Changes in antimicrobial resistance of Escherichia coli isolated from community associated urinary tract infection before and during the COVID-19 pandemic in India

PURPOSE

Impact of COVID-19 pandemic on antimicrobial resistance (AMR) is largely studied in healthcare settings, there is a need to understand the fluctuations in AMR during pandemic at the community level. Urinary tract infection (UTI) being one of the most common infections in the community, AMR profile of Community-acquired UTI (CA-UTI) is considered representative AMR at the community level.

PATIENTS AND METHODS

The study was taken in cohort of patients with clinical diagnosis of CA-UTI. The four study sites represented different community health centres in India. Escherichia coli (E.coli) isolates were analysed phenotypically and genotypically for AMR during Pre-COVID (Oct 2019- Feb 2020), 1st wave (Mar 2020 - Feb 2021) and 2nd wave of COVID-19 (Mar 2021- Dec 2021).

RESULTS

E. coli was the predominant uropathogen (229, 82%) . Increased susceptibility to nitrofurantoin was observed during pandemic. Reduced susceptibility to first line oral antibiotics and carbapenems was seen during 2nd wave. Increased MIC50 to beta-lactams and fluoroquinolones was seen during pandemic. Genomic analysis of E. coli isolates showed some AMR genes {aacC1, aacC4, SHV, QepA} only during 2nd wave.

CONCLUSION

The good impact of pandemic was evidenced by increased susceptibility to nitrofurantoin. The significant decrease in susceptibility to oral antibiotics during 2nd wave and increased MIC50 of few antibiotics are the bad impact. Decreased susceptibility to last-resort carbapenems and occurrence of various AMR genes only during 2nd wave of pandemic are of great concern and are the ugly impact of pandemic on AMR.

Exploring the potential of Moringa oleifera Lam in skin disorders and cosmetics: nutritional analysis, phytochemistry, geographical distribution, ethnomedicinal uses, dermatological studies and cosmetic formulations

Moringa oleifera Lam. is a pan-tropical plant well known to the ancient world for its extensive therapeutic benefits in the Ayurvedic and Unani medical systems. The ancient world was familiar with this tree, but it has only lately been rediscovered as a multifunctional species with a huge range of possible therapeutic applications. It is a folk remedy for skin diseases, edema, sore gums, etc. This review comprises the history, ethnomedicinal applications, botanical characteristics, geographic distribution, propagation, nutritional and phytochemical profile, dermatological effects, and commercially available cosmeceuticals of Moringa oleifera Lam.Compilation of all the presented data has been done by employing various search engines like Science Direct, Google, PubMed, Research Gate, EBSCO, SciVal, SCOPUS, and Google Scholar.Studies on phytochemistry claim the presence of a variety of substances, including fatty acids, phenolic acids, sterols, oxalates, tocopherols, carotenoids, flavonoids, flavonols glycosides, tannins, terpenoids, terpene, saponins, phylates, alkaloids, glucosinolates, glycosides, and isothiocyanate. The pharmacological studies have shown the efficacy of Moringa oleifera Lam. as an antibacterial, antifungal, anti-inflammatory, antioxidant, anti-atopic dermatitis, antipsoriatic, promoter of wound healing, effective in treating herpes simplex virus, photoprotective, and UV protective. As a moisturizer, conditioner, hair growth promoter, cleanser, antiwrinkle, anti-aging, anti-acne, scar removal, pigmentation, and control for skin infection, sores, as well as sweating, it has also been utilized in a range of cosmeceuticals.he Moringa oleifera Lam. due to its broad range of phytochemicals can be proven boon for the treatment of dermatological disorders.

Phytochemistry and biological activity of Erigeron annuus (L.) Pers

Erigeron annuus L. is a flowering herb of North America, Europe, Asia and Russia. This plant is used as folk medicine in China for the cure of indigestion, enteritis, epidemic hepatitis, haematuria and diabetes. Phytochemical studies showed the presence of 170 bioactive compounds like coumarins, flavonoids, terpenoids, polyacetylenic compounds; γ-pyrone derivatives, sterols and various caffeoylquinic acids derived from the essential oil and organic extracts from its various parts such as aerial parts, roots, leaves, stems and flowers. The pharmacological studies demonstrated various extracts and the compounds of E. annuus to exhibit anti-fungal, anti-atherosclerosis, anti-inflammatory, antidiabetic, phytotoxic, cytoprotective, antiobesity and antioxidant activities. This article covers a critical compendious on geographical distribution, botanical description, phytochemistry, ethnomedicinal uses and pharmacological activities of E. annuus. However, further in-depth studies are needed to determine the medical uses of E. annuus and its chemical constituents, pharmacological activities and clinical applications.

Genome profiling of uropathogenic E. coli from strictly defined community-acquired UTI in paediatric patients: a multicentric study

BACKGROUND

Urinary tract infection (UTI) in children is a common bacterial infection. The emergence of extended-spectrum beta-lactamases (ESBLs) poses a major challenge against the treatment of uropathogens. We aimed to characterize the E. coli isolates recovered from children with UTI for their resistance profile and circulating sequence types (ST).

METHODS

Children (> 1.5-18 years of age) from different community health centres of India with symptoms of UTI were enrolled. Isolates causing significant bacteriuria were identified by Matrix-Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) and tested for antimicrobial susceptibility by the automated system, VITEK-2 (Biomeriux, Durhum, US). Nineteen E. coli isolates (15 ESBL positive and 4 ESBL negative) were sequenced in Oxford Nanopore platform followed by core-genome phylogeny, accessory genome cluster analysis, identification of sequence types, mobile genetic elements, genetic antimicrobial resistance markers. The correlation between detection of antimicrobial resistance genes with phenotypic resistance profiles was also investigated.

RESULTS

Eleven percent of children had significant bacteriuria [male:female-1:1, > 50% were 11-18 years of age group]. E. coli was predominant (86%) followed by K. pneumoniae (11%). Susceptibility of E. coli was highest against fosfomycin (100%) followed by carbapenems (90.7%) and nitrofurantoin (88.8%). ST131 (15.8%) and ST167 (10.5%) found as high-risk clones with the presence of plasmid [IncFIB (63.1%), IncFIA (52.6%)], and composite transposon [Tn2680 (46.6%)] in many isolates. Few isolates coharboured multiple beta-lactamases including blaNDM-5 (33.3%), blaOXA-1 (53.3%), blaCTX-M-15 (60%) and blaTEM-4 (60%).

CONCLUSIONS

This study highlights horizontal transmission of resistance genes and plasmids in paediatric patients at community centers across the nation harbouring multidrug-resistant genes such as blaNDM-5 and blaCTX-M-15 associated with high-risk clones ST131 and ST167. The data is alarming and emphasizes the need for rapid identification of resistance markers to reduce the spread in community. To our knowledge, this is the first multicentric study targeting paediatric UTI patients from the community setting of India.

Essential oil and nanocarrier-based formulations approaches for vaginal candidiasis

An exclusive site for local drug delivery is the vagina, especially for vaginal infections. The fungus Candida albicans causes vaginal infection known as vulvovaginal candidiasis, a highly prevalent and recurrent gynaecological disease among women. Vaginal candidiasis affects over 75% of women at a certain point in their life and has a recurrence rate of 40-50%. Medicinal plants provide some very effective phytoconstituents which when delivered as nanosystems have enhanced therapeutic action and efficacy by alteration in their characteristics. Antifungal drugs are used to treat these conditions, alternative medicine is required for prophylaxis and improved prognosis. The current review focuses on the research carried out on various nanocarrier-based approaches and essential oil-based formulations for vaginal candidiasis.

Antibiotic resistance of uropathogens among the community-dwelling pregnant and nonpregnant female: a step towards antibiotic stewardship

BACKGROUND

Indiscriminate and widespread use of antibiotics has resulted in emergence of many antibiotic-resistant organisms. Antibiotic administration during pregnancy is mostly avoided, unless there is compelling medical condition. We hypothesized that the uropathogens isolated from pregnant women would be more susceptible to antibiotics compared to those isolated from nonpregnant women, thus will be helpful in formulating separate empiric guideline for pregnant women based on the resistance pattern.

METHODS

This was a prospective cross-sectional study conducted over a period of 2 years in which females with the clinical diagnosis of either cystitis or asymptomatic bacteriuria during pregnancy were included from the community settings. Uropathogen species and their antimicrobial resistance pattern were compared between the pregnant and nonpregnant groups. After accounting for centre-to-centre variation and adjusting for age and socio-economic status, the adjusted odds ratio for antibiotic resistance was calculated and compared between pregnant and nonpregnant women using logistic regression analysis.

RESULTS

A total of 1758 women (pregnant: 43.3%; nonpregnant: 56.6%) were screened in the study over a period of 2 years, out of which 9.3% (163/1758) were having significant bacteriuria. Escherichia coli and Klebsiella pneumoniae were the two commonest uropathogen in both the groups; their prevalence being 83.6% in pregnant women and 85.2% in nonpregnant women, respectively. Resistance against ampicillin, cefixime, cefoxitin, ceftazidime, ceftriaxone and amoxicillin-clavulanic acid were found significantly lower in the pregnant women compared to nonpregnant. After adjusting the age and socio-economic status accounting for centre-to-centre variation, the odds of resistance for cefixime, amoxicillin-clavulanic acid and co-trimoxazole were found lower and statistically significant among the pregnant women group.

CONCLUSIONS

The antimicrobial resistance was significantly higher among the community-dwelling nonpregnant women compared to pregnant women in case of few antibiotics. The study highlighted the need of building local antibiogram that could help to initiate the empirical treatment and thus prevent emergence of antimicrobial resistance.

Reactive species variation in cold atmospheric pressure plasma jet discharge under the influence of intrinsic parameters and its effect on E. coli inactivation

Cold atmospheric pressure plasma jet (CAPJ) has piqued the interest of researchers for various antimicrobial applications such as disinfection, wound decontamination, etc. In the current context, a deeper understanding of the correlation between CAPJ's intrinsic parameters, discharge characteristics, species composition, and antimicrobial activity is required for any successful application. This research evaluated the effect of intrinsic operational parameters such as voltage, frequency, gas flow rate, and operating gas on the reactive species composition of an in-house-developed CAPJ discharge along with the antimicrobial activity. It was observed that the identified excited atoms (Ar I, He I, N2, and O I), ions (Ar+, N2+, N+, H2O+, H3O+, etc.), radical reactive oxygen and nitrogen species (RONS) (OH•), and nonradical RONS (O I, O+, OH+, NO+, O2+, O2-, NO2-, N2O2-, NO3-, N2O3-, etc.) might play a synergistic role in bacterial inactivation via oxidative and electrostatic stress. The variation in voltage, frequency, gas flow rate, and operating gas influenced the discharge chemistry, leading to variation in bacterial inactivation. The reactive species in the discharge responsible for such variation was evaluated extensively. This investigation into various operational parameters would aid in determining the most effective settings for a developed CAPJ to achieve high productivity.

Heart-Type Fatty Acid Binding Protein as Potential Biomarker for Acute Myocardial Infarction

Acute myocardial infarction (AMI) is the most recurrent heart emergency which can lead to morbidity and death. During infarction, the heart releases cytoplasmic protein in the blood. These proteins such as creatine kinase, troponin and Heart type fatty acid binding protein (H-FABP) are used as indicators to spot cardiovascular arrest. This research paper aims to evaluate the efficiency, specificity and sensitivity of biomarkers in determining the AMI. This paper shows the use of direct sandwich ELISA technique to determine the level of H-FABP released in early stage of AMI. 50 suspected AMI subjects were used to observe the specificity, sensitivity and diagnostic efficacy. The study also discusses the correlation of the concentration of H-FABP in confirmed AMI, non AMI and normal subjects.

Virulence gene mutations as a differentiator of clinical phenotypes: insights from community-acquired uropathogenic Escherichia coli

Uropathogenic Escherichia coli (UPEC) remains an important cause of urinary tract infection during pregnancy. Multiple molecular virulence determinants and antibiotic resistant genes facilitate its pathogenesis and virulence phenotype. Hence it is hypothesized that there will be considerable variation in genes among the isolates from symptomatic as well as asymptomatic bacteriuria (ABU) during pregnancy. The aim of this study was to decipher the genetic variation among the two phenotypes. Six different UPEC isolates collected from urine specimens of consecutive pregnant females (five, symptomatic bacteriuria and one, ABU) were tested for their growth kinetics, and biofilm formation. A total of 87 virulence determinants and 56 antibiotic resistance genes were investigated using whole-genome sequencing, to identify putative drives of virulence phenotype. In this analysis, we identified eight different types of fully functional toxin antitoxin (TA) systems [HipAB, YefM-YoeB, YeeU-YeeV (CbtA), YhaV-PrlF, ChpBS, HigAB, YgiUT and HicAB] in the isolates from symptomatic bacteriuria; whereas partially functional TA system with mutations were observed in the asymptomatic one. Isolates of both the groups showed equivalent growth characteristics and biofilm-formation ability. Genes for an iron transport system (Efe UOB system, Fhu system except FhuA) were observed functional among all symptomatic and asymptomatic isolates, however functional mutations were observed in the latter group. Gene YidE was observed predominantly associated with the biofilm formation along with few other genes (BssR, BssS, YjgK, etc.). This study outlines putative critical relevance of specific variations in the genes for the TA system, biofilm formation, cell adhesion and colonization among UPEC isolates from symptomatic and asymptomatic bacteriuria among pregnant women. Further functional genomic study in the same cohort is warranted to establish the pathogenic role of these genes.

Prevalence and resistance pattern of uropathogens from community settings of different regions: an experience from India

Introduction

Urinary tract infection (UTI) is one of the most common infections in clinical practice worldwide in both healthcare and community settings causing significant morbidity and mortality. It is one of the major conditions at the community level treated empirically and regarded as a potential cause of emergence of antimicrobial resistance (AMR). Limited information is available regarding community-acquired UTI (CA-UTI) from India.

Methodology

This is a first of its kind, multicentric-cross-sectional study at the community level targeting patients attending the out-patient department (OPD) of the community health centre (CHC) from four geographical regions (North, South, West and East) of India. The study had been designed to determine the epidemiology, antibiogram profile and identification of extended-spectrum beta-lactamase (ESBL) producer and carbapenem resistant (CR) uropathogens. Samples were collected prospectively from UTI suspected patients coming at CHC and processed at the tertiary healthcare centres using a common standard operating procedure. Clinical history of all the patients exhibiting significant bacteriuria was collected and data was analysed.

Result

Overall, 250 out of a total of 2459 (10.1 %) urine samples were positive for bacteria with significant bacteriuria (adult: paediatrics, 6.7 : 1). Females were predominantly affected (male: female, 1 : 2.9). History of recent episode of UTI was observed as the commonest risk factor followed by diabetes mellitus. Altogether, 86 % of total cases were caused by Escherichia coli (68 %) and Klebsiella pneumoniae (17.6 %) together. Among the commonly used oral antibiotics for the Gram-negative bacilli (GNB), the highest resistance was observed against beta-lactams, first- and second-generation cephalosporins, fluoroquinolones and co-trimoxazole. Overall, the prevalence of ESBL producer and CR isolates were 44.8, and 4.3 %, respectively. However, the ESBL production, CR and nitrofurantoin resistance among the uropathogenic E. coli (UPEC) isolates was 52.8, 5.1 and 14 %, respectively. No resistance was found against fosfomycin among the UPEC isolates.

Conclusion

The current study highlights the increasing incidence of AMR among uropathogens at the community-settings of India. A significant percentage of ESBL producers among the isolated UPEC and K. pneumoniae were observed. The currently available evidence supports the clinical recommendation of fosfomycin and nitrofurantoin for empiric therapy in CA-UTI in India.

Ethnomedicinal uses, phytochemistry and dermatological effects of Hippophae rhamnoides L.: A review

ETHNOPHARMACOLOGICAL RELEVANCE

Hippophae rhamnoides L. (family- Elaeagnaceae, common name- Sea buckthorn) is a flowering shrub native to cold temperate regions of Eurasia. Berries, seeds, and leaves of the plant are widely used as a folk medicine for the treatment of hypertension, oedema, inflammation, tissue-regeneration, skin-grafts, burns/injury, wounds, and ulcers.

AIM OF THE REVIEW

This article reviews geographical distribution, botanical description, phytochemistry, ethnomedicinal uses, and dermatological activities including, cosmeceuticals of H. rhamnoides available in the market.

MATERIALS AND METHODS

The data has been compiled employing the various search engines like Science Direct, Pub Med, Google, Google Scholar, EBSCO, SCOPUS, and SciVal.

RESULTS AND DISCUSSION

H. rhamnoides is primarily found in cold-temperate regions of Eurasia and was first located in China. Berries are the most prominent feature of the plant. Phytochemical studies reveal the presence of a wide variety of compounds like flavonoids, carotenoids, polyunsaturated fatty acids, minerals, vitamins, Omega 3, 6, 9 and rarest Omega 7 and about 190 bioactive compounds. The pharmacological studies demonstrated, sea buckthorn to exhibit antibacterial, anti-sebum, antifungal, anti-psoriasis, anti-atopic dermatitis and wound healing activities. Besides, it has also been included in various cosmeceuticals for its use in skin-eventone, smoothening, rejuvenation, removal of wrinkles, scars, and pigmentation, and also in hair related problems.

CONCLUSION

Pharmacological evaluation confirmed the ethnomedically claimed biological actions and other beneficial effects on the skin of H. rhamnoides using scientifically accepted protocols and controls, although some of the studies require more elaborative studies. Its full application in the dermatology may be attributed to the presence of a variety of flavonoids, vitamins, and unsaturated fatty acids. Great use of plant in the traditional system for dermatological aspect, demands further comprehensive phytochemical work based on its actual use by the traditional population. Demonstration of the plant in the traditional system, pharmacology, cosmeceuticals not only demands its further therapeutic studies but also warrants focus towards its cultivation and propagation across the globe.

Roylea cinerea (D.Don) Baillon: Ethnomedicinal uses, phytochemistry and pharmacology: A review

ROYLEA CINEREA (D.DON) BAILLON: Roylea cinerea (D.Don) Baillon family Lamiaceae is a shrub of the monotypic genus. Aerial parts of the plant are used traditionally in Indian sub-Himalayas and Nepal for the treatment of jaundice, skin diseases, malaria, diabetes, febrifuge and contusions.

METHOD

This article reviews botanical description, phytochemistry, ethnomedicinal uses and pharmacological activities of R. cinerea to evaluate if the scientifically evaluated pharmacological profile of the plant can corroborate ethnomedicinal uses. A survey was conducted to document ethnomedicinal and folklore uses of the plant in five districts of Himachal Pradesh, India.

RESULTS

Phytochemical studies of R. cinerea reveal the presence of glycosides, diterpenes, flavonoids, tannins, steroids, saponins and phenols. R. cinerea extracts. The compounds showed anticancer, antifungal, hepatoprotective, antiperiodic, antiprotozoal, antidiabetic and antioxidant activities on scientific evaluation. A diterpenoid from the plant, precalyone, exhibited antiproliferative activity against P-388 lymphocytic leukemia cell line. Cinereanoid D, a labdane diterpenoid that inhibits ATP binding of heat shock protein Hsp90, is a potential anticancer lead. Two compounds from aerial parts of the plant, 4-methoxybenzo[b]azet-2(1H)-one and 3β-hydroxy-35-(cyclohexyl-5'-propan-7'-one)-33-ethyl-34-methylbacteriohop-16-ene, showed antidiabetic activity. Thus, the scientific reports confirm the ethnomedicinal use of this plant in diabetes, malaria and liver diseases.

CONCLUSION

Roylea cinerea is a traditionally used medicinal plant from Western Himalayas. The pharmacological evaluation confirmed the ethnomedically claimed antidiabetic activity using scientifically accepted protocols and controls, although some of the studies require reconfirmation. The bioactivity-guided fractionation attributes the activity to 4-methoxybenzo[b]azet-2(1H)-one and 3β-hydroxy-35-(cyclohexyl-5'-propan-7'-one)-33-ethyl-34-methylbacteriohop-16-ene. Further, cinereanoid D is a potential lead for targeting Hsp90 and its medicinal chemistry studies can lead to a potent anticancer compound. The plant extract also showed antimalarial and hepatoprotective activities. Some of the studies discussed in this review require reconfirmation, as the protocols lacked proper positive and negative controls. Thus, the review of the scientific reports on Roylea cinerea supports ethnomedicinal use as antidiabetic, antimalarial and hepatoprotective. Further studies to prove scientific basis for use in leucorrhea, skin diseases, inflammation and strengthening of claims for liver tonic are required.

An update on the Enzyme Portal: an integrative approach for exploring enzyme knowledge

Enzymes are a key part of life processes and are increasingly important for various areas of research such as medicine, biotechnology, bioprocessing and drug research. The goal of the Enzyme Portal is to provide an interface to all European Bioinformatics Institute (EMBL-EBI) data about enzymes (de Matos, P., et al., (2013), BMC Bioinformatics, 14 (1), 103). These data include enzyme function, sequence features and family classification, protein structure, reactions, pathways, small molecules, diseases and the associated literature. The sources of enzyme data are: the UniProt Knowledgebase (UniProtKB) (UniProt Consortium, 2015), the Protein Data Bank in Europe (PDBe), (Valenkar, S., et al., Nucleic Acids Res.2016; 44, D385–D395) Rhea—a database of enzyme-catalysed reactions (Morgat, A., et al., Nucleic Acids Res. 2015; 43, D459-D464), Reactome—a database of biochemical pathways (Fabregat, A., et al., Nucleic Acids Res. 2016; 44, D481–D487), IntEnz—a resource with enzyme nomenclature information (Fleischmann, A., et al., Nucleic Acids Res. 2004 32, D434–D437) and ChEBI (Hastings, J., et al., Nucleic Acids Res. 2013) and ChEMBL (Bento, A. P., et al., Nucleic Acids Res. 201442, 1083–1090)—resources which contain information about small-molecule chemistry and bioactivity. This article describes the redesign of Enzyme Portal and the increased functionality added to maximise integration and interpretation of these data. Use case examples of the Enzyme Portal and the versatile workflows its supports are illustrated. We welcome the suggestion of new resources for integration.

Older Adults Have Delayed Amino Acid Absorption after a High Protein Mixed Breakfast Meal

OBJECTIVES

To measure the postprandial plasma amino acid appearance in younger and older adults following a high protein mixed meal.

DESIGN

Cross-sectional study.

SETTING

Clinical research setting.

PARTICIPANTS

Healthy men and women aged 60-75 (n=15) years, and young controls aged 20-25 years (n=15) matched for body mass index and insulin sensitivity based on the homeostatic model assessment of insulin resistance.

INTERVENTION

High protein mixed meal of complete food products.

MEASUREMENTS

Circulating amino acid concentrations were determined hourly before and for 5 hours after meal ingestion.

RESULTS

There was no difference between cohorts in postprandial appearance of non-essential amino acids, or area under the curve of any individual amino acid or amino acid class. However, older adults had higher baseline concentrations of aspartic acid, glutamic acid, glycine, ornithine, threonine and tyrosine and lower baseline concentrations of hydroxyproline, isoleucine, leucine, methionine and valine compared to younger adults. Younger adults showed peak essential (EAA) and branched-chain amino acid (BCAA) concentrations at 1 hour post meal while older adults' peak EAA and BCAA concentration was at 3 hours. Similarly, peak total amino acid concentrations were at 3 hours in older adults.

CONCLUSION

Older adults digested and absorbed the protein within a mixed meal more slowly than younger adults. Delayed absorption of AA following a mixed meal of complete food products may suppress or delay protein synthesis in senescent muscle.