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.

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.

Enhanced wear resistance,antibacterial performance,and biocompatibility using nanotubes containing nano-Ag and bioceramics in vitro

A good Ti-based joint implant should prevent stress shielding and achieve good bioactivity and anti-infection performance.To meet these requirements,the low-elastic-modulus alloy—Ti–35Nb–2Ta–3Zr—was used as the substrate,and functional coatings that contained bioceramics and Ag ions were prepared for coating on TiO_(2)nanotubes(diameter:(80±20)nm and(150±40)nm)using anodization,deposition,and spin-coating methods.The effects of the bioceramics(nano-β-tricalcium phosphate,microhydroxyapatite(micro-HA),and meso-CaSiO_(3))and Ag nanoparticles(size:(50±20)nm)on the antibacterial activity and the tribocorrosion,corrosion,and early in vitro osteogenic behaviors of the nanotubes were investigated.The tribocorrosion and corrosion results showed that the wear rate and corrosive rate were highly dependent on the features of the nanotube surface.Micro-HA showed great wear resistance with a wear rate of(1.26±0.06)×10^(−3)mm^(3)/(N·m)due to adhesive and abrasivewear.Meso-CaSiO_(3)showed enhanced cell adhesion,proliferation,and alkaline phosphatase activity.The coatings that contained nano-Ag exhibited good antibacterial activity with an antibacterial rate of≥89.5%against Escherichia coli.These findings indicate that hybrid coatings may have the potential to accelerate osteogenesis.

Antimicrobial peptides: new hope in the war against multidrug resistance

The discovery of antibiotics marked a golden age in the revolution of human medicine. However,decades later, bacterial infections remain a global healthcare threat, and a return to the pre-antibiotic era seems inevitable if stringent measures are not adopted to curb the rapid emergence and spread of multidrug resistance and the indiscriminate use of antibiotics. In hospital settings, multidrug resistant(MDR) pathogens, including carbapenem-resistant Pseudomonas aeruginosa, vancomycin-resistant enterococci(VRE), methicillin-resistant Staphylococcus aureus(MRSA), and extendedspectrum β-lactamases(ESBL) bearing Acinetobacter baumannii, Escherichia coli, and Klebsiella pneumoniae are amongst the most problematic due to the paucity of treatment options,increased hospital stay, and exorbitant medical costs. Antimicrobial peptides(AMPs) provide an excellent potential strategy for combating these threats. Compared to empirical antibiotics, they show low tendency to select for resistance, rapid killing action, broad-spectrum activity, and extraordinary clinical efficacy against several MDR strains. Therefore, this review highlights multidrug resistance among nosocomial bacterial pathogens and its implications and reiterates the importance of AMPs as next-generation antibiotics for combating MDR superbugs.

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.

Antimicrobial drug resistance of Staphylococcus aureus in dairy products

Objective:To evaluate the prevalence of multidrug resistant Staphylococcus aureus(S.aureus) in dairy products.Methods:Isolation and identification of S.aureus were performed in 3 dairybased food products.The isolates were tested for their susceptibility to 5 different common antimicrobial drugs.Results:Of 50 samples examined,5(10%) were contaminated with 5. aureus.Subsequently,the 5 isolates were subjected to antimicrobial resistance pattern using five antibiotic discs(methicillin,vancomycin,kanamycin,chloramphenicol and tetracycline).Sample 29 showed resistance to methicillin and vancomycin.Sample 18 showed intermediate response to tetracycline.The other samples were susceptible to all the antibiotics tested.Conclusions:The results provide preliminary data on sources of food contamination which may act as vehicles for the transmission of antimicrobial-resistant Staphylococcus.Therefore,it enables us to develop preventive strategies to avoid the emergence of new strains of resistant S.aureus.

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.

Genetic characterization of antimicrobial resistance in Staphylococcus aureus isolated from bovine mastitis cases in Northwest China

Staphylococcus aureus is the most common etiological pathogen of bovine mastitis. The resistant strains make the disease difficult to cure. The aim of this study was to characterize the genetic nature of the antimicrobial resistance in S. aureus cultured from bovine mastitis in Northwest China in 2014. A total of 44 S. aureus were isolated for antimicrobial resistance and resistance-related genes. Antimicrobial resistance was determined by disc diffusion and the corresponding resistance genes were detected by PCR. Phenotype indicated that S. aureus isolates were resistant to penicillin （84.09%）, erythromycin （20.45%）, tetracycline （15.91%）, gentamicin （9.09%）, tobramycin （6.82%）, kanamycin （6.82%） and methicillin （2.27%）. 9.09% of the S. aureus isolates were classified as multidrug resistant. In addition, genotypes showed that the isolates were resistant to rifampicin （100%, rpoB）, penicillin （95.45%, blaZ）, tetracycline （22.73%, tetK, tetM, alone or in combination）, erythromycin （22.73%, ermB or ermC）, gentamicin/tobramycin/kanamycin （2.27%, aacA-aphD）, methicillin （2.27%, mecA） and vancomycin （2.27%, vanA）. Resistance to tetracycline was attributed to the genes tetK and tetM （r=0.558, P〈0.001）. This study noted high-level geno- and phenotypic antimicrobial resistance in S. aureus isolates from bovine mastitis cases in Northwest China.

Antimicrobial susceptibility testing for Helicobacter pylori in times of increasing antibiotic resistance

The gram-negative bacterium Helicobacter pylori(H.pylori)causes chronic gastritis,gastric and duodenal ulcers,gastric cancer and mucosa-associated lymphoid tissue lymphoma.Treatment is recommended in all symptomatic patients.The current treatment options for H.pylori infection are outlined in this review in light of the recent challenges in eradication success,largely due to the rapid emergence of antibiotic resistant strains of H.pylori.Antibiotic resistance is a constantly evolving process and numerous studies have shown that the prevalence of H.pylori antibiotic resistance varies significantly from country to country,and even between regions within the same country.In addition,recent data has shown that previous antibiotic use is associated with harbouring antibiotic resistant H.pylori.Local surveillance of antibiotic resistance is warranted to guide clinicians in their choice of therapy.Antimicrobial resistance is assessed by H.pylori culture and antimicrobial susceptibility testing.Recently developed molecular tests offer an attractive alternative to culture and allow for the rapid molecular genetic identification of H.pylori and resistance-associated mutations directly from biopsy samples or bacterial culture material.Accumulating evidence indicates that surveillance of antimicrobial resistance by susceptibility testing is feasible and necessary to inform clinicians in their choice of therapy for management of H.pylori infection.

Resistance of Antimicrobial Peptide Gene Transgenic Rice to Bacterial Blight

Antimicrobial peptide is a polypeptide with antimicrobial activity. Antimicrobial peptide genes Np3 and Np5 from Chinese shrimp （Fenneropenaeus Chinensis） were integrated into Oryza sativa L. subsp, japonica cv. Aichi ashahi by Agrobacterium mediated transformation system. PCR analysis showed that the positive ratios of Np3 and Np5 were 36% and 45% in To generation, respectively. RT-PCR analysis showed that the antimicrobial peptide genes were expressed in T1 generation, and there was no obvious difference in agronomic traits between transgenic plants and non-transgenic plants. Four Np3 and Np5 transgenic lines in T1 generation were inoculated with Xanthomonas oryzae pv. oryzae strain CR4, and all the four transgenic lines had significantly enhanced resistance to bacterial blight caused by the strain CR4. The Np5 transgenic lines also showed higher resistance to bacterial blight caused by strains JS97-2, Zhe 173 and OS-225. It is suggested that transgenic lines with Np5 gene might possess broad spectrum resistance to rice bacterial blight.

Prevalence and antimicrobial resistance pattern of bacterial strains isolated from patients with urinary tract infection in Messalata Central Hospital, Libya

Objective: To investigate the prevalence of urinary tract infection among patients at Messalata Central Hospital, Libya, to identify the causative bacteria, and to explore their resistance pattern to antimicrobials. Methods: A total number of 1 153 urine samples were collected from patients, who attended daily to Messalata Central Hospital, Libya, in a study extended for one year. Antimicrobial susceptibility testing and isolates typing were done using Phoenix BD(BD diagnostic). Resistance was confirmed manually using agar disk diffusion method. Results: Of the 1 153 urine samples tested, 160(13.9%) samples were positive, from which 17 different, solely Gram negative, uropathogens were identified. Escherichia coli were the most prevalent(55.6%) bacteria, followed by Klebsiella pneumoniae subspecies pneumoniae(16.3%), Proteus mirabilis(6.3%), Pseudomonas aeruginosa(5.6%), Enterobacter cloacae and Klebsiella oxytoca(2.5%, each), Citrobacter koseri and Providencia rettgeri(1.9%, each), Acinetobacter baumannii, Enterobacter aerogenes and Proteus vulgaris(1.3%, each), and Aeromonas caviae, Citrobacter freundii, Cronobacter sakazakii, Enterobacter amnigenus biogroup 2, Pseudomonas putida and Serratia marcescens(0.6%, each). The isolated uropathogens showed increased levels of resistance ranged from 10.5% to 64.5%, with an overall resistance of 28.9%. Amikacin was the most effective antimicrobial followed by Imipenem and Meropenem(0%, 0.6% and 2.5% resistance, respectively); while, Cephalothin and Ampicillin were the least(80.6% and 90.0% resistance, respectively) effective. Conclusions: The obtained results emphasized the emergence of highly resistant bacteria to most of tested antimicrobials and raise the alarm for physicians to change their treatment pattern depending on antimicrobial susceptibility results.

Analysis on Antimicrobial Resistance of Clinical Bacteria Isolated from County Hospitals and a Teaching Hospital

The distinction of antimicrobial resistance of clinical bacteria isolated from county hospitals and a teaching hospital was investigated. Disc diffusion test was used to study the antimicrobial resistance of isolates collected from county hospitals and a teaching hospital. The data was analyzed by WHONET5 and SPSS statistic software. A total of 655 strains and 1682 strains were collected from county hospitals and a teaching hospital, respectively, in the year of 2003. The top ten pathogens were Coagulase negative staphylococci （CNS）, E. coil, Klebsiella spp. , S. areus, P. aeruginosa, Enterococcus spp. , Enterobacter spp. , otherwise Salmonella spp. , Proteus spp. , Shigella spp. in county hospitals and Streptococcus spp. , Acinetobacter spp. , X. maltophilia in the teaching hospital. The prevalence of multi-drug resistant bacteria was 5 % （4/86） of methicillin-resistant S. areus （MRSA）, 12 % （16/133） and 15.8 % （9/57） of extended-spectrum β-lactamases producing strains of E. coil and Klebsiella spp. , respectively, in county hospitals. All of the three rates were lower than that in the teaching hospital and the difference was statistically significant （P〈0. 01）. However, the incidence of methicillin-resistant CNS （MRCNS） reached to 70 % （109/156） in the two classes of hospitals. Generally, the antimicrobial resistant rates in the county hospitals were lower than those in the teaching hospital, except the resistant rates of ciprofloxacin, erythromycin, clindamycin, SMZco which were similar in the two classes of hospitals. There were differences between county hospitals and the teaching hospital in the distribution of clinical isolates and prevalence of antimicrobial resistance. It was the basis of rational use of antimicrobial agents to monitor antimicrobial resistance by each hospital.

Prevalence and antimicrobial resistance of non-typhoid Solmonella in military personnel,1988-2013

Objective:To describe the spanning 25 years data for the occurrence, magnitude, and trends regarding antimicrobial resistance of non-typhoidalSalmonella (NTS) isolated from non-immune travelers to Thailand participating in joint military operations.Methods:A total of 355 NTS isolates, obtained from 2052 fecal samples from US soldiers deployed for military maneuvers in Thailand during 1988-2013, were examined for NTS serogroup/serotypes and tested for antimicrobial susceptibility by disk diffusion to these 10 antibiotics:ampicillin, azithromycin (AZM), ciprofloxacin, colistin, gentamicin, kanamycin, nalidixic acid, streptomycin (STR), tetracycline (TET), and trimethoprim/sulfamethoxazole. Identified AZM-resistant NTS isolates were further evaluated for their minimal inhibitory concentration by the E-test method.Results:NTS infections accounted for 17.3％ (355/2052), including 11 serogroups and 50 different serotypes. The most prevalent serogroup wasSalmonella group C2-C3 (35.8％, 127/355) followed by groups B (21.1％, 75/355) and C1 (18.6％, 66/355). Identified serotypes includedSalmonellahadar (n=60),Salmonellarissen (n=45), andSalmonella blockley (n=34). Among the predominate serogroups, antimicrobial resistance was consistently high against TET (76.9％, 273/355) followed by STR (40.8％, 145/355). OneSalmonella senftenberg isolate demonstrated decreased ciprofloxacin susceptibility. Most isolates (94.6％) were resistant to one or more antimicrobials, and the most common multidrug resistance was TET-STR-nalidixic acid (11.5％, 41/355).Conclusions:The prevalence of NTS serotypes and the growing magnitude of antibiotic resistant bacteria isolated from deployed US military in Thailand are documented from 1988-2013. This study demonstrates the antibiotic resistance profiles, highlighting the effectiveness of AZM that is a first-line treatment for travelers to Southeast Asia. AZM-resistant NTS isolates are periodically observed over a 25-year period. Hence, the ongoing surveillance and prevalence efforts are required to monitor NTS resistant strains causing further treatment failure.

Genetic Diversity, Antimicrobial Resistance, and Virulence Genes of Aeromonas Isolates from Clinical Patients, Tap Water Systems, and Food

Objective This study aimed to evaluate the genetic diversity,virulence,and antimicrobial resistance of Aeromonas isolates from clinical patients,tap water systems,and food.Methods Ninety Aeromonas isolates were obtained from Ma’anshan,Anhui province,China,and subjected to multi-locus sequence typing(MLST)with six housekeeping genes.Their taxonomy was investigated using concatenated gyr B-cpn60 sequences,while their resistance to 12 antibiotics was evaluated.Ten putative virulence factors and several resistance genes were identified by PCR and sequencing.Results The 90 Aeromonas isolates were divided into 84 sequence types,80 of which were novel,indicating high genetic diversity.The Aeromonas isolates were classified into eight different species.PCR assays identified virulence genes in the isolates,with the enterotoxin and hemolysin genes act,aer A,alt,and ast found in 47(52.2%),13(14.4%),22(24.4%),and 12(13.3%)of the isolates,respectively.The majority of the isolates(≥90%)were susceptible to aztreonam,imipenem,cefepime,chloramphenicol,gentamicin,tetracycline,and ciprofloxacin.However,several resistance genes were detected in the isolates,as well as a new mcr-3 variant.Conclusions Sequence type,virulence properties,and antibiotic resistance vary in Aeromonas isolates from clinical patients,tap water systems,and food.

Transposable elements in <i>Escherichia coli</i>antimicrobial resistance

Transposable elements are capable of switching their positions on the genome thereby causing gene arrangements and contributing to genome evolution. The aim of this review is to specifically discuss the role of transposable elements in transferring antimicrobial resistance genes in E. coli, thus contributing to increase in virulence and conferring the possibility of multidrug resistance. Different types of transposable elements such as transposons and integrons and their profound influence on E. coli antimicrobial resistance are the focus of this review.

Antimicrobial resistance of abnormal vaginal discharges microorganisms in Ouagadougou,Burkina Faso

Objective:To assess the prevalence of bacterial strains and fungal strains infecting the vaginal tract and test their sensitivity to antibiotics in women attending Saint Camille Medical Centre in Ouagadougou.Methods:From January 2008 to December 2009,a total of 2000 vaginal swabs were cultivated for bacterial and fungal identification and isolation.Furthermore,bacterial strains were tested for their susceptibility to several antibiotics used in routine in the centre. Results:The results revealed that microbial isolation and identification was attempted for 1536/2000 sample,a positivity rate of 76.80%.Candida albicans(48.76%),followed by Escherichia coli(16.67%),Streptococcus agalactiae(8-14%) and Staphylococcus aureus(7.55%) were the major agents of genital tract infections in patients.Mycoplasma hominis and Ureaplasma urealyticum combined accounted for less than 7%.Trichomonas vaginalis was identified in 1.04%coses.The antimicrobial tests revealed that the microorganisms developed resistance to several antibiotics including beta lactams.However,antibiotics such as cefamenzol,ciprofloxacin and norfloxacin were still active on these bacteria.Conclusions:The results reveal that many sexually active women are infected by one or more microbial pathogens,probably because of the lock of hygiene or the adoption of some risky behaviors,such as not using condoms or having multiple sexual partners.Efforts should be made to address these points in the country.

A New High-throughput Real-time PCR Assay for the Screening of Multiple Antimicrobial Resistance Genes in Broiler Fecal Samples from China

Objective Antimicrobial resistance(AMR)has become a global concern and is especially severe in China.To effectively and reliably provide AMR data,we developed a new high-throughput real-time PCR assay based on microfluidic dynamic technology,and screened multiple AMR genes in broiler fecal samples.Methods A high-throughput real-time PCR system with an new designed integrated fluidic circuit assay were performed AMR gene detection.A total of 273 broiler fecal samples collected from two geographically separated farms were screened AMR genes.Results The new assay with limits of detection ranging from 40.9 to 8,000 copies/reaction.The sensitivity rate,specificity rate,positive predictive value,negative predictive value and correct indices were 99.30%,98.08%,95.31%,99.79%,and 0.9755,respectively.Utilizing this assay,we demonstrate that AMR genes are widely spread,with positive detection rates ranging from 0 to 97.07%in 273 broiler fecal samples.bla CTX-M,bla TEM,mcr-1,fex A,cfr,optr A,and int I1 showed over 80%prevalence.The dissemination of AMR genes was distinct between the two farms.Conclusions We successfully established a new high-throughput real-time PCR assay applicable to AMR gene surveillance from fecal samples.The widespread existence of AMR genes detected in broiler farms highlights the current and severe problem of AMR.

Antimicrobial susceptibility testing before first-line treatment for Helicobacter pylori infection in patients with dual or triple antibiotic resistance

To evaluate the efficacy of antimicrobial susceptibility-guided therapy before first-line treatment for infection in patients with dual or triple antibiotic resistance.METHODSA total of 1034 patients infected by Helicobacter pylori (H. pylori) during 2013-2014 were tested for antimicrobial susceptibility. 157 of 1034 (15%) patients showed resistance to two (127/1034; 12%) and to three (30/1034; 3%) antibiotics. Sixty-eight patients with dual H. pylori-resistance (clarithromycin, metronidazole or levofloxacin) were treated for 10 d with triple therapies: OAL (omeprazole 20 mg b.i.d., amoxicillin 1 g b.i.d., and levofloxacin 500 mg b.i.d.) 43 cases, OAM (omeprazole 20 mg b.i.d., amoxicillin 1 g b.i.d., and metronidazole 500 mg b.i.d.) 12 cases and OAC (omeprazole 20 mg b.id., amoxicillin 1 g b.i.d., and clarithromycin 500 mg b.i.d.) 13 cases based on the antimicrobial susceptibility testing. Twelve patients showed triple H. pylori-resistance (clarithromycin, metronidazole and levofloxacin) and received for 10 d triple therapy with OAR (omeprazole 20 mg b.id., amoxicillin 1 g b.i.d., and rifabutin 150 mg b.i.d.). Eradication was confirmed by 13C-urea breath test. Adverse effects and compliance were assessed by a questionnaire.RESULTSIntention-to-treat eradication rates were: OAL (97.6%), OAM (91.6%), OAC (92.3%) and OAR (58.3%). Cure rate was significantly higher in naïve patients treated with OAR-10 compared to patients who had two or three previous treatment failures (83% vs 33%). Adverse events rates for OAL, OAM, OAC and OAR were 22%, 25%, 23% and 17%, respectively, all of them mild-moderate.CONCLUSIONAntimicrobial susceptibility-guided triple therapies during 10 d for first-line treatment leads to an eradication rate superior to 90% in patients with dual antibiotic H. pylori resistance.

Antimicrobial Resistance Patterns and Molecular Characterization of <i>Klebsiella pneumoniae</i>in Clinical Isolates at Mbarara Regional Referral Hospital

Background: Klebsiella pneumoniae is one of the most frequent opportunistic pathogens causing a range of infections and being resistant for beta-lactamases (ESBL) and Carbapenemases. Aim: The aim of the present study was to determine the antimicrobial resistance patterns and molecular characterization establishing the phenotypes and genotypes associated with drug resistance, an antibiogram of genotypically positive isolates for resistance of Klebsiella pneumoniae in clinical isolates at MRRH. Materials and Methods: A laboratory-based descriptive cross-sectional study that was conducted from September 2018 to May 2019 at MRRH. Klebsiella pneumoniae was identified by cultural and biochemical methods. Antibiotic sensitivity test was performed by modified Kirby-Bauer disc diffusion technique. ESBL production in Klebsiella pneumoniae was tested by double-disc synergy test, Carbapenemase production by MHT, Boronic Acid or EDTA test using Meropenem phenotypically and both resistance confirmed genotypically by Multiplex PCR. Results: Out of 1055 clinical isolates, 298 (28.2%) were found positive for Klebsiella.spp, 175 isolates were subcultured among which 22 (12.57%) were K. pneumoniae based on API 20E. Overall Sensitivity patterns of these Klebsiella pneumoniae isolates to Ceftriaxone, (Amoxicillin/Clavulanate), Gentamicin, Cefepime, Ciprofloxacin, Cefoxitin, Nitrofurantoin, Cefuroxime, piperacillin/tazobactam, Meropenem, Ceftazidime and cefotaxime were 72.7%, 63.7%, 54.5%, 45.5%, 31.8%, 31.8%, 27.3%, 27.3%, 22.7%, 22.7%, 18.2%, 9.1%, 9.1% respectively. ESBL producing K. pneumoniae was found at 68.18% (15/22) phenotypically. Genotypically;the ESBL genes were blaCTX-M (100%), blaSHV (80%) and blaTEM (100;47%);8/15 (73.3%) had CTX-M, SHV, TEM, 4/15 (26.67%) CTX-M, TEM, 3/15 (20.00%) CTX-M and SHV. Carbapenemase producing K. pneumoniae was found at 31.82% (7/22) phenotypically;1/7 (14.28%) by MHT, 4/7 (57.14%) Boronic acid test and 2/7 (28.58%) EDTA test. Genotypically;3/4 [(75%) 42.86%] had OXA-48, 1/4 [(25%) 14.28%] OXA-48 and KPC gene, 1/2 [(50%) 14.28%] KPC and VIM, 1/2 [(50%) 14.28%] KPC and KPC gene [(100%) 14.28%]. Conclusion/Recommendations: DDS to be used for ESBL production, MHT, Boronic Acid test and EDTA tests using Meropenem/or Imipenem for Carbapenemase-production routinely.

Detection of antimicrobial resistance and virulence-related genes in Streptococcus uberis and Streptococcus parauberis isolated from clinical bovine mastitis cases in northwestern China

The objectives of this study were to investigate antimicrobial resistance of Streptococcus uberis and Streptococcus parauberis isolated from cows with bovine clinical mastitis in China and to examine the distribution of resistance-and virulence-related gene patterns.Antimicrobial susceptibility was determined by the E-test.Genes encoding antimicrobial resistance and invasiveness factors were examined by PCR.A total of 27 strains were obtained from 326 mastitis milk samples.Streptococcus parauberis isolates(n=11)showed high resistance to erythromycin(90.9%),followed by tetracycline(45.5%),chloramphenicol(36.4%)and clindamycin(27.3%).Streptococcus uberis isolates(n=16)were highly resistant to tetracycline(81.3%)and clindamycin(62.5%).Both species were susceptible to ampicillin.The most prevalent resistance gene in S.uberis was tetM(80.0%),followed by blaZ(62.5%)and ermB(62.5%).However,tetM,blaZ,and ermB genes were only found in 27.3,45.5,and 27.3%,respectively,of S.parauberis.In addition,all of the isolates carried at least one selected virulence-related gene.The most prevalent virulence-associated gene pattern in the current study was sua+pauA/skc+gapC+hasC detected in 22.2%of the strains.One S.uberis strain carried 7 virulence-associated genes and belonged to the sua+pauA/skc+gapC+cfu+hasA+hasB+hasC pattern.More than 59.3%of analysed strains carried 4 to 7 virulence-related genes.Our findings demonstrated that S.parauberis and S.uberis isolated from clinical bovine mastitis cases in China exhibited diverse molecular ecology,and that the strains were highly resistant to antibiotics commonly used in the dairy cow industry.The data obtained in the current study contribute to a better understanding of the pathogenesis of bacteria in mastitis caused by these pathogens,and the findings are relevant to the development of multivalent vaccines and targeted prevention procedures.