In Vitro Activity of Tigecycline and Colistin against clinical isolates of Acinetobacter baumannii in Hospitals in Tehran and Bandar-Abbas, Iran

Molecular typing and antibiotic resistance patterns among clinical isolates of Acinetobacter baumannii recovered from burn patients in Tehran, Iran

Acinetobacter baumannii (A. baumannii) is now considered a highly resistant pathogen to various types of antibiotics. Therefore, tracking the source of its prevalence and continuous control is crucial. This study aimed to determine antibiotic resistance and perform various molecular typing methods on clinical isolates of A. baumannii isolated from hospitalized burn patients in Shahid Motahari Burn Hospital, Tehran, Iran. Hospital isolates were confirmed by phenotypic and molecular methods. Then the sensitivity to different antibiotics was determined using the minimum inhibitory concentration (MIC) method. In order to perform molecular typing, three-locus dual assay multiplex polymerase chain reaction (PCR), multiple-locus variable-number tandem repeat analysis (MLVA), and multilocus sequence typing (MLST) methods were used. Among the 60 isolates collected, the frequencies of multidrug-resistant (MDR) and extensively drug-resistant (XDR) isolates were 90 and 10%, respectively. The most effective antibiotics were colistin with 100% and tigecycline with 83.33% sensitivity. Isolates were 100% resistant to piperacillin/tazobactam and cephalosporins, and 68.3% were resistant to carbapenem. The results of multiplex PCR showed five groups that international clone I (IC I) and IC II were the most common. The MLVA method identified 34 MLVA types (MTs), 5 clusters, and 25 singletons. Multilocus sequence typing results for tigecycline-resistant isolates showed seven different sequence types (STs). Increasing antibiotic resistance in A. baumannii isolates requires careful management to control and prevent the occurrence of the pre-antibiotic era. The results of this study confirm that the population structure of A. baumannii isolates has a high diversity. More extensive studies are needed in Iran to better understand the epidemiology of A. baumannii.

Sensitivity of levofloxacin in combination with ampicillin-sulbactam and tigecycline against multidrug-resistant Acinetobacter baumannii

BACKGROUND AND OBJECTIVES

The selection of alternative treatment options with antibiotic combinations may be used for successful managing of multidrug-resistant Acinetobacter baumannii. The aim of this study was to determine the synergistic effects of ampicillin-sulbactam combined with either levofloxacin or tigecycline against MDR A. baumannii.

MATERIALS AND METHODS

A total 124 of A.baumannii isolates collected from clinical samples of hospitalized patients which assessed for antibiotic susceptibility using disk diffusion method. E-test was used on 10 MDR A. baumannii isolates to determine the minimum inhibitory concentration (MIC) of ampicillin-sulbactam, levofloxacin and tigecycline. Any synergistic effects were evaluated at their own MIC using E-test assay at 37°C for 24 hours. Synergy was defined as a fractional inhibitory concentration index (FICI) of ≤0.5.

RESULTS

Levofloxacin plus ampicillin-sulbactam combination was found to have synergistic effects (FIC index: ≤0.5) in 90% of the isolates, but there was no synergistic effect for ampicillin-sulbactam/tigecycline and tigecycline/levofloxacin combination. The antagonist effect in 50% of isolates (FIC index: >2) showed in combination of levofloxacin/tigecycline.

CONCLUSION

The emergence of multidrug A. baumannii isolates requires evaluating by combination therapy. The combination of levofloxacin plus a bactericidal antibiotic such as ampicillin-sulbactam is recommended. Results should be confirmed by clinical studies.

Removal of Penicillin G by combination of sonolysis and Photocatalytic (sonophotocatalytic) process from aqueous solution: process optimization using RSM (Response Surface Methodology)

Introduction

Penicillin G (PG) is used in a variety of infectious diseases, extensively. Generally, when antibiotics are introduced into the food chain, they pose a threat to the environment and can risk health outcomes. The aim of the present study was the removal of Penicillin G from an aqueous solution through an integrated system of UV/ZnO and UV/WO₃ with Ultrasound pretreatment.

Methods

In this descriptive-analytical work dealing with the removal of Penicillin G from an aqueous solution, four significant variables, contact time (60–120 min), Penicillin G concentration (50–150 mg/L), ZnO dose (200–400 mg/L), and WO₃ dose (100–200 mg/L) were investigated. Experiments were performed in a Pyrex reactor (batch, 1 Lit) with an artificial UV 100-Watt medium pressure mercury lamp, coupled with ultrasound (100 W, 40 KHz) for PG pre-treatment. Chemical Oxygen Demand (COD) was selected to follow the performance of the photo-catalytic process and sonolysis. The experiments were based on a Central Composite Design (CCD) and analyzed by Response Surface Methodology (RSM). A mathematical model of the process was designed according to the proposed degradation scheme.

Results

The results showed that the maximum removal of PG occurred in ultrasonic/UV/WO₃ in the presence of 50 mg/L WO₃ and contact time of 120 minutes. In addition, an increase in the PG concentration caused a decrease in COD removal. As the initial concentration of the catalyst increased, the COD removal also increased. The maximum COD removal (91.3%) achieved by 200 mg/L WO₃ and 400 mg/l ZnO, a contact time of 120 minutes, and an antibiotic concentration of 50 mg/L. All of the variables in the process efficiency were found to be significant (p < 0.05). Catalyst dose and contact time were shown to have a positive effect on the response (p < 0.05).

Conclusion

The research data supported the conclusion that the combination of advanced oxidation process of sonolysis and photocatalytic (sonophotocatalytic) were applicable and environmentally friendly processes, which preferably can be applied extensively.

Removal of Penicillin G by combination of sonolysis and Photocatalytic (sonophotocatalytic) process from aqueous solution: process optimization using RSM (Response Surface Methodology)

INTRODUCTION

Penicillin G (PG) is used in a variety of infectious diseases, extensively. Generally, when antibiotics are introduced into the food chain, they pose a threat to the environment and can risk health outcomes. The aim of the present study was the removal of Penicillin G from an aqueous solution through an integrated system of UV/ZnO and UV/WO₃ with Ultrasound pretreatment.

METHODS

In this descriptive-analytical work dealing with the removal of Penicillin G from an aqueous solution, four significant variables, contact time (60-120 min), Penicillin G concentration (50-150 mg/L), ZnO dose (200-400 mg/L), and WO₃ dose (100-200 mg/L) were investigated. Experiments were performed in a Pyrex reactor (batch, 1 Lit) with an artificial UV 100-Watt medium pressure mercury lamp, coupled with ultrasound (100 W, 40 KHz) for PG pre-treatment. Chemical Oxygen Demand (COD) was selected to follow the performance of the photo-catalytic process and sonolysis. The experiments were based on a Central Composite Design (CCD) and analyzed by Response Surface Methodology (RSM). A mathematical model of the process was designed according to the proposed degradation scheme.

RESULTS

The results showed that the maximum removal of PG occurred in ultrasonic/UV/WO₃ in the presence of 50 mg/L WO₃ and contact time of 120 minutes. In addition, an increase in the PG concentration caused a decrease in COD removal. As the initial concentration of the catalyst increased, the COD removal also increased. The maximum COD removal (91.3%) achieved by 200 mg/L WO₃ and 400 mg/l ZnO, a contact time of 120 minutes, and an antibiotic concentration of 50 mg/L. All of the variables in the process efficiency were found to be significant (p < 0.05). Catalyst dose and contact time were shown to have a positive effect on the response (p < 0.05).

CONCLUSION

The research data supported the conclusion that the combination of advanced oxidation process of sonolysis and photocatalytic (sonophotocatalytic) were applicable and environmentally friendly processes, which preferably can be applied extensively.

Invitro Activities of Polymyxins and Rifampicin against Carbapenem Resistant Acinetobacter baumannii at a Tertiary Care Hospital from South India

INTRODUCTION

Acinetobacter baumannii (A.baumannii) is rapidly emerging as a potent organism causing a multitude of nosocomial infections. The organism also carries various resistance mechanisms to antibiotics, making treatment more difficult. Very few choices are left, as A.baumannii strains have begun to develop resistance against cephalosporins, aminoglycosides and even carbapenems.

AIM

To examine the sensitivity pattern of three older antibiotics namely colistin, polymyxin B and rifampicin against carbapenem resistant A.baumannii by disk diffusion method and the sensitivity of colistin alone by Minimum Inhibitory Concentration (MIC) determination by VITEK automated system.

MATERIALS AND METHODS

Hundred clinical isolates of carbapenem resistant A. baumannii were tested for sensitivity to colistin, polymyxin B and rifampicin by Kirby-Bauer disk diffusion method. They were also tested for sensitivity to colistin by VITEK 2C (biomérieux) automated microbial identification system. The zone diameters and Minimum Inhibitory Concentration values for the above two methods, respectively were observed and analysed. All the Antibiotic Susceptibility Tests were done according to the CLSI guidelines.

RESULTS

By Kirby-Bauer disk diffusion method, 78% of the carbapenem resistant strains were found to be sensitive, 12% intermediate sensitive and 10% resistant to colistin. All the isolates were sensitive to polymyxin B and 80% were resistant to rifampicin. By the VITEK automated system, 99% of the isolates were sensitive to colistin (more in number than by disk diffusion method).

CONCLUSION

Polymyxins (colistin - polymyxin E and polymyxin B) are the next choice for multidrug resistant serious nosocomial infections like those of A. baumannii, till newer antibiotics are discovered to treat such infections. Rifampicin resistance was found to be very high and hence, is not advised for monotherapy.