Characterization of Extended Spectrum Beta-lactamase and Carbapenamase Producing Enterobacteriaceae Causing Urinary Tract Infection among Children in Kenya: A Cross-Sectional Study

Introduction: Enterobacteriaceae causing urinary tract infections (UTI) have developed resistance to the commonly used antibiotics due to emergence of Extended Spectrum Beta-Lactamases (ESBLs) and Carbapenamase producing Enterobactericeae which are a public health problem worldwide. This study aims to determine the prevalence and characterize ESBLs and carbapenamase producing Enterobactericeae. Method: A cross-sectional study was carried out in Gertrude’s Children’s Hospital, Nairobi. 238 urine samples were collected from patients with urinary symptoms attending the outpatient department within the period 2020-2021. The urine were examined macroscopically and microscopically. Identification and antimicrobial susceptibility testing were done using VITEK® 2 Compact system (BioMérieux). Double disc synergy test and modified hodge tests were done as confirmatory tests for ESBLs and Carbapenamase phenotypes respectively. Polymerase Chain Reaction was used for the detection of blaCTX-M, blaTEM, blaSHV, blaKPC and blaOXA-48 genes. Results: From the 238 children sampled the prevalence of UTI caused by Enterobactericeae was 22.3%. The Enterobacteriaceae species isolated were Escherichia coli (84.9%), Klebsiella pneumoniae (5.66%), Proteus mirabillis (5.66%), Enterobacter aerogenes (1.89%) and Morganella morganii (1.89%). The isolated species were resistant to ampicillin. Meropenem had the highest susceptibility. Only E. coli species had the ESBLs (26.4%) and carbapenamase (1.9%) phenotypes. 100% had BlaCTX-M while 50% had blaTEM resistant gene. There was a significant association (p Conclusion: Ampicillin resistance resulted to use of alternative drugs and Meropenem was the drug of choice where increased resistance to the recommended drugs was noted. Further research on resistant genes is recommended.

Phenotypic and Genotypic Characterization of Extended Spectrum Beta-Lactamases Producing Bacteria Causing Urinary Tract Infections among Expectant Women Attending Antenatal Clinic at Ruiru Sub County Hospital, Kenya

Background: Urinary tract infection (UTI) is a bacterial infection affecting males and females but is more prevalent in expectant women. ESBLs are bacteria with enzymes that make them resistant to many antibiotics, posing a significant health challenge. This study aims to determine the characteristics of ESBL-producing bacteria causing UTIs in expectant women. Methodology: A self-administered survey was carried out;300 expectant women were recruited using a random sampling method. A questionnaire was used to collect socio-demographic information. Urine samples were collected in sterile universal bottles and processed at the JKUAT Zoology laboratory. Urine samples were analyzed using urinalysis, microscopy, culture, and sensitivity testing. ESBL-producing bacteria were identified phenotypically using the double-disc synergy test (DDST) and genotyped for specific resistant genes using PCR. Results: UTI prevalence was 32.7% (98/300). UTI was significantly associated with the history of previous UTI (OR = 0.84, p = 0.02) and multigravida (OR = 0.14 p = 0.01). UTI was common in women aged between 28-37 years in their second trimester. Bacteria isolated were E. coli 57.1% (56/98), S. aureus 21.4% (21/98) K. pneumonia 11.2% (11/98) and Proteus spp 10.4% (10/98). Bacteria antibiotic resistance patterns were E. coli-tetracycline (91.1%), sulfamethoxazole (55.4%), cefotaxime (53.4%) and augmentin (53.4%). S. aureus-sulfamethozaxole (100%) and augmentin (71.4%), K. pneumoniae-sulfame-thoxazole (72.2%) cefotaxime (63.6%), chloramphenicol and tetracycline (54.5%). Proteus spp: tetracycline (100%), nitrofurantoin (90%), cefotaxime and chloramphenicol (50%). The proportion of ESBLs bacterial producers was 37.6% (29/77) and 44.8% (13/29) possessed ESBLs resistant genes;Bla CTX-M 53.8% (7/13), Bla SHV and Bla TEM 23.1% (3/13) each, Bla OXA (0%) was not detected. Conclusion: The study revealed a high proportion of ESBLs producing bacteria responsible for UTI in expectant women. ESBLs screening, routine culture and sensitivity testing will guide on proper management and empirical treatment of UTI patients thus reducing multi-drug resistance.

In vitro biofilm formation in ESBL producing Escherichia coli isolates from cage birds

Objective:To determine biofilm and hydrophobicity formation ratios in extended spectrum beta lactamases(ESBL) synthesizing Escherichia coli isolates which were isolated from feces samples of 150 cage bird species randomly taken from pet shops in Hatay province,Turkey.Methods:In vitro biofilm production of 4 ESBL positive isolates were performed by Congo Red Agar(CRA),Standard Tube(ST) and Microtitre Plate(MP) methods while their hydrophobicity were examined by bacterial adhesion to hydrocarbon(BATH) test.Results:In the examined isolates,while biofilm production was found to be negative by CRA method,highest biofilm producing strain,among 4 bacteria was determined to be A42 by ST and MP methods.The Scanning Electron Microscopy(SEM) also displayed these confirmed findings.The hydrophobicity values of strains were determined to be between 22.45%and 26.42%.Conclusions:As a result,biofilm formation in cage bird feces originated ESBL positive Escherichia coli isolates was performed for the first time in Turkey.In order to present the relation between pathogenicity and biofilm production in animal originated ESBL positive isolates,further studies are required.

Near Future Perspective of ESBL-Producing Klebsiella pneumoniae Strains Using Mathematical Modeling

While antibiotic resistance is becoming increasingly serious today,there is almost no doubt that more challenging times await us in the future.Resistant microorganisms have increased in the past decades leading to limited treatment options,along with higher morbidity and mortality.Klebsiella pneumoniae is one of the significant microorganisms causing major public health problems by acquiring resistance to antibiotics and acting as an opportunistic pathogen of healthcare-associated infections.The production of extended spectrumbeta-lactamases(ESBL)is one of the resistance mechanisms of K.pneumoniae against antibiotics.In this study,the future clinical situation of ESBL-producing K.pneumoniae was investigated in order to reflect the future scenarios to understand the severity of the issue and to determine critical points to prevent the spread of the ESBL-producing strain.For evaluation purposes,SIS-type mathematical modeling was used with retrospective medical data from the period from 2016 to 2019.Stability of the disease-free equilibrium and basic reproduction ratios were calculated.Numerical simulation of the SISmodel was conducted to describe the dynamics of non-ESBL and ESBL-producing K.pneumoniae.In order to determine the most impactful parameter on the basic reproduction ratio,sensitivity analysis was performed.A study on mathematical modeling using data on ESBL-producing K.pneumoniae strains has not previously been performed in any health institution in Northern Cyprus,and the efficiency of the parameters determining the spread of the relevant strains has not been investigated.Through this study,the spread of ESBL-producing K.pneumoniae in a hospital environment was evaluated using a different approach.According to the study,in approximately seventy months,ESBL-producing K.pneumoniae strains will exceed non-ESBL K.pneumoniae strains.As a result,the analyses showed that hospital admissions and people infected with non-ESBL or ESBL-producing K.pneumoniae have the highest rate of spreading the infections.In addition,it was observed that the use of antibiotics plays a major role in the spread of ESBL-producing K.pneumoniae compared to other risk factors such as in-hospital transmissions.As amatter of course,recoveries fromKlebsiella infections were seen to be the most effective way of limiting the spread.It can be concluded from the results that although the use of antibiotics is one of themost effective factors in the development of the increasing ESBL-producing K.pneumoniae,regulation of antibiotic use policy could be a remedial step together with effective infection control measures.Such steps may hopefully lead to decreased morbidity and mortality rates as well as improved medical costs.

Study Frequency of Antibiotic Resistance Enzymes in Bacillus Species in Some of Foods

The subject of this study was to survey prevalence Beta lactamase enzyme in Bacillus species isolated from foods in Isfahan city in Iran. This is a laboratory study performed during 2009-2010 years in Isfahan. In this study, 150 samples of food, including juice ketchup, mayonnaise,

Assessment and impact of a biosecurity course in raising the awareness of students at the Jinnah post graduate Medical Center,Pakistan

Introduction:Pakistan Biological Safety Association(PBSA)is a not for profit,nongovernmental,professional organization established in 2008 and is striving to promote and implement Bio risk management in Pakistan.PBSA accelerated its program for strategic training of the national life scientists from 2013 and is still working on that mandate with the help of Fogarty International Center(FIC)&National Institute of Health USA and other international organizations working on this Global Health Security Initiative and subsequently Agenda(GHSA)Aims&Objectives:This biosafety training program was developed for capacity building of M.Phil.and PhD graduates the future laboratory users of Basic Medical Sciences Institute(BMSI),Jinnah Post Graduate Medical Center which is the largest tertiary care hospital in Karachi,Pakistan involved in Research&Development(R&D)in medical sciences.Materials&Methods:This Pre post study was carried at Basic Medical Sciences Institute(JPMC),during the period of October 2018 to January 2019.A total of 48(16 PhD.32 M.Phil.)Grads students participated in the following study.The training program is administered through,custom made 4-month course having 16 contact hours also 4 hours of practical training.Training was evaluated using written assessment.The pre and post-training test was conducted after each session.Each test comprised of 15 multiple choice questions(MCQs)pre and post session making it 30 MCQs in total for each session.A final assessment consisting 30 MCQs conducted at the end of course.Results:There was vast difference observed in the post assessment results as compared to the pre assessment results.At the end of the course final assessment was carried out which gave an overall impression of vast change(83.3%)in awareness regarding bio risk management among the graduate students,which reflected the efficacy of this training.To ensure the validity of results and the intention to improvise the quality of course in future,feedback regarding the course and trainer was obtain through Likert scale.Reliability of Likert scale carried through Cronbach’s alpha,showed all variables with a maximum score of 0.9,indicating high reliability of the generated feedback evaluation.Conclusion:This study highlighted that through concerted efforts of professional organizations,proper awareness of public and concerned personals,regarding Biosafety&Biosecurity can certainly reduce the chances of errors and will ensure potential safety and security to the laboratory workers,community and environment,potentially exposed to these pathogens&toxins which are regarded as biohazards.

A Survey on Biosafety Practices in Lab Personnel in 12 Selected Areas of Karachi,Pakistan

The objective of this study was to realize the degree of biosafety precautions and measures recorded among different Private Hospitals and Diagnostic labs personnel situated in different areas of Karachi,Pakistan.One thirty two private hospital based laboratory technicians were selected from all 12 selected areas in Karachi.The laboratory technicians were interviewed then a survey form was completed by the interviewer.The survey was conducted in 3 months duration from May 2017 to July 2017.The total number of members in this study was 132,of which 85 were males and 47 were females.Results presented that 65%of the laboratory technicians did not use any type of PPE and 35%of the respondents recapped used syringes frequently while 25%recapped occasionally.For avoiding the reuse of syringes,Pakistani governments recommend that they be cut before discarding;however,only 65%of the respondents followed the given procedure.Even though mouth pipetting is considered outdated,45%of the technicians continue to do so for numerous purposes.Results of this survey established an absence of awareness about good and proper lab practices and lab biosafety measures among lab technicians in Karachi,Pakistan.

Development of designated laboratories under the United Nations Secretary-General’s Mechanism

The United Nations Secretary-General’s Mechanism(UNSGM)for investigating the alleged use of biological weapons was proposed in early 2013,with support from the World Organization for Animal Health(OIE)and World Health Organization(WHO).1 The UNSGM and related documents call for designated laboratories to support an investigation of the alleged use of biological weapons.Designed laboratories participating in the UNSGM investigations must not report false results,positive or negative.It is not affordable for whatever reason.

Regulating dual-use research:Lessons from Israel and the United States

Over the past 20 years,and with greater urgency since the H5N1 papers controversy(2012),dual-use research of concern(DURC)has been extensively debated by the scientific community,regulators,and the public at large.Many have raised the need to regulate DURC;however,despite the urgency of this issue,to date,only two countries have implemented specific regulations,United States and Israel(notably,China is in the final stages of creating a set of DURC-related regulations).In this paper,I have compared these policies as case studies that may benefit other countries.Therefore,the present study aimed to critically compare the DURC policies of the US and Israel and determine whether their different approaches provide a rigorous framework for the regulation of DURC.I have shown that in some aspects,they have adopted similar approaches;for example,allowing local committees to play a role in assessing the research.However,they differ in certain important aspects;for instance,the US policies have laid out a mechanism through which academic institutions and the government decide jointly on how to address risky studies,while the Israeli law places the authority solely in government hands.My aim in comparing the policies is twofold;first,to reveal the weaknesses and strengths of each policy,thereby aiding their improvement,and second,to provide those that are considering developing policies in this field an overview of what the current approaches look like,thereby enabling them to articulate their own approach while taking into account the experience gained by the US and Israel.