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Gupta M, Gupta V, Gupta R, Chaudhary J. Current trends in antimicrobial resistance of ESKAPEEc pathogens from bloodstream infections - Experience of a tertiary care centre in North India. Indian J Med Microbiol 2024; 50:100647. [PMID: 38871082 DOI: 10.1016/j.ijmmb.2024.100647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 10/09/2023] [Accepted: 06/08/2024] [Indexed: 06/15/2024]
Abstract
INTRODUCTION Bloodstream infections (BSI) due to ESKAPEEc pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanni, Pseudomonas aeruginosa, Enterobacter spp. and Escherichia coli), cause significant mobility and mortality worldwide and are among the most common healthcare associated infections. Rising rates of antimicrobial resistance (AMR) in India are alarming, because of the high infection rates and poor control of antibiotic use. This single-centre, retrospective study was undertaken to identify the patterns of distribution and antimicrobial resistance of ESKAPEEc pathogens in bloodstream infections. METHODOLOGY Blood samples from patients with suspected BSI were cultured and antimicrobial susceptibility testing was performed on automated systems (BD Bactec Fx/BactAlert 3D and Vitek2). The microbiological data on bacterial BSI was retrieved from the laboratory records and antimicrobial resistance profiles were analysed. RESULTS 10.7% of the blood culture samples showed bacterial growth during the study period (adult > paediatric and intensive care unit (ICU) > ward > outpatient department (OPD)). E. coli (24%) and K. pneumoniae (20.5%) were the predominant species isolated, followed by S. aureus (9.5%) and A. baumanni (9%). High rates of resistance to third generation cephalosporins, β-lactam-β-lactamase inhibitor combinations (BL-BLI) and carbapenems was observed, in Gram-negative isolates, especially from ICU patients. Methicillin-resistant S. aureus (MRSA) isolates increased from 67% to 88% over the five-year period. Vancomycin-resistance among Enterococcus isolates also escalated to 40% in 2022 with 11% linezolid resistance. CONCLUSION The study revealed that more than 77% of bloodstream infections were caused by ESKAPEEc pathogens, with high rates of resistance to most antimicrobials. This reinforces the importance of monitoring the frequency of bacteria and antibiograms in individual treatment and hospital infection control programs.
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Affiliation(s)
- Menal Gupta
- Department of Microbiology, Dayanand Medical College & Hospital, Ludhiana, India.
| | - Veenu Gupta
- Department of Microbiology, Dayanand Medical College & Hospital, Ludhiana, India.
| | - Rama Gupta
- Department of Microbiology, Dayanand Medical College & Hospital, Ludhiana, India.
| | - Jyoti Chaudhary
- Department of Microbiology, Dayanand Medical College & Hospital, Ludhiana, India.
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Handa VL, Patel BN, Bhattacharya DA, Kothari RK, Kavathia DG, Vyas BRM. A study of antibiotic resistance pattern of clinical bacterial pathogens isolated from patients in a tertiary care hospital. Front Microbiol 2024; 15:1383989. [PMID: 38694800 PMCID: PMC11061477 DOI: 10.3389/fmicb.2024.1383989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 03/18/2024] [Indexed: 05/04/2024] Open
Abstract
We investigated antibiotic resistance pattern in clinical bacterial pathogens isolated from in-patients and out-patients, and compared it with non-clinical bacterial isolates. 475 bacterial strains isolated from patients were examined for antibiotic resistance. Staphylococcus spp. (148; 31.1%) were found to be the most prevalent, followed by Klebsiella pneumoniae (135; 28.4%), Escherichia coli (74; 15.5%), Pseudomonas aeruginosa (65; 13.6%), Enterobacter spp. (28; 5.8%), and Acinetobacter spp. (25; 5.2%). Drug-resistant bacteria isolated were extended spectrum-β-lactamase K. pneumoniae (8.8%), E. coli (20%), metallo-β-lactamase P. aeruginosa (14; 2.9%), erythromycin-inducing clindamycin resistant (7.4%), and methicillin-resistant Staphylococcus species (21.6%). Pathogens belonging to the Enterobacteriaceae family were observed to undergo directional selection developing resistance against antibiotics ciprofloxacin, piperacillin-tazobactam, cefepime, and cefuroxime. Pathogens in the surgical ward exhibited higher levels of antibiotic resistance, while non-clinical P. aeruginosa and K. pneumoniae strains were more antibiotic-susceptible. Our research assisted in identifying the drugs that can be used to control infections caused by antimicrobial resistant bacteria in the population and in monitoring the prevalence of drug-resistant bacterial pathogens.
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Affiliation(s)
- Vishal L. Handa
- Department of Biosciences, Saurashtra University, Rajkot, Gujarat, India
| | - Bhoomi N. Patel
- Department of Biosciences, Saurashtra University, Rajkot, Gujarat, India
| | - Dr. Arpita Bhattacharya
- Department of Microbiology, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat, India
| | - Ramesh K. Kothari
- Department of Biosciences, Saurashtra University, Rajkot, Gujarat, India
| | - Dr. Ghanshyam Kavathia
- Department of Microbiology, Pandit Deendayal Upadhyay Medical College, Rajkot, Gujarat, India
| | - B. R. M. Vyas
- Department of Biosciences, Saurashtra University, Rajkot, Gujarat, India
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Maputla SP, Van Dalen W, Joubert A, Norman J, Castel S, van der Merwe M, Wiesner L. A validated liquid chromatography-tandem mass spectrometry assay for the analysis of isoniazid and its metabolite acetyl-isoniazid in urine. J Mass Spectrom Adv Clin Lab 2024; 32:11-17. [PMID: 38356778 PMCID: PMC10865391 DOI: 10.1016/j.jmsacl.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/16/2024] Open
Abstract
Introduction Isoniazid (INH) is one of the most effective and potent first-line anti-tubercular drug. INH is also effectively administered as a preventative monotherapy and has been shown to significantly reduce TB incidence. INH is primarily metabolised to acetyl-isoniazid (AcINH) in the liver. AcINH is mainly excreted in urine presenting as a target for monitoring adherence to INH therapy. Objective The study aimed to develop and fully validate a bioanalytical method using liquid chromatography-tandem mass spectrometry for the quantification of INH and AcINH in human urine. Methods The samples were prepared using solid phase extraction, with the internal standards isoniazid-d4 and acetyl-isoniazid-d4 being used. The extracts were chromatographed on an Atlantis T3 analytical column with an isocratic mobile phase. For detection, a AB Sciex™ API 5500 triple quadrupole mass spectrometer was used at unit resolution in the multiple reaction monitoring mode, following positive electrospray ionization. Results The analytical method demonstrated sufficient sensitivity, as indicated by average signal-to-noise ratios of 7.07 and 6.23 at the lower limit of quantification for INH and AcINH, respectively. Validation was performed over three consecutive batches, demonstrating accuracy, precision, and overall robustness based on peak area ratios within the analytical range of 0.234-30.0 µg/mL for both INH and AcINH. All required validation experiments were assessed and met the acceptance criteria guidelines of the US Food and Drug Administration and European Medicines Agency. The validated method was utilized to measure concentrations of AcINH in urine as a means of assessing adherence to the intake of isoniazid in order to prevent TB infection during a phase III open-label multicenter trial. Conclusion A bioanalytical method was developed and fully validated for quantifying isoniazid (INH) and acetyl-isoniazid (AcINH) in 100 µL of human urine.
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Affiliation(s)
- Sydwell Poulo Maputla
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Willem Van Dalen
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Anton Joubert
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Jennifer Norman
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Sandra Castel
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Marthinus van der Merwe
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
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Khanchandani H, Chaudhury M, Rao MS, Ramakrishna N, Venkataramana B, Chaudhury A. In vitro activity of the newly approved antimicrobial agent Cefiderocol against Carbapenem resistant Gram negative clinical isolates. Indian J Med Microbiol 2024; 48:100556. [PMID: 38447857 DOI: 10.1016/j.ijmmb.2024.100556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 01/16/2024] [Accepted: 03/03/2024] [Indexed: 03/08/2024]
Abstract
INTRODUCTION Carbapenem resistant Gram negative bacteria have emerged as priority pathogens in recent years. Cefiderocol is a siderophore cephalosporin licensed in 2019 with claimed activity against ESBL producing and carbapenem resistant bacteria with much better safety margin compared to colistin. The present study was undertaken to assess the in vitro activity of cefiderocol against carbapenem resistant clinical isolates, compared to some select antimicrobial agents including colistin. MATERIALS AND METHODS Seventy-seven isolates of Gram negative bacteria belonging to the three commonly encountered groups of Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp were included. Susceptibility testing for Cefiderocol was determined by Kirby-Bauer's disk diffusion technique as per CLSI guidelines using Cefiderocol disc (30 μg). Sensitivity for the other agents were determined using automated system. RESULTS Of the 77 isolates, 58.4% belonged to Enterobacterales, followed by P.aeruginosa (27.3%) and Acinetobacter spp (14.3%). Three out of 45 Enterobacterales isolates, one out of 21 P.aeruginosa and none in the Acinetobacter group were found resistant to cefiderocol. All the isolates were intermediate sensitive (I) for colistin since the "susceptible" interpretive category has been eliminated. Tigecycline showed good activity (80.0% sensitive) against Enterobacterales followed by aztreonam (71.1% sensitive). CONCLUSION Cefiderocol is not yet available in India and our study is possibly the second one from this country demonstrating in vitro resistance to this important antimicrobial agent. However, with a relatively better safety profile compared to colistin, cefiderocol can be an important agent to combat these highly resistant pathogens.
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Affiliation(s)
| | - Madhulika Chaudhury
- Sri Padmavathi Medical College (Women)-SVIMS, Tirupati, Andhra Pradesh, India.
| | - M Srihari Rao
- Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India.
| | - N Ramakrishna
- Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India.
| | - B Venkataramana
- Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India.
| | - Abhijit Chaudhury
- Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India.
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Pandey P, Pradhan S, Meher K, Lopus M, Vavilala SL. Exploring the efficacy of tryptone-stabilized silver nanoparticles against respiratory tract infection-causing bacteria: a study on planktonic and biofilm forms. Biomed Mater 2024; 19:025047. [PMID: 38364289 DOI: 10.1088/1748-605x/ad2a40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/16/2024] [Indexed: 02/18/2024]
Abstract
Respiratory tract infections (RTIs) are a common cause of mortality and morbidity in the human population. The overuse of antibiotics to overcome such infections has led to antibiotic resistance. The emergence of multidrug resistant bacteria is necessitating the development of novel therapeutic techniques in order to avoid a major global clinical threat. Our study aims to investigate the potential of tryptone stabilised silver nanoparticles (Ts-AgNPs) on planktonic and biofilms produced byKlebsiella pneumoniae(K. pneumoniae)and Pseudomonas aeruginosa(P. aeruginosa). The MIC50of Ts-AgNPs was found to be as low as 1.7 μg ml-1and 2.7 μg ml-1forK. pneumoniae and P.aeruginosarespectively. Ts-AgNPs ability to alter redox environment by producing intracellular ROS, time-kill curves showing substantial decrease in the bacterial growth and significantly reduced colony forming units further validate its antimicrobial effect. The biofilm inhibition and eradication ability of Ts-AgNPs was found to be as high as 93% and 97% in both the tested organisms. A significant decrease in the eDNA and EPS quantity in Ts-AgNPs treated cells proved its ability to successfully distort the matrix and matured biofilms. Interestingly Ts-AgNPs also attenuated QS-induced virulence factors production. This study paves way to develop Ts-AgNPs as novel antibiotics against RTIs causing bacterial biofilms.
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Affiliation(s)
- Pooja Pandey
- School of Biological Sciences, UM-DAE Centre for Excellence in Basic Sciences, University of Mumbai, Vidyanagari, Kalina Campus, Mumbai 400098, India
| | - Sristi Pradhan
- School of Biological Sciences, UM-DAE Centre for Excellence in Basic Sciences, University of Mumbai, Vidyanagari, Kalina Campus, Mumbai 400098, India
| | - Kimaya Meher
- School of Biological Sciences, UM-DAE Centre for Excellence in Basic Sciences, University of Mumbai, Vidyanagari, Kalina Campus, Mumbai 400098, India
| | - Manu Lopus
- School of Biological Sciences, UM-DAE Centre for Excellence in Basic Sciences, University of Mumbai, Vidyanagari, Kalina Campus, Mumbai 400098, India
| | - Sirisha L Vavilala
- School of Biological Sciences, UM-DAE Centre for Excellence in Basic Sciences, University of Mumbai, Vidyanagari, Kalina Campus, Mumbai 400098, India
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Natsheh IY, Alsaleh MM, Alkhawaldeh AK, Albadawi DK, Darwish MM, Shammout MJA. The dark side of drug repurposing. From clinical trial challenges to antimicrobial resistance: analysis based on three major fields. Drug Target Insights 2024; 18:8-19. [PMID: 38751378 PMCID: PMC11094707 DOI: 10.33393/dti.2024.3019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 04/18/2024] [Indexed: 05/18/2024] Open
Abstract
Drug repurposing is a strategic endeavor that entails the identification of novel therapeutic applications for pharmaceuticals that are already available in the market. Despite the advantageous nature of implementing this particular strategy owing to its cost-effectiveness and efficiency in reducing the time required for the drug discovery process, it is essential to bear in mind that there are various factors that must be meticulously considered and taken into account. Up to this point, there has been a noticeable absence of comprehensive analyses that shed light on the limitations of repurposing drugs. The primary aim of this review is to conduct a thorough illustration of the various challenges that arise when contemplating drug repurposing from a clinical perspective in three major fields-cardiovascular, cancer, and diabetes-and to further underscore the potential risks associated with the emergence of antimicrobial resistance (AMR) when employing repurposed antibiotics for the treatment of noninfectious and infectious diseases. The process of developing repurposed medications necessitates the application of creativity and innovation in designing the development program, as the body of evidence may differ for each specific case. In order to effectively repurpose drugs, it is crucial to consider the clinical implications and potential drawbacks that may arise during this process. By comprehensively analyzing these challenges, we can attain a deeper comprehension of the intricacies involved in drug repurposing, which will ultimately lead to the development of more efficacious and safe therapeutic approaches.
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Affiliation(s)
- Iyad Y. Natsheh
- Department of Medical Applied Sciences, Zarqa University College, Al-Balqa Applied University, Salt - Jordan
| | - Majd M. Alsaleh
- Department of Medical Applied Sciences, Zarqa University College, Al-Balqa Applied University, Salt - Jordan
- Department of Biology, School of Science, University of Jordan, Amman - Jordan
| | - Ahmad K. Alkhawaldeh
- Department of Medical Applied Sciences, Zarqa University College, Al-Balqa Applied University, Salt - Jordan
| | - Duaa K. Albadawi
- Department of Medical Applied Sciences, Zarqa University College, Al-Balqa Applied University, Salt - Jordan
| | - Maisa’ M. Darwish
- Department of Biology, School of Science, University of Jordan, Amman - Jordan
- National Agricultural Research Center, Amman - Jordan
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Itani R, Khojah HMJ, Karout S, Rahme D, Hammoud L, Awad R, Abu-Farha R, Mukattash TL, Raychouni H, El-Lakany A. Acinetobacter baumannii: assessing susceptibility patterns, management practices, and mortality predictors in a tertiary teaching hospital in Lebanon. Antimicrob Resist Infect Control 2023; 12:136. [PMID: 38031181 PMCID: PMC10685635 DOI: 10.1186/s13756-023-01343-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/22/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Acinetobacter baumannii is a major nosocomial pathogen capable of causing life-threatening infections. This bacterium is highly resistant to antibiotics and associated with high mortality rates. Therefore, this study aimed to evaluate A. baumannii's susceptibility patterns to antimicrobials, assess the appropriateness of the initiated antimicrobial therapy, determine the mortality rate, and identify predictors associated with mortality. METHODS A retrospective observational study was conducted among patients infected with A. baumannii at a university hospital in Lebanon through the revision of medical records. Kaplan-Meier survival analysis and log-rank tests were used to analyze time-to-mortality. Binary logistic regression was performed to identify predictors of mortality. RESULTS The records of 188 patients were screened, and 111 patients with A. baumannii infection were enrolled. Almost all isolates were resistant to carbapenem, and 43% of the isolates were extensively-drug resistant. Almost half of the patients received initial inappropriate antimicrobial therapy (n = 50, 45.1%). The 30-day mortality rate associated with A. baumannii infection was 71.2% (79/111). The time to mortality in patients who received inappropriate antimicrobial therapy (5.70 ± 1.07 days) was significantly shorter than in those who received appropriate antimicrobial therapy (12.43 ± 1.01 days, P < 0.01). Binary logistic regression revealed that inappropriate antimicrobial therapy (adjusted odds ratio [AOR] = 16.22, 95% CI 2.68-9.97, P = 0.002), mechanical ventilation (AOR = 14.72, 95% CI 3.27-6.61, P < 0.001), and thrombocytopenia (AOR = 8.82, 95% CI 1.12-9.75, P = 0.003) were more likely associated with mortality. CONCLUSIONS A. baumannii exhibits an alarming mortality rate among infected patients. Thrombocytopenia, mechanical ventilation, and inappropriate antibiotic administration are associated with mortality in patients infected with A. baumannii. The prompt initiation of appropriate antimicrobial therapy, infection control measures, and effective stewardship program are crucial to reduce the incidence of A. baumannii and improve the treatment outcomes.
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Affiliation(s)
- Rania Itani
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Riad El Solh, 1107 2809, P.O. Box: 11-5020, Beirut, Lebanon
| | - Hani M J Khojah
- Department of Pharmacy Practice, College of Pharmacy, Taibah University, P.O. Box: 30051, 41477, Madinah, Kingdom of Saudi Arabia
| | - Samar Karout
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Riad El Solh, 1107 2809, P.O. Box: 11-5020, Beirut, Lebanon.
| | - Deema Rahme
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Riad El Solh, 1107 2809, P.O. Box: 11-5020, Beirut, Lebanon
- INSPECT-LB (Institut National de Santé Publique, d'Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Lara Hammoud
- Pharmacy Department, Hammoud Hospital University Medical Center, Sidon, Lebanon
| | - Reem Awad
- Pharmacy Practice Department, Faculty of Pharmacy, Beirut Arab University, Riad El Solh, 1107 2809, P.O. Box: 11-5020, Beirut, Lebanon
| | - Rana Abu-Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, P.O. Box: 11931, Amman, Jordan
| | - Tareq L Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, P.O. Box: 3030, Irbid, 22110, Jordan
| | - Hamza Raychouni
- Intensive Care Unit, Central Military Hospital, Military Healthcare, Lebanese Army, Beirut, Lebanon
- Intensive Care Unit, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdalla El-Lakany
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Beirut Arab University, Riad El Solh, 1107 2809, P.O. Box: 11-5020, Beirut, Lebanon
- Department of Pharmacognosy, Faculty of Pharmacy, Alexandria University, Alexandria, Egypt
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Sarva K, Marimuthu Ragavan R, Tadi LJ, Raja S, Narasingam A. Performance of Carbapenemase Nordmann-Poirel, Modified Carbapenem Inactivation, and EDTA Carbapenem Inactivation Methods for Detecting Carbapenem-Resistant Klebsiella pneumoniae Isolates. Microb Drug Resist 2023; 29:504-509. [PMID: 37729073 DOI: 10.1089/mdr.2023.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
Infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) are a major threat to public health. Timely detection of CRKP will help treat patients with appropriate antibiotics. This study aimed to evaluate the performance of the carbapenemase Nordmann-Poirel (CarbaNP), modified carbapenem inactivation (mCIM), and EDTA carbapenem inactivation (eCIM) methods for the detection of CRKP. We compared the results of the three assays with that of real-time PCR. In total, 195 K. pneumoniae isolates, including 150 carbapenem-resistant and 45 carbapenem-susceptible isolates, were investigated. Carbapenem-resistance genes, such as blaKPC, blaNDM, blaVIM, blaIMP, and blaOXA-48-like, were identified using real-time PCR. Among the 150 CRKP isolates, 94 (62.7%) were positive for blaNDM, 29 (19.3%) were positive for blaOXA-48-like, and 27 (18%) were positive for both blaNDM and blaOXA-48-like. For detecting CRKP isolates, CarbaNP, mCIM, and eCIM showed 96.0%, 95.4%, and 96.7% sensitivity, respectively, and all three methods showed 100% specificity. All three phenotypic confirmatory tests are reliable for identifying CRKP, easy to perform, cost-effective, and can be incorporated with routine antibiotic susceptibility testing.
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Affiliation(s)
- Kamalakar Sarva
- Central Research Laboratory, Meenakshi Academy of Higher Education and Research (Deemed to be University), Chennai, India
| | | | | | | | - Arunagirinathan Narasingam
- Central Research Laboratory, Meenakshi Academy of Higher Education and Research (Deemed to be University), Chennai, India
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S S, N H, Fasim A, More SS, Das Mitra S. Identification of a potential inhibitor for New Delhi metallo-β-lactamase 1 (NDM-1) from FDA approved chemical library- a drug repurposing approach to combat carbapenem resistance. J Biomol Struct Dyn 2023; 41:7700-7711. [PMID: 36165602 DOI: 10.1080/07391102.2022.2123402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/06/2022] [Indexed: 10/14/2022]
Abstract
Superbugs producing New Delhi metallo-β-lactamase 1 (NDM-1) enzyme is a growing crisis, that is adversely affecting the global health care system. NDM-1 empowers the bacteria to inactivate entire arsenal of β-lactam antibiotics including carbapenem (the last resort antibiotic) and remains ineffective to all the available β lactamase inhibitors used in the clinics. Limited therapeutic option available for rapidly disseminating NDM-1 producing bacteria makes it imperative to identify a potential inhibitor for NDM-1 enzyme. With drug repurposing approach, in this study, we used virtual screening of available Food and Drug Administration (FDA) approved chemical library (ZINC12 database) and captured 'adapalene' (FDA drug) as a potent inhibitor candidate for NDM-1 enzyme. Active site docking with NDM-1, showed adapalene with binding energy -9.21 kcal/mol and interacting with key amino acid residues (Asp124, His122, His189, His250, Cys208) in the active site of NDM-1. Further, molecular dynamic simulation of NDM-1 docked with the adapalene at 100 ns displayed a stable conformation dynamic, with relative RMSD and RMSF in the acceptable range. Subsequently, in vitro enzyme assays using recombinant NDM-1 protein demonstrated inhibition of NDM-1 by adapalene. Further, the combination of adapalene plus meropenem (carbapenem antibiotic) showed synergistic effect against the NDM-1 producing carbapenem (meropenem) resistant clinical isolates (Escherichia coli and Klebsiella pneumoniae). Overall, our data indicated that adapalene can be a potential inhibitor candidate for NDM-1 enzyme that can contribute to the development of a suitable adjuvant to save the activity of carbapenem antibiotic against infections caused by NDM-1 positive gram-negative bacteria. Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Shailaja S
- Department of Biological Sciences, School of Basic & Applied Sciences, Dayananda Sagar University, Bangalore, Karnataka, India
| | - Harshitha N
- Department of Biological Sciences, School of Basic & Applied Sciences, Dayananda Sagar University, Bangalore, Karnataka, India
| | - Aneesa Fasim
- Department of Biological Sciences, School of Basic & Applied Sciences, Dayananda Sagar University, Bangalore, Karnataka, India
| | - Sunil S More
- Department of Biological Sciences, School of Basic & Applied Sciences, Dayananda Sagar University, Bangalore, Karnataka, India
| | - Susweta Das Mitra
- Department of Biological Sciences, School of Basic & Applied Sciences, Dayananda Sagar University, Bangalore, Karnataka, India
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Prajescu B, Gavriliu L, Iesanu MI, Ioan A, Boboc AA, Boboc C, Galos F. Bacterial Species and Antibiotic Resistance-A Retrospective Analysis of Bacterial Cultures in a Pediatric Hospital. Antibiotics (Basel) 2023; 12:966. [PMID: 37370285 DOI: 10.3390/antibiotics12060966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Antimicrobial resistance (AMR) has become a major healthcare concern having a rising incidence, especially in pediatric patients who are more susceptible to infections. The aim of our study was to analyze the bacterial species isolated from patients admitted to our tertiary hospital and their AMR profiles. We conducted a retrospective observational study by examining the bacterial cultures collected from pediatric patients admitted to our hospital over a period of one year. We identified the most common bacterial species from 1445 clinical isolates and their AMR patterns using standard microbiological techniques. Our analysis revealed that the most frequently isolated bacterial species were Escherichia coli (23.73%), Staphylococcus aureus (15.64%), Klebsiella species (12.04%), and Pseudomonas species (9.96%). Additionally, these species exhibited varying levels of resistance to commonly used antibiotics. Notably, we observed high rates of resistance among Gram-negative bacteria, including extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species. Among Gram-positive bacteria, we observed a high level of methicillin-resistant Staphylococcus aureus. Our findings highlight the urgent need for effective antibiotic management programs and infection control measures to address the rising incidence of AMR in pediatric hospitals. Further research is needed to identify the mechanisms of resistance in these bacterial species and to develop new strategies for preventing and treating infections caused by antibiotic-resistant bacteria in pediatric patients.
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Affiliation(s)
- Bianca Prajescu
- Department of Pediatrics, Marie Curie Emergency Children's Hospital, 041451 Bucharest, Romania
| | - Liana Gavriliu
- Department for Prevention of Healthcare-Associated Infections, Marie Curie Emergency Children's Hospital, 041451 Bucharest, Romania
- Department of Infectious Disease, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mara Ioana Iesanu
- Department of Pediatrics, Marie Curie Emergency Children's Hospital, 041451 Bucharest, Romania
- Department of Physiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Andreea Ioan
- Department of Pediatrics, Marie Curie Emergency Children's Hospital, 041451 Bucharest, Romania
| | - Anca Andreea Boboc
- Department of Pediatrics, Marie Curie Emergency Children's Hospital, 041451 Bucharest, Romania
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Ro-mania
| | - Catalin Boboc
- Department of Pediatrics, Marie Curie Emergency Children's Hospital, 041451 Bucharest, Romania
| | - Felicia Galos
- Department of Pediatrics, Marie Curie Emergency Children's Hospital, 041451 Bucharest, Romania
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Ro-mania
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11
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Mardourian M, Lyons H, Rhodes Brunner J, K. Edwards M, Lennox A, Mahadevaiah S, Chandrashekhar S, Prudhvi Raj S, Pradhan A, Kalyatanda G. Prevalence of antimicrobial resistance in urine, blood, and wound pathogens among rural patients in Karnataka, India. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e91. [PMID: 37228505 PMCID: PMC10204140 DOI: 10.1017/ash.2023.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 03/27/2023] [Accepted: 03/29/2023] [Indexed: 05/27/2023]
Abstract
Background and objective Antimicrobial resistance (AMR) is increasing in tertiary-care hospitals across India, which consumes more antibiotics than any other country. Microorganisms with novel resistance mechanisms, initially isolated in India, are now recognized worldwide. Until now, most efforts to stem AMR in India have focused on the inpatient setting. Ministry of Health data now suggest that rural areas are playing a more significant role in the pathogenesis of AMR than was previously appreciated. Thus, we conducted this pilot study to ascertain whether AMR is common in pathogens causing infections acquired in the wider rural community. Methods We performed a retrospective prevalence survey of 100 urine, 102 wound, and 102 blood cultures obtained from patients who were admitted to a tertiary-care facility in Karnataka, India, with infections acquired in the community. The study population included patients >18 years of age who (1) were referred to the hospital by primary care doctors, (2) had a positive blood, urine, or wound culture, and (3) were not previously hospitalized. Bacterial identification and antimicrobial susceptibility testing (AST) were carried out on all isolates. Results Enterobacteriaceae were the most common pathogens isolated from urine and blood cultures. Significant resistance to quinolones, aminoglycosides, carbapenems, and cephalosporins was noted among pathogens isolated from all cultures. Specifically, high resistance rates (>45%) to quinolones, penicillin, and cephalosporins were evident among all 3 types of culture. Among blood and urinary pathogens, there were high resistance rates (>25%) to both aminoglycosides and carbapenems. Conclusion Efforts to stem AMR rates in India need to focus on rural populations. Such efforts will need to characterize antimicrobial overprescribing practices, healthcare-seeking behaviors, and antimicrobial use in agriculture in rural settings.
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Affiliation(s)
- Markos Mardourian
- University of Florida College of Medicine, Gainesville, Florida, United States
| | - Hannah Lyons
- University of Florida College of Medicine, Gainesville, Florida, United States
| | | | - Matthew K. Edwards
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Archibald Lennox
- Malcolm Randall Department of Veterans’ Affairs Medical Center, Gainesville, Florida, United States
| | - Sumana Mahadevaiah
- Department of Microbiology, JSS Medical College, Mysore, Karnataka, India
| | | | - Suvvada Prudhvi Raj
- JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Anjali Pradhan
- JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, Karnataka, India
| | - Gautam Kalyatanda
- Division of Infectious Disease and Global Medicine, University of Florida, Gainesville, Florida, United States
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12
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Karuna T, Gupta A, Vyas A, Kumar S, Sampath A, Goel P, Shukla P, Mishra V, Sharma S, Chakraborty S, Jaiswal SP, Mishra A, Gupta A, Sahu M, Tiwari S, Pal A, Nagendra M, Gautham H, Patel K, Asati S, Khadanga S. Changing Trends in Antimicrobial Susceptibility Patterns of Bloodstream Infection (BSI) in Secondary Care Hospitals of India. Cureus 2023; 15:e37800. [PMID: 37214059 PMCID: PMC10195700 DOI: 10.7759/cureus.37800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction Bloodstream infection (BSI) and subsequent sepsis are life-threatening medical conditions. The onset of antimicrobial resistance and subsequent multi-drug resistant organisms (MDRO) significantly increase healthcare-associated expenditure with adverse clinical outcomes. The present study was undertaken to identify the trends of BSI in community settings in secondary care hospitals (smaller private hospitals and district hospitals) in the state of Madhya Pradesh in Central India with the support of the Indian Council of Medical Research (ICMR) and National Health Mission, Madhya Pradesh. Methodology The present study was a prospective, longitudinal observational chart review type of study. The study was carried out at 10 secondary care hospitals (eight smaller private hospitals and two government district hospitals) nominated by the State Government as part of the ICMR Antimicrobial Resistance Surveillance and Research Network (AMRSN). The hospitals were nominated depending on the availability of a microbiology laboratory and a full-time microbiologist. Result A total of 6202 blood samples were received from patients with suspected BSI, out of which 693 samples were positive for aerobic culture. Among these, 621 (89.6%) showed bacterial growth and 72 (10.3%) grew Candida species (spp). Out of the 621 bacterial growth samples, Gram-negative bacteria were 406 (65.3%) and Gram-positive bacteria were 215 (34.6%). Among the Gram-negative isolates (406), the predominant isolate was Escherichia coli (115; 28.3%) followed by Klebsiella pneumoniae (109; 26.8%), Pseudomonas aeruginosa (61; 15%), Salmonella spp. (52; 12.8%), Acinetobacter spp. (47; 11.6%) and the other Enterobacter spp. (22; 5.4%). Among the Gram-positive isolates (215), the predominant isolate was Staphylococcus aureus (178; 82.8%) followed by Enterococcus spp. (37; 17.2%). Among the Escherichia coli, third-generation cephalosporin resistance was identified in 77.6%, piperacillin-tazobactam resistance in 45.2%, carbapenem resistance in 23.5% and colistin resistance in 16.5% of cases. Among the Klebsiella pneumoniae, third-generation cephalosporin resistance was identified in 80.7%, piperacillin-tazobactam resistance in 72.8%, carbapenem resistance in 63.3% and colistin resistance in 14% of cases. Among the Pseudomonas aeruginosa, ceftazidime resistance was identified in 61.2%, piperacillin-tazobactam resistance in 55%, carbapenem resistance in 32.8%, and colistin resistance in 38.3% of cases. Among the Acinetobacter spp., piperacillin-tazobactam resistance was identified in 72.7%, carbapenem resistance in 72.3%, and colistin resistance in 9.3% cases. While analyzing the antibiogram for Staphylococcus aureus isolates, methicillin resistance (MRSA) was seen in 70.3% of cases, followed by vancomycin resistance (VRSA) in 8% of cases and linezolid resistance in 8.1%. Among the Enterococcus spp. isolates, linezolid resistance was found in 13.5%, vancomycin resistance (VRE) in 21.6%, and teicoplanin resistance in 29.7% of cases. Conclusion In conclusion, the first-ever study to identify the risk of high-end antibiotics causing significant drug resistance in secondary and tertiary care settings has highlighted the urgent need for more randomized control studies and proactive measures from healthcare authorities and serves as a beacon for future research efforts and underscores the importance of implementing antibiograms to combat the growing threat of antibiotic resistance.
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Affiliation(s)
- T Karuna
- Microbiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ayush Gupta
- Microbiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Apurva Vyas
- General Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Shweta Kumar
- General Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ananyan Sampath
- Medical School, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Pramod Goel
- Health Policy, Government of Madhya Pradesh, Bhopal, IND
| | - Pankaj Shukla
- Health Policy, Government of Madhya Pradesh, Bhopal, IND
| | - Vivek Mishra
- Health Policy, Government of Madhya Pradesh, Bhopal, IND
| | - Sandeep Sharma
- Health Policy, Government of Madhya Pradesh, Bhopal, IND
| | | | | | - Abhi Mishra
- Microbiology, Government Prakashchandra Sethi Hospital, Indore, IND
| | | | - Manisa Sahu
- Microbiology, Balco Medical Centre, Raipur, IND
| | | | - Anisa Pal
- Microbiology, Jabalpur Hospital and Research Centre, Jabalpur, IND
| | - Manish Nagendra
- Microbiology, Netaji Subhash Chandra Bose Medical College, Jabalpur, IND
| | | | | | - Shruti Asati
- Microbiology, Netaji Subhash Chandra Bose Medical College, Jabalpur, IND
| | - Sagar Khadanga
- General Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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Distribution of Clinical Staphylococccus aureus Isolates and Antibiotic Resistance Profile: Three-Year Data. JOURNAL OF CONTEMPORARY MEDICINE 2022. [DOI: 10.16899/jcm.1082385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective: Staphylococci cause community-acquired and hospital-acquired infections, and Staphylococcus aureus is one of leading agents. In the last decades methicillin-resistant S.aureus (MRSA), vancomycin-intermediate S.aureus (VISA) and vancomycin-resistant S.aureus (VRSA) became as major concerns. Resistance to other antibiotics is also another growing issue. The aim of this study was to investigate the prevalence of S.aureus species and to evaluate susceptibilities to antimicrobial agents in a state (tertiary) hospital.
Methods: Clinical cultures from various samples (urinary tract, respiratory, wound, abscess, tissue, catheter and external auditory) obtained from January 2017 to December 2019 in XXX hospital were included in the study. Isolated S.aureus strains and their antibiotic susceptibilities were retrospectively evaluated.
Results: A total of 765 S.aureus strains were isolated. 165 S.aureus strains were found as methicillin resistant (MRSA; 21.9%). There was not any statistically significant difference in MRSA rates among evaluated years (p=0.772). There was not any strain that was resistant to vancomycin, teicoplanin and/or linezolid. The highest rate was observed in penicillin resistance (n=646/728, 88.7%). There was not any statistically significant alteration in the resistance rates of all tested antibiotics during the three-year period.
Conclusions: Despite dwindling MRSA rates in UAMDSS, CAESAR report indicates that Turkey seems to be in the beginning phase of this struggle. Local and/or national antimicrobial stewardship programs are in effect in Turkey, but further measures are required.
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Fazaludeen Koya S, Hasan Farooqui H, Mehta A, Selvaraj S, Galea S. Quantifying antibiotic use in typhoid fever in India: a cross-sectional analysis of private sector medical audit data, 2013-2015. BMJ Open 2022; 12:e062401. [PMID: 36253043 PMCID: PMC9577907 DOI: 10.1136/bmjopen-2022-062401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To estimate the antibiotic prescription rates for typhoid in India. DESIGN Cross-sectional study. SETTING Private sector primary care clinicians in India. PARTICIPANTS The data came from prescriptions of a panel of 4600 private sector primary care clinicians selected through a multistage stratified random sampling accounting for the region, specialty type and patient turnover. The data had 671 million prescriptions for antibiotics extracted from the IQVIA database for the years 2013, 2014 and 2015. PRIMARY AND SECONDARY OUTCOME MEASURES Mean annual antibiotic prescription rates; sex-specific and age-specific prescription rates; distribution of antibiotic class. RESULTS There were 8.98 million antibiotic prescriptions per year for typhoid, accounting for 714 prescriptions per 100 000 population. Children 10-19 years of age represented 18.6% of the total burden in the country in absolute numbers, 20-29 year age group had the highest age-specific rate, and males had a higher average rate (844/100 000) compared with females (627/100 000). Ten different antibiotics accounted for 72.4% of all prescriptions. Cefixime-ofloxacin combination was the preferred drug of choice for typhoid across all regions except the south. Combination antibiotics are the preferred choice of prescribers for adult patients, while cephalosporins are the preferred choice for children and young age. Quinolones were prescribed as monotherapy in 23.0% of cases. CONCLUSIONS Nationally representative private sector antibiotic prescription data during 2013-2015 indicate a higher disease burden of typhoid in India than previously estimated. The total prescription rate shows a declining trend. Young adult patients account for close to one-third of the cases and children less than 10 years account for more than a million cases annually.
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Affiliation(s)
| | | | - Aashna Mehta
- Health Economics, Financing and Policy Division, Public Health Foundation of India, New Delhi, India
| | - Sakthivel Selvaraj
- Health Economics, Financing and Policy Division, Public Health Foundation of India, New Delhi, India
| | - Sandro Galea
- School of Public Health, Boston University, Boston, Massachusetts, USA
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15
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Global Prevalence of Colistin Resistance in Klebsiella pneumoniae from Bloodstream Infection: A Systematic Review and Meta-Analysis. Pathogens 2022; 11:pathogens11101092. [PMID: 36297149 PMCID: PMC9607870 DOI: 10.3390/pathogens11101092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/19/2022] [Accepted: 09/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Among gram-negative bacteria, Klebsiella pneumoniae is one of the most common causes of healthcare-related infection. Bloodstream infections (BSIs) caused by Klebsiella pneumoniae are notorious for being difficult to treat due to resistance to commonly used antimicrobials. Klebsiella pneumoniae isolates from bloodstream infections are becoming increasingly resistant to carbapenems. In the fight against carbapenem-resistant Klebsiella pneumoniae, colistin [polymyxin E] is the antimicrobial of choice and is thus widely used. Objective: This study aimed to determine the global prevalence of colistin resistance amongst Klebsiella pneumoniae isolates from bloodstream infections. Methods: PubMed, Medline, Scopus, and the Cochrane Library were searched for published articles without restricting the search period. Studies meeting the predefined inclusion and exclusion criteria were included, and quality was assessed using Joanna Briggs Institute Checklist. We used a statistical random effect model to analyze data with substantial heterogeneity (I2 > 50%) in the meta-analysis. Results: A total of 10 studies out of 2873 search results that met the inclusion criteria were included in the final synthesis for this study. A pooled prevalence of colistin resistance was 3.1%, 95% CI (1.5−4.7%). The highest colistin resistance pooled prevalence was recorded in isolates studied in 2020 and beyond 12.90% (4/31), while Klebsiella pneumoniae isolates studied in 2015 and before and in 2016−2019 showed a pooled colistin resistance rate of 2.89% (48/1661) and 2.95% (28/948), respectively. The highest colistin resistance was found in Klebsiella pneumoniae isolates from Thailand (19.2%), while the least pooled resistance was in Klebsiella pneumoniae from South Korea (0.8%). The pooled prevalence of the multidrug-resistant (MDR) of Klebsiella pneumoniae from bloodstream infection ranged from 80.1%, 95% CI (65.0−95.2%), and the resistance prevalence of other antibiotics by Klebsiella pneumoniae from bloodstream infections were as follows; ciprofloxacin (45.3%), ertapenem (44.4%), meropenem (36.1%), imipenem (35.2%), gentamicin (33.3%), amikacin (25.4%) and tigecycline (5.1%). Klebsiella pneumoniae recovered from the intensive care unit (ICU) showed higher colistin resistance, 11.5% (9/781%), while non-ICU patients showed 3.03% (80/2604) pooled colistin resistance. Conclusion: This study showed low colistin resistance in Klebsiella pneumoniae isolates from global bloodstream infections. However, significant colistin resistance was observed in isolates collected from 2020 and beyond. Significant colistin resistance was also observed in Klebsiella pneumoniae isolates in bloodstream infections from the intensive care unit (ICU) compared to those from non-ICUs. As a result, there is a need to institute colistin administration stewardship in the ICU in clinical settings.
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Samtiya M, Matthews KR, Dhewa T, Puniya AK. Antimicrobial Resistance in the Food Chain: Trends, Mechanisms, Pathways, and Possible Regulation Strategies. Foods 2022; 11:2966. [PMID: 36230040 PMCID: PMC9614604 DOI: 10.3390/foods11192966] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/09/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Antimicrobial resistance (AMR) remains of major interest for different types of food stakeholders since it can negatively impact human health on a global scale. Antimicrobial-resistant bacteria and/or antimicrobial resistance genes (transfer in pathogenic bacteria) may contaminate food at any stage, from the field to retail. Research demonstrates that antimicrobial-resistant bacterial infection(s) occur more frequently in low- and middle-income countries (LMICs) than in developed countries. Worldwide, foodborne pathogens are a primary cause of morbidity and mortality. The spread of pathogenic bacteria from food to consumers may occur by direct or indirect routes. Therefore, an array of approaches both at the national and international level to control the spread of foodborne pathogens and promote food safety and security are essential. Zoonotic microbes can spread through the environment, animals, humans, and the food chain. Antimicrobial drugs are used globally to treat infections in humans and animals and prophylactically in production agriculture. Research highlights that foods may become contaminated with AMR bacteria (AMRB) during the continuum from the farm to processing to retail to the consumer. To mitigate the risk of AMRB in humans, it is crucial to control antibiotic use throughout food production, both for animal and crop agriculture. The main inferences of this review are (1) routes by which AMRB enters the food chain during crop and animal production and other modes, (2) prevention and control steps for AMRB, and (3) impact on human health if AMR is not addressed globally. A thorough perspective is presented on the gaps in current systems for surveillance of antimicrobial use in food production and/ or AMR in the food chain.
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Affiliation(s)
- Mrinal Samtiya
- Department of Nutrition Biology, Central University of Haryana, Mahendergarh 123029, India
| | - Karl R. Matthews
- Department of Food Science, Rutgers University, New Brunswick, NJ 08901, USA
| | - Tejpal Dhewa
- Department of Nutrition Biology, Central University of Haryana, Mahendergarh 123029, India
| | - Anil Kumar Puniya
- Dairy Microbiology Division, ICAR-National Dairy Research Institute, Karnal 132001, India
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Murhekar MV, Kumar CPG. Health-care-associated infection surveillance in India. THE LANCET GLOBAL HEALTH 2022; 10:e1222-e1223. [DOI: 10.1016/s2214-109x(22)00317-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
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Linezolid Resistance against Gram Positive Bacteria Isolated from Blood Stream Infections: A Challenging Threat. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2022. [DOI: 10.22207/jpam.16.3.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The gradual rise of multidrug resistant micro-organisms is a national concern for all health care providers. Linezolid belongs to the oxazolidinone class of antimicrobials. it is a “last resort” used for the management of gram positive bacterial infections. Developing linezolid resistance creates a great challenge for treating bacterial infections. The objective of the current study is to determine the microbial profile and linezolid resistance in gram positive cocci isolated from blood stream infections. 1855 blood samples were analysed for microbial profile and antimicrobial sensitivity testing in our tertiary care centre over a 6 month period. In using Kirby-Bauer’s disk diffusion method for antimicrobial susceptibility testing, linezolid resistance was detected according to CLSI guidelines. Out of 1855 blood culture samples, 732 (39.4%) were identified to be culture positive. Amongst culture positive isolates mostly (83.3%) gram negative bacteria were isolated, and 16.7% were Gram positive bacterial isolates. Klebsiella species were the most prevalent among gram negative isolates. The linezolid resistance pattern was coagulase negative staph (CONS) was 25%, staphylococcus was 24% and streptococcus was 20%. This study reveals significant linezolid resistance in gram positive bacteria isolated from blood culture. The emergence of linezolid resistance is a major issue for clinicians treating the infection and it will require prompt monitoring of antibiotic policy and antimicrobial stewardship programs.
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Salsabila K, Toha NMA, Rundjan L, Pattanittum P, Sirikarn P, Rohsiswatmo R, Wandita S, Hakimi M, Lumbiganon P, Green S, Turner T. Early-onset neonatal sepsis and antibiotic use in Indonesia: a descriptive, cross-sectional study. BMC Public Health 2022; 22:992. [PMID: 35581620 PMCID: PMC9112545 DOI: 10.1186/s12889-022-13343-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early diagnosis and prompt antibiotic treatment are crucial to reducing morbidity and mortality of early-onset sepsis (EOS) in neonates. However, this strategy remains challenging due to non-specific clinical findings and limited facilities. Inappropriate antibiotics use is associated with ineffective therapy and adverse outcomes. This study aims to determine the characteristics of EOS and use of antibiotics in the neonatal-intensive care units (NICUs) in Indonesia, informing efforts to drive improvements in the prevention, diagnosis, and treatment of EOS. METHODS A descriptive study was conducted based on pre-intervention data of the South East Asia-Using Research for Change in Hospital-acquired Infection in Neonates project. Our study population consisted of neonates admitted within 72 h of life to the three participating NICUs. Neonates who presented with three or more clinical signs or laboratory results consistent with sepsis and who received antibiotics for 5 consecutive days were considered to have EOS. Culture-proven EOS was defined as positive blood or cerebrospinal fluid culture. Type and duration of antibiotics used were also documented. RESULTS Of 2,509 neonates, 242 cases were suspected of having EOS (9.6%) with culture-proven sepsis in 83 cases (5.0% of neonatal admissions in hospitals with culture facilities). The causative organisms were mostly gram-negative bacteria (85/94; 90.4%). Ampicillin / amoxicillin and amikacin were the most frequently prescribed antibiotics in hospitals with culture facilities, while a third-generation cephalosporin was mostly administered in hospital without culture facilities. The median durations of antibiotic therapy were 19 and 9 days in culture-proven and culture-negative EOS groups, respectively. CONCLUSIONS The overall incidence of EOS and culture-proven EOS was high in Indonesia, with diverse and prolonged use of antibiotics. Prospective antibiotic surveillance and stewardship interventions are required.
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Affiliation(s)
- Khansa Salsabila
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- School of Public Health and Preventive Medicine, Monash University, 3rd Floor, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Nadira Mohammad Ali Toha
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- School of Public Health and Preventive Medicine, Monash University, 3rd Floor, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Lily Rundjan
- Department of Child Health, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Porjai Pattanittum
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen, Thailand
| | - Prapassara Sirikarn
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Khon Kaen, Thailand
| | - Rinawati Rohsiswatmo
- Department of Child Health, Faculty of Medicine, Universitas Indonesia - Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Setya Wandita
- Department of Child Health, Dr Sardjito Hospital, Yogyakarta, Indonesia
| | - Mohammad Hakimi
- Department of Obstetrics and Gynaecology, Gadjah Mada University, Yogyakarta, Indonesia
| | | | - Sally Green
- School of Public Health and Preventive Medicine, Monash University, 3rd Floor, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
| | - Tari Turner
- School of Public Health and Preventive Medicine, Monash University, 3rd Floor, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
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Seethalakshmi PS, Charity OJ, Giakoumis T, Kiran GS, Sriskandan S, Voulvoulis N, Selvin J. Delineating the impact of COVID-19 on antimicrobial resistance: An Indian perspective. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 818:151702. [PMID: 34798093 PMCID: PMC8592853 DOI: 10.1016/j.scitotenv.2021.151702] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/24/2021] [Accepted: 11/11/2021] [Indexed: 05/23/2023]
Abstract
The COVID-19 pandemic has shattered millions of lives globally and continues to be a challenge to public health due to the emergence of variants of concern. Fear of secondary infections following COVID-19 has led to an escalation in antimicrobial use during the pandemic, while some antimicrobials have been repurposed as treatments for SARS-CoV-2, further driving antimicrobial resistance. India is one of the largest producers and consumers of antimicrobials globally, hence the task of curbing antimicrobial resistance is a huge challenge. Practices like empirical antimicrobial prescription and repurposing of drugs in clinical settings, self-medication and excessive use of antimicrobial hygiene products may have negatively impacted the prevalence of antimicrobial resistance in India. However, the expanded production of antimicrobials and disinfectants during the pandemic in response to increased demand may have had an even greater impact on the threat of antimicrobial resistance through major impacts on the environment. The review provides an outline of the impact COVID-19 can have on antimicrobial resistance in clinical settings and the possible outcomes on the environment. This review calls for the upgrading of existing antimicrobial policies and emphasizes the need for research studies to understand the impact of the pandemic on antimicrobial resistance in India.
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Affiliation(s)
- P S Seethalakshmi
- Department of Microbiology, Pondicherry University, Puducherry 605014, India.
| | - Oliver J Charity
- NIHR Health Protection Research Unit in Healthcare associated infection and AMR, Department of Infectious Disease, Imperial College London, UK.
| | | | - George Seghal Kiran
- Department of Food Science and Technology, Pondicherry University, Puducherry 605014, India
| | - Shiranee Sriskandan
- NIHR Health Protection Research Unit in Healthcare associated infection and AMR, Department of Infectious Disease, Imperial College London, UK; MRC Centre for Molecular Bacteriology & Infection, Imperial College London, UK.
| | | | - Joseph Selvin
- Department of Microbiology, Pondicherry University, Puducherry 605014, India.
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Bir R, Gautam H, Arif N, Chakravarti P, Verma J, Banerjee S, Tyagi S, Mohapatra S, Sood S, Dhawan B, Chaudhry R, Kapil A, Das BK, Das B. Analysis of colistin resistance in carbapenem-resistant Enterobacterales and XDR Klebsiella pneumoniae. Ther Adv Infect Dis 2022; 9:20499361221080650. [PMID: 35237435 PMCID: PMC8883296 DOI: 10.1177/20499361221080650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 01/26/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction: Increasing occurrence of infections caused by multidrug-resistant Gram-negative bacteria resulted in colistin being the last agent for treatment. Apart from plasmid-mediated mcr genes, mutations involving several genes like mgrB, phoP/phoQ, pmrA, pmrB, pmrC, and crrABC genes, are leading causes of colistin resistance. Four colistin susceptibility testing methods were compared against broth microdilution (BMD) and determined the presence of the mcr1-5 gene. Methodology: A total of 100 carbapenem-resistant Enterobacterales isolates were tested for colistin susceptibility by commercial broth microdilution (cBMD), E-test, VITEK-2, and rapid polymyxin NP assay (RPNP) and compared with BMD. The presence of the mcr1-5 gene was determined by modified RPNP and PCR. Two non-mcr colistin-resistant XDR isolates were subjected to whole-genome sequencing using Illumina MiSeq sequencing platform. Results: Among 100 carbapenem-resistant Enterobacterales isolates, 15% were resistant to colistin. Essential agreement, categorical agreement, major error, and very major error for cBMD/E-test/VITEK-2/RPNP were 96%/73%/82%/NA; 99%/86%/88%/91%, 1.2%/9.4%/11.8%/8.2% and 0%/40%/13.3%/13.3%, respectively. Only one Klebsiella pneumoniae isolate harbored the mcr-1 gene, observed by both methods. Whole-genome sequencing of two non-mcr XDR Klebsiella pneumoniae showed multiple mutations in 10 genes responsible for lipopolysaccharide biosynthesis. Conclusions: The performance of cBMD was excellent, whereas the E-test was unacceptable. VITEK-2 and RPNP performed better but remained unreliable due to high error rates. Multiple mutations in the target proteins involving lipopolysaccharide formation, modification, and regulation were seen, resulting in colistin resistance.
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Affiliation(s)
- Raunak Bir
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Hitender Gautam
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi 110029, India
| | - Nazneen Arif
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Jyoti Verma
- Translational Health Science and Technology Institute, Faridabad, India
| | | | - Sonu Tyagi
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sarita Mohapatra
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Seema Sood
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Benu Dhawan
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arti Kapil
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bimal Kumar Das
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Bhabatosh Das
- Translational Health Science and Technology Institute, Faridabad, India
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22
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Talat A, Bashir Y, Khan AU. Repurposing of Antibiotics: Sense or Non-sense. Front Pharmacol 2022; 13:833005. [PMID: 35264965 PMCID: PMC8900814 DOI: 10.3389/fphar.2022.833005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 01/27/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Absar Talat
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, India
| | - Yasir Bashir
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, India
| | - Asad U. Khan
- Interdisciplinary Biotechnology Unit, Aligarh Muslim University, Aligarh, India
- *Correspondence: Asad U. Khan,
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23
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Gwenzi W, Shamsizadeh Z, Gholipour S, Nikaeen M. The air-borne antibiotic resistome: Occurrence, health risks, and future directions. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 804:150154. [PMID: 34798728 DOI: 10.1016/j.scitotenv.2021.150154] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
Antibiotic resistance comprising of antibiotic resistant bacteria (ARB) and antibiotic resistance genes (ARGs) is an emerging problem causing global human health risks. Several reviews exist on antibiotic resistance in various environmental compartments excluding the air-borne resistome. An increasing body of recent evidence exists on the air-borne resistome comprising of antibiotic resistance in air-borne bioaerosols from various environmental compartments. However, a comprehensive review on the sources, dissemination, behavior, fate, and human exposure and health risks of the air-borne resistome is still lacking. Therefore, the current review uses the source-pathway-receptor-impact-mitigation framework to investigate the air-borne resistome. The nature and sources of antibiotic resistance in the air-borne resistome are discussed. The dissemination pathways, and environmental and anthropogenic drivers accounting for the transfer of antibiotic resistance from sources to the receptors are highlighted. The human exposure and health risks posed by air-borne resistome are presented. A health risk assessment and mitigation strategy is discussed. Finally, future research directions including key knowledge gaps are summarized.
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Affiliation(s)
- Willis Gwenzi
- Biosystems and Environmental Engineering Research Group, Department of Agricultural and Biosystems Engineering, Faculty of Agriculture, University of Zimbabwe, P.O. Box MP 167, Mount Pleasant, Harare, Zimbabwe.
| | - Zahra Shamsizadeh
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Environmental Health Engineering, Environmental Science and Technology Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Sahar Gholipour
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Environmental Health Engineering, Faculty of Health, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahnaz Nikaeen
- Department of Environmental Health Engineering, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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24
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Garg R, Tellapragada C, Shaw T, Eshwara VK, Shanbhag V, Rao S, Virk HS, Varma M, Mukhopadhyay C. Epidemiology of sepsis and risk factors for mortality in intensive care unit: a hospital based prospective study in South India. Infect Dis (Lond) 2022; 54:325-334. [PMID: 34986756 DOI: 10.1080/23744235.2021.2017475] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The present study was aimed at elucidating the epidemiology of sepsis, with a special emphasis on identifying the common bacterial aetiology, proportion of infections caused by multi-drug resistant (MDR) bacteria, and risk factors associated with 28-day mortality at a university hospital in South India. METHODS A prospective study was undertaken from January 2017 to March 2018. Adult patients with the diagnosis of sepsis requiring intensive care unit (ICU) care were recruited. Baseline clinical, epidemiological, and laboratory data were recorded, and their association with 28-day mortality was assessed using logistic regression models. RESULTS 400 subjects with a qSOFA score ≥2 at the time of ICU admission were included in the study. The mean age was 55.7 ± 16.6 years, and 69% were males. The mean SOFA score at the time of admission was 9.9 ± 2.7. Bacterial aetiology of sepsis was established in 53.5% of cases and 24% were caused by MDR pathogens. Carbapenem resistance was observed in 37% of the Gram-negative isolates. Escherichia coli (34.1%) was the leading pathogen. Overall, the 28-day mortality in ICU was 40%. 38% died within 48 h of ICU admission. Hypertension and SOFA > 9, male gender, and baseline-creatinine values >2.4 mg/dl were risk factors for mortality. CONCLUSIONS Male gender, hypertension, SOFA > 9, and increased creatinine were identified as the predictors for mortality. Infectious aetiology remained undetected in nearly half of the cases using routine microbiology culture methods. Mortality within the first 48 h of admission to ICU is high and prompts the need for increasing awareness about early sepsis diagnosis in community health care settings.
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Affiliation(s)
- Rahul Garg
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.,Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Chaitanya Tellapragada
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.,Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden
| | - Tushar Shaw
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.,Faculty of Life and Allied Health Sciences, Ramaiah University of Applied Sciences, Bangalore, India
| | - Vandana Kalwaje Eshwara
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.,Center for Antimicrobial Resistance and Education, Manipal Academy of Higher Education, Manipal, India
| | - Vishal Shanbhag
- Department of Critical care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Shwethapriya Rao
- Department of Critical care, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Harjeet S Virk
- Center for Experimental Molecular Medicine, Department of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Muralidhar Varma
- Center for Antimicrobial Resistance and Education, Manipal Academy of Higher Education, Manipal, India.,Department of Infectious diseases, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India.,Center for Antimicrobial Resistance and Education, Manipal Academy of Higher Education, Manipal, India.,Center for Emerging and Tropical Diseases, Manipal Academy of Higher Education, Manipal, India
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25
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Bakthavatchalam YD, Routray A, Mane A, Kamat S, Gupta A, Bari AK, Rohit A, Poojary A, Mukherjee DN, Sethuraman N, Munshi N, Shah S, Balaji V, Gupta Y. nIn vitro activity of ceftazidime – avibactam and its comparators against carbapenem resistant collected across India: Results from ATLAS surveillance 2018-2019. Diagn Microbiol Infect Dis 2022; 103:115652. [DOI: 10.1016/j.diagmicrobio.2022.115652] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/07/2022] [Accepted: 01/20/2022] [Indexed: 11/15/2022]
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26
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Singhal A, Shaw S, Mahesh M. Antimicrobial resistance an alarming global concern: Antimicrobial stewardship is the key. JOURNAL OF MARINE MEDICAL SOCIETY 2022. [DOI: 10.4103/jmms.jmms_167_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
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27
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Colson AR, Morton A, Årdal C, Chalkidou K, Davies SC, Garrison LP, Jit M, Laxminarayan R, Megiddo I, Morel C, Nonvignon J, Outterson K, Rex JH, Sarker AR, Sculpher M, Woods B, Xiao Y. Antimicrobial Resistance: Is Health Technology Assessment Part of the Solution or Part of the Problem? VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1828-1834. [PMID: 34838281 DOI: 10.1016/j.jval.2021.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/24/2021] [Accepted: 06/07/2021] [Indexed: 06/13/2023]
Abstract
Antimicrobial resistance is a serious challenge to the success and sustainability of our healthcare systems. There has been increasing policy attention given to antimicrobial resistance in the last few years, and increased amounts of funding have been channeled into funding for research and development of antimicrobial agents. Nevertheless, manufacturers doubt whether there will be a market for new antimicrobial technologies sufficient to enable them to recoup their investment. Health technology assessment (HTA) has a critical role in creating confidence that if valuable technologies can be developed they will be reimbursed at a level that captures their true value. We identify 3 deficiencies of current HTA processes for appraising antimicrobial agents: a methods-centric approach rather than problem-centric approach for dealing with new challenges, a lack of tools for thinking about changing patterns of infection, and the absence of an approach to epidemiological risks. We argue that, to play their role more effectively, HTA agencies need to broaden their methodological tool kit, design and communicate their analysis to a wider set of users, and incorporate long-term policy goals, such as containing resistance, as part of their evaluation criteria alongside immediate health gains.
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Affiliation(s)
- Abigail R Colson
- Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, Scotland, UK.
| | - Alec Morton
- Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, Scotland, UK
| | - Christine Årdal
- Antimicrobial Resistance Centre, Norwegian Institute of Public Health, Oslo, Norway
| | - Kalipso Chalkidou
- School of Public Health, Imperial College London, London, England, UK
| | - Sally C Davies
- UK Department of Health and Social Care, London, England, UK
| | - Louis P Garrison
- The Comparative Health Outcomes, Policy, and Economics Institute, University of Washington, Seattle, WA, USA
| | - Mark Jit
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, England, UK
| | | | - Itamar Megiddo
- Management Science, Strathclyde Business School, University of Strathclyde, Glasgow, Scotland, UK
| | - Chantal Morel
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany; Department of Business Studies, Uppsala University, Uppsala, Sweden; Geneva Transformative Governance Lab, Science Faculty, University of Geneva, Geneva, Switzerland
| | - Justice Nonvignon
- Department of Health Policy, Planning and Management, School of Public Health, University of Ghana, Legon, Ghana
| | | | - John H Rex
- F2G Limited, Eccles, Cheshire, UK and AMR Solutions, Boston, MA, USA
| | | | - Mark Sculpher
- Centre for Health Economics, University of York, York, England, UK
| | - Beth Woods
- Centre for Health Economics, University of York, York, England, UK
| | - Yue Xiao
- China National Health Development Research Centre (National Centre for Medicine and Health Technology Assessment), Beijing, P. R. China
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28
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Dadashi M, Sameni F, Bostanshirin N, Yaslianifard S, Khosravi-Dehaghi N, Nasiri MJ, Goudarzi M, Hashemi A, Hajikhani B. Global Prevalence and Molecular Epidemiology of mcr-Mediated Colistin Resistance in Escherichia coli Clinical Isolates: A Systematic Review. J Glob Antimicrob Resist 2021; 29:444-461. [PMID: 34788692 DOI: 10.1016/j.jgar.2021.10.022] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/10/2021] [Accepted: 10/25/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND AND AIM The continuing rise in infections caused by multi-drug resistant (MDR) bacteria is one of the most serious public health issues in today's societies. Colistin is a last-resort antimicrobial medication used to treat infections caused by MDR gram-negative bacteria; therefore resistance to this antibiotic is extremely hazardous. The current study aimed to evaluate the global prevalence and distribution of colistin resistance genes among human clinical isolates of Escherichia coli (E. coli) as a systematic review. METHODS PubMed, Embase, and Web of Science databases were systematically searched. For further evaluation, all original English-language articles that demonstrated colistin resistance in E. coli clinical isolates published between 2000 and 2020 were examined. RESULTS Out of 4857 initial articles, after various stages of review and evaluation, 190 related articles were selected. More than 79 % of the publications selected in this research were published from 2014 to 2020. In Asia, Europe, America, Africa, and Oceania, the prevalence of mobilized colistin resistance (mcr) producing colistin-resistant E. coli was 66.72%, 25.48%, 5.19%, 2.27%, and 0.32 %, respectively. CONCLUSION The recent widespread spreading of E. coli strains harboring mcr conferring colistin resistance, especially in Asia and Europe, is concerning and needs more attention.
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Affiliation(s)
- Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran; Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Fatemeh Sameni
- Department of Microbiology, School of Medicine, Shahed University, Tehran, Iran
| | - Nazila Bostanshirin
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Somayeh Yaslianifard
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Nafiseh Khosravi-Dehaghi
- Department of Pharmacognosy, School of Pharmacy, Alborz University of Medical Sciences, Karaj, Iran; Evidence-Based Phytotherapy and Complementary Medicine Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohammad Javad Nasiri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Hashemi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Hajikhani
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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29
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SİG AK, KULA ATİK T, ÇETİN DURAN A. Antibiotic resistance of Enterococcus species: 3-year data. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2021. [DOI: 10.32322/jhsm.949498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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30
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RAHAL ANU, KUMAR AMIT. Strategies to combat antimicrobial resistance in Indian scenario. THE INDIAN JOURNAL OF ANIMAL SCIENCES 2021. [DOI: 10.56093/ijans.v91i2.113812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Antimicrobial resistance (AMR) is one of the major public health crisis recognised globally. Microbial infections cause significant productivity losses in animals and humans. In livestock, these microbial infections reduce the growth rates and fertility, diminish production of meat and milk, and occasionally lead to mortality, and are therefore, a major concern for animal welfare. In the dearth of alternative prophylactic measures, antibiotics remain the principal tool for their management. Once an antibiotic is used rampantly, resistance against it is inevidently seen in the microbe population and the hunt for a new drug grows. Discovery and development of a new antimicrobial drug is a time taking and expensive procedure with limited assurance of success. As a result, the past few decades have witnessed only a very few new classes of antibiotics. If the AMR can be restricted or reverted, the success rate of antimicrobial therapy can be boosted and many public health issues be avoided. All these ask for a comprehensive plan to prevent or reduce the antimicrobial resistance and economic losses to the animal husbandry sector. The present review provides an overview of AMR in India, mechanism of its occurrence and the possible roadmap to combat the emerging threat of AMR in Indian scenario.
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31
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Pauwels I, Versporten A, Drapier N, Vlieghe E, Goossens H. Hospital antibiotic prescribing patterns in adult patients according to the WHO Access, Watch and Reserve classification (AWaRe): results from a worldwide point prevalence survey in 69 countries. J Antimicrob Chemother 2021; 76:1614-1624. [PMID: 33822971 PMCID: PMC8120336 DOI: 10.1093/jac/dkab050] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 01/29/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives The WHO Access, Watch and Reserve (AWaRe) classification has been developed to support countries and hospitals in promoting rational use of antibiotics while improving access to these essential medicines. We aimed to describe patterns of worldwide antibiotic use according to the AWaRe classification in the adult inpatient population. Methods The Global Point Prevalence Survey on Antimicrobial Consumption and Resistance (Global-PPS) collects hospital antibiotic use data using a standardized PPS methodology. Global-PPS 2015, 2017 and 2018 data, collected by 664 hospitals in 69 countries, were categorized into AWaRe groups to calculate proportional AWaRe use, Access-to-Watch ratios and the most common indications for treatment with selected Watch antibiotics. Only prescriptions for systemic antibiotics on adult inpatient wards were analysed. Results Regional Access use ranged from 28.4% in West and Central Asia to 57.7% in Oceania, whereas Watch use was lowest in Oceania (41.3%) and highest in West and Central Asia (66.1%). Reserve use ranged from 0.03% in sub-Saharan Africa to 4.7% in Latin America. There were large differences in AWaRe prescribing at country level. Watch antibiotics were prescribed for a range of very different indications worldwide, both for therapeutic and prophylactic use. Conclusions We observed considerable variations in AWaRe prescribing and high use of Watch antibiotics, particularly in lower- and upper-middle-income countries, followed by high-income countries. The WHO AWaRe classification has an instrumental role to play in local and national stewardship activities to assess prescribing patterns and to inform and evaluate stewardship activities.
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Affiliation(s)
- Ines Pauwels
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Corresponding author. E-mail:
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Nico Drapier
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Erika Vlieghe
- Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, University Hospital Antwerp, Antwerp, Belgium
- Global Health Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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32
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Investigation of Antimicrobial Susceptibilities Among Bacteria Isolated from Blood Cultures in Hospitalized Patients, Tehran, Iran. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2021. [DOI: 10.5812/archcid.86878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Bacteremia is the status, which is detected via a positive blood culture test with no contamination. Centers for Disease Control and Prevention (CDC) indicates that direct medical procedures and total costs are significantly high. Antibiotic resistance can play a major role in the costs, which are related to the long duration of treatment. Objectives: The aim of this study was to investigate the rate and profiles of antimicrobial susceptibility of blood culture isolates from Tehran, Iran. Methods: In the current cross-sectional study, a total of 5,000 blood culture samples were collected from patients hospitalized in the Loghman General Hospital, Tehran, Iran, with positive blood culture results from 2012 to 2013. Susceptibility to antimicrobial agents was analyzed using National Committee for Clinical Laboratory Standards guidelines. Results: Coagulase-negative staphylococci (38.8%), Staphylococcus aureus (20.5%), Acinetobacter (11.9%), and Escherichia coli (11.7%) were the most frequent bacteria isolated from the blood cultures, collectively accounting for > 80% of the isolates. Of isolated microorganisms, 63.75% and 36.24% belonged to Gram-positive and Gram-negative bacteria, respectively. Moreover, 88% of the isolates were MRSA (oxacillin-/methicillin-resistant), and 7% were VRE (vancomycin-resistant). Conclusions: The most frequent isolated organisms were Gram-positive bacteria, and the rate of MDR (multi-drug resistance) was high. The results of the current study obviously indicate the misuse of antibiotic in society. National surveillance studies in Iran will be useful for clinicians to choose the right empirical treatment and will help control and prevent infections caused by resistant organisms.
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33
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Bhardwaj S, Bhatia S, Singh S, Franco Jr F. Growing emergence of drug-resistant Pseudomonas aeruginosa and attenuation of its virulence using quorum sensing inhibitors: A critical review. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2021; 24:699-719. [PMID: 34630947 PMCID: PMC8487598 DOI: 10.22038/ijbms.2021.49151.11254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 11/24/2020] [Indexed: 12/25/2022]
Abstract
A perilous increase in the number of bacterial infections has led to developing throngs of antibiotics for increasing the quality and expectancy of life. Pseudomonas aeruginosa is becoming resistant to all known conventional antimicrobial agents thereby posing a deadly threat to the human population. Nowadays, targeting virulence traits of infectious agents is an alternative approach to antimicrobials that is gaining much popularity to fight antimicrobial resistance. Quorum sensing (QS) involves interspecies communication via a chemical signaling pathway. Under this mechanism, cells work in a concerted manner, communicate with each other with the help of signaling molecules called auto-inducers (AI). The virulence of these strains is driven by genes, whose expression is regulated by AI, which in turn acts as transcriptional activators. Moreover, the problem of antibiotic-resistance in case of infections caused by P. aeruginosa becomes more alarming among immune-compromised patients, where the infectious agents easily take over the cellular machinery of the host while hidden in the QS mediated biofilms. Inhibition of the QS circuit of P. aeruginosa by targeting various signaling pathways such as LasR, RhlR, Pqs, and QScR transcriptional proteins will help in blocking downstream signal transducers which could result in reducing the bacterial virulence. The anti-virulence agent does not pose an immediate selective pressure on growing bacterium and thus reduces the pathogenicity without harming the target species. Here, we review exclusively, the growing emergence of multi-drug resistant (MDR) P. aeruginosa and the critical literature survey of QS inhibitors with their potential application of blocking P. aeruginosa infections.
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Affiliation(s)
- Snigdha Bhardwaj
- Department of Pharmaceutical Science, SHALOM Institute of Health and Allied Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences (SHUATS), Naini, Prayagraj, India
| | - Sonam Bhatia
- Department of Pharmaceutical Science, SHALOM Institute of Health and Allied Sciences, Sam Higginbottom University of Agriculture, Technology and Sciences (SHUATS), Naini, Prayagraj, India
| | - Shaminder Singh
- Regional Centre for Biotechnology, NCR Biotech Science Cluster, 3rd Milestone, Faridabad-Gurugram Expressway, Faridabad - 121 001, Haryana, India
| | - Francisco Franco Jr
- Department of Chemistry, De La Salle University, Manila, Metro Manila, Philippines
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34
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Sarjana Safain K, Bhuyan GS, Hassan Hasib S, Islam MS, Mahmud-Un-Nabi MA, Sultana R, Tasnim S, Noor FA, Sarker SK, Islam MT, Rahat A, Leung DT, Domman D, Manzoor F, Anwar S, Majid Bhuiyan MA, Chowdhury EK, Qadri SS, Qadri F, Mannoor K. Genotypic and phenotypic profiles of antibiotic-resistant bacteria isolated from hospitalised patients in Bangladesh. Trop Med Int Health 2021; 26:720-729. [PMID: 33838068 DOI: 10.1111/tmi.13584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Characterisation of resistance phenotype and genotype is crucial to understanding the burden and transmission of antimicrobial resistance (AMR). This study aims to determine the spectrum of AMR and associated genes encoding aminoglycoside, macrolide and β-lactam classes of antimicrobials in bacteria isolated from hospitalised patients in Bangladesh. METHODS 430 bacterial isolates from patients with respiratory, intestinal, wound infections and typhoid fever, presenting to clinical care from 2015 to 2019, were examined. They included Escherichia coli (n = 85); Staphylococcus aureus (n = 84); Salmonella typhi (n = 82); Klebsiella pneumoniae (n = 42); Streptococcus pneumoniae (n = 36); coagulase-negative staphylococci (n = 28); Enterococcus faecalis (n = 27); Pseudomonas aeruginosa (n = 26); and Acinetobacter baumannii (n = 20). Reconfirmation of these clinical isolates and antimicrobial susceptibility tests was performed. PCR amplification using resistance gene-specific primers was done, and the amplified products were confirmed by Sanger sequencing. RESULTS 53% of isolates were multidrug-resistant (MDR), including 97% of Escherichia coli. There was a year-wise gradual increase in MDR isolates from 2015 to 2018, and there was an almost twofold increase in the number of MDR strains isolated in 2019 (P = 0.00058). Among the 5 extended-spectrum β-lactamases investigated, CTX-M-1 was the most prevalent (63%) followed by NDM-1 (22%); Escherichia coli was the major reservoir of these genes. The ermB (55%) and aac(6')-Ib (35%) genes were the most frequently detected macrolide and aminoglycoside resistance genes, respectively. CONCLUSION MDR pathogens are highly prevalent in hospital settings of Bangladesh.
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Affiliation(s)
- Kazi Sarjana Safain
- Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh.,Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | - Golam Sarower Bhuyan
- Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh
| | - Saad Hassan Hasib
- Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh
| | - Mohammad Sazzadul Islam
- Genetics and Genomics Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh.,Department of Biochemistry and Molecular Biology, Jagannath University, Dhaka, Bangladesh
| | - Mohammad Al Mahmud-Un-Nabi
- Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh
| | - Rosy Sultana
- Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh.,Department of Immunology, Bangladesh University of Health Sciences, Dhaka, Bangladesh
| | - Sadia Tasnim
- Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh.,Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | - Farjana Akther Noor
- Genetics and Genomics Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh.,Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
| | - Suprovath Kumar Sarker
- Genetics and Genomics Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh
| | - Md Tarikul Islam
- Genetics and Genomics Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh
| | - Asifuzzaman Rahat
- Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh
| | - Daniel T Leung
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Daryl Domman
- Department of Internal Medicine, Center for Global Health, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Farhana Manzoor
- Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | - Sajid Anwar
- Genetics and Genomics Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh
| | - Md Abdul Majid Bhuiyan
- BIHSH and UHC Component Institution, Bangladesh Institute of Health Sciences General Hospital, Dhaka, Bangladesh
| | - Emran Kabir Chowdhury
- Department of Biochemistry and Molecular Biology, University of Dhaka, Dhaka, Bangladesh
| | - Syed Saleheen Qadri
- Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh.,Genetics and Genomics Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh
| | - Firdausi Qadri
- Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh.,Genetics and Genomics Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh.,Department of Enteric and Respiratory Infectious Diseases, Infectious Diseases Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Kaiissar Mannoor
- Infectious Diseases Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh.,Genetics and Genomics Laboratory, Institute for Developing Science and Health Initiatives, Dhaka, Bangladesh
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Javaid N, Sultana Q, Rasool K, Gandra S, Ahmad F, Chaudhary SU, Mirza S. Trends in antimicrobial resistance amongst pathogens isolated from blood and cerebrospinal fluid cultures in Pakistan (2011-2015): A retrospective cross-sectional study. PLoS One 2021; 16:e0250226. [PMID: 33901205 PMCID: PMC8075205 DOI: 10.1371/journal.pone.0250226] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/02/2021] [Indexed: 12/29/2022] Open
Abstract
While antimicrobial resistance (AMR) continues to be a major public health problem in Pakistan, data regarding trends of resistance among pathogenic bacteria remains scarce, with few studies presenting long-term trends in AMR. This study was therefore designed to analyze long-term AMR trends at a national level in Pakistan. We report here results of a comprehensive analysis of resistance, among pathogens isolated from blood and cerebrospinal fluid (CSF), between 2011 and 2015. Susceptibility data was obtained from a local laboratory with collection points all across Pakistan (Chughtai Laboratory). Resistance proportions to most commonly used antimicrobials were calculated for each pathogen over a period of five years. While Acinetobacter species demonstrated highest resistance rates to all tested antimicrobials, a sharp increase in carbapenem resistance was the most noticeable (50%-95%) between 2011-2015. Our results also highlight the presence of third and fourth generation cephalosporins resistance in Salmonella enterica serovar Typhi in Pakistan. Interestingly, where rise in AMR was being observed in some major invasive pathogens, decreasing resistance trends were observed in Staphylococcus aureus, against commonly used antimicrobials. Overall pathogens isolated from blood and CSF between 2011-2015, showed an increase in resistance towards commonly used antimicrobials.
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Affiliation(s)
- Nida Javaid
- Department of Biology, School of Science and Engineering, Lahore University of Management Science, Lahore, Pakistan
| | - Qamar Sultana
- Department of Microbiology, Chughtai Lab/Chughtai Institute of Pathology, Lahore, Pakistan
| | - Karam Rasool
- Department of Microbiology, Chughtai Lab/Chughtai Institute of Pathology, Lahore, Pakistan
| | - Sumanth Gandra
- Division of Infectious Diseases, Washington University School of Medicine in St. Louis, St. Louis, MI, United States of America
| | - Fayyaz Ahmad
- Department of Statistics, University of Gujrat, Gujrat, Pakistan
| | - Safee Ullah Chaudhary
- Biomedical Informatics Research Laboratory, Department of Biology, Lahore University of Management Sciences, Lahore, Pakistan
| | - Shaper Mirza
- Department of Biology, School of Science and Engineering, Lahore University of Management Science, Lahore, Pakistan
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Azam M, Gaind R, Yadav G, Sharma A, Upmanyu K, Jain M, Singh R. Colistin Resistance Among Multiple Sequence Types of Klebsiella pneumoniae Is Associated With Diverse Resistance Mechanisms: A Report From India. Front Microbiol 2021; 12:609840. [PMID: 33692764 PMCID: PMC7937630 DOI: 10.3389/fmicb.2021.609840] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 01/22/2021] [Indexed: 12/25/2022] Open
Abstract
Background: The resistance to colistin and carbapenems in Klebsiella pneumoniae infections have been associated with increased morbidity and mortality worldwide. A retrospective observational study was conducted to determine the prevalence and molecular events contributing to colistin resistance. Methods: Clinical samples were screened for colistin resistance and underlying mechanisms were studied by PCR-based amplification and sequence analysis of genes of two-component regulatory system (phoPQ and pmrAB), regulatory transmembrane protein-coding mgrB, and mobilized colistin resistance genes (mcr-1-8). Gene expression of pmrC and pmrK was analyzed by qRT-PCR, and the genetic relationship was assessed by MLST. The putative effect of amino-acid substitutions was predicted by a combination of bioinformatics tools. Results: Of 335 Klebsiella spp. screened, 11 (3.2%) were identified as colistin-resistant (MIC range, 8 to >128 μg/ml). K. pneumoniae isolates belonged to clonal complex-11 (CC11) with sequence types (STs): 14, 16, 43, 54, 147 and 395, whereby four isolates conferred three novel STs (3986, 3987 and 3988) profiles. Sequence analysis revealed non-synonymous potentially deleterious mutations in phoP (T151A), phoQ (del87–90, del263–264, L30Q, and A351D), pmrA (G53S), pmrB (D150V, T157P, L237R, G250C, A252G, R315P, and Q331H), and mgrB (C28G) genes. The mgrB gene in three strains was disrupted by insertion sequences encoding IS1-like and IS5/IS1182 family-like transposase genes. All 11 isolates showed an elevation in the transcription level of pmrC gene. Mobilized colistin-resistance (mcr) genes were not detected. All but one of the colistin-resistant isolates was also resistant to carbapenems; β-lactamase genes blaNDM-1-like, blaOXA-48-like, and blaCTX-M-like were detected in eight, five, and nine isolates, respectively. Conclusion: All the studied colistin- and carbapenem-resistant K. pneumoniae isolates were genetically distinct, and various mechanisms of colistin resistance were detected, indicating its spontaneous emergence in this bacterial species.
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Affiliation(s)
- Mudsser Azam
- ICMR-National Institute of Pathology, New Delhi, India
| | - Rajni Gaind
- Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Gulshan Yadav
- ICMR-National Institute of Pathology, New Delhi, India
| | - Amit Sharma
- Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Kirti Upmanyu
- ICMR-National Institute of Pathology, New Delhi, India
| | - Manisha Jain
- Department of Microbiology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Ruchi Singh
- ICMR-National Institute of Pathology, New Delhi, India
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Kumar S, Tadepalli K, Joshi R, Shrivastava M, Malik R, Saxena P, Saigal S, Jhaj R, Khadanga S. Practice of antimicrobial stewardship in a government hospital of India and its impact on extended point prevalence of antibiotic usage. J Family Med Prim Care 2021; 10:991-997. [PMID: 34041110 PMCID: PMC8138414 DOI: 10.4103/jfmpc.jfmpc_1473_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global concern requiring immediate attention. Among many proven measures of decreasing AMR, practice of antimicrobial stewardship is the lowest hanging which can be adapted with negligible financial implications. METHODS This is a case record based extended cross-sectional type of observational operation research study conducted at an institute of national importance established by Government of India. Point prevalence of antibiotic usage among the patients admitted in the hospital, on four different days in four different quarters of a year was done to study the impact of antimicrobial stewardship program (AMSP). RESULTS A cumulative 711 patients were exposed on antibiotics among 1396 study participants. There was a significant decrease in antibiotic consumption across the 1st and 4th quarter. The average antibiotic usage was 50.9% (61.75, 60%, 48.4%, and 39% respectively in the 1st to 4th quarter). Among the total number of patients, intravenous antibiotic usage was 47.9% (60.71%, 58.4%, 44.9%, and 34.2% respectively in 1st to 4th quarter). Among the newly admitted patients, the consumption of antibiotic usage decreased from 45.9% to 25.7%. Among the intravenous antibiotics, the top 10 consumed antibiotics were 3rd generation cephalosporin (39.8%), aminoglycoside (14.8%), amoxicillin/amoxy-clav (12.5%), piperacillin-tazobactum (8.5%), carbapenams (6.6%), cefuroxime (6.4%), quinolones (4.3%), vancomycin/linezolid (4.1%), colistin (0.8%), and others (0.8%). CONCLUSION Government run hospitals can run low budget antimicrobial stewardship program with sustainable impact on antibiotic consumption. For a successful AMSP, it requires change in attitude, commitment, and administrative support rather than a huge financial support.
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Affiliation(s)
- Shweta Kumar
- Department of General Medicine, AIIMS Bhopal, Madhya Pradesh, India
| | | | - Rajnish Joshi
- Department of General Medicine, AIIMS Bhopal, Madhya Pradesh, India
| | | | - Rajesh Malik
- Department of Radiodiagnosis, AIIMS Bhopal, Madhya Pradesh, India
| | - Pradeep Saxena
- Department of General Surgery, AIIMS Bhopal, Madhya Pradesh, India
| | - Saurabh Saigal
- Department of Anesthesia and Critical Care, AIIMS Bhopal, Madhya Pradesh, India
| | - Ratinder Jhaj
- Department of Pharmacology, AIIMS Bhopal, Madhya Pradesh, India
| | - Sagar Khadanga
- Department of General Medicine, AIIMS Bhopal, Madhya Pradesh, India
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38
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Evaluating the antimicrobial resistance and frequency of AmpC β-lactamases bla gene in Gram-negative bacteria isolates collected from selected hospitals of Iran: A multicenter retrospective study. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100868] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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39
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Periasamy H, Gnanamani A. Polymyxins resistance among Gram-negative pathogens in India. THE LANCET. INFECTIOUS DISEASES 2020; 20:1362-1363. [PMID: 33186513 DOI: 10.1016/s1473-3099(20)30855-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/22/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | - Arumugam Gnanamani
- Department of Microbiology CSIR-Central Leather Research Institute, Adyar, Chennai 600 020, India.
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40
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Farooqui HH, Selvaraj S, Mehta A, Mathur MR. The impact of stringent prescription-only antimicrobial sale regulation (Schedule H1) in India: an interrupted time series analysis, 2008-18. JAC Antimicrob Resist 2020; 2:dlaa076. [PMID: 34223031 PMCID: PMC8210317 DOI: 10.1093/jacamr/dlaa076] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/02/2020] [Indexed: 12/25/2022] Open
Abstract
Objectives To assess the impact of Schedule H1 regulation notified and implemented in 2014 under the amended rules of the Drugs and Cosmetics Act (DCA), 1940 on the sale of antimicrobials in the private sector in India. Methods The dataset was obtained from the Indian pharmaceutical sales database, PharmaTrac. The outcome measure was the sales volume of antimicrobials in standard units (SUs). A quasi-experimental research design—interrupted time series analysis—was used to detect the impact of the intervention. Results We observed a substantial rise in antimicrobial consumption during 2008–18 in the private sector in India, both for antimicrobials regulated under Schedule H1 as well as outside the regulation. Key results suggested that post-intervention there was an immediate reduction (level change) in use of Schedule H1 antimicrobials by 10% (P = 0.007), followed by a sustained decline (trend change) in utilization by 9% (P > 0.000) compared with the pre-intervention trend. Segregated analysis on different antimicrobial classes suggests a sharp drop (level changes) and sustained decline (trend changes) in utilization post-intervention compared with the pre-intervention trend. Our findings remained robust on carrying out sensitivity analysis with the oral anti-diabetics market as a control. Post-intervention, the average monthly difference between antimicrobials under Schedule H1 and the control group witnessed an immediate increase of 16.3% (P = 0.10) followed by a sustained reduction of 0.5% (P = 0.13) compared with the pre-intervention scenario. Conclusions Though the regulation had a positive impact in terms of reducing sales of antimicrobials notified under the regulation, optimizing the effectiveness of such stand-alone policies will be limited unless accompanied by a broader set of interventions.
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Affiliation(s)
- Habib Hasan Farooqui
- Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram 122001, India
| | - Sakthivel Selvaraj
- Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram 122001, India
| | - Aashna Mehta
- Public Health Foundation of India, Plot No. 47, Sector 44, Institutional Area, Gurugram 122001, India
| | - Manu Raj Mathur
- University of Liverpool, Room B123, Waterhouse Building, Brownlow Street, Liverpool L69 3GL, UK
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Gandra S, Alvarez-Uria G, Turner P, Joshi J, Limmathurotsakul D, van Doorn HR. Antimicrobial Resistance Surveillance in Low- and Middle-Income Countries: Progress and Challenges in Eight South Asian and Southeast Asian Countries. Clin Microbiol Rev 2020; 33:e00048-19. [PMID: 32522747 PMCID: PMC7289787 DOI: 10.1128/cmr.00048-19] [Citation(s) in RCA: 94] [Impact Index Per Article: 23.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Antimicrobial resistance (AMR) is a serious global health threat and is predicted to cause significant health and economic impacts, particularly in low- and middle-income countries (LMICs). AMR surveillance is critical in LMICs due to high burden of bacterial infections; however, conducting AMR surveillance in resource-limited settings is constrained by poorly functioning health systems, scarce financial resources, and lack of skilled personnel. In 2015, the United Nations World Health Assembly endorsed the World Health Organization's Global Action Plan to tackle AMR; thus, several countries are striving to improve their AMR surveillance capacity, including making significant investments and establishing and expanding surveillance networks. Initial data generated from AMR surveillance networks in LMICs suggest the high prevalence of resistance, but these data exhibit several shortcomings, such as a lack of representativeness, lack of standardized laboratory practices, and underutilization of microbiology services. Despite significant progress, AMR surveillance networks in LMICs face several challenges in expansion and sustainability due to limited financial resources and technical capacity. This review summarizes the existing health infrastructure affecting the establishment of AMR surveillance programs, the burden of bacterial infections demonstrating the need for AMR surveillance, and current progress and challenges in AMR surveillance efforts in eight South and Southeast Asian countries.
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Affiliation(s)
- Sumanth Gandra
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gerardo Alvarez-Uria
- Department of Infectious Diseases, Rural Development Trust Hospital, Bathalapalli, Anantapur, Andhra Pradesh, India
| | - Paul Turner
- Cambodia Oxford Medical Research Unit, Angkor Hospital for Children, Siem Reap, Cambodia
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jyoti Joshi
- Center for Disease Dynamics, Economics and Policy, New Delhi, India
| | - Direk Limmathurotsakul
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - H Rogier van Doorn
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, National Hospital for Tropical Diseases, Hanoi, Vietnam
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Gandra S, Tseng KK, Arora A, Bhowmik B, Robinson ML, Panigrahi B, Laxminarayan R, Klein EY. The Mortality Burden of Multidrug-resistant Pathogens in India: A Retrospective, Observational Study. Clin Infect Dis 2020; 69:563-570. [PMID: 30407501 PMCID: PMC6669283 DOI: 10.1093/cid/ciy955] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/06/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The threat posed by antibiotic resistance is of increasing concern in low- and middle-income countries (LMICs) as their rates of antibiotic use increase. However, an understanding of the burden of resistance is lacking in LMICs, particularly for multidrug-resistant (MDR) pathogens. METHODS We conducted a retrospective, 10-hospital study of the relationship between MDR pathogens and mortality in India. Patient-level antimicrobial susceptibility test (AST) results for Enterococcus spp., Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. were analyzed for their association with patient mortality outcomes. RESULTS We analyzed data on 5103 AST results from 10 hospitals. The overall mortality rate of patients was 13.1% (n = 581), and there was a significant relationship between MDR and mortality. Infections with MDR and extensively drug resistant (XDR) E. coli, XDR K. pneumoniae, and MDR A. baumannii were associated with 2-3 times higher mortality. Mortality due to methicillin-resistant S. aureus (MRSA) was significantly higher than susceptible strains when the MRSA isolate was resistant to aminoglycosides. CONCLUSIONS This is one of the largest studies undertaken in an LMIC to measure the burden of antibiotic resistance. We found that MDR bacterial infections pose a significant risk to patients. While consistent with prior studies, the variations in drug resistance and associated mortality outcomes by pathogen are different from those observed in high-income countries and provide a baseline for studies in other LMICs. Future research should aim to elucidate the burden of resistance and the differential transmission mechanisms that drive this public health crisis.
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Affiliation(s)
- Sumanth Gandra
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | - Katie K Tseng
- Center for Disease Dynamics, Economics & Policy, Washington, DC
| | - Anita Arora
- Fortis Healthcare Ltd., Gurgaon, Haryana, India
| | | | - Matthew L Robinson
- Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Ramanan Laxminarayan
- Center for Disease Dynamics, Economics & Policy, Washington, DC.,Princeton Environmental Institute, Princeton University, New Jersey.,Department of Global Health, University of Washington, Seattle
| | - Eili Y Klein
- Center for Disease Dynamics, Economics & Policy, Washington, DC.,Department of Emergency Medicine, Johns Hopkins School of Medicine.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Yangzom T, Tsering DC, Kar S, Kapil J. Antimicrobial Susceptibility Trends among Pathogens Isolated from Blood: A 6-Year Retrospective Study from a Tertiary Care Hospital in East Sikkim, India. J Lab Physicians 2020; 12:3-9. [PMID: 32792787 PMCID: PMC7419168 DOI: 10.1055/s-0040-1712814] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background Bloodstream infections (BSIs) are one of the frequent nosocomial infections among hospitalized patients. To understand the local epidemiology and evolving antimicrobial drug resistance of blood-borne pathogens, we analyzed the distribution and antibiotic sensitivity profile of organisms causing BSI in our hospital-based study. Materials and Methods We reviewed retrospective data of laboratory-confirmed BSIs, from January 2013 to December 2018. Causative organisms and their antibiotic susceptibility profile of primary and secondary BSI reports were determined from BacT/Alert and Vitek systems findings (bioMérieux). A 6-year multidrug resistance indexing was done to document the resistance pattern of the commonly isolated organisms. Results A total of 1,340 (10.2%) BSIs were reported from 13,091 blood cultures. Organisms were frequently isolated from the younger population (≤20 years), especially from ages < 1 year (20.8% of total BSIs). Majority of pathogens were bacterial (97.1%) whereas 2.9% were fungal in origin. Monomicrobial growth was recorded in over 98% of BSIs. Gram-positive and gram-negative bacteria isolated were 518 (39.8%) and 783 (60.2%), respectively. Commonly isolated organisms were coagulase-negative Staphylococci (29.4%), Escherichia coli (19.8%), Klebsiella species (13.5%), Salmonella species (9.4%), and Staphylococcus aureus (7.5%). Multidrug-resistance index was observed highest in Acinetobacter species followed by Pseudomonas aeruginosa and S. aureus . Conclusion Overall, there has been a gradual decline in the reporting of BSI. However, infections by gram-negative bacilli and multidrug-resistant organisms remain persistently high. Ages < 20 years were the vulnerable group, with infants < 1 year contributing to the maximum number of BSI cases caused by both bacteria and fungi. Therefore, additional methods are required to study the origin and causation of these infections, particularly among vulnerable patients.
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Affiliation(s)
- Tsering Yangzom
- Department of Microbiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Sikkim, India
| | - Dechen Chomu Tsering
- Department of Microbiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Sikkim, India
| | - Sumit Kar
- Department of Microbiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Sikkim, India
| | - Jyotsna Kapil
- Department of Microbiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Sikkim, India
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Antimicrobial Resistance Profiles for Different Isolates in Aden, Yemen: A Cross-Sectional Study in a Resource-Poor Setting. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1810290. [PMID: 32382529 PMCID: PMC7195635 DOI: 10.1155/2020/1810290] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 04/02/2020] [Indexed: 11/17/2022]
Abstract
Background There is a rapid deterioration in the effectiveness of antibiotics due to the global prevalence of bacterial antimicrobial resistance (AMR). AMR can cause an increase in mortality and morbidity due to treatment failures and a lack of effective therapy. Objective The purpose of this study was to evaluate the AMR pattern of different bacterial isolates at hospitals and laboratories. Materials and Methods A cross-sectional study from March 2019 to June 2019 was conducted at different governmental and private hospitals and laboratories in Aden, Yemen. Age, sex, specimen type, bacterial isolates, and antibiotic susceptibility pattern were collected using a data extraction sheet. Descriptive statistics were used for data analysis. Result Data were recorded for 412 patients from whom 20 clinical specimens were collected and analyzed. The most common bacteria isolated were Staphylococcus spp. (n = 172, 41.74%), E. coli (n = 164, 39.80%), Pseudomonas spp. (n = 37, 8.98%), and Klebsiella pneumoniae (n = 18, 4.36%); other bacteria were less common. The overall bacterial resistance was highest against the combination of sulfamethoxazole with trimethoprim (73.12%), followed by amoxicillin and clavulanate (65.19%). The cephalosporin antibiotics also showed high resistance rates. The study also showed moderate bacterial resistance to gentamycin (32.65%), azithromycin (29.92%), cefoxitin (62.65%), and ciprofloxacin (25.60%). Ertapenem (16.67%) and levofloxacin (15.56%) had the lowest resistance rates. Conclusion There was a high percentage of bacteria resistant to several antibiotics. Antibiotic susceptibility testing is a prerequisite guide for the selection of appropriate antibiotic therapy for bacterial infections.
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Shariati A, Dadashi M, Chegini Z, van Belkum A, Mirzaii M, Khoramrooz SS, Darban-Sarokhalil D. The global prevalence of Daptomycin, Tigecycline, Quinupristin/Dalfopristin, and Linezolid-resistant Staphylococcus aureus and coagulase-negative staphylococci strains: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2020; 9:56. [PMID: 32321574 PMCID: PMC7178749 DOI: 10.1186/s13756-020-00714-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 03/31/2020] [Indexed: 12/16/2022] Open
Abstract
Objective Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCoNS) are among the main causes of nosocomial infections, which have caused major problems in recent years due to continuously increasing spread of various antibiotic resistance features. Apparently, vancomycin is still an effective antibiotic for treatment of infections caused by these bacteria but in recent years, additional resistance phenotypes have led to the accelerated introduction of newer agents such as linezolid, tigecycline, daptomycin, and quinupristin/dalfopristin (Q/D). Due to limited data availability on the global rate of resistance to these antibiotics, in the present study, the resistance rates of S. aureus, Methicillin-resistant S. aureus (MRSA), and CoNS to these antibiotics were collected. Method Several databases including web of science, EMBASE, and Medline (via PubMed), were searched (September 2018) to identify those studies that address MRSA, and CONS resistance to linezolid, tigecycline, daptomycin, and Q/D around the world. Result Most studies that reported resistant staphylococci were from the United States, Canada, and the European continent, while African and Asian countries reported the least resistance to these antibiotics. Our results showed that linezolid had the best inhibitory effect on S. aureus. Although resistances to this antibiotic have been reported from different countries, however, due to the high volume of the samples and the low number of resistance, in terms of statistical analyzes, the resistance to this antibiotic is zero. Moreover, linezolid, daptomycin and tigecycline effectively (99.9%) inhibit MRSA. Studies have shown that CoNS with 0.3% show the lowest resistance to linezolid and daptomycin, while analyzes introduced tigecycline with 1.6% resistance as the least effective antibiotic for these bacteria. Finally, MRSA and CoNS had a greater resistance to Q/D with 0.7 and 0.6%, respectively and due to its significant side effects and drug-drug interactions; it appears that its use is subject to limitations. Conclusion The present study shows that resistance to new agents is low in staphylococci and these antibiotics can still be used for treatment of staphylococcal infections in the world.
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Affiliation(s)
- Aref Shariati
- Student Research Committee, Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Masoud Dadashi
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.,Non Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Zahra Chegini
- Student Research Committee, Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alex van Belkum
- Open Innovation & Partnerships, Route de Port Michaud, 38390, La Balme Les Grottes, France
| | - Mehdi Mirzaii
- School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Seyed Sajjad Khoramrooz
- Cellular and Molecular Research Center and Department of Microbiology, School of Medicine, Yasuj University of Medical Sciences, Yasuj, Iran
| | - Davood Darban-Sarokhalil
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
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46
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Unorthodox Parenteral β-Lactam and β-Lactamase Inhibitor Combinations: Flouting Antimicrobial Stewardship and Compromising Patient Care. Antimicrob Agents Chemother 2020; 64:AAC.00168-20. [PMID: 32122901 DOI: 10.1128/aac.00168-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In India and China, indigenous drug manufacturers market arbitrarily combined parenteral β-lactam and β-lactamase inhibitors (BL-BLIs). In these fixed-dose combinations, sulbactam or tazobactam is indiscriminately combined with parenteral cephalosporins, with BLI doses kept in ratios similar to those for the approved BL-BLIs. Such combinations have been introduced into clinical practice without mandatory drug development studies involving pharmacokinetic/pharmacodynamic, safety, and efficacy assessments being undertaken. Such unorthodox combinations compromise clinical outcomes and also potentially contribute to resistance development.
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Prevalence of Colistin-Resistant, Carbapenem-Hydrolyzing Proteobacteria in Hospital Water Bodies and Out-Falls of West Bengal, India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031007. [PMID: 32033408 PMCID: PMC7037630 DOI: 10.3390/ijerph17031007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/17/2020] [Accepted: 01/22/2020] [Indexed: 12/20/2022]
Abstract
Indiscriminate use of antibiotics has resulted in a catastrophic increase in the levels of antibiotic resistance in India. Hospitals treat critical bacterial infections and thus can serve as reservoirs of multidrug resistant (MDR) bacteria. Hence, this study was conducted to gauge the prevalence patterns of MDR bacteria in hospital wastewater. Water samples collected from 11 hospitals and 4 environmental sources belonging to 5 most-densely populated districts of West Bengal, India were grown on MacConkey and Eosin Methylene Blue agar. A total of 84 (hospital-associated = 70, environmental water sources = 14) isolates were characterized. The predominant species found in water from hospital-associated areas (HAA) were Acinetobacter baumannii (22.9%), Escherichia coli (28.6 %), and Klebsiella pneumoniae (25.7%). Greater than 75% of the HAA isolates were found to be mcr-1 gene negative and colistinresistant. Meropenem non-susceptibility was also high among the HAA isolates at 58.6%, with the presence of the carbapenemase gene and blaNDM in 67.1% of the non-susceptible isolates. Among the three predominant species, significantly higher numbers of E. coli isolates were found to be non-susceptible to meropenem ((80%), p-value = 0.00432) and amikacin (AK (90%), p-value = 0.00037). This study provides evidence for the presence of high numbers of colistin-resistant and carbapenem-hydrolyzing Proteobacteriain hospital wastewater.
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48
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Malhotra K, Shankar S, Chauhan N, Rai R, Singh Y. Design, characterization, and evaluation of antibacterial gels, Boc-D-Phe-γ 4-L-Phe-PEA/chitosan and Boc-L-Phe-γ 4-L-Phe-PEA/chitosan, for biomaterial-related infections. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 110:110648. [PMID: 32204079 DOI: 10.1016/j.msec.2020.110648] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 08/29/2019] [Accepted: 01/03/2020] [Indexed: 12/27/2022]
Abstract
Self-assembled peptide gels have generated interest as antibacterial materials to prevent biomaterial-related infections but these peptides are often associated with poor proteolytic stability. Efforts have been made to stabilize peptides by incorporating non-natural amino acids and/or linkages but complexation with polymers have not been explored. Therefore, we developed self-assembled peptide/chitosan gels, Boc-D-Phe-γ4-L-Phe-PEA (NH007)/chitosan and Boc-L-Phe-γ4-L-Phe-PEA (NH009)/chitosan, by complexing dipeptide NH007 or NH009 with chitosan in DMSO:acetic acid. The gels were characterized using SEM, FTIR, contact angle, and rheology data and found to exhibit excellent viscoelastic and self-healing characteristics. Complexation with chitosan led to an increase in stability against proteolytic degradation. Peptide/chitosan gels showed broad spectrum antibacterial activities against Gram-negative and Gram-positive bacteria, such as Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, and Bacillus subtilis at a high inoculum of 107-108 cfu/mL. NH007/chitosan gels showed 70-75% inhibition, whereas NH009/chitosan showed 78-81% inhibition and NH009/chitosan gels, in particular, showed strong antibacterial activity against pathogenic strain of P. aeruginosa. A unique feature of these gels is that the antibacterial activities did not decrease gradually but were sustained for up to 48 h. The mechanistic studies using SEM and HR-TEM indicated interaction of gels with bacterial membrane components, leading to cell lysis. The MTT and LDH assays indicated >90% cell viability and only 8-10% toxicity towards NIH 3T3 fibroblast cells. Thus, peptide/chitosan gels developed in the present work showed improved proteolytic stability and sustained antibacterial activities and, therefore, may be used for preventing biomaterial-related infections.
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Affiliation(s)
- Kamal Malhotra
- Department of Chemistry, Indian Institute of Technology Ropar, Rupnagar 140001, Punjab, India
| | - Sudha Shankar
- Medicinal Chemistry Division, CSIR- Indian Institute of Integrative Medicine, Canal Road, Jammu Tawi 180001, Jammu and Kashmir, India; Academy of Scientific and Innovative Research, New Delhi 110001, Delhi, India
| | - Neelam Chauhan
- Department of Chemistry, Indian Institute of Technology Ropar, Rupnagar 140001, Punjab, India
| | - Rajkishor Rai
- Medicinal Chemistry Division, CSIR- Indian Institute of Integrative Medicine, Canal Road, Jammu Tawi 180001, Jammu and Kashmir, India; Academy of Scientific and Innovative Research, New Delhi 110001, Delhi, India
| | - Yashveer Singh
- Department of Chemistry, Indian Institute of Technology Ropar, Rupnagar 140001, Punjab, India.
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49
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Das S, Roy S, Roy S, Goelv G, Sinha S, Mathur P, Walia K, Bhattacharya S. Colistin susceptibility testing of gram-negative bacilli: Better performance of vitek2 system than E-test compared to broth microdilution method as the gold standard test. Indian J Med Microbiol 2020; 38:58-65. [PMID: 32719210 DOI: 10.4103/ijmm.ijmm_19_480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Introduction Unavailability of optimal susceptibility testing (ST) challenges the clinical use of colistin. Broth microdilution (BMD), which is the reference for colistin ST, is inconvenient for diagnostics. Vitek2 and E-test although technically easier, are no longer recommended. Materials and Methods For the evaluation of Vitek2 and E-test in reference with BMD, a total of 138 Gram-negative bacilli (GNB) especially carbapenem-resistant isolates from Tata Medical Center, Kolkata, India, were included during 2017-2018. The evaluation was performed only for Enterobacteriaceae (n = 102), but not for non-fermentative GNB (n = 36) due to lack of colistin-resistant (COLR) isolates. Results and Conclusion Of 138 isolates, meropenem, colistin and dual resistance were detected in 110 (79.7%), 31 (22.5%) and 21 (15.2%) of isolates, respectively. Using the European Committee on Antimicrobial Susceptibility Testing guidelines (susceptible, ≤2 μg/ml), Vitek2 performed better than E-test (essential agreement, 92.2% vs. 63.7%; categorical agreement, 94.1% vs. 93.1%; very major error [VME], 10% vs. 23.3%). However, Vitek2 overcalled resistance than E-test (major error, 4.2% vs. 0%). Considering Chew et al. proposed breakpoints (susceptible, ≤1 μg/ml), VMEs declined for both test (6.7% vs. 10%), but still remained unacceptable. Of eight colistin-heteroresistant isolates, two VME were categorised by Vitek2, one VME was by E-test, and two were uninterpretable. Both Vitek2 and E-test are unreliable. Further studies correlating minimum inhibitory concentrations with clinical outcome are needed to determine the accurate breakpoints for better patient management.
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Affiliation(s)
- Surojit Das
- Department of Bio-Medical Laboratory Science and Management, Vidyasagar University, Midnapore, West Bengal, India
| | - Subhanita Roy
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Samadrita Roy
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
| | - Gaurav Goelv
- Department of Bio-Medical Laboratory Science and Management, Vidyasagar University, Midnapore, West Bengal, India
| | - Subir Sinha
- Department of Statistics, Tata Medical Center, Kolkata, West Bengal, India
| | - Purva Mathur
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kamini Walia
- Division of Epidemiology and Communicable Diseases, Indian Council of Medical Research, New Delhi, India
| | - Sanjay Bhattacharya
- Department of Microbiology, Tata Medical Center, Kolkata, West Bengal, India
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50
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Li G, Bielicki JA, Ahmed ASMNU, Islam MS, Berezin EN, Gallacci CB, Guinsburg R, da Silva Figueiredo CE, Santarone Vieira R, Silva AR, Teixeira C, Turner P, Nhan L, Orrego J, Pérez PM, Qi L, Papaevangelou V, Triantafyllidou P, Iosifidis E, Roilides E, Sarafidis K, Jinka DR, Nayakanti RR, Kumar P, Gautam V, Prakash V, Seeralar A, Murki S, Kandraju H, Singh S, Kumar A, Lewis L, Pukayastha J, Nangia S, K N Y, Chaurasia S, Chellani H, Obaro S, Dramowski A, Bekker A, Whitelaw A, Thomas R, Velaphi SC, Ballot DE, Nana T, Reubenson G, Fredericks J, Anugulruengkitt S, Sirisub A, Wong P, Lochindarat S, Boonkasidecha S, Preedisripipat K, Cressey TR, Paopongsawan P, Lumbiganon P, Pongpanut D, Sukrakanchana PO, Musoke P, Olson L, Larsson M, Heath PT, Sharland M. Towards understanding global patterns of antimicrobial use and resistance in neonatal sepsis: insights from the NeoAMR network. Arch Dis Child 2020; 105:26-31. [PMID: 31446393 PMCID: PMC6951234 DOI: 10.1136/archdischild-2019-316816] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 07/31/2019] [Accepted: 08/06/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To gain an understanding of the variation in available resources and clinical practices between neonatal units (NNUs) in the low-income and middle-income country (LMIC) setting to inform the design of an observational study on the burden of unit-level antimicrobial resistance (AMR). DESIGN A web-based survey using a REDCap database was circulated to NNUs participating in the Neonatal AMR research network. The survey included questions about NNU funding structure, size, admission rates, access to supportive therapies, empirical antimicrobial guidelines and period prevalence of neonatal blood culture isolates and their resistance patterns. SETTING 39 NNUs from 12 countries. PATIENTS Any neonate admitted to one of the participating NNUs. INTERVENTIONS This was an observational cohort study. RESULTS The number of live births per unit ranged from 513 to 27 700 over the 12-month study period, with the number of neonatal cots ranging from 12 to 110. The proportion of preterm admissions <32 weeks ranged from 0% to 19%, and the majority of units (26/39, 66%) use Essential Medicines List 'Access' antimicrobials as their first-line treatment in neonatal sepsis. Cephalosporin resistance rates in Gram-negative isolates ranged from 26% to 84%, and carbapenem resistance rates ranged from 0% to 81%. Glycopeptide resistance rates among Gram-positive isolates ranged from 0% to 45%. CONCLUSION AMR is already a significant issue in NNUs worldwide. The apparent burden of AMR in a given NNU in the LMIC setting can be influenced by a range of factors which will vary substantially between NNUs. These variations must be considered when designing interventions to improve neonatal mortality globally.
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Affiliation(s)
- Grace Li
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Julia Anna Bielicki
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, London, UK,Paediatric Pharmacology and Pharmacometrics Research, University of Basel Children's Hospital, Basel, Switzerland
| | | | | | | | | | - Ruth Guinsburg
- Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | | | | | | | - Paul Turner
- Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
| | - Ladin Nhan
- Angkor Hospital for Children, Siem Reap, Cambodia
| | - Jaime Orrego
- Fundación Valle del Lili, Santiago de Cali, Colombia
| | | | - Lifeng Qi
- Shenzhen Children’s Hospital, Shenzhen, China
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Elias Iosifidis
- School of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Emmanuel Roilides
- School of Health Sciences, Aristotle University, Thessaloniki, Greece
| | - Kosmas Sarafidis
- School of Health Sciences, Aristotle University, Thessaloniki, Greece
| | | | | | - Praveen Kumar
- Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Gautam
- Paediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Vinayagam Prakash
- Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Chennai, India
| | - Arasar Seeralar
- Institute of Obstetrics and Gynaecology and Government Hospital for Women and Children, Chennai, India
| | - Srinivas Murki
- Department of Neonatology, Fernandez Hospital, Hyderabad, India
| | | | | | - Anil Kumar
- Amrita Institute of Medical Sciences, Kochi, India
| | | | | | | | - Yogesha K N
- Lady Hardinge Medical College, New Delhi, India
| | | | - Harish Chellani
- Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Stephen Obaro
- International Foundation Against Infectious Disease in Nigeria, Omaha, Nebraska, USA
| | - Angela Dramowski
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Adrie Bekker
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Andrew Whitelaw
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa,National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
| | - Reenu Thomas
- University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Trusha Nana
- University of the Witwatersrand, Johannesburg, South Africa
| | - Gary Reubenson
- University of the Witwatersrand, Johannesburg, South Africa
| | - Joy Fredericks
- University of the Witwatersrand, Johannesburg, South Africa
| | | | | | - Pimol Wong
- Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | | | - Tim R Cressey
- Chiangrai Prachanukroh Hospital, Chiang Rai, Thailand
| | | | | | | | | | - Philippa Musoke
- Paediatrics and Child Health, Makerere University, Kampala, Kampala, Uganda,Mulago Hospital, Kampala, Uganda
| | - Linus Olson
- Karolinska Institute in collaboration with Vietnam National Children's Hospital within Training and Research Academic Collaboration (TRAC) Sweden – Vietnam, Hanoi, Vietnam
| | - Mattias Larsson
- Karolinska Institute in collaboration with Vietnam National Children's Hospital within Training and Research Academic Collaboration (TRAC) Sweden – Vietnam, Hanoi, Vietnam
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, London, UK
| | - Michael Sharland
- Paediatric Infectious Diseases Research Group, Institute of Infection and Immunity, St George's, University of London, London, UK
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