Antimicrobial resistance profiles and associated factors of Acinetobacter and Pseudomonas aeruginosa nosocomial infection among patients admitted at Dessie comprehensive specialized Hospital, North-East Ethiopia. A cross-sectional study

Prevalence of phenotypic drug resistance profiles and multi-drug-resistant Pseudomonas and Acinetobacter species recovered from clinical specimens in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Antimicrobial-resistant Pseudomonas and Acinetobacter species are emerging as serious public health risks, both globally and in resource-limited countries such as Ethiopia. These microorganisms cause serious, life-threatening infections and are becoming increasingly resistant to commonly prescribed antibiotics. The high prevalence and resistance patterns of these bacteria need immediate action to inform treatment guidelines, increase infection control measure, and develop effective public health policies. This systematic review and meta-analysis aimed to assess the prevalence of phenotypic drug resistance profiles and multi-drug-resistant Pseudomonas and Acinetobacter species recovered from clinical specimens in Ethiopia.

METHODS

This systematic review and meta-analysis, which followed PRISMA principles, analyzed data from PubMed, Scopus, and Google Scholar to determine the prevalence and antibiotic resistance trends of Pseudomonas and Acinetobacter species in Ethiopia. Eligible studies were extracted by using Microsoft Excel and exported to STATA version 17 for analysis. The pooled prevalence was estimated using a random-effects model, and heterogeneity was examined using the I2 statistic. Publication bias was investigated using funnel plot analysis and Egger's test, and sensitivity analysis was used to assess the impact of individual studies on the total pooled findings.

RESULT

Of the 1,375 studies identified, 187 were eligible for qualitative analysis, leading to the inclusion of 65 studies in the meta-analysis. This analysis encompassed a total of 1,264 isolates, with 364 identified as Pseudomonas and Acinetobacter species. The systematic review revealed a pooled prevalence of 19.12% (95% CI: 14.86-23.38) for Pseudomonas species and 12.46% (95% CI: 5.82-19.10) for Acinetobacter species. The combined prevalence of both pathogens was 25.31 (95% CI: 18.61-32.00) with substantial heterogeneity (I2 = 93.6%, p < 0.001). across the studies. Pseudomonas exhibited high resistance rates to amoxicillin-clavulanic Acid (83.73%) and tetracycline (89.15%), while Acinetobacter showed 87.21% resistance to tetracycline and 79.72% to ceftriaxone. The overall pooled prevalence of MDR Pseudomonas species was 72.73% (95% CI: 67.02-78.44), and for Acinetobacter species, it reached 84.69% (95% CI: 78.78-90.59), respectively. Moreover, the pooled prevalence of MDR for both species isolated from clinical samples in Ethiopia was 74.79% (95% CI: 70.14-79.43), with significant heterogeneity (I2 = 99.7%, p < 0.001) across the studies.

CONCLUSION

The pooled prevalence of Pseudomonas and Acinetobacter species and their antibiotic resistance were alarmingly high in clinical samples in Ethiopia. These findings highlight the crucial need for more antimicrobial surveillance, stronger stewardship programs, and targeted research to combat the growing threat of resistance. Strategic public health policies are required to decrease these pathogens.

Chemical Synthetic Lethality Screens Identify Selective Drug Combinations against Pseudomonas aeruginosa

The emergence of bacterial ESKAPE pathogens presents a formidable challenge to global health, necessitating the development of innovative strategies for antibiotic discovery. Here, we leverage chemical synthetic lethality to locate therapeutic combinations of small molecules against multidrug-resistant Pseudomonas aeruginosa. Using a transposon screen, we identify PyrD as a target for sensitizing P. aeruginosa to subinhibitory doses of ceftazidime. High-throughput inhibitor screens identify two PyrD inhibitors, nordihydroguaiaretic acid (NDGA) and chlorhexidine (CHX), each of which does not significantly affect growth in isolation but exhibits chemical synthetic lethality when combined with low-dose ceftazidime. Downstream biochemical studies elucidate the mechanism of inhibition by NDGA and CHX. Remarkably, this combination is toxic to P. aeruginosa but leaves commensal bacteria, which are more susceptible to antibiotics, unscathed. Aside from advancing drug combinations that may be explored further in the future, our results offer a new approach for devising potent and specific drug combinations against recalcitrant pathogens.

Antimicrobial resistance pattern of Acinetobacter baumannii clinical isolate in Ethiopia. A systematic review and meta-analysis

BACKGROUND

Antimicrobial resistance (AMR) is a growing global health threat. Acinetobacter baumannii (A. baumannii) emerged as one of the most concerning critical priority pathogens due to its ability to develop resistance to multiple antimicrobial agents. In Ethiopia, the public health impact of AMR is increasingly significant, with A. baumannii responsible for a variety of infections. Although A. baumannii causes a range of infections in Ethiopian patients, the drug resistance status of the clinical isolates has not been thoroughly assessed. Therefore, this systematic review and meta-analysis aimed to determine the country-wide AMR of A. baumannii.

METHODS

This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted a search of articles on PubMed, Web of Science, Science Direct, Scopes electronic databases, Google Scholar search engine, and institutional repositories/libraries for studies published between 2015 and 2024. Eligible studies on A. baumannii-related infections and AMR in Ethiopia were assessed for quality using the Joanna Briggs Institute (JBI) criteria. Data on study characteristics were extracted, and statistical analyses, including heterogeneity (Invers of variance), publication bias (Eggers test), and subgroup analyses, were performed using STATA 17.0. A random effect model was used to compute the pooled prevalence of AMR.

RESULTS

This systematic review and meta-analysis of 26 Ethiopian studies (26,539 participants) found an A. baumannii prevalence of 3.99% (95% CI: 3.01-4.98%) and 9.13% of all bacterial infections (95% CI: 6.73-11.54%). The most common infections were surgical site infections, urinary tract infections, pneumonia, and sepsis. Pooled resistance to antibiotics varied, with amikacin showing the lowest resistance (20.27%) (95% CI: 11.51-29.03) and cefotaxime the highest (83.18) (95% CI: 71.87-94.48). A pooled multi-drug resistant (MDR) A. baumannii was found in 88.22% (95% CI: 82.28-94.15) of isolates, with regional and infection-type variations, particularly in higher prevalence in Oromia and Amhara regions and sepsis cases.

CONCLUSION

This systematic review underscores the alarming rise of antimicrobial resistance in A. baumannii, particularly against carbapenems. The findings highlight a high prevalence of MDR A. baumannii and widespread extended-spectrum beta-lactamase production, with notable regional variations in resistance patterns. These high resistance rates reinforce A. baumannii as a critical global health threat, necessitating urgent interventions such as enhanced antimicrobial stewardship programs, improved infection control measures, and the development of alternative treatment strategies. Healthcare professionals, policymakers, and researchers must collaborate to mitigate the clinical and public health impact of this pathogen.

PROTOCOL REGISTRATION

This systematic review and meta-analysis was registered on PROSPERO (Registration ID: CRD42024623927).

Magnitude of Health Care Associated Infections and its Clinical Predictors in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Health care-acquired infections (HCAIs) are the growing global public health problems facing today requiring an immediate collaborative action of stockholders to be prevented and controlled. Thus, this study was aimed to assess the magnitude and clinical related factors of HCAIs in Ethiopia.

METHODS

Articles were extensively searched in bibliographic databases and grey literatures using entry terms or phrases. Studies meeting eligibility criteria was extracted in Ms excel and exported in to STATA version 17 software for statistical analysis. A random-effect model was used to compute the pooled magnitude of HCAIs using meta-prop. The heterogeneity was quantified by using the I2 value. Publication bias was assessed using a funnel plot and Egger's test. Sensitivity analysis, meta-regression and subgroup analysis were computed.

RESULT

Of the 1707 studies identified, 33 studies were selected for meta-analysis of magnitude of HCAIs. The overall pooled prevalence of HCAIs in Ethiopia was 37% (95% CI: 27.0-47.0%). The predominant bacterial aetiologies were E. coli. There was no single study effect and publication bias. Diabetes mellitus, comorbidities, contaminated wound, history of UTI and history of admission in ICU were statistically significant clinical predictors of HCAIs.

CONCLUSION

the pooled prevalence of HCAIs have alarmingly increased which underscores the importance of implementation of personalized infection prevention and control approach which identifies patients at risk of HCAIs from the point of admission maximizes the potential for prevention of HCAIs.

Multicenter Surveillance of Pseudomonas aeruginosa Isolates From Blood: Clinical Distribution Characteristics and Antibiotic Resistance Trends in Hebei Province, China (2016-2021)

Purpose

To analyze the clinical distribution and antimicrobial resistance of Pseudomonas aeruginosa (P. aeruginosa) isolated from blood specimens in 75 hospitals in Hebei Province from 2016 to 2021 to aid in the rational selection of antimicrobial drugs.

Patients and Methods

WHONET 5.6 and SPSS 24.0 were used to retrospectively analyze clinical distribution characteristics and variations in drug-resistance.

Results

Between 2016 and 2021, 2208 P. aeruginosa strains were detected in blood specimens from Hebei Province. The median age of the patients with isolated P. aeruginosa was 63 years, with a male-to-female ratio of 2.1:1. Predominantly, patients were in the hematology (20.7%) and critical care medicine (18.4%) departments. During the monitoring period, the resistance rate of P. aeruginosa to various antibacterial drugs, such as aminoglycosides, fluoroquinolones, and carbapenems, decreased to varying degrees, with an average resistance rate of less than 20.0% over six years. Resistance rates were notably higher in pediatric and intensive care medicine, particularly in neonatal patients, where resistance to antimicrobial drugs, such as piperacillin/tazobactam, gentamicin, ciprofloxacin, and levofloxacin, exceeded 75%.

Conclusion

The main isolates of P. aeruginosa were from elderly and intensive care patients, with a male predominance. From 2016 to 2021, the resistance rate of P. aeruginosa isolated from blood specimens in Hebei Province to various antibiotics such as aminoglycosides, fluoroquinolones, and carbapenems decreased to varying degrees. The resistance rates are high in pediatric and intensive care medicine, especially among neonatal patients. However, resistance to antibiotics varies with age and department, necessitating tailored antimicrobial administration. The issue of antibacterial drug resistance in newborn patients is concerning, and special attention is needed when during treatment.

Decoding MexB efflux pump genes: structural, molecular, and phylogenetic analysis of multidrug-resistant and extensively drug-resistant Pseudomonas aeruginosa

Objective

Emerging drug resistance in Pseudomonas aeruginosa is of great concern in clinical settings. P. aeruginosa activates its efflux-pump system in order to evade the effect of antibiotics. The current investigation aims to detect MexB genes in P. aeruginosa, their structural and molecular analysis and their impact on antimicrobial susceptibility profiling.

Methods

A total of 42 clinical specimens were aseptically collected from hospitalized patients who had underlying infections related to medical implants. Matrix-assisted laser desorption ionization-time of flight (MALDI-ToF) were used for the identification of isolates. The methods used in this study were antibiotic susceptibility profiling, minimum inhibitory concentration (MIC), polymerase chain reaction (PCR), sanger sequencing, phylogenetic analysis, MolProbity score, Ramachandran plot analysis and multiple sequence alignment.

Results

The highest resistance was shown by P. aeruginosa against cefoperazone (67%), gentamycin and amikacin (66%) each, followed by cefotaxime (64%). The prevalence of multi-drug resistant (MDR) and extensively drug resistant (XDR) was 57% and 12%, respectively. The presence of an active efflux-pump system was indicated by the MexB genes found in most of the resistant isolates (p<0.05). Following addition of efflux pump inhibitor carbonyl cyanide m-chlorophenyl hydrazone (CCCP), a significant decrease (p<0.05) in MIC was observed in resistance, that revealed the presence of active efflux pump system. Phylogenetic analysis revealed evolutionary relationships with the P. aeruginosa strains isolated in Switzerland, Denmark and Germany. Protein domain architecture revealed that MexB gene proteins were involved in particular efflux pump function. Protein sequences aligned by multiple sequence alignment revealed conserved regions and sequence variants, which suggested antibiotic translocation and evolutionary divergence. These highly conserved regions could be used for diagnostic purposes of efflux pump MexB genes.

Conclusion

To avoid their spread in hospital settings, responsible authorities ought to begin rigorous initiatives in order to reduce the prevalence of multi-drug resistant, extensively drug resistant, and efflux pump carrying isolates in clinical settings.

Inhibition of Pseudomonas aeruginosa Biofilm Formation Using Silver Nanoparticles

Background and aim Nanotechnology explores the unique properties of nanoparticles, which are very dissimilar from their bulk forms. Silver (Ag) has been exhibited to have antimicrobial and antibiofilm properties; since ancient times, silver has been used for its therapeutic qualities. Currently, medical research is investigating the activity and potential uses of silver nanoparticles (AgNPs). Pseudomonas aeruginosa is frequently seen in nosocomial settings because of its capacity to form biofilms on medical devices, implants, and instruments, which increases the risk of infection in hospitalized patients. When P. aeruginosa forms biofilms, it becomes more resistant to antimicrobials and can persist on medical equipment. Biofilms contribute to drug resistance and can drive the progression from acute to chronic diseases. Novel approaches can be aimed at a co-treatment strategy that mixes a drug that disrupts biofilms with conventional antibiotics, and this may make the biofilms more susceptible to treatment. In the present investigation, we study the antibiofilm effect of AgNPs against the biofilm production of P . aeruginosa. Materials and methods The study included 196 P . aeruginosa isolates from specimens at Krishna Hospital & Medical Research Center, Karad. Identification (ID) and antibiotic susceptibility testing (AST) were done by using the VITEK 2 compact system (BioMérieux, France). Biofilm production and antibiofilm assays were evaluated using the tissue culture plate (TCP) method. Results Biofilm production was observed in 171 (87.24%) of isolates, with 25 (12.76%) being non-biofilm producers. Among biofilm producers, 91 (46.43%) were weak, 58 (29.59%) moderate, and 22 (11.22%) strong. At 400 µg/mL of AgNP concentration, 68 (85%) of isolates showed 60%-90% inhibition. Conclusions P . aeruginosa is a significant hospital-associated pathogen, as indicated by its isolation rate of 16.15%, emphasizing its clinical importance. Notably, 87% of isolates were biofilm producers. Nanotechnology, particularly AgNPs, presents promising solutions for combating biofilms, offering versatile and effective approaches for healthcare and industrial applications.

Preparation and Characterization of Essential oil from Lavandula spica Plant and its Antimicrobial Activity against Pseudomonas aeruginosa and Staphylococcus aureus

The biological properties of herbs and essential oils (EOs), such as their antibacterial, analgesic, anti-inflammatory, antioxidant, and anticancer characteristics, make them widely used in a variety of fields. This research aims to assess the antibacterial efficacy of lavender oil against Staphylococcus aureus (S. aureus) and Pseudomonas aeruginosa (P. aeruginosa). The essential oil from Lavandula spica was extracted via water distillation and characterized by using Gas Chromatography-Mass Spectrometry (GC-MS) and Fourier Transform Infrared Spectroscopy (FTIR). Bacterial strains were isolated from burn wounds, confirmed by polymerase chain reaction technique, and were tested using disc diffusion method and Minimum Inhibitory Concentration (MIC) calculations. The study identified 28 components in the EO, with monoterpenes being the predominant. Out of 150 samples, 56 (45.52 %) were positive for P. aeruginosa and 67 (54.47 %) for S. aureus by using standard microbiological techniques including Gram staining, biochemical tests and Polymerase chain reaction technique. P. aeruginosa showed high resistance to cefazolin (100 %) and levofloxacin (83.3 %), while S. aureus was highly resistant to cefoxitin, piperacillin, amoxicillin/clavulanic acid, and ampicillin/sulbactam. The zone of inhibition and MIC for EO against P. aeruginosa were 9.910 ± 0.866 and 2.376 ± 0.352 while for S. aureus were 10.597 ± 0.818 and 0.894 ± 0.073 respectively with significance levels of p > 0.05 and p < 0.01. The study concluded that L. spica EO shows promising antimicrobial activity, particularly against Gram-positive bacteria suggesting its potential for further research and antimicrobial use.

Antimicrobial resistance profile, biofilm forming capacity and associated factors of multidrug resistance in Pseudomonas aeruginosa among patients admitted at Tikur Anbessa Specialized Hospital and Yekatit 12 Hospital Medical College in Addis Ababa, Ethiopia

BACKGROUND

Pseudomonas aeruginosa is one of the leading causes of nosocomial infections and the most common multidrug-resistant pathogen. This study aimed to determine antimicrobial resistance patterns, biofilm-forming capacity, and associated factors of multidrug resistance in P. aeruginosa isolates at two hospitals in Addis Ababa, Ethiopia.

METHODS

A cross-sectional study was conducted from August 2022 to August 2023 at Tikur Anbessa Specialized Hospital and Yekatit 12 Hospital Medical College. Culture and identification of P. aeruginosa were done using standard microbiological methods. An antimicrobial susceptibility test was done by Kirby-Bauer disk diffusion according to CLSI recommendations. The microtiter plate assay method was used to determine biofilm-forming capacity. SPSS version 25 was used for data analysis. Bivariate and multivariable logistic regression were used to assess factors associated with multidrug resistance in P. aeruginosa. The Spearman correlation coefficient (rs = 0.266)) was performed to evaluate the relationship between biofilm formation and drug resistance.

RESULTS

The overall prevalence of P. aeruginosa was 19.6%. High levels of resistance were observed for ciprofloxacin (51.8%), ceftazidime (50.6%), and cefepime (48.2%). The level of multidrug-resistance was 56.6%. The isolates showed better susceptibility to ceftazidime-avibactam (95.2%) and imipenem (79.5%). Overall, 95.2% of P. aeruginosa were biofilm-producing isolates, and 27.7% and 39.8% of isolates were strong and moderate biofilm producers, respectively. A positive correlation and statistically significant relationship was observed between resistance to multiple drugs and the level of biofilm formation (rs = 0.266; p-value = 0.015). Previous history of exposure to ciprofloxacin (OR, 5.1; CI, 1.12-24.7, p-value, 0.032) was identified as an independent associated factor for multidrug resistance in P. aeruginosa.

CONCLUSION

The present study indicates an association between multidrug resistance in P. aeruginosa and its biofilm formation capabilities. Additionally, over half of the isolates were resistant to multiple drugs, with prior use of ciprofloxacin linked to the development of multidrug-resistance. These findings suggest that antibiotic stewardship programs in hospital settings may be beneficial in addressing resistance.

Geographical mapping and temporal trends of Acinetobacter baumannii carbapenem resistance: A comprehensive meta-analysis

BACKGROUND

Carbapenem-resistant Acinetobacter baumannii (CRAB) is of critical concern in healthcare settings, leading to limited treatment options. In this study, we conducted a comprehensive meta-analysis to assess the prevalence of CRAB by examining temporal, geographic, and bias-related variations.

METHODS

We systematically searched prominent databases, including Scopus, PubMed, Web of Science, and EMBASE. Quality assessment was performed using the JBI checklist. Subgroup analyses were performed based on the COVID-19 timeframes, years, countries, continents, and bias levels, antimicrobial susceptivity test method and guidelines.

RESULTS

Our comprehensive meta-analysis, which included 795 studies across 80 countries from 1995 to 2023, revealed a surge in carbapenem resistance among A. baumannii, imipenem (76.1%), meropenem (73.5%), doripenem (73.0%), ertapenem (83.7%), and carbapenems (74.3%). Temporally, 2020-2023 witnessed significant peaks, particularly in carbapenems (81.0%) and meropenem (80.7%), as confirmed by meta-regression, indicating a steady upward trend.

CONCLUSION

This meta-analysis revealed an alarmingly high resistance rate to CRAB as a global challenge, emphasizing the urgent need for tailored interventions. Transparency, standardized methodologies, and collaboration are crucial for the accurate assessment and maintenance of carbapenem efficacy.

Distribution and Molecular Characterization of Antibiotic-Resistant Pseudomonas aeruginosa in Hospital Settings of Sulaymaniyah, Iraq

Pseudomonas aeruginosa is a significant pathogen in hospital settings, notorious for its role in hospital-acquired infections and its ability to develop resistance to multiple antibiotics. This study investigates the prevalence, distribution, and antibiotic resistance gene profiles of P. aeruginosa in seven hospitals in Sulaymaniyah City. A total of 300 samples were collected from various hospital surfaces including mops, sinks, medical equipment, beds, desks, and floors. Using bacteriological, biochemical, and molecular methods, 66 isolates were confirmed as Pseudomonas species, with 26 identified as P. aeruginosa. Antibiotic susceptibility testing revealed resistance rates of 23.3% to streptomycin, 13.6% to tobramycin, 22.7% to moxifloxacin, 21.2% to levofloxacin, and 22.7% to norfloxacin. Furthermore, the antibiotic resistance gene detection showed the presence of the bla CTX-M, bla SHV, qnrB, and bla ACC-1 genes among the isolates. The study highlights a 22% contamination rate of hospital surfaces with Pseudomonas species, emphasizing the urgent need for enhanced infection control measures and targeted antimicrobial stewardship to manage and reduce the spread of multidrug-resistant P. aeruginosa.

Prevalence and associated factors of cancer-related fatigue among adult patients with cancer attending oncology units: an institution-based cross-sectional study design in the Amhara region, Ethiopia, 2022

Introduction

Cancer-related fatigue (CRF) continues to be a common problem among most patients with cancer. It is a subjective feeling of tiredness, weakness or lack of energy. CRF has a significant impact on social interactions, everyday activities and the general quality of life of patients with cancer worldwide. However, little is known about CRF in Ethiopia as well as in the current study area. Therefore, the aim of this study was to assess the prevalence and associated factors of CRF among adult patients attending oncology units at the comprehensive specialised hospitals in the Amhara regional state of Ethiopia.

Methods

An institution-based cross-sectional study was conducted among adult patients with cancer undergoing treatment. A systematic random sampling technique was employed to select the study participants. An interviewer-administered questionnaire and participants' medical charts were used to collect the data. The questionnaire consisted of eight subsections, including sociodemographic characteristics, behavioural characteristics, Brief Fatigue Inventory, Performance Status Scale, Oslo Social Support Status, Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, and clinical and medical factors. The data were entered into EpiData V.4.6 and exported into SPSS V.26 for analysis. The participants' characteristics were compiled using descriptive statics. Bivariable and multivariable logistic regressions were used to identify associations between dependent and independent variables. Variables with a value of p<0.05 were considered statistically significant.

Result

A total of 326 randomly selected patients with cancer, undergoing treatment, participated in this study; the response rate was 94%. The prevalence of CRF was found to be 63.93% (95% CI 58.5% to 69.25%). Depression (adjusted OR (AOR) 1.975, 95% CI 1.009 to 3.865), poor sleep quality (AOR 3.309, 95% CI 1.057 to 10.345), poor performance status (AOR 1.983, 95% CI 1.176 to 4.70), cancer stage (AOR 3.242, 95% CI 1.016 to 10.342) and admitted patients with cancer (AOR 2.047, 95% CI 1.122 to 3.734) were associated with CRF.

Conclusion and recommendation

The prevalence of CRF was found to be high. Stage of cancer, poor sleep quality, poor performance status, depression and hospital admission were significant factors. The results show that healthcare providers should focus on risk factors as well as CRF through early screening and management.

Antimicrobial resistance profile of Pseudomonas aeruginosa clinical isolates from healthcare-associated infections in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Antimicrobial-resistant (AMR) bacterial infection is a significant global threat to the healthcare systems. Pseudomonas aeruginosa, the leading infectious agent in the healthcare setting is now one of the major threats due to AMR. A comprehensive understanding of the magnitude of AMR, particularly highly public health important pathogens such as P. aeruginosa, is necessary for the management of infections based on local information.

OBJECTIVE

This systematic review and meta-analysis aimed to determine the country-wide AMR of P. aeruginosa.

METHODS

Systematic searches were performed to retrieve articles from PubMed, Scopus, Web of Science, ScienceDirect electronic databases, Google Scholar search engine, and repository registrars from 2015 to 31st December 2023. Twenty-three studies that provided important data on AMR in P. aeruginosa were systematically reviewed and analyzed to determine the country-wide magnitude of P. aeruginosa AMR profile from healthcare-associated infections. AMR of P. aeruginosa to 10 different antibiotics were extracted separately into Microsoft Excel and analyzed using STATA 17.0. Cohen's kappa was computed to determine the agreement between reviewers, the Inverse of variance (I2) was used to evaluate heterogeneity across studies, and Egger's test to identify publication bias. A random effect model was used to determine the pooled resistance to each antibiotic. Subgroup analysis was performed by infection type and year of publication.

RESULTS

This systematic review and meta-analysis revealed that the pooled prevalence of P. aeruginosa in clinical specimens associated with HAI was 4.38%(95%CI: 3.00-5.76). The pooled prevalence of AMR in P. aeruginosa for different antibiotics varies, ranging from 20.9% (95%CI: 6.2-35.8) for amikacin to 98.72% (95%CI: 96.39-101.4) for ceftriaxone. The pooled resistance was higher for ceftriaxone (98.72%), Trimethoprim-sulfamethoxazole (75.41), and amoxicillin-clavulanic acid (91.2). In contrast relatively lower AMR were observed for amikacin (20.9%) and meropenem (28.64%). The pooled multi-drug resistance (MDR) in P. aeruginosa was 80.5% (95%CI: 66.25-93.84). Upon subgroup analysis by infection types and year of publication, P. aeruginosa isolated from healthcare-associated infections exhibited higher resistance to ceftazidime (94.72%) compared to isolates from mixed types of healthcare-associated infections (70.84%) and surgical site infections (57.84%). Antimicrobial resistance in gentamicin was higher during the periods of 2018-2020 (73.96%), while comparatively lower during 2021-2023 (42.69%) and 2015-2017 (29.82%).

CONCLUSIONS

Significantly high AMR and MDR were observed from this systematic review and meta-analysis. AMR obtained from this systematic review and meta-analysis urges the need for improved infection control, antimicrobial stewardship practices, and strengthened surveillance systems to control the spread of AMR and ensure effective treatment of P. aeruginosa infections.

PROTOCOL REGISTRATION

This systematic review and meta-analysis was registered on PROSPERO (Registration ID: CRD42024518145).

Biofilm Formation by Hospital-Acquired Resistant Bacteria Isolated from Respiratory Samples

BACKGROUND

Hospital-acquired resistant infections (HARI) are infections, which develop 48 h or more after admission to a healthcare facility. HARI pose a considerably acute challenge, due to limited treatment options. These infections are associated bacterial biofilms, which act as a physical barrier to diverse external stresses, such as desiccation, antimicrobials and biocides. We assessed the influence of multiple factors on biofilm production by HARI -associated bacteria.

METHODS

Bacteria were isolated from samples of patients with respiratory HARI who were hospitalized during 2020-2022 in north Israel. Following antibiotic susceptibility testing by disc diffusion or broth microdilution, biofilm formation capacities of resistant bacteria (methicillin-resistant staphylococcus aureus, extended spectrum beta-lactamase-producing Escherichia coli and Klebsiela pneumonia, and multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii) was assessed using the crystalline violet staining method. Data regarding season, time to infection, bacterial species, patient age and gender, year, and medical department were collected from the patient medical records.

RESULTS

Among the 226 study isolates, K. pneumonia was the most prevalent (35.4%) bacteria, followed by P. aeruginosa (23.5%), and methicillin-resistant staphylococcus aureus (MRSA) (21.7%). A significantly higher rate of HARI was documented in 2022 compared to 2020-2021. The majority of isolates (63.3%) were strong biofilm producers, with K. pneumonia (50.3%) being most dominant, followed by P. aeruginosa (29.4%). Biofilm production strength was significantly affected by seasonality and hospitalization length, with strong biofilm production in autumn and in cases where hospitalization length exceeded 30 days.

CONCLUSION

Biofilm production by HARI bacteria is influenced by bacterial species, season and hospitalization length.

Dramatic increase in antimicrobial resistance in ESKAPE clinical isolates over the 2010-2020 decade in India

RATIONALE AND OBJECTIVES

ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) constitute a threat to humans worldwide. India is now the most populous country. The goal was to investigate the evolution of the rates of antimicrobial resistance in ESKAPE pathogens across India over the 2010-20 decade.

METHODS

The data (89 studies) were retrieved from the Medline PubMed repository using specific keywords.

RESULTS

The study of 20 177 ESKAPE isolates showed that A. baumannii isolates were the most represented (35.9%, n = 7238), followed by P. aeruginosa (25.3%, n = 5113), K. pneumoniae (19.5%, n = 3934), S. aureus (16.3%, n = 3286), E. faecium (2.6%, n = 517) and Enterobacter spp. (0.4%, n = 89). A notable increase in the resistance rates to antimicrobial agents occurred over the 2010-20 decade. The most important levels of resistance were observed in 2016-20 for A. baumannii (90% of resistance to the amoxicillin-clavulanate combination) and K. pneumoniae (81.6% of resistance to gentamycin). The rise in β-lactamase activities was correlated with an increase in the positivity of Gram-negative isolates for β-lactamase genes.

CONCLUSIONS

This review highlighted that, in contrast to developed countries that kept resistance levels under control, a considerable increase in resistance to various classes of antibiotics occurred in ESKAPE pathogens in India over the 2010-2020 decade.

Antimicrobial resistance in bacterial wound, skin, soft tissue and surgical site infections in Central, Eastern, Southern and Western Africa: A systematic review and meta-analysis

Antimicrobial resistance (AMR) is a major global threat and AMR-attributable mortality is particularly high in Central, Eastern, Southern and Western Africa. The burden of clinically infected wounds, skin and soft tissue infections (SSTI) and surgical site infections (SSI) in these regions is substantial. This systematic review reports the extent of AMR from sampling of these infections in Africa, to guide treatment. It also highlights gaps in microbiological diagnostic capacity. PubMed, MEDLINE and Embase were searched for studies reporting the prevalence of Staphylococcus aureus, Eschericheria coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii in clinically infected wounds, SSTI and SSI in Central, Eastern, Southern or Western Africa, and studies reporting AMR from such clinical isolates. Estimates for proportions were pooled in meta-analyses, to estimate the isolation prevalence of each bacterial species and the proportion of resistance observed to each antibiotic class. The search (15th August 2022) identified 601 articles: 59 studies met our inclusion criteria. S. aureus was isolated in 29% (95% confidence interval [CI] 25% to 34%) of samples, E. coli in 14% (CI 11% to 18%), K. pneumoniae in 11% (CI 8% to 13%), P. aeruginosa in 14% (CI 11% to 18%) and A. baumannii in 8% (CI 5% to 12%). AMR was high across all five species. S. aureus was resistant to methicillin (MRSA) in >40% of isolates. E. coli and K. pneumoniae were both resistant to amoxicillin-clavulanic acid in ≥80% of isolates and resistant to aminoglycosides in 51% and 38% of isolates respectively. P. aeruginosa and A. baumannii were both resistant to anti-pseudomonal carbapenems (imipenem or meropenem) in ≥20% of isolates. This systematic review found that a large proportion of the organisms isolated from infected wounds, SSTI and SSI in Africa displayed resistance patterns of World Health Organisation (WHO) priority pathogens for critical or urgent antimicrobial development.

Prevalence of meropenem-resistant Pseudomonas Aeruginosa in Ethiopia: a systematic review and meta‑analysis

INTRODUCTION

Antimicrobial resistance (AMR) is a pressing global health concern, particularly pronounced in low-resource settings. In Ethiopia, the escalating prevalence of carbapenem-resistant Pseudomonas aeruginosa (P. aeruginosa) poses a substantial threat to public health.

METHODS

A comprehensive search of databases, including PubMed, Scopus, Embase, Hinari, and Google Scholar, identified relevant studies. Inclusion criteria encompassed observational studies reporting the prevalence of meropenem-resistant P. aeruginosa in Ethiopia. Quality assessment utilized JBI checklists. A random-effects meta-analysis pooled data on study characteristics and prevalence estimates, with subsequent subgroup and sensitivity analyses. Publication bias was assessed graphically and statistically.

RESULTS

Out of 433 studies, nineteen, comprising a total sample of 11,131, met inclusion criteria. The pooled prevalence of meropenem-resistant P. aeruginosa was 15% (95% CI: 10-21%). Significant heterogeneity (I2 = 83.6%) was observed, with the number of P. aeruginosa isolates identified as the primary source of heterogeneity (p = 0.127). Subgroup analysis by infection source revealed a higher prevalence in hospital-acquired infections (28%, 95% CI: 10, 46) compared to community settings (6%, 95% CI: 2, 11). Geographic based subgroup analysis indicated the highest prevalence in the Amhara region (23%, 95% CI: 8, 38), followed by Addis Ababa (21%, 95% CI: 11, 32), and lower prevalence in the Oromia region (7%, 95% CI: 4, 19). Wound samples exhibited the highest resistance (25%, 95% CI: 25, 78), while sputum samples showed the lowest prevalence. Publication bias, identified through funnel plot examination and Egger's regression test (p < 0.001), execution of trim and fill analysis resulted in an adjusted pooled prevalence of (3.7%, 95% CI: 2.3, 9.6).

CONCLUSION

The noteworthy prevalence of meropenem resistance among P. aeruginosa isolates in Ethiopia, particularly in healthcare settings, underscores the urgency of implementing strict infection control practices and antibiotic stewardship. Further research is imperative to address and mitigate the challenges posed by antimicrobial resistance in the country.

Drug resistance and extended-spectrum β-lactamase (ESBLs) - producing Enterobacteriaceae, Acinetobacter and Pseudomonas species from the views of one-health approach in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Although antimicrobial resistance (AMR) bacteria present a significant and ongoing public health challenge, its magnitude remains poorly understood, especially in many parts of the developing countries. Hence, this review was conducted to describe the current pooled prevalence of drug resistance, multidrug- resistance (MDR), and Extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae, Acinetobacter, and Pseudomonas species in humans, the environment, and animals or food of animal origin in Ethiopia.

METHODS

PubMed, Google Scholar, and other sources were searched for relevant articles as per the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines. A critical appraisal for screening, eligibility, and inclusion in the meta-analysis was made based on the Joanna Briggs Institute's (JBI) essential appraisal tools. The meta-analysis was done on Statistical Software Package (STATA) version 17.0.

RESULTS

A total of 33 research articles were included in this systematic review and meta-analysis. Escherichia coli, Klebsiella species, Acinetobacter, and Pseudomonas species were the most frequently reported bacteria from two or more sources. More than 50% of Klebsiella species and 25% to 89% of Escherichia coli from two or more sources were resistant to all analysed antibiotics, except carbapenems. Fifty-five percent (55%) to 84% of Acinetobacter species and 33% to 79% of Pseudomonas species from human and environmental sources were resistant to all analyzed antibiotics. Carbapenem resistance was common in Acinetobacter and Pseudomonas species (38% to 64%) but uncommon in Enterobacteriaceae (19% to 44%). Acinetobacter species (92%), Klebsiella species (86%), and Pseudomonas species (79%) from human sources, and Proteus species (92%), and Acinetobacter species (83%), from environmental sources, were the common multidrug-resistant isolates. About 45% to 67% of E. coli, Klebsiella, Acinetobacter, and Pseudomonas species from human and environmental sources were ESBL producers.

CONCLUSION

Our review report concluded that there was a significant pooled prevalence of drug resistance, MDR, and ESBL-producing Enterobacteriaceae, Acinetobacter, and Pseudomonas species from two or more sources. Hence, our finding underlines the need for the implementation of integrated intervention approaches to address the gaps in reducing the emergence and spread of antibiotic- resistant bacteria.

Investigation of virulence factors in Pseudomonas aeruginosa isolates by phenotypic and genotypic methods

INTRODUCTION

Pseudomonas aeruginosa possesses a variety of virulence factors that may contribute to its pathogenicity, and relationship has been determined between antibiotic resistance and biofilm. The aim of this study was to investigate the virulence factors of Pseudomonas aeruginosa isolates by genotypic and phenotypic methods, as well as whether there is a relationship between other virulence factors and antibiotic resistance.

METHODS

A total of 80 Pseudomonas aeruginosa strains were sent from various clinics included in the study. Identification and antibiotic resistance profile of isolates were determined by Vitek 2 (Biomerioux, France) automated system. Pseudomonas P agar, Pseudomonas F agar, and motility test medium were used for phenotyping tests. Tox A, Exo S, Plc N, and Las B were evaluated with Real-time PCR (Anatolia, Geneworks, Turkey).

RESULTS

The highest rates of antibiotic resistance were observed against imipenem (42.5%) and meropenem (40%). Among the isolates, 81.3% tested positive for Tox A, 30% for Exo S, 32.5% for Plc N, and 42.5% for Las B. Additionally, 70.4% of the isolates tested positive for pyocyanin, 41.3% for pyoverdine, 1.8% for pyorubin, and 8.9% tested negative for pyorubin. No statistically significant difference was found between antibiotic resistance and the presence of virulence factors (p > 0.005).

CONCLUSIONS

The relationship between antibiotic resistance and virulence factors is controversial. There are studies demonstrating the relationship between virulence factors and antibiotic resistance, as well as studies that indicate the absence of such a relationship. Investigating virulence and antibiotic resistance rates may be important for identifying potential drug targets for subsequent research.

Antimicrobial stewardship in the intensive care unit

High resistance rates to antimicrobials continue to be a global health threat. The incidence of multidrug-resistant (MDR) microorganisms in intensive care units (ICUs) is quite high compared to in the community and other units in the hospital because ICU patients are generally older, have higher numbers of co-morbidities and immune-suppressed; moreover, the typically high rates of invasive procedures performed in the ICU increase the risk of infection by MDR microorganisms. Antimicrobial stewardship (AMS) refers to the implementation of coordinated interventions to improve and track the appropriate use of antibiotics while offering the best possible antibiotic prescription (according to dose, duration, and route of administration). Broad-spectrum antibiotics are frequently preferred in ICUs because of greater infection severity and colonization and infection by MDR microorganisms. For this reason, a number of studies on AMS in ICUs have increased in recent years. Reducing the use of broad-spectrum antibiotics forms the basis of AMS. For this purpose, parameters such as establishing an AMS team, limiting the use of broad-spectrum antimicrobials, terminating treatments early, using early warning systems, pursuing infection control, and providing education and feedback are used. In this review, current AMS practices in ICUs are discussed.

The impact of multi-drug resistant Pseudomonas aeruginosa infections on acute pancreatitis patients

INTRODUCTION

Acute pancreatitis (AP) accounts for a high proportion of digestive diseases worldwide and has a high risk of infection. Pseudomonas aeruginosa, a common pathogen of hospital infections, has been observed to increase the resistance rate to several antibiotics, causing difficulties in treatments. Our study aims to investigate the impact of the multi-drug resistant Pseudomonas aeruginosa (MDR-PA) infections on AP patients.

METHODS

At two Chinese tertiary referral centers for AP patients infected with MDR-PA, a retrospective case-control study with a 1:2 case-control ratio was performed. Comparisons were preformed between with/without MDR-PA infections and different drug-resistance of MDR-PA infections patients, respectively. Independent risk factors of overall mortality were assessed via univariate and multivariate binary logistic regression analyses, and the distribution and antibiotic resistant rates of strains were described.

RESULTS

Mortality in AP patients with MDR-PA infections was significantly higher than in those without MDR-PA infections (7 (30.4%) vs. 4 (8.7%), P = 0.048). The rate of prophylactic use of carbapenem for 3 days (0 vs. 50%, P = 0.019) and the incidence rate of multiple organ failure (MOF) (0 vs. 57.1%, P = 0.018) were remarkably higher in the carbapenem-resistant Pseudomonas aeruginosa group compared with the carbapenem-sensitive Pseudomonas aeruginosa group. In the multivariate analysis, the severe categories of AP (OR = 13.624, 95% CIs = 1.567-118.491, P = 0.018) and MDR-PA infections (OR = 4.788, 95% CIs = 1.107-20.709, P = 0.036) were independent risk factors for mortality. The resistance rates of MDR-PA strains were low for amikacin (7.4%), tobramycin (3.7%), and gentamicin (18.5%). The resistance rates of MDR-PA strains to imipenem and meropenem were up to, 51.9% and 55.6%, respectively.

CONCLUSION

In AP patients, severe categories of AP and MDR-PA infections were both independent risk factors for mortality. Inappropriate use of carbapenem antibiotics and MOF were related to carbapenem-resistant Pseudomonas aeruginosa infections. Amikacin, tobramycin, and gentamicin are recommended for the treatment of AP patients with MDR-PA infections.

Antimicrobial Resistance Profile of Pseudomonas aeruginosa from Different Clinical Samples in Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia

Background

Pseudomonas aeruginosa is one of the leading causes of hospital-acquired infections and the most common antimicrobial-resistant pathogens. It is associated with a variety of infections. This study aimed to determine the prevalence of P. aeruginosa and its antimicrobial resistance profile from different clinical specimens at Debre Tabor Comprehensive Referral Hospital (DTCRH).

Methods

A cross-sectional study was conducted from May to July 2022 at DTCRH. Socio-demographic and clinical data were collected using a structured questionnaire. Clinical samples (blood, wound swab, urine, and sputum) were collected from 348 study participants and processed following the standard bacteriological techniques. Antibiotic susceptibility testing was done by the Kirby-Bauer disc diffusion method. Data were entered and analyzed using SPSS version 25 statistical software. Descriptive statistics was used to present the findings of the study.

Results

The prevalence of P.aeruginosa was 74(19.3%). The detection of the isolates was different based on the type of samples that ranged from 0% to 54.5% from sputum and wound swabs, respectively. P.aeruginosa showed resistance against gentamicin at 62.2%, ceftazidime 51.4%, cefepime 50%, amikacin 29.7%, imipenem 28.4% and ciprofloxacin 14.9%. The level of multi-drug resistance (MDR) was 45.9%, and the suspicious extreme-drug resistance (XDR) rate was 9.5%. Being inpatient and wound swab samples were factors associated with the detection of P.aeruginosa from clinical samples.

Conclusion

The antibiotic resistance profile of P. aeruginosa isolates in the present study area was found to be alarming. Actions to minimize the effect of antimicrobial resistance should be strengthened, and further large-scale study should be conducted to find out the main reasons behind antibiotic resistance of P.aeruginosa and other clinically relevant isolates.

Machine Learning Techniques for Antimicrobial Resistance Prediction of Pseudomonas Aeruginosa from Whole Genome Sequence Data

AIM

Due to the growing availability of genomic datasets, machine learning models have shown impressive diagnostic potential in identifying emerging and reemerging pathogens. This study aims to use machine learning techniques to develop and compare a model for predicting bacterial resistance to a panel of 12 classes of antibiotics using whole genome sequence (WGS) data of Pseudomonas aeruginosa.

METHOD

A machine learning technique called Random Forest (RF) and BioWeka was used for classification accuracy assessment and logistic regression (LR) for statistical analysis.

RESULTS

Our results show 44.66% of isolates were resistant to twelve antimicrobial agents and 55.33% were sensitive. The mean classification accuracy was obtained ≥98% for BioWeka and ≥96 for RF on these families of antimicrobials. Where ampicillin was 99.31% and 94.00%, amoxicillin was 99.02% and 95.21%, meropenem was 98.27% and 96.63%, cefepime was 99.73% and 98.34%, fosfomycin was 96.44% and 99.23%, ceftazidime was 98.63% and 94.31%, chloramphenicol was 98.71% and 96.00%, erythromycin was 95.76% and 97.63%, tetracycline was 99.27% and 98.25%, gentamycin was 98.00% and 97.30%, butirosin was 99.57% and 98.03%, and ciprofloxacin was 96.17% and 98.97% with 10-fold-cross validation. In addition, out of twelve, eight drugs have found no false-positive and false-negative bacterial strains.

CONCLUSION

The ability to accurately detect antibiotic resistance could help clinicians make educated decisions about empiric therapy based on the local antibiotic resistance pattern. Moreover, infection prevention may have major consequences if such prescribing practices become widespread for human health.

Prevalence and Trends of Carbapenem-Resistant Pseudomonas aeruginosa and Acinetobacter Species Isolated from Clinical Specimens at the Ethiopian Public Health Institute, Addis Ababa, Ethiopia: A Retrospective Analysis

Purpose

Carbapenem-resistant Acinetobacter species and P. aeruginosa are the leading cause of nosocomial infections. Therefore, the objective of this study was to analyze the prevalence, antimicrobial susceptibility profile, and trends of carbapenem-resistant P. aeruginosa and Acinetobacter species isolated from clinical specimens.

Patients and Methods

This retrospective study included data from Ethiopian Public Health Institute from 2017 to 2021. BD phoenix M50, Vitek 2 compact, and conventional identification methods were used to identify the organisms. The Kirby-Bauer disc diffusion, BD phoenix M50, and Vitek 2 compact methods were used to determine the antimicrobial susceptibility profiles of the isolates. Chi-square for linear trends using Epi Info was employed to test the significance of carbapenem resistance trends over time. The p-values of ≤0.05 were considered statistically significant.

Results

Following data cleaning, 7110 reports were used. Out of this, (N=185, 2.6%) and (N=142, 2%), Acinetobacter species and P. aeruginosa were isolated, respectively. Twenty-four Acinetobacter species and fourteen P. aeruginosa species were omitted because carbapenem antimicrobial agents were not tested for them. The overall prevalence of carbapenem-resistant Acinetobacter species and P. aeruginosa were 61% and 22%, respectively. The prevalence of carbapenem-resistant Acinetobacter species increased significantly from 50% in 2017 to 76.2% in 2021 (p=0.013). The trend of carbapenem-resistant P. aeruginosa was fluctuating (p=0.99). Carbapenem-resistant Acinetobacter had a lower resistance rate to amikacin (44%) and tobramycin (55%); similarly, carbapenem-resistant P. aeruginosa had a lower resistance rate to amikacin (27%) and tobramycin (47%).

Conclusion

This study revealed a high prevalence of carbapenem-resistant Acinetobacter species and P. aeruginosa, both of which showed better sensitivity to amikacin and tobramycin. Furthermore, Acinetobacter species showed a statistically significant increasing trend in carbapenem resistance.

Antibacterial efficacy of silver nanoparticles (AgNPs) against metallo-β-lactamase and extended spectrum β-lactamase producing clinically procured isolates of Pseudomonas aeruginosa

Resistance to carbapenems is a global threat, especially in developing countries with limited health resources. Prevalence, antibiogram, PCR detection of antibiotic resistance genes, and potency of Silver Nanoparticles (AgNPs) against multidrug-resistant (MDR) Pseudomonas aeruginosa were studied. Kirby-Bauer disc method and PCR were used to study antibiogram and drug resistance genes respectively in 255 isolates of Pseudomonas aeruginosa obtained from a tertiary care hospital. Silver nitrate (AgNO₃) precursor salts were reacted with Aspergillus flavus culture filtrate to trigger the extracellular mycosynthesis of AgNPs. Mycosynthesis was first monitored regularly by visible ultraviolet spectroscopy that recorded AgNP peaks of approximately 400-470 nm. Confirmation by Transmission electron micrographs provided confirmation of AgNPs formed within a range of 5-30 nm. Individual and combined antibacterial activity of ten antibiotics and AgNPs was analyzed. Pearson correlation coefficients (r) were calculated for phenotypic and genotypic multidrug resistance. Data were evaluated using SPSS version 20. p-value < 0.05 was considered statistically significant. 61.5% were carbapenemase producers (p < 0.01). The recorded frequency of bla_IMP-1, bla_SHV, bla_VIM, bla_OXA, and bla_TEM were 13%, 32%, 15%, 21%, and 43%, respectively. The reducing order of antimicrobial activity of antibiotics and AgNPs was piperacillin/tazobactam + AgNPs (31 mm), cefoxitin + AgNPs (30 mm) > amikacin + AgNPs (25 mm) > aztreonam + AgNPs (23 mm) > meropenem + AgNPs (22 mm) > imipenem + AgNPs (20 mm) > gentamycin + AgNPs (17 mm) > ciprofloxacin + AgNPs (16 mm) > cefoperazone/sulbactam + AgNPs (14 mm) ≥ ceftazidime + AgNPs (14 mm). The conjugated effect of AgNPs plus antibiotics showed a 0.15-3.51 (average of 2.09) fold-area augmentation of antimicrobial activity. AgNPs conjugated with antibiotics effectively inhibited MDR Pseudomonas aeruginosa. To the best of our understanding, this is an inaugural report from Punjab Pakistan enlisting co-expression of Metallo-β-lactamases, extended-spectrum β-lactamases, and AmpC-β-lactamase plus activity of antibiotic-AgNPs.

Emergence of High Antimicrobial Resistance among Critically Ill Patients with Hospital-Acquired Infections in a Tertiary Care Hospital

Background and Objectives: Inappropriate antibiotic usage in hospitalized patients contributes to microbial resistance. Our study aimed to examine the incidence of clinical bacterial isolates and their antibiotic resistance burden among critically ill patients in different hospital units. Materials and Methods: A single-centered cross-sectional study was conducted in a 120-bed tertiary care hospital that included 221 critically ill patients with hospital-acquired infections. Bacterial cultures and sensitivity reports were obtained and followed by a formal analysis of the antibiogram results to explore recovered isolates' prevalence and antibiotic susceptibility patterns. Results: Gram-negative bacteria were the most predominant pathogens among recovered isolates from the various hospital units (71%). Klebsiella sp. was the most prevalent microbe, followed by Acinetobacter sp., with an incidence level of 28% and 16.2%, respectively. Among the Gram-positive organisms, the coagulase-negative Staphylococci were the most predominant organism (11.3%), while (6.3%) methicillin-resistant Staphylococcus aureus (MRSA) isolates were recovered from different hospital units. Antibiotic sensitivity testing showed that polymyxin B was the most effective antibiotic against Gram-negative bacteria, whereas vancomycin and linezolid were the most active antibiotics against Gram-positive pathogens. Moreover, 7% of the Gram-negative bacteria isolated from different units showed positive production of extended-spectrum beta-lactamase (ESBL). Conclusions: The current study describes the high antibiotic resistance patterns in various hospital units that need extra legislation to prevent healthcare providers from misprescription and overuse of antibiotics.

Molecular epidemiology and antimicrobial susceptibility of Pseudomonas spp. and Acinetobacter spp. from clinical samples at Jimma medical center, Ethiopia

Introduction

Pseudomonas aeruginosa (P. aeruginosa) and Acinetobacter baumannii (A. baumannii) can cause difficult-to-treat infections. We characterized molecular epidemiology of ceftazidime-resistant P. aeruginosa and carbapenem-resistant A. baumannii at a tertiary hospital in Ethiopia.

Materials and methods

Non-fermenting gram-negative bacilli (n = 80) isolated from admitted patients were subjected for species identification by MALDI-TOF. Pseudomonas species resistant to ceftazidime or meropenem, and Acinetobacter species resistant to meropenem, or imipenem were selected for whole genome sequencing. DNA extracted with EZ1 Advanced XL instrument (Qiagen, Hilden, Germany) was sequenced on Illumina (HiSeq2500) using libraries prepared by NEXTRA-kits (Illumina). Raw reads were assembled using SPAdes 3.13.0, and assembled genomes were used to query databases for resistome profile and sequence types.

Result

Among Pseudomonas species isolated, 31.7% (13/41), and 7.3% (3/41) were non-susceptible to ceftazidime, and meropenem, respectively. Carbapenem-resistance was 56.4% (22/39) among Acinetobacter species. Moreover, 92% (12/13) of Pseudomonas species non-susceptible to ceftazidime and/or meropenem, and 89.4% (17/19) of Acinetobacter species encoded multiple resistance genes for at least three classes of antimicrobials. The prevalent β - lactamase genes were bla_OXA–486 (53.8%, 7/13), bla_CTX–M–15 (23.0%, 3/13) among Pseudomonas, and bla_GES–11 (57.8%, 11/19) among Acinetobacter. The bla_OXA–51-like β - lactamase, bla_OXA–69 (63.1%, 12/19) was the most prevalent carbapenemase gene among Acinetobacter isolates. Single isolates from both P. aeruginosa, and A. baumannii were detected with the bla_NDM–1. Sequence type (ST)1 A. baumannii and ST274 P. aeruginosa were the prevalent sequence types. A cgMLST analysis of the ST1 A. baumannii isolates showed that they were closely related and belonged to the international clonal complex one (ICC1). Similarly, ST274 P. aeruginosa isolates were clonally related.

Conclusion

The prevalence of MDR isolates of Pseudomonas and Acinetobacter spp. was high. A. baumannii isolates were clonally spreading in the admission wards at the hospital. Emergence of bla_NDM–1 in the intensive care, and surgical wards of the hospital is a severe threat that requires urgent intervention.

Novel Pseudomonas aeruginosa Strains Co-Harbouring bla NDM-1 Metallo β-Lactamase and mcr-1 Isolated from Immunocompromised Paediatric Patients

Background

The rising resistance to carbapenems in Gram-negative bacteria worldwide poses a major clinical and public health risk. This study aimed to characterise carbapenem- and colistin-resistance genes, bla NDM-1 and mcr-1 located on IncX4 plasmid in MDR Pseudomonas aeruginosa, isolated from paediatric patients undergoing chemotherapy as a result of leukaemia.

Methods

In this study, six carbapenem-resistant strains of P. aeruginosa were isolated from two paediatric patients under chemotherapy treatment (1.8 years old female and 2.1 years male) from the Shenzhen Hospital, China, in the year 2019. Isolates were screened for conventional antibiotics such as tobramycin, cefepime, imipenem, and ciprofloxacin in additional colistin by using the broth dilution method. Furthermore, resistance determinants: mcr-1, bla NDM-1, bla KPC-1, and bla GES were screened using PCR and sequencing followed by multi-locus sequence typing. The horizontal gene transfer and location of mcr-1 and bla NDM-1 were determined by a liquid mating assay. In addition, Incompatibility type (Inc), PCR-based replicon type, and subgroup (MOB) of plasmid were studied.

Results

The screening for conventional antibiotics isolates showed 100% resistance to all the tested antibiotics except tobramycin. All isolates harboured carbapenemase encoding bla NDM-1, of which three also had mcr-1 located on a single IncX4 transferable plasmid. MLST typing revealed that four strains had a novel (new) STs type, while two belonged to ST1966.

Conclusion

This study identified for the first time colistin- and carbapenem-resistant MDR P. aeruginosa in paediatric patients with leukaemia in Shenzhen, China. It highlights the need for continuous surveillance in high-risk clones of MDR P. aeruginosa. Prudent use of antibiotics based on local antimicrobial susceptibility and clinical characteristics can help in reducing mortality in immunocompromised patients.

Antibiotic resistance, biofilm production ability and genetic diversity of carbapenem-resistant Pseudomonas aeruginosa strains isolated from nosocomial infections in southwestern Iran

Background

This study was aimed to evaluate the antibiotic resistance, biofilm formation, and genetic diversity of carbapenem-resistant Pseudomonas aeruginosa (CRPA) strains isolated from four types of nosocomial infections (NIs) including urinary tract infection (UTI), ventilator-associated pneumonia (VAP), surgical site infection (SSI), and bloodstream infection (BSI).

Methods and results

In total, 115 isolates of NIs-causing P. aeruginosa were collected from NIs. Antibiotic susceptibility testing (AST) was performed using disk diffusion method and minimum inhibitory concentrations. Biofilm formation was tested on 96-well polystyrene microtiter plates (MTP). CRPA isolates were genotyped using multiple-locus variable number of tandem repeat analysis (MLVA). The most resistance and susceptibility rates were observed to amikacin (70.6%) and colistin (96.1%), respectively. Colistin and meropenem were the most active antimicrobial agents in VAP, SSI, and BSI. While, colistin and cefepime were the most active in UTIs. In total, 52.2% (n = 60/115) of P. aeruginosa isolates were carbapenem resistant, of which 95.0%, 55.0%, and 5.0% were multidrug-resistant, extensively drug-resistant, and pandrug-resistant, respectively. There was a significant association between resistance to carbapenem and resistance to other antibiotics except for piperacillin/tazobactam. The biofilm production of CRPA isolates was 95.0%, of which 23.3% were strong biofilm producers. Based on MLVA, there were 34 different types of CRPA isolates classified into three main clusters and 5 sub clusters.

Conclusion

The association of CRPA with other antibiotic resistance, the high rates of biofilm production, and the high genetic diversity of the isolates may be a warning of the need for a careful surveillance program.