Analysis of Pathogen Distribution and Drug Resistance of Nosocomial Infections Accompanied in Patients with Malignant Tumor

Objective： To investigate the pathogen distribution and drug resistance of nosocomial infections accompanied in patients with malignant tumor. Methods： The pathogen culture and drug-sensitivity data of 107 specimens isolated from malignant tumor patients accompanied with nosocomial infection were retrospectively analyzed. Results： Among 118 strains of pathogens isolated from 107 specimens, 77 were gram-negative bacillus（65.3%）, 26 were gram-positive coccus（65.3%）, and 15 were fungus（12.7%）. Eleven specimens were revealed to have combined infection of bacterium and fungus. Gram-negative bacillus showed high sensitivity to amikacin, ciprofloxacin, and tienam. Gram-positive cocci were highly sensitive to tienam and vancomycin. The bacteria were resistant to other antibiotics in different degrees, Vancomycin-resistant staphylococcus was not detected, Candida was sensitive to antifungals. Conclusion： Conditional pathogenic bacteria were mainly responsible for nosocomial infections in malignant tumor patients with considerable drug resistance. This shows that bacterial tests and the rational use of antibiotics should be emphasized in clinical practice to prevent the formation of drug resistant strains and further endogenous infections.

Analysis on Distribution and Drug Resistance of Pathogenic Bacteria in ICU Patients with Nosocomial Infection from 2019 to 2021

Objective:To understand the pathogenic bacteria isolated from patients and their drug resistance changes in general ICU of the Affiliated Hospital of Hebei University,so as to provide reference for appropriate selection of antibiotics in clinical practice.Methods:A retrospective investigation was conducted to analyze the bacteriological distribution and drug resistance of nosocomial pathogens isolated from the specimens of hospitalized patients in the comprehensive ICU of the hospital from 2019 to 2021.The US technology BD Phoenix 100 automatic bacterial identification analyzer was used for bacterial identification of the pathogen samples,disk diffusion method was used for drug susceptibility test,and SPSS 22.0 software was used to analyze the trend of drug resistance.Results:A total of 970 strains of nosocomial pathogens were detected in the three years.The main pathogens were Acinetobacter baumannii(133 strains,13.71%),Klebsiella pneumoniae(106 strains,10.93%),Pseudomonas aeruginosa(83 strains,8.56%),Escherichia coli(76 strains,7.84%)and Enterococcus faecium(69 strains,7.11%).The resistance rate of Acinetobacter baumannii to antibiotics was high.Klebsiella pneumoniae,Pseudomonas aeruginosa and Escherichia coli had low resistance rates to carbapenems.The situation of bacterial drug resistance is still serious.Conclusion:The drug resistance of pathogenic bacteria collected from Class III Grade A Hospital’s patients to antibiotics was generally high.Therefore,clinical departments should strengthen the inspection of specimens of infection and drug sensitivity test in order to grasp the resistance mechanisms and drug resistance of pathogenic bacteria changes,and select appropriate antimicrobial agents according to the test results.Besides,the formation of drug-resistant strains also needs to be prevented,and the treatment of patients with severe infection needs to be improved.

Antibacterial and antioxidant activities of Musa sp.leaf extracts against multidrug resistant clinical pathogens causing nosocomial infection

Objective:To investigate different Musa sp.leave extracts of hexane,ethyl acetate and methanol were evaluated for antibacterial activity against multi-drug resistant pathogens causing nosocomial infection by agar well diffusion method and also antioxidant activities.Methods:The four different Musa species leaves were extracted with hexane,ethyl acetate and methanol.Antibacterial susceptibility test,minimum inhibitory concentration and minimum inhibitory bacterial concentration were determined by agar well diffusion method.Total phenolic content and in vitro antioxidant activity was determined.Results:All the Musa sp.extracts showed moderate antibacterial activities expect Musa paradisiaca with the inhibition zone ranging from 8.0 to 18.6 mm.Among four species ethyl acetate extracts of Musa paradisiaca showed highest activity against tested pathogens particularly E.coli,P.aeruginosa and Citrobacter sp.The minimum inhibitory concentrations were within the value of 15.63-250μg/ml.and minimum bactericidal concentrations were ranging from 31.25-250μg/mL.Antioxidant activity of Musa acuminate exhibited maximum activity among other three Musa species.Conclusions:The present study concluded that among the different Musa species,Musa paradisiaca displayed efficient antibacterial activity followed by Musa acuminata against multidrug resistant nosocomial infection causing pathogens.Further,an extensive study is needed to identify the bioactive compounds,mode of action and toxic effect in.vivo of Musa sp.

Biofilm formation in clinical isolates of nosocomial Acinetobacter baumannii and its relationship with multidrug resistance

Objective: To check biofilm formation by Acinetobacter baumannii(A. baumannii)clinical isolates and show their susceptibility to different antibiotics and investigate a possible link between establishment of biofilm and multidrug resistance.Methods: This study was performed on clinical samples collected from patients with nosocomial infections in three hospitals of Tehran. Samples were initially screened by culture and biochemical tests for the presence of different species of Acinetobacter. Identifications were further confirmed by PCR assays. Their susceptibilities to 11 antibiotics of different classes were determined by disc diffusion method according to Clinical and Laboratory Standards Institute guidelines. The ability to produce biofilm was investigated using methods: culture on Congo red agar, microtiter plate, and test tube method.Results: From the overall clinical samples, 156 specimens were confirmed to contain A. baumannii. The bacteria were highly resistant to most antibiotics except polymyxin B.Of these isolates, 10.26% were able to produce biofilms as shown on Congo red agar.However, the percentage of bacteria with positive biofilm in test tube, standard microtiter plate, and modified microtiter plate assays were 48.72%, 66.66%, and 73.72%, respectively. At least 92% of the biofilm forming isolates were multidrug resistant.Conclusions: Since most of the multidrug resistant strains produce biofilm, it seems necessary to provide continuous monitoring and determination of antibiotic susceptibility of clinical A. baumannii. This would help to select the most appropriate antibiotic for treatment.

Nosocomial spontaneous bacterial peritonitis antibiotic treatment in the era of multi-drug resistance pathogens: A systematic review

To systematically review literature upon aetiology of nosocomial spontaneous bacterial peritonitis (N-SBP) given the rising importance of multidrug-resistant (MDR) bacteria. METHODSA literature search was performed on MEDLINE and Google Scholar databases from 2000 to 15th of November 2016, using the following search strategy: “spontaneous” AND “peritonitis”. RESULTSThe initial search through electronic databases retrieved 2556 records. After removing duplicates, 1958 records remained. One thousand seven hundred and thirty-five of them were excluded on the basis of the screening of titles and abstract, and the ensuing number of remaining articles was 223. Of these records, after careful evaluation, only 9 were included in the qualitative analysis. The overall proportion of MDR bacteria turned out to be from 22% to 73% of cases across the studies. CONCLUSIONN-SBP is caused, in a remarkable proportion, by MDR pathogens. This should prompt a careful re-assessment of guidelines addressing the treatment of this clinical entity.

Analysis of Etiology and Drug Resistance of Biliary Infections

Summary: The bile was collected from fro patients with biliary infections, with the bacterium isolated to study the sensitivity of each kind of the bacterium to several antibiotics in common use. Except G-bacterium, we also found some kinds of G+ bacterium in infection bile. G-bacterium were not sensitive to Clindamycin, G+ bacterium were sensitive to Ciprofloxacin. Escherichia coli, Xanthomonas maltophilia, Enterobacter cloacae, Pseudomonas aeruginosa were sensitive to Ampicillin. G+ bacterium were not sensitive to Azactam. Enterococcus faecalis, Enterococcus faecium, Enterobacter cloacae were not sensitive to Ceftazidime. Enterococcus faecalis, Staphylococcus coagulase negative, Staphylococcus epidermidis, Pseudomonas aeruginosa were not sensitive to Ceftriaxone Sodium. We didn't found any bacterium resistance Imipenem. The possibility of the existence of G+ bacterium as well as drug resistance should be considered n patients with biliary infections. The value of susceptibility test should be respected to avoid drug abuse of antibiotics.

Multiple drug resistance and bacterial infection

Drug resistance is becoming a great problem in developing countries due to excessive use and misuse of antibiotics. The emergence of new pathogenic strains with resistance developed against most of the antibiotics which may cause,difficult to treat infection.To understand the current scenario in different mode of infection is most important for the clinicians and medical practitioners.This article summarized some common infections and antibiotic resistance pattern found among these pathogens.

Multi-Drug Resistance Pattern of Lactose Non-Fermenting <i>Escherichia coli</i>as Causative Agent of Urine Tract Infections in Luanda, Angola

This prospective study was carried out to assess the sensitivity and resistance pattern of lactose non-fermenting Escherichia coli from July 2018 to December 2018 in the Laboratory of Microbiology at Luanda Medical Center, Angola. Out of 1170 patient, a total of 120 urine specimens infected with Escherichia coli (>105 CFU/ml) were collected according to the routine protocol of urinalysis. Among these 120 isolates, 25 (21%) isolates were determined as “atypical”, lactose non-fermenting E. colis trains. The twenty-five lactose non-fermenting Escherichia coli strains isolated from urine samples in Luanda Medical Center were declared as Multiple Drugs-Resistant strains with high resistance to Cefalexine (100%), Cefuroxime (100%), Ceftriaxone (92%), Gentamycin (92%), Ciprofloxacin (72%) and Amoxiciclin/Clavulanic (80%). The alarming resistance level to the first-choice drugs for the treatment of urinary tract infections caused by non-fermentative lactose E. coli was observed.

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.

Analysis on Immune Tolerance and Resistance Mechanism of <i>Cryptococcus albidus</i>of AIDS Patients with Opportunistic Cryptococci Infection

Objective: To explore more about the immune tolerance and drug resistance of white Cryptococci albidus in AIDS patients with opportunistic Cryptococcus infection. Methods: To analyze drug resistance of the samples of white Cryptococcus albidus extracted from opportunistic infection AIDS patients in the certain infection area from October 2011 to December 2014. Results: After analyzing two samples of Cryptococcus albidus from 885 cases with opportunistic infection, we found that one of the samples do resist to ten common antibiotics. They were fluconazole, flu-cytosine, fluconazole, caspofungin, amphotericin B, MI miconazole, terbinafine, ketoconazole and itraconazole. The other one was sensitive to voriconazole, but resistant to the rest of the drug. Two strains of bacteria were inoculated into the animals in vivo and their DNA was extracted to carry out the genotyping analysis. The results showed that different degrees of resistance gene amplification bands were found in the 10 kinds of antibiotics. Conclusion: Although there were few opportunistic infection Cryptococcus albidus in AIDS patients, it was easy to show its resistance to drugs. Therefore, great attention should be paid to it for the medical workers.

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.

Distribution and drug resistance of pathogens in burn patients in China from 2006 to 2019

BACKGROUND In this study,recent trends in the distribution and drug resistance of pathogenic bacteria isolated from patients treated at a burn ward between 2006 and 2019 were investigated.AIM To develop more effective clinical strategies and techniques for the prevention and treatment of bacterial infections in burn patients.METHODS Clinical samples with positive bacteria were collected from patients at the burn ward in Beijing Jishuitan Hospital in China between January 2006 and December 2019.The samples were retrospectively analyzed,the distribution of pathogenic bacteria was determined,and the trends and changes in bacterial drug resistance during different period were assessed.Drug resistance in several main pathogenic bacteria from 2006 to 2011 and from 2012 to 2019 was comparatively summarized and analyzed.RESULTS Samples from 17119 patients were collected and analyzed from 2006 to 2019.Surprisingly,a total of 7960 strains of different pathogenic bacteria were isolated at this hospital.Among these bacteria,87.98%(7003/7960)of the strains were isolated from burn wounds,and only 1.34%(107/7960)were isolated from the blood of patients.In addition,49.70%(3956/7960)were identified as Grampositive bacteria,48.13%(3831/7960)were Gram-negative bacteria,and the remaining 2.17%(173/7960)were classified as fungi or other pathogens.Importantly,Staphylococcus aureus(21.68%),Pseudomonas aeruginosa(14.23%),and Staphylococcus epidermidis (9.61%) were the top three pathogens most frequentlyisolated from patients.CONCLUSION In patients treated at the burn ward in this hospital from 2006 to 2019,Staphylococcus aureus and Pseudomonas aeruginosa were the predominant clinicalpathogens responsible for bacterial infections. The circumstantial detection anddetailed monitoring of the intensity and growth of different pathogenic bacteria inclinical patients as well as tests of drug sensitivity during burn recovery areparticularly important to provide guidelines for the application of antibiotics andother related drugs. Careful collection and correct, standard culture of bacterialspecimens are also crucial to improve the efficiency of bacterial infectiondetection. Effective monitoring and timely clinical treatment in patients may helpreduce the possibility and rate of infection as well as alleviate the effects of drugresistance among patients in burn centers.

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.

Microbial spectrum and drug resistance of pathogens cultured from gallbladder bile specimens of patients with cholelithiasis:A singlecenter retrospective study

BACKGROUND Bacterial infection is an important cause of cholelithiasis or gallstones and interferes with its treatment.There is no consensus on bile microbial culture profiles in previous studies,and identified microbial spectrum and drug resistance is helpful for targeted preventive and therapeutic drugs in the perioperative period.AIM To analyze the bile microbial spectrum of patients with cholelithiasis and the drug susceptibility patterns in order to establish an empirical antibiotic treatment for cholelithiasis-associated infection.METHODS A retrospective single-center study was conducted on patients diagnosed with cholelithiasis between May 2013 and December 2018.RESULTS This study included 185 patients,of whom 163(88.1%)were diagnosed with gallstones and 22(11.9%)were diagnosed with gallstones and common bile duct stones(CBDSs).Bile culture in 38 cases(20.5%)was positive.The presence of CBDSs(OR=5.4,95%CI:1.3-21.9,P=0.03)and longer operation time(>80 min)(OR=4.3,95%CI:1.4-13.1,P=0.01)were identified as independent risk factors for positive bile culture.Gram-negative bacteria were detected in 28 positive bile specimens,and Escherichia coli(E.coli)(19/28)and Klebsiella pneumoniae(5/28)were the most frequently identified species.Gram-positive bacteria were present in 10 specimens.The resistance rate to cephalosporin in E.coli was above 42%and varied across generations.All the isolated E.coli strains were sensitive to carbapenems,with the exception of one imipenem-resistant strain.K.pneumoniae showed a similar resistance spectrum to E.coli.Enterococcus spp.was largely sensitive to glycopeptides and penicillin,except for a few strains of E.faecium.CONCLUSION The presence of common bile duct stones and longer operation time were identified as independent risk factors for positive bile culture in patients with cholelithiasis.The most commonly detected bacterium was E.coli.The combination ofβ-lactam antibiotics andβ-lactamase inhibitors prescribed perioperatively appears to be effective against bile pathogens and is recommended.Additionally,regular monitoring of emerging resistance patterns is required in the future.

The Increased Frequency of Carbapenem Resistant Non Fermenting Gram Negative Pathogens as Causes of Health Care Associated Infections in Adult Cancer Patients

Background and Aim: Multi drug resistant Non fermenting gram negative bacilli (NFGNB) have emerged as a major cause of health-care associated infections especially in immunocompromised hosts. The aim of the study was to investigate the prevalence of NFGNB as a cause of health-care associated infections (HAI) in cancer patients and determine their resistance pattern. Patients and Methods: During the study period, 158 NFGNB isolates were collected. Microscan Walk Away 9 was used for identification and testing for the metallo-β-lactamases (MBLs) was done by Imipenem-EDTA combined disk synergy test (CDST-IPM). Results: NFGNB represented 29.0% of infections caused by gram negative organisms. Carbapenem resistance, the multi-drug resistant (MDR) phenotype, and MBL production were documented in 70%, 63%, and 59% of NFGNB isolates, respectively. MDR-NFGNB rates were significantly higher among hospitalized patients, medical department and those with longer duration of hospital stay (p = 0.034, 0.026, 0.019;respectively) than non MDR-NFGNB. Conclusion: A high level of carbapenem and multi-drug resistance were detected among the non-fermenter pathogens isolated from hospitalized cases and were more frequently encountered in high risk adult cancer patients requiring longer duration of hospitalization. The MDR-NFGNB are constituting important causes of health-care associated infections in cancer patients.

Prevalence,serotyping and drug susceptibility patterns of Escherichia coli isolates from kidney transplanted patients with urinary tract infections

BACKGROUND Extended-spectrumβ-lactamase(ESBL)-producing Escherichia coli(E.coli)are among the main pathogens in urinary tract infections(UTIs)among kidney transplant patients(KTPs).AIM To estimate the prevalence of ESBL-producing E.coli in KTPs and to evaluate the most prevalent serotypes and antibacterial susceptibility patterns of isolated bacteria in Tehran,Iran.METHODS A total of 60 clinical isolates of uropathogenic E.coli were collected from 3 kidney transplant centers from April to May 2019.Antimicrobial susceptibility testing was performed by the disk diffusion method as recommended by the Clinical Laboratory and Standards Institute.The serotyping of E.coli isolates was performed by the slide agglutination method.The presence of blaTEM,blaSHV,and bla CTX-M genes was evaluated by polymerase chain reaction.RESULTS The frequency of ESBL-producing E.coli in KTPs was found to be 33.4%.All of the 60 E.coli isolates were found to be susceptible to doripenem(100%)and ertapenem(100%).High resistance rates to ampicillin(86%),cefotaxime(80%),and cefazolin(77%)were also documented.The most frequent serotypes were serotype I(50%),serotype II(15%),serotype III(25%),and serotype VI(10%).The gene most frequently found was blaTEM(55%),followed by blaCTX-M(51%)and blaSHV(41%).CONCLUSION Molecular analysis showed that blaTEM was the most common ESBL-encoding gene.The high resistance toβ-lactams antibiotics(i.e.,ampicillin,cefotaxime,and cefazolin)found in E.coli from KTPs with UTIs remains a serious clinical challenge.Further efforts to control ESBL-producing E.coli should include the careful use of all antibiotics as well as barrier precautions to reduce spread.

HIV Genetic Diversity, Virological Failure, and Drug Resistance in Libreville, Capital of Gabon, before a Total Dolutegravir-Based Regimen Transition

Context: The Human Immunodeficiency Virus (HIV) continues to be the main public health challenge in Gabon. The latest studies highlight a high rate of virological failure and HIV drug resistance in semi-rural Gabon. In Libreville, virological failure data is sparse, data on HIV drug resistance for the former first line and new first-line regimen is lacking. Methods: Between January 28th, 2019, and January 31st, 2020, we received patient living with HIV (PLWHA) for CD4 counts, HIV-1 viral load, and/or genotyping of HIV-1 mutation drug resistance. We used the BD FACSPresto for CD4 count, the Biocentric Generic HIV viral load test for HIV-1 quantification, and the HIV-1 drug resistance mutation genotyping (ARNS protocol). Results: A total of 1129 HIV-1 patients have been enrolled for this study. The median age was 46 years old and the median of CD4 was 386 cells per cubic millimeter. The virological suppression success was observed at 62.7% of patients on the former first line regimen and 70.6% of the patient on DBR. We successfully amplified and analyzed 76 sequences and noticed the presence of the nineteen different subtypes with the predominance of the subtypes CRF02-AG (37.95%), followed by subtype A (22.3%). For HIV drug resistance analyses, 108 (65.1%) had resistance mutation to nucleoside reverse transcriptase inhibitors (NRTIs);of these, 91 (84%) present M184V/I. When looking for NNRTI mutations, 119 (71.7%) sequences had at least one mutation. Of these, 82 had K103N (68.9%), representing the main NNRTI mutations. The pattern showing the high level of resistance (HLR) in all molecules of NRTIs and NNRTIs, except for the TDF (intermediate resistance) was M41L-E44DL74I-M184-L210W-T215Y-K101P-K103N-V106I. Conclusion: This report paints a picture of a relatively female-dominated HIV-infected Gabonese population with a low level of immunity. The level of drug resistance with the former first-line regimen suggests the need to monitor the drug Dolutegravir resistance.

The emergence of drug resistant HIV variants and novel anti-retroviral therapy

After its identification in 1980s,HIV has infected more than 30 million people worldwide.Inthe era of highly active anti-retroviral therapy,anti-retroviral drug resistance results frominsufficient anti-retroviral pressure,which may lead to treatment failure.Preliminary studiessupport the idea that anti-retroviral drug resistance has evolved largely as a result of low-adherence of patients to therapy and extensive use of anti-retroviral drugs in the developedworld;however,a highly heterogeneous horde of viral quasi-species are currently circulating indeveloping nations.Thus,the prioritizing of strategies adopted in such two worlds should be quitedifferent considering the varying anti-retroviral drug resistance prevalence.In this article,weexplore differences in anti-retroviral drug resistance patterns between developed and developingcountries,as they represent two distinct ecological niches of HIV from an evolutionary standpoint.

New determinants of prognosis in bacterial infections in cirrhosis

Despite major advances in the knowledge and management of liver diseases achieved in recent decades,decompensation of cirrhosis still carries a high burden of morbidity and mortality.Bacterial infections are one of the main causes of decompensation.It is very important for clinical management to be aware of the population with the highest risk of poor outcome.This review deals with the new determinants of prognosis in patients with cirrhosis and bacterial infections reported recently.Emergence of multiresistant bacteria has led to an increasing failure rate of the standard empirical antibiotic therapy recommended by international guidelines.Moreover,it has been recently reported that endothelial dysfunction is associated with the degree of liver dysfunction and,in infected patients,with the degree of sepsis.It has also been reported that relative adrenal insufficiency is frequent in the non-critically ill cirrhotic population and it is associated with a higher risk of developing infection,severe sepsis,hepatorenal syndrome and death.We advise a change in the standard empirical antibiotic therapy in patients with high risk for multiresistant infections and also to take into account endothelial and adrenal dysfunction in prognostic models in hospitalized patients with decompensated cirrhosis.

Antibiotic resistance pattern of Pseudomonas aeruginosa wound isolates among Chinese burn patients:A systematic review and meta analysis

Objective:To investigate the resistance profiles to antimicrobial agents of wound-isolated Pseudomonas(P.)aeruginosa among Chinese burn patients.Methods:Electronic databases and manual search were used to identify eligible studies published since 2010.The objectives were pooled resistance rates for eleven common antimicrobial agents,estimated by a random-effects model.Subgroup analyses were conducted by stratifying the studies into three four-year periods based on year of isolation.Results:A total of 35 studies were included.Gentamicin had the highest pooled resistance rate(56%,95%CI 48%-64%),while meropenem had the lowest pooled resistance rate(29%,95%CI 20%-40%).There was an increasing trend of resistance to common antimicrobial agents of wound-isolated P.aeruginosa over a span of twelve years(2009-2020).There remained the highest risk of gentamicin resistance over time in China.Subgroup analyses indicated significantly higher resistances to ceftazidime and levofloxacin from 2017 to 2020.Conclusions:Enhanced resistance to common antimicrobial agents in wound-isolated P.aeruginosa presents a challenge in burn wound management in China's Mainland.Effective stewardship programs should be established based on corresponding resistance profiles,thereby optimizing treatment options for hospitalized burn patients.