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14 pages, 284 KiB

Open AccessArticle

Prevalence and Abundance of Beta-Lactam Resistance Genes in Hospital Wastewater and Enterobacterales Wastewater Isolates

by Dewi Santosaningsih, Aulia Putri Fadriyana, Nathanael Ibot David and Irene Ratridewi

Trop. Med. Infect. Dis. 2023, 8(4), 193; https://doi.org/10.3390/tropicalmed8040193 - 27 Mar 2023

Cited by 3 | Viewed by 2439

Abstract

Antimicrobial resistance may develop in nature including in hospital wastewater through horizontal genetic transfer. Few studies were conducted on the antimicrobial resistance genes in hospital wastewater and wastewater isolates in Indonesia. The prevalence and abundance of beta-lactam resistance genes in hospital wastewater and [...] Read more.

Antimicrobial resistance may develop in nature including in hospital wastewater through horizontal genetic transfer. Few studies were conducted on the antimicrobial resistance genes in hospital wastewater and wastewater isolates in Indonesia. The prevalence and abundance of beta-lactam resistance genes in hospital wastewater and Enterobacterales wastewater isolates were investigated. Twelve wastewater samples were collected from an influent wastewater treatment plant. Escherichia coli and Klebsiella pneumoniae were isolated from the wastewater samples by culture-based methods. DNA was extracted from wastewater samples and the isolates. Nineteen beta-lactam resistance genes were tested by a high throughput qRT-PCR method. bla_GES and bla_TEM were the most abundant genes detected in hospital wastewater and Escherichia coli, respectively (p < 0.001). The relative abundance of bla_{CMY_2}, bla_CTX-M5, bla_CTX-M8, bla_GES, bla_NDM, and bla_SHV11 in Klebsiella pneumoniae was higher than in the wastewater and Escherichia coli (p < 0.001; p = 0.006; p = 0.012; p < 0.001; p = 0.005; p < 0.001). Klebsiella pneumoniae might be associated with resistance to piperacillin/tazobactam, ceftriaxone, and cefepime (p < 0.001; p = 0.001; p < 0.001). In conclusion, ESBL genes showed higher abundance than carbapenemase genes in hospital wastewater samples. The ESBL-producing bacteria that were predominantly found in hospital wastewater may originate from clinical specimens. The culture-independent antibiotic resistance monitoring system might be developed as an early warning system for the increasing beta-lactam resistance level in clinical settings. Full article

(This article belongs to the Special Issue Global Burden of Antimicrobial Resistance (AMR))

12 pages, 770 KiB

Open AccessArticle

Antibiotic Consumption in Vanuatu before and during the COVID-19 Pandemic, 2018 to 2021: An Interrupted Time Series Analysis

by Nicola D. Foxlee, Amsaline Lui, Agnes Mathias, Nicola Townell and Colleen L. Lau

Trop. Med. Infect. Dis. 2023, 8(1), 23; https://doi.org/10.3390/tropicalmed8010023 - 27 Dec 2022

Cited by 4 | Viewed by 3942

Abstract

The study objectives were to examine antibiotic consumption at Vila Central Hospital (VCH), Vanuatu between January 2018 and December 2021 and the influence of the COVID-19 pandemic on antibiotic consumption during this period. Data on antibiotic usage were obtained from the Pharmacy database. [...] Read more.

The study objectives were to examine antibiotic consumption at Vila Central Hospital (VCH), Vanuatu between January 2018 and December 2021 and the influence of the COVID-19 pandemic on antibiotic consumption during this period. Data on antibiotic usage were obtained from the Pharmacy database. We used the WHO’s Anatomical Therapeutic Classification/Defined Daily Dose (ATC/DDD) index, VCH’s inpatient bed numbers and the hospital’s catchment population to calculate monthly antibiotic consumption. The results were expressed as DDDs per 100 bed days for inpatients (DBDs) and DDDs per 1000 inhabitants per day for outpatients (DIDs). Interrupted time series (ITS) was used to assess the influence of COVID-19 by comparing data before (January 2018 to January 2020) and during (February 2020 to December 2021) the pandemic. Ten antibiotics were examined. In total, 226 DBDs and 266 DBDs were consumed before and during COVID-19 by inpatients, respectively with mean monthly consumption being significantly greater during COVID-19 than before the pandemic (2.66 (p = 0.009, 95% CI 0.71; 4.61)). Whilst outpatients consumed 102 DIDs and 92 DIDs before and during the pandemic, respectively, the difference was not statistically significant. Findings also indicated that outpatients consumed a significantly lower quantity of Watch antibiotics during COVID-19 than before the pandemic (0.066 (p = 0.002, 95% CI 0.03; 0.11)). The immediate impact of COVID-19 caused a reduction in both inpatient and outpatient mean monthly consumption by approximately 5% and 16%, respectively, and this was followed by an approximate 1% monthly increase until the end of the study. By mid-2021, consumption had returned to pre-pandemic levels. Full article

(This article belongs to the Special Issue Global Burden of Antimicrobial Resistance (AMR))

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11 pages, 1105 KiB

Open AccessArticle

A Retrospective Analysis of Culture-Confirmed Enterococci Bloodstream Infections in South Africa, 2016–2020: A Cross-Sectional Study

by Ruth Mogokotleng, Husna Ismail, Olga Perovic and Sabelle Jallow

Trop. Med. Infect. Dis. 2023, 8(1), 19; https://doi.org/10.3390/tropicalmed8010019 - 27 Dec 2022

Cited by 2 | Viewed by 2279

Abstract

(1) Background: The emergence of multidrug resistance enterococci is a major public health concern. This study aimed to determine the prevalence and antimicrobial resistance of enterococci isolated from blood cultures over a five-year period (2016–2020) at public hospitals in South Africa. (2): [...] Read more.

(1) Background: The emergence of multidrug resistance enterococci is a major public health concern. This study aimed to determine the prevalence and antimicrobial resistance of enterococci isolated from blood cultures over a five-year period (2016–2020) at public hospitals in South Africa. (2): Methods: A retrospective analysis of clinical enterococci isolated from bloodstream infection samples at the South African public hospitals was conducted. The ESKAPE dataset from January 2016 to December 2020 was obtained from the central data warehouse (CDW) at the National Health Laboratory Service (NHLS). (3): Results: Following de-duplication, a total of 130,352/306,592 organisms isolated from blood cultures were identified as ESKAPE pathogens. In this study, K. pneumoniae (25%; 33,082/130,352), was the most frequently isolated pathogen from blood cultures, followed by S. aureus (23%; 29,922/130,352) and enterococci (16%; 21,339/130,352). Of the enterococci cases, about 43% (9132/21,339) of cases were from the infants aged (<1-year old) and 32% (6745/21,339) from the adult patients. No changes observed in vancomycin, teicoplanin, and linezolid susceptibility; however, E. faecium and E. faecalis blood culture isolates remained highly susceptible (>97%) to these antibiotics. (4): Conclusions: The current study revealed a significant increase of E. faecalis and E. faecium blood culture isolates as compared to the previous national ESKAPE data. Low vancomycin resistance was observed. Continuous monitoring of antimicrobial resistant Enterococcus species is warranted in South Africa. Full article

(This article belongs to the Special Issue Global Burden of Antimicrobial Resistance (AMR))

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15 pages, 1453 KiB

Open AccessArticle

Association of Multidrug Resistance Bacteria and Clinical Outcomes of Adult Patients with Sepsis in the Intensive Care Unit

by Khalid Ahmad Al-Sunaidar, Noorizan Abd Aziz, Yahaya Hassan, Shazia Jamshed and Mahendran Sekar

Trop. Med. Infect. Dis. 2022, 7(11), 365; https://doi.org/10.3390/tropicalmed7110365 - 9 Nov 2022

Cited by 5 | Viewed by 3072

Abstract

Background: Multi-drug resistance organisms (MDRO) often cause increased morbidity, mortality, and length of stays (LOS). However, there is uncertainty whether the infection of MDRO increase the morbidity, mortality, and ICU-LOS. Objective: This study was performed to determine the prevalence of MDRO in the [...] Read more.

Background: Multi-drug resistance organisms (MDRO) often cause increased morbidity, mortality, and length of stays (LOS). However, there is uncertainty whether the infection of MDRO increase the morbidity, mortality, and ICU-LOS. Objective: This study was performed to determine the prevalence of MDRO in the ICU, the site of infection, and the association of MDRO or site of infection with mortality. The secondary outcome was determined by ascertaining the association of MDRO or site of infection with ICU-LOS. Methods: A retrospective cohort study was performed with adult sepsis patients in the ICU. Univariate and multivariate (MVA) logistic regression with cox regression modeling were performed to compute the association of MDRO with ICU mortality. MVA modelling was performed for ICU-LOS predictors. Results: Out of 228 patients, the isolated MDRO was 97 (42.5%), of which 78% were Gram-negative bacteria. The mortality rate among those with MDRO was 85 (37.3%). The hospital acquired infection (HAI) was a significant predictor for ICU-LOS in univariate linear regression (R² = 0.034, p = 0.005). In MVA linear regression, both Enterococcus faecalis infection and Acinetobacter baumannii (AC)-MDRO were predictors for ICU-LOS with (R² = 0.478, p < 0.05). In the univariate cox regression, only the infection with AC-MDRO was a risk factor for ICU-mortality with [HR = 1.802 (95% CI: 1.2–2.706; p = 0.005)]. Conclusions: Identifying risk factors for MDRO addresses the appropriate administration of empirical antibiotics and allows to effectively control the source of infection, which would reduce mortality and ICU-LOS. The usage of broad-spectrum antibiotics should be limited to those with substantial risk factors for acquiring MDRO. Full article

(This article belongs to the Special Issue Global Burden of Antimicrobial Resistance (AMR))

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12 pages, 590 KiB

Open AccessArticle

Prompt Identification of Sepsis on Hospital Floors: Are Healthcare Professionals Ready for the Implementation of the Hour-1 Bundle?

by Sadia Shakeel, Wajiha Iffat, Shagufta Nesar, Sidra Shayan, Aatka Ali, Márió Gajdács and Shazia Jamshed

Trop. Med. Infect. Dis. 2022, 7(10), 291; https://doi.org/10.3390/tropicalmed7100291 - 10 Oct 2022

Viewed by 2103

Abstract

Early intervention in sepsis management with recognized therapeutic targets may be effective in lowering sepsis-related morbidity and mortality, although this necessitates timely identification of sepsis by healthcare professionals. The present study aimed to assess knowledge levels, attitudes, and agreement among physicians regarding the [...] Read more.

Early intervention in sepsis management with recognized therapeutic targets may be effective in lowering sepsis-related morbidity and mortality, although this necessitates timely identification of sepsis by healthcare professionals. The present study aimed to assess knowledge levels, attitudes, and agreement among physicians regarding the Surviving Sepsis Campaign (SSC) guidelines (more specifically, the Hour-1 bundle). A quantitative, descriptive, cross-sectional study was conducted among physicians working in different clinical settings in Karachi, Pakistan, using a self-administered questionnaire. The mean cumulative knowledge score of the respondents towards SSC was 6.8 ± 2.1 (out of 10), where a total of n = 127 respondents (51.62%) had a strong understanding of the SSC guidelines, compared to n = 78 (31.7%) and n = 41 (16.7%) respondents with fair and inadequate knowledge, respectively. The majorly known bundle elements by the respondents were to administer broad-spectrum antibiotics (89.8%, n = 221), the need for taking blood cultures before administering antibiotics (87.8%, n = 216), and measurement of blood lactate levels (75.6%, n = 186). Experienced physicians were more likely to use norepinephrine as the first-choice vasopressor (p < 0.001). Female respondents were more likely to consider the duration of antibiotic therapy to be determined according to the site of infection, the microbiological etiology, the patient’s response to treatment, and the likelihood of achieving adequate source control (p = 0.001). The current study concluded that respondents had an optimistic approach and frequently practice in accordance with the SSC guidelines, while some respondents were not up to date with the most recent guidelines. There is a need for further interventions and continuous medical education to encourage physicians towards appropriate use of the recommended guiding principles for improving treatment outcomes in sepsis patients. Full article

(This article belongs to the Special Issue Global Burden of Antimicrobial Resistance (AMR))

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15 pages, 3207 KiB

Open AccessArticle

In Vitro and In Vivo Effect of Amikacin and Imipenem Combinations against Multidrug-Resistant E. coli

by Sara Mahmoud Farhan, Rehab Mahmoud Abd El-Baky, Salah Abdalla, Ahmed Osama EL-Gendy, Hala Rady Ahmed, Doaa Safwat Mohamed, Amr El Zawily and Ahmed Farag Azmy

Trop. Med. Infect. Dis. 2022, 7(10), 281; https://doi.org/10.3390/tropicalmed7100281 - 2 Oct 2022

Cited by 1 | Viewed by 2599

Abstract

Introduction: The emergence of multidrug-resistant (MDR) E. coli has developed worldwide; therefore, the use of antibiotic combinations may be an effective strategy to target resistant bacteria and fight life-threatening infections. The current study was performed to evaluate the in vitro and in vivo [...] Read more.

Introduction: The emergence of multidrug-resistant (MDR) E. coli has developed worldwide; therefore, the use of antibiotic combinations may be an effective strategy to target resistant bacteria and fight life-threatening infections. The current study was performed to evaluate the in vitro and in vivo efficacy of amikacin and imipenem alone and in combination against multidrug-resistant E. coli. Methods: The combination treatment was assessed in vitro using a checkerboard technique and time-killing curve and in vivo using a peritonitis mouse model. In resistant isolates, conventional PCR and quantitative real-time PCR techniques were used to detect the resistant genes of Metallo-

β

-lactamase gene Imipenemase (bla-_IMP) and aminoglycoside 6

^{'}

-N-acetyltransferase (aac (6 $^{'}$ )-Ib). Scanning electron microscopy was used to detect the morphological changes in the resistant isolates after treatment with each drug alone and in combination. In vitro and in vivo studies showed a synergistic effect using the tested antibiotic combinations, showing fractional inhibitory concentration indices (FICIs) of ≤0.5. Regarding the in vivo study, combination therapy indicated a bactericidal effect after 24 h. E. coli isolates harboring the resistant genes Metallo-

β

-lactamase gene Imipenemase (bla-_IMP) and aminoglycoside 6

^{'}

-N-acetyltransferase (aac (6 $^{'}$ )-Ib) represented 80% and 66.7%, respectively, which were mainly isolated from wound infections. The lowest effect on Metallo-

β

-lactamase gene Imipenemase (bla-_IMP) and aminoglycoside 6

^{'}

-N-acetyltransferase (aac (6 $^{'}$ )-Ib) gene expression was shown in the presence of 0.25 × MIC of imipenem and 0.5 × MIC of amikacin. The scanning electron microscopy showed cell shrinkage and disruption in the outer membrane of E. coli in the presence of the antibiotic combination. Amikacin and imipenem combination can be expected to be effective in the treatment and control of serious infections caused by multidrug-resistant (MDR) E. coli and the reduction in bacterial resistance emergence. Full article

(This article belongs to the Special Issue Global Burden of Antimicrobial Resistance (AMR))

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12 pages, 1738 KiB

Open AccessArticle

Molecular Epidemiology of Clinical Carbapenem-Resistant Acinetobacter baumannii-calcoaceticus complex Isolates in Tertiary Care Hospitals in Java and Sulawesi Islands, Indonesia

by Heriyannis Homenta, Julyadharma Julyadharma, Hani Susianti, Noorhamdani Noorhamdani and Dewi Santosaningsih

Trop. Med. Infect. Dis. 2022, 7(10), 277; https://doi.org/10.3390/tropicalmed7100277 - 30 Sep 2022

Cited by 1 | Viewed by 1853

Abstract

Carbapenem-resistant Acinetobacter baumannii (A. baumannii)-calcoaceticus complex (CRAb-cc) is an important pathogen causing nosocomial infections worldwide; however, molecular epidemiology of the A. baumannii-calcoaceticus complex in Indonesian hospitals is scarce. This study aimed to determine the clonal relatedness of CRAb-cc in two tertiary care hospitals [...] Read more.

Carbapenem-resistant Acinetobacter baumannii (A. baumannii)-calcoaceticus complex (CRAb-cc) is an important pathogen causing nosocomial infections worldwide; however, molecular epidemiology of the A. baumannii-calcoaceticus complex in Indonesian hospitals is scarce. This study aimed to determine the clonal relatedness of CRAb-cc in two tertiary care hospitals in Malang and Manado in Indonesia. The CRAb-cc isolates from routine clinical cultures in two tertiary care hospitals in Malang and Manado were identified using the Vitek2^® system (bioMérieux, Lyon, France). Multi-locus variable-number tandem-repeat analysis (MLVA) typing, multi-locus sequence typing (MLST), clonal complex (CC), and phylogenetic tree analysis were conducted for a subset of isolates. Seventy-three CRAb-cc isolates were collected. The CRAb-cc isolates were frequently found among lower-respiratory-tract specimens. We detected the MLVA type (MT) 1, MT3, and MT4 CRAB-cc isolates belonging to the sequence type (ST) 642, and CC1 was the predominant clone in this study. In conclusion, we identified the clonal relatedness of A. baumannii-calcoaceticus complex isolates in two tertiary care hospitals in Malang and Manado in Indonesia. Further study is required to investigate the clinical importance and distribution of ST642 in Indonesian hospitals for developing prevention and control measures. Full article

(This article belongs to the Special Issue Global Burden of Antimicrobial Resistance (AMR))

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13 pages, 2655 KiB

Open AccessArticle

Molecular Characterization and Antifungal Susceptibility of Aspergillus spp. among Patients with Underlying Lung Diseases

by Ehssan Moglad, Samar Saeed, Humodi Saeed, Hind Ahmed, Kwathar Salih, Hisham Altayb and Wafa Elhag

Trop. Med. Infect. Dis. 2022, 7(10), 274; https://doi.org/10.3390/tropicalmed7100274 - 28 Sep 2022

Cited by 2 | Viewed by 2211

Abstract

Background. Pulmonary aspergillosis is a lung infection caused by Aspergillus spp., which can cause severe illnesses in immunocompromised patients with underlying lung disease or who have asthma and inhale their spores. This study aimed to screen the antifungal susceptibility of Aspergillus spp. isolated [...] Read more.

Background. Pulmonary aspergillosis is a lung infection caused by Aspergillus spp., which can cause severe illnesses in immunocompromised patients with underlying lung disease or who have asthma and inhale their spores. This study aimed to screen the antifungal susceptibility of Aspergillus spp. isolated from patients with underlying pulmonary infections and characterize the isolates using PCR and sequencing. Method. Three hundred and eighty-four sputum or bronchoalveolar lavage samples were collected and processed for the isolation and identification, and characterization of Aspergillus species and molecular amplification of the ITS1-5.8S-ITS2 region by the PCR and Sanger sequencing method. Antifungal susceptibility tests for itraconazole and voriconazole were performed using the E-test. Result. The overall results revealed that out of 384 patients, 32 (8.3%) were positive for fungal growth, including 28 (87.5%) Aspergillus spp. The highest resistance rate (100 and 44.4%) was obtained from itraconazole against A. niger and A. fumigatus. In contrast, voriconazole revealed the best activities against all tested fungi compared to itraconazole. All A. flavus were sensitive to voriconazole, while only 54.5% were sensitive to itraconazole. The MICs of E-test for Aspergillus spp were 1.6 ± 1.8 and 0.6 ± 0.93 for itraconazole and voriconazole, respectively. Conclusions. The prevalence of aspergillosis was high, with a significant association with underlying lung diseases. Voriconazole was the drug of choice for isolated fungi. Full article

(This article belongs to the Special Issue Global Burden of Antimicrobial Resistance (AMR))

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13 pages, 1649 KiB

Open AccessArticle

Antimicrobial Resistance in E. coli Isolated from Chicken Cecum Samples and Factors Contributing to Antimicrobial Resistance in Nepal

by Pramesh Koju, Rajeev Shrestha, Abha Shrestha, Sudichhya Tamrakar, Anisha Rai, Priyanka Shrestha, Surendra Kumar Madhup, Nishan Katuwal, Archana Shrestha, Akina Shrestha, Sunaina Shrestha, Sandip K.C, Prashamsa Karki, Pooja Tamang, Pruthu Thekkur and Sony Shakya Shrestha

Trop. Med. Infect. Dis. 2022, 7(9), 249; https://doi.org/10.3390/tropicalmed7090249 - 15 Sep 2022

Cited by 13 | Viewed by 3344

Abstract

Microorganisms with antimicrobial resistance (AMR) are prevalent among humans and animals, and also found in the environment. Though organisms with AMR can spread to humans via food from animal sources, the burden of AMR in food-producing animals remains largely unknown. Thus, we assessed [...] Read more.

Microorganisms with antimicrobial resistance (AMR) are prevalent among humans and animals, and also found in the environment. Though organisms with AMR can spread to humans via food from animal sources, the burden of AMR in food-producing animals remains largely unknown. Thus, we assessed the resistance pattern among Escherichia coli isolated from chicken cecum samples and explored issues contributing to AMR in animals in the Dhulikhel Municipality of Nepal. We conducted a mixed-methods study, comprising a cross-sectional quantitative component, with collection of chicken cecal samples from slaughter houses/shops. In addition, a descriptive qualitative component was undertaken, with a focus group discussion and key informant interviews among stakeholders involved in animal husbandry. Of the 190 chicken cecum samples collected, 170 (89%) were subjected to culture and drug sensitivity testing, of which E. coli was isolated from 159 (94%) samples. Of the 159 isolates, 113 (71%) had resistance to ≥3 antimicrobial class. Resistance to tetracycline (86%) and ciprofloxacin (66%) were most prevalent. Overuse of antimicrobials, easy availability of antimicrobials, and lack of awareness among farmers about AMR were major issues contributing to AMR. The high prevalence of resistance among E. coli in chicken cecal samples calls for rational use of antimicrobials, educating farmers, and multi-sectoral coordination. Full article

(This article belongs to the Special Issue Global Burden of Antimicrobial Resistance (AMR))

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10 pages, 569 KiB

Open AccessArticle

Carbapenem-Resistant Organisms Isolated in Surgical Site Infections in Benin: A Public Health Problem

by Carine Laurence Yehouenou, Reza Soleimani, Arsène A. Kpangon, Anne Simon, Francis M. Dossou and Olivia Dalleur

Trop. Med. Infect. Dis. 2022, 7(8), 200; https://doi.org/10.3390/tropicalmed7080200 - 21 Aug 2022

Cited by 4 | Viewed by 2377

Abstract

An alarming worldwide increase in antimicrobial resistance is complicating the management of surgical site infections (SSIs), especially in low-middle income countries. The main objective of this study was to describe the pattern of carbapenem-resistant bacteria in hospitalized patients and to highlight the challenge [...] Read more.

An alarming worldwide increase in antimicrobial resistance is complicating the management of surgical site infections (SSIs), especially in low-middle income countries. The main objective of this study was to describe the pattern of carbapenem-resistant bacteria in hospitalized patients and to highlight the challenge of their detection in Benin. We collected pus samples from patients suspected to have SSIs in hospitals. After bacterial identification by MALDI-TOF mass spectrometry, antimicrobial susceptibility was performed according to the Kirby–Bauer method. Carbapenem-resistant strains were characterized using, successively, the Modified Hodge Test (MHT), the RESIST-5 O.K.N.V.I: a multiplex lateral flow and finally the polymerase chain reaction. Six isolates were resistant to three tested carbapenems and almost all antibiotics we tested but remained susceptible to amikacin. Four (66.7%) of them harbored some ESBL genes (bla_CTX-M-1 and bla_TEM-1). The MHT was positive for Carbapenems but not for Pseudomonas aeruginosa and Acinetobacter baumannii. As surgical antimicrobial prophylaxis, five of the six patients received ceftriaxone. The following carbapenems genes were identified: bla _OXA-48(33.3%, n = 2), bla_NDM (33.3%, n = 2) and bla_VIM (33.3%, n = 2). These findings indicate a need for local and national antimicrobial resistance surveillance and the strengthening of antimicrobial stewardship programs in the country. Full article

(This article belongs to the Special Issue Global Burden of Antimicrobial Resistance (AMR))

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13 pages, 681 KiB

Open AccessArticle

Multicenter Study of the Risk Factors and Outcomes of Bloodstream Infections Caused by Carbapenem-Non-Susceptible Acinetobacter baumannii in Indonesia

by Dewi Anggraini, Dewi Santosaningsih, Pepy Dwi Endraswari, Novira Jasmin, Fajri Marindra Siregar, Usman Hadi and Kuntaman Kuntaman

Trop. Med. Infect. Dis. 2022, 7(8), 161; https://doi.org/10.3390/tropicalmed7080161 - 31 Jul 2022

Cited by 8 | Viewed by 2297

Abstract

The prevalence of bacteremia caused by carbapenem-non-susceptible Acinetobacter baumannii (CNSAB) continues to increase, and it is associated with a high mortality rate. Early recognition of infection and mortality determinants risk factors is necessary for adequate antibiotic administration. We aimed to determine the risk [...] Read more.

The prevalence of bacteremia caused by carbapenem-non-susceptible Acinetobacter baumannii (CNSAB) continues to increase, and it is associated with a high mortality rate. Early recognition of infection and mortality determinants risk factors is necessary for adequate antibiotic administration. We aimed to determine the risk factors and outcomes of CNSAB bacteremia in Indonesia. A multicenter case-control study was conducted in three referral hospitals in Indonesia. Data were collected retrospectively from January 2019 to December 2021. Cases were defined as patients with bacteremia where CNSAB was isolated from the blood, while the controls were patients with bacteremia caused by carbapenem-susceptible A. baumannii (CSAB). Risk factors for bacteremia and mortality associated with CNSAB bacteremia were determined using univariates analysis (chi-squared and Student’s t-test or Mann–Whitney test) and multivariate logistic regression analysis. A total of 144 bacteremia patients were included, of whom 72 patients were for each case and control group. The final model of multivariate regression analysis revealed that bacteremia source from the lower respiratory tract (adjusted odds ratio (aOR): 3.24; 95% CI: 1.58–6.63, p = 0.001) and the use of central venous catheter (aOR: 2.56; 95% CI: 1.27–5.18; p = 0.009) were independent risk factors for CNSAB bacteremia. Charlson Comorbidity Index ≥ 4 (aOR: 28.56; 95% CI: 3.06–265.90, p = 0.003) and Pitt Bacteremia Score ≥ 4 (aOR: 6.44; 95% CI: 1.17–35.38; p = 0.032) were independent risk factors for mortality due to CNSAB bacteremia. Only high Pitt Bacteremia Score was an independent risk factor for mortality of CSAB bacteremia. In conclusion, we identified the risk factors for CNSAB-associated bacteremia and the risk factors for death, which are relevant for empiric therapy and infection control prevention, as well as prognosis evaluation of patients with bloodstream infections. Full article

(This article belongs to the Special Issue Global Burden of Antimicrobial Resistance (AMR))

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14 pages, 1677 KiB

Open AccessArticle

Hydroquinine Possesses Antibacterial Activity, and at Half the MIC, Induces the Overexpression of RND-Type Efflux Pumps Using Multiplex Digital PCR in Pseudomonas aeruginosa

by Nontaporn Rattanachak, Sattaporn Weawsiangsang, Touchkanin Jongjitvimol, Robert A Baldock and Jirapas Jongjitwimol

Trop. Med. Infect. Dis. 2022, 7(8), 156; https://doi.org/10.3390/tropicalmed7080156 - 30 Jul 2022

Cited by 7 | Viewed by 6300

Abstract

Hydroquinine is an organic compound that is closely related to quinine-derivative drugs and contains anti-malarial and anti-arrhythmia activities. It has been also found in abundance in some natural extracts that possess antibacterial properties. However, there is little evidence demonstrating the antibacterial effect of [...] Read more.

Hydroquinine is an organic compound that is closely related to quinine-derivative drugs and contains anti-malarial and anti-arrhythmia activities. It has been also found in abundance in some natural extracts that possess antibacterial properties. However, there is little evidence demonstrating the antibacterial effect of hydroquinine. Therefore, we aimed to investigate the antibacterial properties of hydroquinine using broth microdilution methods. In addition, we evaluated the transcriptional responses of P. aeruginosa to hydroquinine-induced stress using RNA sequencing with transcriptomic analysis and validated the results using PCR-based methods. The MIC and MBC values of hydroquinine against all eight bacterial strains investigated ranged from 650 to 2500 and from 1250 to 5000 µg/mL, respectively. Transcriptomic analysis demonstrated that RND efflux pump transcripts were overexpressed (4.90–9.47 Log₂ fold change). Using mRT-dPCR and RT-qPCR, we identified that mRNA levels of mexD and mexY genes were overexpressed in response to just half the MIC of hydroquinine in P. aeruginosa. In conclusion, we uncover the antimicrobial potential of hydroquinine as well as identify changes in gene expression that may contribute to bacterial resistance. Further work will be required to explore the efficacy and potential use of hydroquinine in the clinic. Full article

(This article belongs to the Special Issue Global Burden of Antimicrobial Resistance (AMR))

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17 pages, 729 KiB

Open AccessArticle

The Resistance Patterns in E. coli Isolates among Apparently Healthy Adults and Local Drivers of Antimicrobial Resistance: A Mixed-Methods Study in a Suburban Area of Nepal

by Abha Shrestha, Rajeev Shrestha, Pramesh Koju, Sudichhya Tamrakar, Anisha Rai, Priyanka Shrestha, Surendra Kumar Madhup, Nishan Katuwal, Archana Shrestha, Akina Shrestha, Sunaina Shrestha, Sandip K.C, Supriya Kharel, Pooja Tamang, Pruthu Thekkur and Sony Shakya Shrestha

Trop. Med. Infect. Dis. 2022, 7(7), 133; https://doi.org/10.3390/tropicalmed7070133 - 12 Jul 2022

Cited by 6 | Viewed by 3464

Abstract

Evidence-based decision-making to combat antimicrobial resistance (AMR) mandates a well-built community-based surveillance system for assessing resistance patterns among commensals and pathogenic organisms. As there is no such surveillance system in Nepal, we attempted to describe the antimicrobial resistance pattern in E. coli isolated [...] Read more.

Evidence-based decision-making to combat antimicrobial resistance (AMR) mandates a well-built community-based surveillance system for assessing resistance patterns among commensals and pathogenic organisms. As there is no such surveillance system in Nepal, we attempted to describe the antimicrobial resistance pattern in E. coli isolated from the fecal samples of apparently healthy individuals in Dhulikhel municipality and also explored the local drivers of AMR. We used a mixed-method design with a cross-sectional quantitative component and a descriptive qualitative component, with focus group discussion and key informant interviews as the data collection method. Fecal samples were collected from 424 individuals randomly selected for the study. E. coli was isolated from 85.9% of human fecal samples, of which 14% were resistant to ≥3 class of antimicrobials (multidrug resistant). Of the 368 isolates, resistance to ampicillin (40.0%), tetracycline (20.7%) and cefotaxime (15.5%) were most prevalent. The major drivers of AMR were: lack of awareness of AMR, weak regulations on sales of antimicrobials, poor adherence to prescribed medications, and incomplete dosage due to financial constraints. These findings indicate the need for strict implementation of a national drug act to limit the over-the-counter sales of antimicrobials. Additionally, awareness campaigns with a multimedia mix are essential for educating people on AMR. Full article

(This article belongs to the Special Issue Global Burden of Antimicrobial Resistance (AMR))

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20 pages, 3747 KiB

Open AccessSystematic Review

Mycobacterium tuberculosis Drug Resistance in Ethiopia: An Updated Systematic Review and Meta-Analysis

by Melese Abate Reta, Birhan Alemnew Tamene, Biruk Beletew Abate, Eric Mensah, Nontuthuko Excellent Maningi and P. Bernard Fourie

Trop. Med. Infect. Dis. 2022, 7(10), 300; https://doi.org/10.3390/tropicalmed7100300 - 14 Oct 2022

Cited by 11 | Viewed by 3545

Abstract

Background: Tuberculosis (TB) remains a significant global public health issue, despite advances in diagnostic technologies, substantial global efforts, and the availability of effective chemotherapies. Mycobacterium tuberculosis, a species of pathogenic bacteria resistant to currently available anti-TB drugs, is on the rise, threatening [...] Read more.

Background: Tuberculosis (TB) remains a significant global public health issue, despite advances in diagnostic technologies, substantial global efforts, and the availability of effective chemotherapies. Mycobacterium tuberculosis, a species of pathogenic bacteria resistant to currently available anti-TB drugs, is on the rise, threatening national and international TB-control efforts. This systematic review and meta-analysis aims to estimate the pooled prevalence of drug-resistant TB (DR-TB) in Ethiopia. Materialsand Methods: A systematic literature search was undertaken using PubMed/MEDLINE, HINARI, the Web of Science, ScienceDirect electronic databases, and Google Scholar (1 January 2011 to 30 November 2020). After cleaning and sorting the records, the data were analyzed using STATA 11. The study outcomes revealed the weighted pooled prevalence of any anti-tuberculosis drug resistance, any isoniazid (INH) and rifampicin (RIF) resistance, monoresistance to INH and RIF, and multidrug-resistant TB (MDR-TB) in newly diagnosed and previously treated patients with TB. Results: A total of 24 studies with 18,908 patients with TB were included in the final analysis. The weighted pooled prevalence of any anti-TB drug resistance was 14.25% (95% confidence interval (CI): 7.05–21.44%)), whereas the pooled prevalence of any INH and RIF resistance was found in 15.62% (95%CI: 6.77–24.47%) and 9.75% (95%CI: 4.69–14.82%) of patients with TB, respectively. The pooled prevalence for INH and RIF-monoresistance was 6.23% (95%CI: 4.44–8.02%) and 2.33% (95%CI: 1.00–3.66%), respectively. MDR-TB was detected in 2.64% (95%CI: 1.46–3.82%) of newly diagnosed cases and 11.54% (95%CI: 2.12–20.96%) of retreated patients with TB, while the overall pooled prevalence of MDR-TB was 10.78% (95%CI: 4.74–16.83%). Conclusions: In Ethiopia, anti-tuberculosis drug resistance is widespread. The estimated pooled prevalence of INH and RIF-monoresistance rates were significantly higher in this review than in previous reports. Moreover, MDR-TB in newly diagnosed cases remained strong. Thus, early detection of TB cases, drug-resistance testing, proper and timely treatment, and diligent follow-up of TB patients all contribute to the improvement of DR-TB management and prevention. Besides this, we urge that a robust, routine laboratory-based drug-resistance surveillance system be implemented in the country. Full article

(This article belongs to the Special Issue Global Burden of Antimicrobial Resistance (AMR))

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32 pages, 4444 KiB

Open AccessSystematic Review

Prevalence of Antimicrobial Resistance Genes in Salmonella Typhi: A Systematic Review and Meta-Analysis

by Nik Yusnoraini Yusof, Nur Iffah Izzati Norazzman, Nur Fatihah Mohd Zaidi, Mawaddah Mohd Azlan, Basyirah Ghazali, Mohamad Ahmad Najib, Abdul Hafiz Abdul Malik, Mohamad Aideil Helmy Abdul Halim, Muhammad Nor Syamim Mohd Sanusi, Annur Ashyqin Zainal and Ismail Aziah

Trop. Med. Infect. Dis. 2022, 7(10), 271; https://doi.org/10.3390/tropicalmed7100271 - 27 Sep 2022

Cited by 4 | Viewed by 5719

Abstract

Salmonella enterica serovar Typhi (S. Typhi) that has developed resistance to many antimicrobials poses a serious challenge to public health. Hence, this study aimed to systematically determine the prevalence of antimicrobial resistance (AMR) in S. Typhi isolated from the environment and humans [...] Read more.

Salmonella enterica serovar Typhi (S. Typhi) that has developed resistance to many antimicrobials poses a serious challenge to public health. Hence, this study aimed to systematically determine the prevalence of antimicrobial resistance (AMR) in S. Typhi isolated from the environment and humans as well as to ascertain the spread of the selected AMR genes in S. Typhi. This systematic review and meta-analysis were performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines, and the study protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO). A total of 2353 studies were retrieved from three databases, of which 42 studies fulfilled the selection criteria. The pooled prevalence of AMR S. Typhi (using a random-effect model) was estimated at 84.8% (95% CI; 77.3–90.2), with high heterogeneity (I²: 95.35%, p-value < 0.001). The high estimated prevalence indicates that control methods should be improved immediately to prevent the spread of AMR among S. Typhi internationally. Full article

(This article belongs to the Special Issue Global Burden of Antimicrobial Resistance (AMR))

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