ve bacteria to ajowan oil,holy basil oil,cinnamaldehyde,and cinnamon oil,but more susceptible to sandalwood oil(P<0.01).However,for antibiotics,G+ve were more often susceptible than G−ve bacteria to cephalosporins,doxycycline,and nitrofurantoin.Conclusion:The study concludes that to understand the role of good and bad bacteria in the urinary tract microbiome more targeted studies are needed to discern the isolates at the pathotype level.Further,the study suggests the use of antibiotics by observing good antibiotic stewardship following antibiotic susceptibility testing only.

In-vitro antimicrobial activity of marine actinobacteria against multidrug resistance Staphylococcus aureus

Objective:To investigate the antibacterial aclivily of marine actinobacteria against multidrug resistance Staphylococcus aureus(MDRSA).Methods:Fifty one actinobacterial strains were isolated from salt pans soil,costal area in Kothapattanam,Ongole,Andhra Pradesh.Primary screening was done using cross-streak method against MDRSA.The bioaclive compounds are extracted from efficient actinobacteria using solvent extraction.The antimicrobial activity of crude and solvent extracts was perfomied using Kirby-Bauer method.MIC for ethyl acetate extract was determined by modified agar well diffusion method.The potent actinobacteria are identified using Nonomura key,Shirling and Gottlieb 1966 with Bergey's manual of determinative bacteriology.Results:Among the fifty one isolates screened for antibacterial activity,SRB25were found efficient against MDRSA.The ethyl acetate extracts showed high inhibition against test organism.MIC test was performed with the ethyl acetate extract against MDRSA and found to be 1 000μg/mL.The isolaled actinobacteria are identified as Streptomyces sp with the help of Nonomura key.Conclusions:The current investigation reveals that the marine actinobacteria from salt pan environment can be able to produce new drug molecules against drug resistant microorganisms.

Impact of Antimicrobial Stewardship Programs on Antibiotic Use and Drug Resistance:Analysis of Data from Maternal and Child Health Care Hospitals in Hubei Province,China

ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).

5-Fluorouracil Loaded Chitosan–PVA/Na^+MMT Nanocomposite Films for Drug Release and Antimicrobial Activity

In the present study, chitosan and polyvinyl alcohol(PVA) were blended with different concentrations of sodium montmorillonite(Na^+MMT) clay solution by a solvent casting method. X-ray diffraction and transition electron microscope results show that the film properties are related to the co-existence of Na^+MMT intercalation/exfoliation in the blend and the interaction between chitosan–PVA and Na^+MMT. 5-Fluorouracil(5-FU) was loaded with chitosan–PVA/Na^+MMT nanocomposite films for in vitro drug delivery study. The antimicrobial activity of the chitosan–PVA/Na^+MMT films showed significant effect against Salmonella(Gram-negative) and Staphylococcus aureus(Gram-positive), whereas5-FU encapsulated chitosan–PVA/Na^+MMT bio-nanocomposite films did not show any inhibition against bacteria. Our results indicate that combination of a flexible and soft polymeric material with high drug loading ability of a hard inorganic porous material can produce improved control over degradation and drug release. It will be an economically viable method for preparation of advanced drug delivery vehicles and biodegradable implants or scaffolds.

Knowledge, Attitudes, and Practices of Antimicrobial Use and Resistance among Village Animal Health Workers and Veterinary Drug Retailers in Cambodia

Misuse, overuse, and missed prescription of antimicrobials are the driving factors to antimicrobial resistance (AMR) leading to a globally increasing public health concern. This study was conducted to assess the current knowledge, attitudes, and practices (KAP) of village animal health workers (VAHWs) and veterinary drug retailers (VDRs) on antimicrobial use (AMU) and antimicrobial resistance (AMR). The sample size was calculated following [1]. KAP data were scored and categorized following Bloom’s cut-off score. A total of 108 study populations (66 VAHWs and 42 VDRs) were purposively surveyed using a validated KAP questionnaire in 5 provinces across Cambodia. This study found that VAHWs and VDRs have moderate levels of knowledge (61% to 65%) and good attitudes towards AMU (83% to 84%) but employed moderate practices (59% to 74%) on AMU. VAHWs had moderate (66%);while DVRs had poor knowledge (58%) on AMR. Thus, regular awareness education specifically on proper use, prudent use, and stewardships on AMU and AMR in the form of refresher training or awareness events must be provided to VAHWs and VDRs to avoid inappropriate use of antimicrobials and spreading the AMR knowledge across Cambodia.

Fractional-Order Model for Multi-Drug Antimicrobial Resistance

Drug resistance is one of the most serious phenomena in financial,economic and medical terms.The present paper proposes and investigates a simple mathematical fractional-order model for the phenomenon of multi-drug antimicrobial resistance.The model describes the dynamics of the susceptible and three kinds of infected populations.The first class of the infected society responds to the first antimicrobial drug but resists to the second one.The second infected individuals react to the second antimicrobial drug but resist to the first one.The third class shows resistance to both of the two drugs.We formulate the model and associate it with some of its properties.The stability conditions of the multi-drug antimicrobial resistance equilibrium states are derived.We illustrate the analytical results by some numerical simulations.

Molecular characterization of antimicrobial multi-drug resistance in non-typhoidal Salmonellae from chicken and clam in Mangalore, India

Salmonella enterica has been documented as one of the leading causes of salmonellosis throughout the world and is most commonly associated with the consumption of contaminated food products. Thus, this research was aimed at studying the antimicrobial susceptibility pattern and detection of quinolone resistance in Salmonella spp isolated from food of animal origin. Thirty-six Salmonella isolates comprising 8 from poultry and 28 from seafood（clams） were identified, serotyped and characterized for their antimicrobial susceptibility against 10 different antibiotics. Plasmid DNA was isolated from all the isolates by alkaline lysis, quinolone resistant non-typhoidal S. Weltevreden were examined for mutation in the DNA gyrase coding gene. Among the 36 Salmonella isolates, 20 were S. weltevreden（8 from poultry and 12 from seafood） and 16 were S. Typhimurium（from seafood）. All the isolates showed multiple resistance to nalidixic acid, tetracycline, co-trimoxazole and nitrofurantoin, but, interestingly, the isolates were 100% susceptible to ampicillin, chloramphenicol and gentamicin. Resistant isolates from the study carried the genes responsible for resistance to respective antibiotics. The strain S130 isolated in the study showed single point mutation,Asp87Gly, at position 87 in quinolone resistance determining region. It revealed mutation in quinolone resistance determining region as a cause for quinolone resistance in non-typhoidal Salmonellae. The occurrence of genes accountable for plasmid mediated resistance to quinolones（viz., qnrA, qnrB and qnrS） in plasmid of non-typhoidal Salmonellae isolates provides evidence for plasmid mediated quinolone resistance.

Synthesis, Spectroscopic and Antimicrobial Investigations of Scandium(Ⅲ) Complexes with Four Kinds of Sulfa Drugs

Herein,this article was focused on the synthesis and discussed the spectroscopic characterizations of four new scandium(Ⅲ)sulfa-drug complexes.The nomenclature and symbols of these drugs were sulfadimidine(sulp-1),sulfanilamide(sulp-2),sulfamethoxazole(sulp-3)and sulfadiazine(sulp-4).The microanalytical and spectroscopic analyses which utilized in this study were micro-analyses,magnetic,FT-IR,UV-Vis techniques.The mid infrared spectra deduced that the four sulfa-drug chelates acts as a bidentate chelates with scandium(Ⅲ)ion via two nitrogen atoms of-NH2-Ar and-NH-SO2 groups.Also,the FTIR spectra of Sc3+complexes referred to the existed of new medium weak bands in the range of 500~400 cm^-1 due to stretching vibration bands ofν(M-N).The elemental analysis technique confirmed the 1∶2 stoichiometry between Sc3+ions and sulp ligand with molecular formula[Sc(sulp)2(Cl)2]·Cl.At room temperature,the results of magnetic measurements for the Sc(Ⅲ)complexes indicated that all of the synthesized complexes have a diamagnetic character with octahedral configuration.The electronic spectra of the free sulfa-drug ligands shows band at 275 and 310 nm which are intraligand charge transfer band.The electronic sbsorption spectra of the Sc3+complexes were recorded using DMSO solvent.The spectra of complexes display bands within 275~388 nm,which attributed toπ-π*,n-π*and charge-transfer M-LCT electronic transitions,which strongly favors the octahedral geometry around Sc(Ⅲ)metal ions.1HNMR spectra of complexes referred to the downfield proton shifts of the-NH2 and NHSO2 groups,which supported the place of coordination.The half maximal inhibitory concentration(IC50)of the ScⅢcomplexes was assessed against the human hepato cellular carcinoma(HepG-2)tumor cell line.

Distribution of pathogenic bacteria and antimicrobial sensitivity of eye infections in Suzhou

AIM:To investigate the types of bacteria in patients with eye infections in Suzhou and their drug resistance to commonly used antibacterial drugs.METHODS:The clinical data of 155 patients were retrospectively collected in this study,and the pathogenic bacteria species and drug resistance of each pathogenic bacteria were analyzed.RESULTS:Among the 155 patients(age from 12 to 87 years old,with an average age of 57,99 males and 56 females)with eye infections(160 eyes:74 in the left eye,76 in the right eye and 5 in both eyes,all of which were exogenous),71(45.81%)strains were gram-positive bacteria,23(14.84%)strains were gram-negative bacteria and 61(39.35%)strains were fungi.Gram-positive bacteria were highly resistant to penicillin and erythromycin(78.87%and 46.48%respectively),but least resistant to vancomycin at 0.Gram-negative bacteria were highly resistant to cefoxitin and compound sulfamethoxazole(100%and 95.65%respectively),but least resistant to meropenem at 0.Comparison of the resistance of gram-positive and gram-negative bacteria to some drugs revealed statistically significant differences(P<0.05)in the resistance of both to cefoxitin,cotrimoxazole,levofloxacin,cefuroxime,ceftriaxone and ceftazidime,and both had higher rates of resistance to gram-negative bacteria than to gram-positive bacteria.The distribution of bacterial infection strains showed that Staphylococcus epidermidis was the most common strain in the conjunctiva,cornea,aqueous humor or vitreous body and other eye parts.Besides,Fusarium and Pseudomonas aeruginosa were also among the most common strains of conjunctival and corneal infections.CONCLUSION:Gram-positive bacteria are the dominant bacteria in eye infections,followed by gram-negative bacteria and fungi.Considering the resistance of gramnegative bacteria to multiple drugs,monitoring of bacteria should be strengthened in eye bacterial infections for effective prevention and control to reduce complications caused by eye infections.

Core and variable antimicrobial resistance genes in the gut microbiomes of Chinese and European pigs

Monitoring the prevalence of antimicrobial resistance genes(ARGs)is vital for addressing the global crisis of antibiotic-resistant bacterial infections.Despite its importance,the characterization of ARGs and microbiome structures,as well as the identification of indicators for routine ARG monitoring in pig farms,are still lacking,particularly concerning variations in antimicrobial exposure in different countries or regions.Here,metagenomics and random forest machine learning were used to elucidate the ARG profiles,microbiome structures,and ARG contamination indicators in pig manure under different antimicrobial pressures between China and Europe.Results showed that Chinese pigs exposed to high-level antimicrobials exhibited higher total and plasmid-mediated ARG abundances compared to those in European pigs(P<0.05).ANT(6)-Ib,APH(3')-IIIa,and tet(40)were identified as shared core ARGs between the two pig populations.Furthermore,the core ARGs identified in pig populations were correlated with those found in human populations within the same geographical regions.Lactobacillus and Prevotella were identified as the dominant genera in the core microbiomes of Chinese and European pigs,respectively.Forty ARG markers and 43 biomarkers were able to differentiate between the Chinese and European pig manure samples with accuracies of 100%and 98.7%,respectively.Indicators for assessing ARG contamination in Chinese and European pigs also achieved high accuracy(r=0.72-0.88).Escherichia flexneri in both Chinese and European pig populations carried between 21 and 37 ARGs.The results of this study emphasize the importance of global collaboration in reducing antimicrobial resistance risk and provide validated indicators for evaluating the risk of ARG contamination in pig farms.

Analysis of Multi-Drug Resistant Organism Surveillance and Antimicrobial Resistance Early Warning in a Hospital in 2022

Objective:To determine the clinical distribution of multi-drug resistant organism(MDRO)in Jiangyan Hospital and the monitoring and warning of drug-resistance bacteria to provide an important basis for guiding the application of broad-spectrum antibiotics in clinical treatment and reducing the occurrence of nosocomial infection.Methods:Retrospective screening and analysis were conducted on the pathogenic strains of hospitalized patients in our hospital in 2022.Results:A total of 2,769 strains of pathogenic bacteria and 390 strains of MDRO were detected and isolated in our hospital in 2022;the detection rate of MDRO was 14.08%.A total of 516 strains(18.64%)Klebsiella pneumoniae(KP)and 62 strains(12.02%)of carbapenem-resistant Klebsiella pneumoniae(CR-KP)were detected;436 strains(15.75%)of Escherichia coli(ECO)were detected,including 8 strains(1.83%)of CR-ECO;342 strains(12.35%)of Pseudomonas aeruginosa(PA)and 116 strains(33.92%)of CR-PA were detected;there were 194 strains(7.01%)of Acinetobacter baumannii(AB),among which 125 strains(64.43%)were CR-AB;there were 291 strains(10.51%)of Staphylococcus aureus,among which 79 strains(27.15%)of methicillin-resistant Staphylococcus aureus(MRSA)were detected;78 strains(2.82%)of Enterococcus faecalis were detected,and vancomycin-resistant enterococcus(VRE)was not detected.The first five MDROs were CR-AB,CR-PA,MRSA,CR-KP,and CR-ECO.The top five departments with the highest MDRO detection rate in 2022 were the ICU(37.44%),the Pulmonology Department(ward 13;31.03%),the Department of Rehabilitation(ward 5;6.67%),the Department of Neurosurgery(ward 11;4.62%),and the Department of General Surgery(ward 10;3.59 The resistance rate of antibacterial drugs is divided into four levels for early warning:30%to 40%,41%to 50%,51%to 75%,and 75%or more.Conclusion:Our hospital should strengthen the monitoring of antimicrobial resistance warning related to MDRO and the abuse of antimicrobial drugs.Based on the results of drug sensitivity and antimicrobial resistance warning,the use of antibiotics should be standardized in clinical practice to reduce nosocomial infection。

Expression of Exogenous Antimicrobial Peptide and Resistance to Stem Rot Disease of Houttuynia cordata Thunb.

[Objective] This study was to identify the expression of exogenous antimicrobial peptide in transgenic Houttuynia cordata Thunb. plants,and analyze their resistance to stem rot disease. [Methods] SDS-PAGE and Western blot analysis were employed to detect expression of exogenous antimicrobial peptide in transgenic H. cordata plants. Both wild type and transgenic H. cordata plants were inoculated with different concentrations of Rhizoctonia solani spores for detecting their resistance. [Results] The exogenous antimicrobial peptide was detected at translation level. The optimal parameters for detecting the resistance of transgenic H. cordata plants to R. solani was inoculation of spores at a concentration of 3×105 ind./ml and cultured for three days. The results showed that resistance of transgenic H. cordata plants to R. solani was enhanced in comparison with CKs. [Conclusion] Expression of exogenous antimicrobial peptide can enhance the resistance of transgenic H. cordata plants to stem rot disease.

Seafood as a Reservoir of Gram-negative Bacteria Carrying Integrons and Antimicrobial Resistance Genes in Japan

PCR and DNA sequencing were used to screen and characterize integrons and resistance genes in Gram-negative bacteria isolated from seafood products in Japan.A total of 215 Gram-negative bacteria were isolated from local and imported seafood samples collected from retail markets in Hiroshima Prefecture.Class 1 integrons containing gene cassettes encoding resistance to trimethoprim

Response to Comment on "The role of wildlife (wild birds) in the global transmission of antimicrobial resistance genes"

DEAR EDITOR,Since our first identification of plasmid-mediated colistin resistance gene mcr-1 in 2015 （Liu et al., 2016）, it has been described in human clinics, domestic animals, foods, and the environment worldwide （Schwarz ＆ Johnson, 2016）. Although it is still rare, the emergence of mcr-I in wild animals is of great concern. We summarized two previous reports on mcr-1 in wild birds from Lithuania and Argentina to describe its emergence and characteristics in wildlife and highlight the potentially important role of wild animals, particularly birds, in its global transmission （Wang et al., 2017）. The first detection of mcr-1 in wildlife in Asia was identified in an extended-spectrum β- lactamase-producing Escherichia coil strain isolated from Eurasian coot （Fulica atra）,

Comment on ＂The role of wildlife (wild birds)in the global transmission of antimicrobial resistance genes＂

DEAR EDITOR, We read with interest the article by Wang and colleagues regarding the role of wildlife in the transmission of antimicrobial resistance （AMR） （Wang et al., 2017）. Although we appreciate the efforts in reviewing this important topic, we would like to comment on some statements that we believe are not up-to- date or properly cited.

Urinary Tract Infection among Adults Seeking Medicare at Kiambu Level 5 Hospital, Kenya: Prevalence, Diversity, Antimicrobial Susceptibility Profiles and Possible Risk Factors

Urinary tract infections are among the most prevalent extra-intestinal infections, with high prevalence globally. This cross-sectional study established prevalence of bacterial aetiology causing urinary tract infection (UTI) and their antimicrobial susceptibility profiles. A questionnaire was used to capture socio-demographic data and possible UTI risk factors among the 206 consented adults seeking medicare at Kiambu Level 5 Hospital. The collected midstream urine samples were subjected to dipstick analysis, microscopy and culture for UTI diagnosis. Results: The overall prevalence rate of UTIs was 27.6%, with women’s prevalence rate being significantly higher at 80.7% compared to men 19.2%. Pregnant women had UTI prevalence at 34% which was higher than other sets of participants. Women who did not frequently change their underpants daily had a higher UTI cases at 34.8%. Escherichia coli, Staphylococcus aureus and Klebsiella pneumoniae were the most prevalent bacterial pathogens at 38.5%, 21% and 19.3%, respectively. Antimicrobial sensitivity analysis revealed high resistances towards Sulfamethoxazole and Ampicillin at range between 50% - 85%, suggesting that these drugs are no longer effective for UTI empirical treatment. The resistance patterns towards Cefotaxime, Cefepime and Ciprofloxacin were below 40%. However, more resistance patterns at a range between 14% - 40% revealed towards Amoxicillin-clavulanic and Nitrofurantoin imply that these are drugs remain potent but there is the need to revise the current UTI management guidelines. In addition, to elude treatment failure, innovation of prophylactic measures is key to halt UTI contraction and offer support to pharmaceutical industries that have fewer new antibiotics in the pipeline.

Evaluation of rational use of antimicrobial agents in a Brazilian intensive care unit

The present study sought to assess the rational use of antimicrobial agents in a Brazilian intensive care unit (ICU) and its association with antimicrobial resistance in elderly patients admitted to the unit. Results: Choice of empiric and sensitivity-guided therapy was inadequate in > 80% and 59% of cases respectively. Inadequate antimicrobial therapy, whether empiric or sensitivity-guided, was positively correlated with bacterial resistance (r = 0.316;p = 0.001). Sensitivity testing revealed a 46.5% resistance rate to eight out of the ten most commonly used antibiotics. Multiple drug-resistant organisms were found in 40.8% of patients. A significant increase was observed in the number of multidrug-resistant samples between 2006/2007 and 2008 (r = 0.41, p = 0.006), (r = 0.598, p = 0.001), (r = 0.688, p = 0.00). Conclusion: We found a high rate of antibiotic misuse in the study sample. Inadequate therapy was correlated with resistance to antimicrobial agents.

Development of Helicobacter pylori treatment: How do we manage antimicrobial resistance?

Helicobacter pylori(H. pylori) antimicrobial resistance is an urgent, global issue. In2017, the World Health Organization designated clarithromycin-resistant H.pylori as a high priority bacterium for antibiotic research and development. In addition to clarithromycin, resistance to metronidazole and fluoroquinolones has also increased worldwide. Recent international guidelines for management of H.pylori infection recommend bismuth or non-bismuth quadruple therapy for 14 d as a first-line treatment for H. pylori in areas of high clarithromycin and/or metronidazole resistance. Although these treatment regimens provide acceptable H. pylori eradication rates, the regimens used should not contribute to future resistance of H. pylori to antimicrobials. Moreover, these regimens can promote resistance, due to prolonged therapy with multiple antibiotics. A new strategy that can eradicate H. pylori as well as reduce the antibiotics used is required to prevent future antimicrobial resistance in H. pylori. Dual-therapy with vonoprazan and amoxicillin could be a breakthrough for H. pylori eradication in an era of growing antimicrobial resistance. This regimen may provide a satisfactory eradication rate of H. pylori and also minimize antimicrobial resistance due to single antibiotic use and the strong inhibitory effect of vonoprazan on gastric acid secretion.