Nature’s Pharmacy under Siege: Investigating Antibiotic Resistance Pattern in Endophytic Bacteria of Medicinal Plants

Antibiotic resistance poses a significant global health threat, necessitating a thorough understanding of its prevalence in various ecological contexts. Medicinal plants, renowned for their therapeutic properties, host endophytic bacteria that produce bioactive compounds. Understanding antibiotic resistance dynamics in these bacteria is vital for human health and antibiotic efficacy preservation. In this study, we investigated antibiotic resistance profiles in endophytic bacteria from five medicinal plants: Thankuni, Neem, Aparajita, Joba, and Snake plant. We isolated and characterized 113 endophytic bacteria, with varying resistance patterns observed against multiple antibiotics. Notably, 53 strains were multidrug-resistant (MDR), with 14 exhibiting extensive drug resistance (XDR). Thankuni-associated bacteria displayed 44% MDR and 11% XDR, while Neem-associated bacteria showed higher resistance (60% MDR, 13% XDR). Aparajita-associated bacteria had lower resistance (22% MDR, 6% XDR), whereas Joba-associated bacteria exhibited substantial resistance (54% MDR, 14% XDR). Snake plant-associated bacteria showed 7% MDR and 4% XDR. Genus-specific distribution revealed Bacillus (47%), Staphylococcus (21%), and Klebsiella (11%) as major contributors to MDR. Our findings highlight diverse drug resistance patterns among plant-associated bacteria and underscore the complexity of antibiotic resistance dynamics in diverse plant environments. Identification of XDR strains emphasizes the severity of the antibiotic resistance problem, warranting further investigation into contributing factors.

Effective Antibiotic Stewardship Program: Controlling Antibiotic Resistance and Optimizing Drug Use in Ahmadi Hospital

An Antimicrobial Stewardship Program (ASP) is established to promote cost effective and safe use of antimicrobial agents. Basically, this approach directs the management of antimicrobials in terms of selection of appropriate drugs, determination of administration routes and standardization of both medication dosage and treatment duration. The program involves, but is not limited to, Hospital Staff Education, Pharmacodynamics Dose Optimization, Computer-Assisted Decision Support Programs, Pharmacist-Driven Intravenous to Oral Switch Programs, Pharmacy Dosing Programs and Antibiotic Cycling. A study was conducted to determine effectiveness of the ASP in significantly improving patient outcomes (e.g. decrease morbidity and mortality from infection). This was undertaken by collecting restrospective data on patient length of hospital stay, bed turnover rate and antibiotic consumption over a period of 2 years since the ASP was initiated. Periodic data were then compared and interpreted based on its clinical, quality and financial implications in order to measure effectiveness of the program implementation.

Clinical Isolates of Staphylococcus aureus Show Variation in β-Lactamase Production and Are More Susceptible to Antibiotics Conjugated with β-Lactamase Inhibitors

β-Lactam antibiotics are a cornerstone in the treatment of bacterial infections on account of its high therapeutic index and selective toxicity—they act by inhibiting the biosynthesis of peptidoglycan, a key component in bacterial cell wall. Ninety (90) clinical specimens obtained from the microbiology unit Specialist Hospital Bauchi were screened for S. aureus, positive isolates were examined for β-Lactamase expression by using two Penicillin G concentrations (5000 IU/ml and 25,000 IU/ml) in acidometric agar technique with phenol red as indicator, and the susceptibility pattern of the isolates to β-Lactam antibiotics was also determined. S. aureus prevalence of 31% (28/90) was obtained, of which 96% (27/28) of strains were β-Lactamase positive in the standard test, while 63% (17/27) were able to hydrolyze penicillin G concentration of 25,000 IU/ml (5X the concentration in the standard test), and a strain was found to be β-Lactamase negative. The resistance to five β-Lactams, ampicillin, cephalexin, amoxicillin, cloxacillin and flucloxaillin, were 100%, 96%, 89%, 74% and 56% respectively. When ampicillin and amoxicillin were conjugated to β-Lactamase inhibitors sulbactam and clavulanic acid respectively the resistance to ampicillin decreased to 21% and to amoxicillin to 15%. The antibiotic susceptibility profile revealed β-Lactamase elaboration to be the major mechanism of resistance to the β-Lactams. β-Lactam utilization as therapeutic option would thus require the search for sensitive irreversible β-Lactamase inhibitors for the β-Lactamase enzymes or agents to block the release of β-Lactamase by strains.

Drug resistance of infectious pathogens after liver transplantation

BACKGROUND: Infection in liver recipients is related to high risk of transplantation failure and mortality. Infectious agents isolated from 55 liver recipients from January 2003 through June 2005 were studied to improve the anti-infectious therapy. METHODS: Pathogens were isolated from routine culture. K-B method was used to examine the drug susceptibility. Extended spectrum β-lactamase, AmpC β-lactamase and Van gene in E. coli were examined by the agar-dilution susceptibility test and Nitrocefin test. RESULTS: Thirty-nine of the 55 recipients got infection. The 513 strains of pathogens isolated from 1861 specimens were predominantly Gram negative bacteria and over 40% of them showed resistance to more than 4 drugs. The positive rates of extended spectrum β-lactamse and AmpC β-lactamse production in E. cloacae were 32.4% and 36.8%, in E. coli were 33.8% and 10.5%, but the rates of these 2 bacteria producing both lactamses were 24.3% and 7.0%. The β-lactamse production rates of Enterococcus faecalis and En-terococcus faecium were 8.8% and 11.1%, and the resistance rates to vancomycin were 11.2% and 18.5%, respectively. CONCLUSIONS: Infectious pathogens isolated from liver recipients are potent and multiple drug resistant. ESBLs and AmpC β-lactamases are the major factors associated with Gram negative drug resistance. The infection of En-terococcal species presents as a particular challenge.

Studies of β-lactamase production in ampicillin resistant Haemophilus influenzae

Objective:To study the molecular mechanisms of β-lactamase production in ampicillin resistant(AmP ) Hae- mophilus influenzae(HI). Methods: Identified the β-lactamases production strain from AmP HI was isolated from clinical cases with K-B method. β-lactamase encoding gene in enzyme production strains were detected by PCR with lactamase gene specific primers, and both plasmid and chromosomal DNA samples. Results: Thirty-two out of 36 (88 .9% ) were found to be β-lactamase production. Twenty-nine out of 32 enzyme production stain were PCR positive (the ratio of PCR positives 90.6% ). There were 25 stains amplified with plasmid DNA positively, and 4 with chromosomal DNA. Conclusion: (l ) Most of the AmPr HI strain produce lactamase is mediated by plasmid. (2) Detection of lactamase encoding gene in HI is a simple and efficient approach to study the molecular basis of ampicillin resistance.

Clinical Distribution and Drug Resistance of 224 Strains of Pseudomonas Aeruginosa

Objective:To provide evidence for a rational and effective prevention and treatment of Pseudomonas aeruginosa,the clinical characteristics and the resistance to various antibiotics of were investigated.Methods:A retrospective analysis of 224 strains of Pseudomonas aeruginosa isolated from various specimens from various clinical departments of our hospital(April 1,2018 to June 31,2019)were conducted.Identification and drug susceptibility test of isolated strains was performed using a fully automatic bacterial identification analyzer(MicroScan WalkAway-96 plus),and data analysis was performed using WH0NET5.6 software.Results:Among all the bacteria isolated in our hospital during the above period,Pseudomonas aeruginosa accounted for 10.09% of them all and 12.57% of Gram-negative bacilli,respectively.These isolates were mainly derived from sputum specimens(68.75%),mainly from male patients(70.54%),and mostly 61-70(27.23%)or 51-60(22.77%)years old.Pseudomonas aeruginosa isolates are mainly from Rehabilitation Ward,ICU,and Liver Transplantation Unit,accounted for 29.91%,12.95% and 10.27% of all isolates,respectively.The sensitivity of Pseudomonas aeruginosa to various antibacterial drugs,in the order of high to low were carbapenems,aztreonam,quinolones,cephalosporins,piperacillin/tazobactam,aminoglycoside,with a lowest resistance rate(2.4%)to amikacin and a highest resistance rate to imipenem(33.0%).Conclusion:The isolation rate of Pseudomonas aeruginosa was relatively stable during the study period,and among all the P.aeruginosa detected,most of them were from the respiratory secretions of elderly male patients.The resistance rate of Pseudomonas aeruginosa isolates to various antibiotics is mainly within 30%.Clinical units such as Rehabilitation Ward,ICU,and Liver Transplantation Unit have a high detection rate;therefore,these departments should be monitored in a focused manner.Our research provides a scientific basis for the rational use of antibiotics and a better control of Pseudomonas aeruginosa infection.

Clinical study of Cangbai Shiduqing Granul in reversing drug resistance of ureaplasma urealyticum

Ureaplasma Urealyticum(UU) can not only cause a wide range of nongonococcalinfectionsto urogenital tract,but also lead to infertility,sterility,intrauterinefetal infection,abortion or other bad consequences.For males,UU may cause prostatitis,epididymitis and other diseases.With great harm to the human health,UU infection has been taken as one of the most important STDs in China for prevention and cure.However,the drug resistance of UU is increasingly stronger with the widespread use of antibiotics.Many nongonococcal patients with mycoplasma infection often fail to be cured after a long time of treatment,and drug sensitive tests find that,multidrug resistance brings physical and mental pains to patients all the time.Luckily,integrated Chinese traditional and western medicine greatly improves the cure rate,though the mechanism is not clear.There have been many studies on the reversion action and mechanism of TCM on the antibiotic resistance of bacteria,but studies on the reversion to UU drug resistance are deficient.Here we chose some voluntary patients with multidrug resistance as the research objects,who received treatment in my hospital in recent 3 years.They were given the oral administration of self-prescribed Cangbai Shiduqing Granule.Then,Cangbai Shiduqing Granule's reversion effect on UU drug resistance,namely,the sensitivity transformation situation of drug-resistant antibiotics,was observed.And the observation results are presented in the paper.

The Five Years Surveillance and Trends of Antibiotic Resistance in Some Common Gram Negative Bacteria at the Vietnam Military Hospital

The study is to identify trends and levels of antibiotic resistance of some common Gram-negative strains over time. The samples were collected from Vietnam Military Hospital 103 between 2014 and 2019. A total of 405 Acinetobacter baumannii., 528 Pseudomonas aeruginosa, 741 Escherichia coli, and 352 Klebsiella pneumoniae strains were identified and antimicrobial susceptibility was by Vitek system and Etest method. The multi-drug resistance (MDR) was major proportion of four common bacteria. In particular, there is a tendency to shift from MDR to Extended drug resistance (XDR) or possibly Pan drug resistant (pPDR). A. baumannii had the highest level of antibiotic resistance, namely, carbapenem (61.5% - 82.5%) and cephalosporin (72.7% - 88.7%). P. aeruginosa resisted most of commonly antibiotics, ranging from 50% to 70%. E. coli had a high resistance with antibiotics like ampicillin (87.2% - 97.6%) and the 3rd generation cephalosporins (up to 79.6%). K. pneumoniae resisted carbapenem from 14.7% to 44.4%, and other antibiotics with the higher rate of 40%. The collected data will be a prerequisite for further studies on mechanisms and factors related to antibiotic resistant bacteria, in order to find out a rational and effective using strategy of antibiotics.

Analysis on clinical distribution and drug resistance of Klebsiella pneumoniae isolated for 5 consecutive years

Objective:To analyze the clinical distribution and drug resistance of Klebsiella pneumoniae isolated from patients in a certain hospital and provide a basis for the rational use of antibiotics in the clinical treatment for the infection of Klebsiella pneumoniae.Methods:1,192 strains of Klebsiella pneumoniae isolated from clinical specimens from 2012 to 2016 were collected.The strains were identified by VITEK-2 Compact Microbiological Identification System,and the corresponding results of the antimicrobial susceptibility test were interpreted in accordance with the standards recommended by Clinical and Laboratory Standards Institute(CLSI).Results:1,192 strains of Klebsiella pneumoniae were mainly isolated from sputum(65.6%),and most of them were from Respiratory Medicine Department and Medical Intensive Care Unit of Respiratory Medicine Department(MICU),accounting for 41.4%.Out of 1,192 strains,448 strains were detected to produce extended-spectrum beta-lactamases(ESBLs),accounting for 37.6%.In addition,the detection rates of ESBL-producing Klebsiella pneumoniae for 5 consecutive years showed an increasing trend year by year,and they were higher than the national average values published by China Antimicrobial Resistance Surveillance System(CARSS)in the corresponding period.The drug resistance rate of ESBL-producing Klebsiella pneumoniae was significantly higher than that of non ESBL-producing strains.Conclusions:The infection caused by Klebsiella pneumoniae mainly occurs in the lower respiratory tract,and the drug resistance rates of Klebsiella pneumoniae to antibiotics in the drug susceptibility spectrum are maintained at a high level.Therefore,the rational selection of antibiotics for the clinical treatment of lower respiratory tract infection caused by Klebsiella pneumoniae must be based on the production of ESBLs and the results of antimicrobial susceptibility test.

Combatting Antibiotic Resistance:Regulatory Exclusivities for New Antibiotic Development in the United States and Europe

Antimicrobial resistance is a global concern that has led to millions of deaths worldwide.Genetic changes occur naturally in pathogens such as viruses,bacteria,parasites,and fungi.To overcome these concerns,there is a need to develop a new generation of antimicrobials.In an effort to encourage innovation,both the United States(US)and the European Union have introduced exclusivity programs.The US offered 5 years of additional nonpatent exclusivity for Qualified Infectious Disease Products under the Generating Antibiotic Incentives Now Act.In parallel,the European Commission offers a patent extension of 12 months across Europe(EU)countries or the option to sell the vouchers to other pharmaceutical companies through transferable exclusivity extension vouchers.This review focuses on the most important innovative strategies of antibiotic development the drug approvals,their mode of action,spectra of activity,and targeting of microorganisms,in past 5 years were mentioned,and discusses how to overcome the challenges of drug approval under antibiotic exclusivity in the US and EU,which will benefit the companies to develop novel drugs in several nations.

Isolation and identification of Salmonella from curry samples and its sensitivity to commercial antibiotics and aqueous extracts of Camelia sinensis(L.) and Trachyspermum ammi(L.)

Objective:To isolate Salmonella from curry samples and to evaluate the drug sensitivity of the food-borne Salmonella and its susceptibility to specific plant extracts.Methods:Salmonella was isolated from the curry samples by standard microbiological methods and was confirmed by biochemical tests.The antibiotic susceptibility test was conducted by disc diffusion method using commercially available antibiotics such as ampicillin,tetracycline,chloramphenicol,kanamycin,and penicillin.In addition,the susceptibility of the food-borne Salmonella was also evaluated against the aqueous extracts of Camelia sinensis(L.) Theaceae(tea leaves) and the Trachyspermum ammi(L.) Apiaceae(ajwain or omum seeds).Results:Out of fifty curry samples,only seven samples were identified to have Salmonella contamination.The Salmonella isolates showed a significant drug resistance pattern except for kanamycin.The plant extracts showed a considerable antibacterial activity against the isolates,indicating the presence of antimicrobial principle which can be exploited after complete pharmacological investigations.Conclusions:The present study demonstrates the occurrence of Salmonella in the curry samples,and shows significant drug resistance against most of the commercially available antibiotics,except kanamycin.Antimicrobial effect of the plant extracts against the food-bone Salmonella suggests that dietary including medicinal herbs would be one strategy to manage food borne pathogens.

Multidrug-resistant organisms in intensive care units and logistic analysis of risk factors

BACKGROUND Intensive care unit(ICU)patients are critically ill and have low immunity.They will undergo various trauma medical procedures during diagnosis and treatment.The use of high-dose hormones and broad-spectrum antibiotics will increase the incidence of nosocomial infection in ICU patients.Therefore,it is necessary to explore the causes of nosocomial infection in ICU and provide basis for the prevention and control of nosocomial infection in ICU.AIM To explore major pathogens of nosocomial infection in ICUs,methods of detection and drug resistance trends.METHODS Risk factors of multidrug-resistant infection were analyzed to provide a basis for clinical rational use of antimicrobial drugs in the ICU.These findings were used to standardize rational use of antimicrobial agents.BD PhoenixTM100 automatic bacterial identification analyzer was used to for cell identification in specimens collected from the ICU between January 2016 and December 2019.Drug sensitivity tests were carried out and drug resistance trends were analyzed using the optical disc diffusion method.Odds ratios and corresponding 95%CI of independent variables were calculated using a logistic regression model.Backward elimination(trend=0.1)was used as an inclusion criterion for multivariate analysis.All data were analyzed using SPSS version 22.0,and P<0.05 was considered statistically significant.RESULTS We collected 2070 samples from ICU patients between January 2016 and December 2019.Sample types comprised sputum(1139 strains,55.02%),blood(521 strains,25.17%),and drainage fluid(117 strains,5.65%).A total of 1051 strains of major pathogens,including Acinetobacter baumannii,Escherichia coli(E.coli),Pseudomonas aeruginosa(P.aeruginosa),Klebsiella pneumoniae(K.pneumoniae)and Staphylococcus aureus,were detected,with a detection rate of 35.97%(378/1051).Most of these strains were resistant to antibiotics.Detection rate of E.coli was 21.79%(229/1051),and it was generally sensitive to many antimicrobial drugs.Detection rate of P.aeruginosa was 24.74%(260/1051),and showed low sensitivity to most antibiotics.Detection rate of K.pneumoniae was 9.42%(99/1051),which was generally resistant to multiple antimicrobial drugs and resistant forms.K.pneumoniae was resistant to imipenem for approximate 4 years,and showed a 19.9%(19/99)and 20.20%(20/99)rate of meropenem resistance.Logistic analysis showed that mechanical ventilation and ureteral intubation were risk factors for multidrug-resistant bacterial infections.CONCLUSION This study showed a high incidence of ICU infections.Mechanical ventilation and urine tube intubation were risk factors for infection with multidrug-resistant bacteria.

Extensively drug-resistant bacteria are an independent predictive factor of mortality in 130 patients with spontaneous bacterial peritonitis or spontaneous bacteremia

AIM: To evaluate the epidemiology and outcomes of culture-positive spontaneous bacterial peritonitis(SBP) and spontaneous bacteremia(SB) in decompensated cirrhosis.METHODS: We prospectively collected clinical, laboratory characteristics, type of administered antibiotic, susceptibility and resistance of bacteria to antibiotics in one hundred thirty cases(68.5% males) with positive ascitic fluid and/or blood cultures during the period from January 1, 2012 to May 30, 2014. All patients with SBP had polymorphonuclear cell count in ascitic fluid > 250/mm3. In patients with SB a thorough study did not reveal any other cause of bacteremia. The patients were followed-up for a 30-d periodfollowing diagnosis of the infection. The final outcome of the patients was recorded in the end of follow-up and comparison among 3 groups of patients according to the pattern of drug resistance was performed.RESULTS: Gram-positive-cocci(GPC) were found in half of the cases. The most prevalent organisms in a descending order were Escherichia coli(33), Enterococcus spp(30), Streptococcus spp(25), Klebsiella pneumonia(16), S. aureus(8), Pseudomanas aeruginosa(5), other Gram-negative-bacteria(GNB)(11) and anaerobes(2). Overall, 20.8% of isolates were multidrug-resistant(MDR) and 10% extensively drugresistant(XDR). Health-care-associated(HCA) and/or nosocomial infections were present in 100% of MDR/XDR and in 65.5% of non-DR cases. Meropenem was the empirically prescribed antibiotic in HCA/nosocomial infections showing a drug-resistance rate of 30.7% while third generation cephalosporins of 43.8%. Meropenem was ineffective on both XDR bacteria and Enterococcus faecium(E. faecium). All but one XDR were susceptible to colistin while all GPC(including E. faecium) and the 86% of GNB to tigecycline. Overall 30-d mortality was 37.7%(69.2% for XDR and 34.2% for the rest of the patients)(log rank, P = 0.015). In multivariate analysis, factors adversely affecting outcome included XDR infection(HR = 2.263, 95%CI: 1.005-5.095, P = 0.049), creatinine(HR = 1.125, 95%CI: 1.024-1.236, P = 0.015) and INR(HR =1.553, 95%CI: 1.106-2.180, P = 0.011).CONCLUSION: XDR bacteria are an independent lifethreatening factor in SBP/SB. Strategies aiming at restricting antibiotic overuse and rapid identification of the responsible bacteria could help improve survival.

Antibacterial effect of Allium sativum cloves and Zingiber officinale rhizomes against multiple-drug resistant clinical pathogens

Objective:To evaluate the antibacterial properties ot Allium sativum(garlic) cloves and Zingiber officinale(ginger) rhizomes against multi-drug resistant clinical pathogens causing nosocomial infection.Methods:The cloves of garlic and rhizomes of ginger were extracted with 95%(v/v) ethanol.The ethanolic extracts were subjected to antibacterial sensitivity test against clinical pathogens.Results:Anti-bacterial potentials of the extracts of two crude garlic cloves and ginger rhizomes were tested against five gram negative and two gram positive multi-drug resistant bacteria isolates.All the bacterial isolates were susceptible to crude extracts of both plants extracts.Except Enterobacter sp.and Klebsiella sp.,all other isolates were susceptible when subjected to ethanolic extracts of garlic and ginger.The highest inhibition zone was observed with garlic(19.4S mm) against Pseudomonas aeruginosa(P.aeruginosa).The minimal inhibitory concentration was as low as 67.00 μg/mL against P.aeruginosa.Conclusions:Natural spices of garlic and ginger possess effective anti-bacterial activity against multi-drug clinical pathogens and can be used for prevention of drug resistant microbial diseases and further evaluation is necessary.

Metallo-β-Lactamases:A Major Threat to Human Health

Antibiotic resistance is one of the most significant challenges facing global healthcare. Since the 1940s, antibiotics have been used to fight infections, initially with penicillin and subsequently with various derivatives including cephalosporins, carbapenams and monobactams. A common characteristic of these antibiotics is the four-memberedβ-lactam ring. Alarmingly, in recent years an increasing number of bacteria have become resistant to these antibiotics. A major strategy employed by these pathogens is to use Zn(II)-dependent enzymes, the metallo-β-lactamases (MBLs), which hydrolyse theβ-lactam ring. Clinically useful MBL inhibitors are not yet available. Consequently, MBLs remain a major threat to human health. In this review biochemical properties of MBLs are discussed, focusing in particular on the interactions between the enzymes and the functionally essential metal ions. The precise role(s) of these metal ions is still debated and may differ between different MBLs. However, since they are required for catalysis, their binding site may present an alternative target for inhibitor design.

In vitro antimicrobial and synergistic effect of essential oil from the red macroalgae Centroceras clavulatum (C. Agardh) Montagne with conventional antibiotics

Objective:To study the chemical profile,antimicrobial properties,and synergistic effect with known antibiotics of essential oil extracted from the marine red macroalgae Centroceras clavulatum(C.Agardh)Montagne,collected in Morocco.Methods:The chemical composition of the oil was analyzed by gas chromatography-mass spectrometry.The oil was evaluated for antibacterial(Pseudomonas aeruginosa,Escherichia coli,Bacillus subtilis,Micrococcus luteus,Staphylococcus aureus,and Klebsiella pneumoniae),and antifungal activity(Candida albicans,Candida glabrata,Candida krusei,and Candida parapsilosis),by the disc diffusion method.The minimum inhibitory and minimum microbicidal concentrations of the oil were determined,as well as the synergistic effects of its application combined with the antibiotics ciprofloxacin and fluconazole,by the checkerboard method.Results:Thirty molecules were identified in the essential oil,comprising 96.27%of the total oil composition.Monoterpenes such as carvacrol(36.06%)were the most abundant compounds,followed by caryophyllene(14.67%),endo-borneol(9.04%),pyroterebic acid(3.23%)and caryophyllene oxide(3.13%).The oil exhibited a moderate antimicrobial activity with inhibition zone diameters ranging from 9.0 to 15.0 mm.The minimum inhibitory concentration values varied between 0.9 and 14.7 mg/mL,and Bacillus subtilis and Escherichia coli were the more sensitive bacteria with 0.9 and 1.9 mg/mL,respectively.The minimum microbicidal concentration values ranged from 0.4 to 14.7 mg/mL.A significant synergic action was observed when the oil was applied in combination with ciprofloxacin and fluconazole,with fractional inhibitory concentration index values ranging from 0.31 to 0.50.Synergy was found in 80%of the combinations and a 2 to 16-fold reduction of antibiotics MIC was observed.Conclusions:Our findings suggest that the essential oil of Centroceras clavulatum should be further appraised for its potential use in the management of multi-drug resistant microorganisms,with the purpose to restore the activity of standard antimicrobial drugs.

Antibiotics for complicated urinary tract infection and acute pyelonephritis: A systematic review

BACKGROUND The increasing rates of antibiotic-resistance in the recent years has caused the emergence of multiple drug-resistant bacteria.Therefore,antibiotics that are recommended by the current clinical guidelines may not be effective for the treatment of complicated urinary tract infection(UTI)and acute pyelonephritis.AIM To determine the clinical efficacy and safety of antibiotics for the treatment of complicated urinary tract infection and acute pyelonephritis.METHODS A search of three medical databases(PubMed,EMBASE and Google Scholar)were conducted for eligible articles describing the use of antibiotics in managing complicated UTI and acute pyelonephritis.The following keywords were used to perform the literature search:“urinary tract infection”,“complicated UTI”,“pyelonephritis”,“treatment”and“antibiotics”.Additional articles of interest were retrieved from the reference list of selected papers.Eligibility criteria for this systematic review were diagnosis of either complicated urinary tract infection or acute pyelonephritis and the use of antibiotics in management.Clinical trials and observational studies were included in this review while case reports and reviews were excluded.The methodological quality of clinical trials and observational studies was assessed.A descriptive approach was adopted to analyze the data due to the variation of methodology and interventions.RESULTS A total of 183 studies were screened;eight studies that matched all the eligibility criteria were included in this review.The antibiotics included in this systematic review were ceftazidime-avibactam,doripenem,levofloxacin,meropenemvaborbactam,piperacillin-tazobactam,plazomicin,tazobactam-ceftolozane and gentamicin.Two clinical trials reported that shorter duration of levofloxacin or non-fluoroquinolone antibiotics treatment was as effective as the duration of antibiotic therapy recommended by the current guidelines in treating complicated UTI and pyelonephritis.Besides that,ceftazidime-avibactam,piperacillintazobactam and tazobactam-ceftolozane can be used as an alternative to carbapenem in treating extended-spectrumβ-lactamase-producing Escherichia coli.In the included studies,the cure rates of the complicated UTI and pyelonephritis by meropenem-vaborbactam,piperacillin-tazobactam and tazobactam-ceftolozane was comparable at between 95.6%and 98.4%.Furthermore,the clinical trials showed that levofloxacin had a relatively high rate of adverse events(33.1%and 47.7%in two clinical trials)while tazobactamceftolozane had a relatively low rate of adverse events(17.5%).All studies have limitations and a potential for bias.CONCLUSION The use of novel antibiotics and combination antibiotic therapy can be considered in treating complicated UTI and acute pyelonephritis when resistance to recommended antibiotics occurs.

Evaluation of the Impact of Hydrocarbon-Generated Soot on Antibiotics Susceptibility of <i>Staphylococcus aureus</i>and <i>Escherichia coli</i>Isolates

Background: The antibiotic susceptibility of bacterial interaction with soot, a by-product of incomplete combustion of fossil fuel, has not been established. Aim: The study aimed to establish the antibiotics susceptibility of Staphylococcus aureus and Escherichia coli exposed to soot. Method: The bacteria were exposed to 12.5%, 25%, and 50% concentrations of soot at different time intervals. Control bacterial cultures without exposure to soot were also carried out. These cultures were incubated for 24 hrs. The numbers of surviving bacteria were determined by analyzing 10 μL of the incubated cultures at 6 hrs and 24 hrs on tryptone soy agar. Again, the bacteria were inoculated on Mueller Hinton agar and subjected to antibiotics susceptibility testing using the disk diffusion method. Results: After 6 hrs of exposure, the number of E. coli in the absence of soot was 102.50 ± 3.54 × 103 CFU/mL while at 12.5%, 25%, and 50% of soot, the surviving E. coli were 26.00 ± 1.41 (p = 0.0012), 21.00 ± 1.41 (p = 0.0011) and 5.50 ± 2.12 (p = 0.0009) × 103 CFU/mL respectively. Similarly, the population of S. aureus without soot was 122.5 ± 3.53 × 104 CFU/mL while at 12.5%, 25.0% and 50.0% of soot, the surviving S. aureus 46.00 ± 2.83 (p = 0.0017), 23.00 ± 1.41 (p = 0.0007) and 11.50 ± 2.12 (p = 0.0007) × 104 CFU/mL respectively. Similar results were obtained after 24 hrs of exposure. The soot shows some level of potency in reducing the number of E. coli and S. aureus significantly (p < 0.05). After 24 hrs, almost all treatment conditions (except for the Gentamicin for S. aureus), there was resistance to all the antibiotics while at 0 hr there was sensitivity to these drugs. Conclusion: These results suggest that while soot has some potency on E. coli and S. aureus, their exposure to soot could induce resistance.

Antiboitic Resistance of Uropathogenic Eshcherichia coli in Pateints of Hargeisa Group Hospital, Hargeisa, Somaliand

Background: Urinary tract infection is a common disease in Somaliland society. The predominant causative organism of Urinary tract infection is Escherichia coli. This research studies antibiotic resistance of uropathogenic E. coli in patients of Hargeisa Group Hospital. The study selected commonly prescribed antibiotics for urinary tract infection treatment. Methodology: Urine samples of patients were cultured to isolate causative organisms of the urinary tract infection. Chromo-agar media, CLED, and biochemical tests are applied to identify the type of bacteria. Antibiotic reactions to E. coli bacteria are measured to differentiate between sensitive and resistant drugs with the guidance of the Clinical and Laboratories Standard Institute (CLSI). Kirby Bauer disc diffusion method is applied to assess antimicrobial activity against E. coli. Data of patients such as age, sex, symptoms of UTI, previous UTI infection, and history of antibiotic use were recorded. SPSS and Microsoft Excel are applied to analyze and interpret data. Results: The predominant organism that caused urinary tract infection was Escherichia coli (55%), Klebsiella spp (15%), Candida spp (15%), Enterococcus spp (10%), Staph spp 2.5%, and Pseudomonas spp 2.5% while other 55% were negative. The study assessed antibiotic resistance of E. coli, which reported resistance to Tetracycline at (70%), Ampicillin (64%), and Cotrimoxazole (61%). The bacteria showed moderate resistance to Ceftriaxone (43.5%), Nalidixic acid (43%), and Ciprofloxacin (36%). The bacteria are sensitive to Amikacin (100%), Nitrofurantoin (96%), Levofloxacin (73%) and gentamicin (74%). Conclusion: The overall incidence of antibiotic resistance to E. coli is high because the bacteria show a percentage of resistance to each antibiotic except Amikacin which gives (100%) sensitivity. The research recommends public awareness of the risks associated with antibiotic use and periodic evaluation of antibiotic resistance to accomplish better managing urinary tract infections.

Bacterial contamination of orally-consumed crude herbal remedies:A potential source for multi-drug resistant pathogens in man

Objective:The acceptability of herbal remedies for alleviating discomforts and ill-health has become very popular, on the account of the increasing cost of allopathic medicine for personal health maintenance.The observable non-adherence of herbalists to the established World Health Organization(WHO) / National Agency for Food and Drug Administration Control(NAFDAC) regulations for the quality control of herbal medicines is an issue for concern.In view of this,34 popular and widely consumed crude herbal remedies in southwestern,Nigeria were screened for compliance with standard limits for bacterial contamination,bacteria flora and their antibiotic susceptibility pattern.Methods:Isolates recovered from samples were identified using the cultural, morphological and biochemical characteristics.They were also tested for drug sensitivity using standard procedures. Results:A heavy bacteria load ranging from 3.00×10~3-9.58×10~5 CFU/ML and 1.20×10~5- 5.41×10~5 CFU/ML was observed for water and spirit extracted preparations respectively.The bacteria flora cum contaminants were:Staphylococcus aureus,Bacillus cereus,Bacillus subtilis,Pseudomonas aeruginosa, Micrococcus luteus,Lactobacillus plantarum,Klebsiella pneumoniae,Escherichia coli,streptococcus,Shigella, Neisseria,Arthrobacter,Kurthia and Clostridium species.All the isolates were multi-drug resistant(MDR) strains.Conclusion:The crude herbal preparations consumed in Nigeria failed to comply with the internationally recognized standards regarding bacteria load and flora.The presence of MDR pathogens is of greatest concern. It poses a great risk to consumers health and could be a source of introducing MDR organisms into the human population.There is the need for the enforcement of established guidelines to ensure the safety of these preparations.