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Thimmaiah G, Pandey N, Prinja S, Jain K, Biswal M, Agarwal R, Koushal V, Sethi S. Ventilator-associated pneumonia - What price does the public health system pay? Lung India 2024; 41:278-283. [PMID: 38953191 DOI: 10.4103/lungindia.lungindia_597_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 01/31/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is the commonest healthcare-associated infection (HAI) in intensive care units (ICU), especially in trauma patients. VAP imposes a significant cost burden on the healthcare ecosystem. However, there are few data from the developing world. METHODOLOGY We conducted this study in the trauma ICU (TICU) of PGIMER, Chandigarh, from October 2021 to December 2022. The incidence, incidence density, and average length of stay (ALOS) of both VAP and non-VAP patients were established. The health system cost was assessed using a mixed (top-down and bottom-up) micro-costing approach. We collected data for all the resources (direct and indirect costs) utilized during service delivery and estimated the health system cost per bed per day. RESULTS In this study, 494 patients were admitted to TICU, of which 484 received Mechanical Ventilation (MV) and 47 developed VAP. We included 41 and 44 patients with and without VAP. The VAP incidence rate was 9.7% and the VAP incidence density was 10.79/1000 MV days. The ALOS for VAP patients was 21 days, and for non- VAP patients was 8.2 days. Our study estimated a total health system cost of INR 25,927 per bed per day. The health system cost of treating a VAP patient was INR 544,467 compared to INR 207,416 for a non-VAP patient. CONCLUSION Treatment of VAP poses substantial costs for the health system and patients. There is a need to focus on preventing VAP, which would eventually reduce the length of stay and the resultant financial impact on the health system and the patient.
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Affiliation(s)
- Guruprasad Thimmaiah
- Department of Hospital Administration, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Navin Pandey
- Department of Hospital Administration, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shankar Prinja
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Kajal Jain
- Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manisha Biswal
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ritesh Agarwal
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Vipin Koushal
- Department of Hospital Administration, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Saru Sethi
- Department of Hospital Administration, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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Kharat AS, Makwana N, Nasser M, Gayen S, Yadav B, Kumar D, Veeraraghavan B, Mercier C. Dramatic increase in antimicrobial resistance in ESKAPE clinical isolates over the 2010-2020 decade in India. Int J Antimicrob Agents 2024; 63:107125. [PMID: 38431109 DOI: 10.1016/j.ijantimicag.2024.107125] [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: 03/01/2023] [Revised: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
RATIONALE AND OBJECTIVES ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) constitute a threat to humans worldwide. India is now the most populous country. The goal was to investigate the evolution of the rates of antimicrobial resistance in ESKAPE pathogens across India over the 2010-20 decade. METHODS The data (89 studies) were retrieved from the Medline PubMed repository using specific keywords. RESULTS The study of 20 177 ESKAPE isolates showed that A. baumannii isolates were the most represented (35.9%, n = 7238), followed by P. aeruginosa (25.3%, n = 5113), K. pneumoniae (19.5%, n = 3934), S. aureus (16.3%, n = 3286), E. faecium (2.6%, n = 517) and Enterobacter spp. (0.4%, n = 89). A notable increase in the resistance rates to antimicrobial agents occurred over the 2010-20 decade. The most important levels of resistance were observed in 2016-20 for A. baumannii (90% of resistance to the amoxicillin-clavulanate combination) and K. pneumoniae (81.6% of resistance to gentamycin). The rise in β-lactamase activities was correlated with an increase in the positivity of Gram-negative isolates for β-lactamase genes. CONCLUSIONS This review highlighted that, in contrast to developed countries that kept resistance levels under control, a considerable increase in resistance to various classes of antibiotics occurred in ESKAPE pathogens in India over the 2010-2020 decade.
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Affiliation(s)
- Arun S Kharat
- Laboratory of Applied Microbiology, School of Life Sciences, Jawaharlal Nehru University, New Delhi, India.
| | - Nilesh Makwana
- Laboratory of Applied Microbiology, School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Mahfouz Nasser
- Department of Biotechnology, Dr. Babasaheb Ambedkar Marathwada University, Subcampus Osmanbad, MS, Aurangabad, Maharashtra, India; National Center for Public Health Laboratories, Hodeidah, Yemen
| | - Samarpita Gayen
- Department of Biotechnology, Dr. Babasaheb Ambedkar Marathwada University, Subcampus Osmanbad, MS, Aurangabad, Maharashtra, India
| | - Bipin Yadav
- Laboratory of Applied Microbiology, School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Durgesh Kumar
- Laboratory of Applied Microbiology, School of Life Sciences, Jawaharlal Nehru University, New Delhi, India
| | - Balaji Veeraraghavan
- Department of Clinical Microbiology, Christian Medical College, Vellore Tamil Nadu, India
| | - Corinne Mercier
- Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000 Grenoble, France.
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R K, Anil A, Thomas P, Samuel Raju N, Reji SM. Antibiotic Susceptibility Profiling of Gram-Positive and Gram-Negative Bacterial Isolates in a Tertiary Care Hospital: Establishment of an Antibiogram. Cureus 2024; 16:e60542. [PMID: 38887355 PMCID: PMC11181123 DOI: 10.7759/cureus.60542] [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: 05/18/2024] [Indexed: 06/20/2024] Open
Abstract
Introduction Antimicrobial resistance poses a significant global healthcare challenge in the management of bacterial infections, which is frequently attributed to rapid bacterial adaptations. This study aims to develop an antibiogram for a tertiary care hospital, providing comprehensive antibiotic sensitivity profiles for Gram-positive and Gram-negative bacteria. It informs healthcare providers of antibiotic resistance trends, enabling informed treatment decisions and enhanced infection control measures. Methods We conducted a six-month prospective observational study, during which we gathered and analyzed data from the microbiology laboratory to identify patterns of antimicrobial sensitivity. Subsequently, the data underwent analysis and interpretation using the respected WHONET software, a readily available tool designed for this specific task. Our methodology adhered to the guidelines established by the Clinical & Laboratory Standards Institute for the standardization of antibiogram generation procedures, and these guidelines are easily integrated into the WHONET software for analytical purposes. Results There were a total of 357 isolates across various hospital departments, comprising 13 distinct bacterial species. Among them, nine were identified as Gram-negative bacteria, accounting for 262 (73.3%) isolates. Escherichia coli accounted for 131 (36.6%) isolates, while Klebsiella accounted for 62 (17.3%), emerging as the predominant species among them. The remaining four bacterial species were identified as Gram-positive bacteria, totaling 95 (26.6%) isolates, with Staphylococcus aureus being the most frequently isolated species at 51 (14.2%), followed by Enterococcus at 26 (7.2%). Subsequent analysis using the WHONET software facilitated the creation of an antibiogram. Among the Gram-negative bacteria, E. coli displayed high sensitivity (100%) to aztreonam and clindamycin, followed by nitrofurantoin (98%), imipenem (94%), and meropenem (95%). However, it exhibited decreased sensitivity to ampicillin (25%), cefuroxime (34%), and ceftriaxone (39%). Conversely, among the Gram-positive bacteria, S. aureus demonstrated 100% sensitivity to ampicillin, amoxiclav, cefazolin, teicoplanin, linezolid, rifampicin, nitrofurantoin, and cefotaxime. However, it exhibited zero sensitivity to vancomycin and only 6% sensitivity to cotrimoxazole. Conclusion This study advances the understanding of antibiotic susceptibility in a tertiary care setting and provides an invaluable tool for optimizing treatment strategies, enhancing infection control measures, and combating antibiotic resistance.
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Affiliation(s)
- Kannan R
- Pharmacology and Therapeutics, East Point College of Pharmacy, Bangalore, IND
| | - Ashik Anil
- Pharmacology and Therapeutics, East Point Hospital and Research Center, Bangalore, IND
| | - Pritty Thomas
- Clinical Pharmacy, St John's Medical College Hospital, Bangalore, IND
| | - Nijin Samuel Raju
- Pharmacology and Therapeutics, Believers Church Medical College Hospital, Bangalore, IND
| | - Sherin M Reji
- Pharmacy, Hillside College of Pharmacy and Research Centre, Bangalore, IND
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Verma N, Sharma T, Bhardwaj A, Vemuluri VR. Comparative genomics and characterization of a multidrug-resistant Acinetobacter baumannii VRL-M19 isolated from a crowded setting in India. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2024; 118:105549. [PMID: 38181886 DOI: 10.1016/j.meegid.2023.105549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/17/2023] [Accepted: 12/31/2023] [Indexed: 01/07/2024]
Abstract
A crowded vegetable market serves as a mass gathering, posing a potential risk for infection transmission. In this study, we isolated a multidrug-resistant Acinetobacter baumannii strain, VRL-M19, from the air of such a market and conducted comparative genomics and phenotypic characterization. Antimicrobial susceptibility testing, genome sequencing using Illumina HiSeq X10, and pan-genome analysis with 788 clinical isolates identified core, accessory, and unique drug-resistant determinants. Mutational analysis of drug-resistance genes, virulence factor annotation, in vitro pathogenicity assessment, subsystem analysis, Multilocus sequence typing, and whole genome phylogenetic analysis were performed. VRL-M19 exhibited multidrug resistance with 69 determinants, and analysis across 788 clinical isolates and 350 Indian isolates revealed more accessory genes (52 out of 69) in the Indian isolates. Multiple mutations were observed in drug target modification genes, and the strain was identified as a moderate biofilm-former with 55 virulence factors. Whole genome phylogenetics indicated a close relationship between VRL-M19 and clinical A. baumannii strains. In conclusion, our comprehensive study suggests that VRL-M19 is a multidrug-resistant, potential pathogen with biofilm-forming capabilities, closely associated with clinical A. baumannii strains.
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Affiliation(s)
- Neha Verma
- Microbial Type Culture Collection and Gene Bank (MTCC), CSIR-Institute of Microbial Technology, Chandigarh 160036, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Tina Sharma
- Bioinformatics Centre, CSIR-Institute of Microbial Technology, Chandigarh 160036, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India
| | - Anshu Bhardwaj
- Bioinformatics Centre, CSIR-Institute of Microbial Technology, Chandigarh 160036, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India.
| | - Venkata Ramana Vemuluri
- Microbial Type Culture Collection and Gene Bank (MTCC), CSIR-Institute of Microbial Technology, Chandigarh 160036, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad 201002, India.
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Kipsang F, Munyiva J, Menza N, Musyoki A. Carbapenem-resistant Acinetobacter baumannii infections: Antimicrobial resistance patterns and risk factors for acquisition in a Kenyan intensive care unit. IJID REGIONS 2023; 9:111-116. [PMID: 38020185 PMCID: PMC10652105 DOI: 10.1016/j.ijregi.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023]
Abstract
Objectives Multidrug-resistant (MDR) Acinetobacter baumannii (AB), especially carbapenem-resistant (CR) strains, presents a significant challenge in intensive care units (ICUs) but surveillance data in many resource-constrained countries is inadequate. Here, we determined the prevalence of MDRAB and risk factors for infection and mortality in ICU-admitted patients. Methods A cross-sectional study among 132 consecutive patients between July 2019 and July 2020, with infected patients followed for 30 days from sample collection to ICU discharge/death. Blood, urine, and tracheal aspirate samples were processed following the standard bacteriological procedures. Isolate identity and antimicrobial susceptibility were elucidated by VITEK 2 Compact system. Results The prevalence of MDRAB was 22.7% (30/132), mostly from urine samples (12.1%, 16/132), and dominated by CRAB (83.3%) that were colistin-nonresistant and exhibited high multiple antibiotic resistance indices, ranging from 0.64-0.91. Risk factors for infection were occupation (adjusted odds ratio = 4.41, P = 0.016) and interhospital referral status (adjusted odds ratio = 0.14, P = 0.001). ICU mortality was 20% (6/30). Conclusion Our findings underpin the need for strict adherence to and evaluation of infection prevention and control, and continuous surveillance of CRAB in ICU, especially among the risk groups, in the current study setting and beyond.
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Affiliation(s)
- Fred Kipsang
- Department of Biomedical Sciences, Kabarak University, P.O. Private Bag 20157, Nakuru, Kenya
| | - Jeniffer Munyiva
- Department of Laboratory Medicine, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya
| | - Nelson Menza
- Department of Medical Laboratory Sciences, Kenyatta University, P.O. BOX 43844-00100, Nairobi, Kenya
| | - Abednego Musyoki
- Department of Medical Laboratory Sciences, Kenyatta University, P.O. BOX 43844-00100, Nairobi, Kenya
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Sharma S, Pramanik S, Marndi P, Banerjee T. Hospital-acquired infections due to carbapenem-resistant Providencia stuartii. Indian J Med Res 2023; 158:145-150. [PMID: 37787258 PMCID: PMC10645031 DOI: 10.4103/ijmr.ijmr_3668_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Indexed: 10/04/2023] Open
Abstract
Background & objectives During the course of a retrospective survey on healthcare associated infections (HAIs) due to carbapenem-resistant organisms, an unusual prevalence of HAIs due to carbapenem-resistant Providencia stuartii (CRPS) was found. Hence this study aimed to conduct the occurrence of P. stuartii associated HAIs with special reference to the drug resistance profiling of these isolates. Methods Of the eight total HAI cases (7.5% of total HAIs and 33.3% of HAIs due to Enterobacterales) of CRPS infections included in this study, three were reported from ventilator-associated pneumonia (VAP), three were surgical site infections (SSIs), one was a catheter-associated urinary tract infection (CAUTI) and one was a bloodstream infection. All the eight CRPS isolates were tested for extended-spectrum β-lactamases production, AmpC hyperproduction as well as carbapenem resistance. Typing of the isolates was performed by repetitive extragenic palindromic polymerase chain reaction (REP-PCR). Results All the eight isolates of CRPS were found to be AmpC hyperproducers, carbapenemase producers, and harboured chromosomally located blaNDM in seven isolates and blaIMP genes in one. All the cases with CRPS infections had prior history of colistin therapy along with prolonged hospital stay (>20 days). The cases were located in five different wards/intensive care unit (ICU) within the hospital in one year. However, strain typing by REP-PCR revealed 100 per cent similarity and clonal relatedness in all the seven isolates carrying blaNDM genes. Interestingly, routine hospital surveillance revealed a high carriage of P. stuartii in the axilla of patients admitted to the ICU. Interpretation & conclusions The study findings suggest CRPS as an important cause of HAIs. This organism often goes unnoticed due to the burden of carbapenem resistance in other Enterobacterales and non-fermenters.
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Affiliation(s)
- Swati Sharma
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sangita Pramanik
- Department of Botany, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Pooja Marndi
- Department of Botany, Institute of Science, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Tuhina Banerjee
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Agyepong N, Fordjour F, Owusu-Ofori A. Multidrug-resistant Acinetobacter baumannii in healthcare settings in Africa. FRONTIERS IN TROPICAL DISEASES 2023. [DOI: 10.3389/fitd.2023.1110125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
The emergence of multidrug-resistant Acinetobacter baumannii is a major concern to healthcare providers and facilities in many parts of the world. This bacterial pathogen is commonly implicated in hospital-acquired infections, particularly in critically ill patients admitted to the intensive care unit (ICU). The extensive use of antibiotics, particularly in ICUs, and the lack of proper infection control interventions in many hospitals have led to an increased emergence of multidrug-resistant A. baumannii. Infections due to multidrug-resistant A. baumannii are associated with prolonged hospital stays and high morbidity and mortality, particularly among hospitalized ICU patients. The lack of antibiotic stewardship programmes in many healthcare facilities has exacerbated the burden of A. baumannii infections in many parts of Africa. This review discusses the prevalence and antibiotic-resistance pattern of the multidrug-resistant A. baumannii, and the possible ways to address or minimise its emergence in healthcare settings in Africa.
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Sharma S, Banerjee T, Yadav G, Kumar A. Susceptibility profile of bla OXA-23 and metallo-β-lactamases co-harbouring isolates of carbapenem resistant Acinetobacter baumannii (CRAB) against standard drugs and combinations. Front Cell Infect Microbiol 2023; 12:1068840. [PMID: 36683677 PMCID: PMC9853021 DOI: 10.3389/fcimb.2022.1068840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/20/2022] [Indexed: 01/09/2023] Open
Abstract
Background The rapid emergence of carbapenem resistant Acinetobacter baumannii (CRAB) has resulted in an alarming situation worldwide. Realizing the dearth of literature on susceptibility of CRAB in genetic context in the developing region, this study was performed to determine the susceptibility profile against standard drugs/combinations and the association of in-vitro drug synergy with the prevalent molecular determinants. Methods and findings A total of 356 clinical isolates of A. baumannii were studied. Confirmation of the isolates was done by amplifying recA and ITS region genes. Susceptibility against standard drugs was tested by Kirby Bauer disc diffusion. Minimum inhibitory concentration (MIC), MIC50 and MIC90 values against imipenem, meropenem, doripenem, ampicillin/sulbactam, minocycline, amikacin, polymyxin B, colistin and tigecycline was tested as per guidelines. Genes encoding enzymes classes A (bla GES, bla IMI/NMC-A, bla SME, bla KPC), B (bla IMP, bla VIM, bla NDM) and D (bla OXA-51, bla OXA-23 and bla OXA-58) were detected by multiplex polymerase chain reaction. Synergy against meropenem-sulbactam and meropenem-colistin combinations was done by checkerboard MIC method. Correlation of drug synergy and carbapenemase encoding genes was statistically analyzed. Results Of the total, resistance above 90% was noted against gentamicin, ciprofloxacin, levofloxacin, ceftazidime, cefepime, ceftriaxone, cotrimoxazole and piperacillin/tazobactam. By MIC, resistance rates from highest to lowest was seen against imipenem 89.04% (n=317), amikacin 80.33% (n=286), meropenem 79.49% (n=283), doripenem 77.80% (n=277), ampicillin/sulbactam 71.62% (n=255), tigecycline 55.61% (n=198), minocycline 14.04% (n=50), polymyxin B 10.11% (n=36), and colistin 2.52% (n=9). CRAB was 317 (89.04%), 81.46% (n=290) were multidrug resistant and 13.48% (n=48) were extensively drug resistant. All the CRAB isolates harboured bla OXA-51 gene (100%) and 94% (n=298) bla OXA-23 gene. The bla IMP gene was most prevalent 70.03% (n=222) followed by bla NDM, 59.62% (n=189). Majority (87.69%, 278) were co-producers of classes D and B carbapenemases, bla OXA-23 with bla IMP and bla NDM being the commonest. Synergy with meropenem-sulbactam and meropenem-colistin was 47% and 57% respectively. Reduced synergy (p= <0.0001) was noted for those harbouring bla OXA-51+blaOXA-23with bla NDM gene alone or co-producers. Conclusion Presence of bla NDM gene was a significant cause of synergy loss in meropenem-sulbactam and meropenem-colistin. In bla NDM endemic regions, tigecycline, minocycline and polymyxins could be viable options against CRAB isolates with more than one carbapenemase encoding genes.
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Affiliation(s)
- Swati Sharma
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Tuhina Banerjee
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ghanshyam Yadav
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashok Kumar
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Araya S, Gebreyohannes Z, Tadlo G, Gessew GT, Negesso AE. Epidemiology and Multidrug Resistance of Pseudomonas aeruginosa and Acinetobacter baumanni Isolated from Clinical Samples in Ethiopia. Infect Drug Resist 2023; 16:2765-2773. [PMID: 37187480 PMCID: PMC10178297 DOI: 10.2147/idr.s402894] [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: 12/28/2022] [Accepted: 05/03/2023] [Indexed: 05/17/2023] Open
Abstract
Background A. baumannii and P. aeruginosa are important nosocomial pathogens in health-care settings. Both are intrinsically resistant to many drugs and are able to become resistant to the virtually most antimicrobial agents. An increasing prevalence of infections caused by multidrug-resistant isolates has been reported in many countries. Methods An institutional-based cross-sectional five-year retrospective study was conducted to assess the antimicrobial resistance trend of P. aeruginosa and A. baumani. 893 A. baumani and 729 P. aeruginosa isolates were included in the study. Conventional method was used for identification and antimicrobial susceptibility was determined by Kirby-Bauer disc-diffusion method. The isolates were from suspected bloodstream infections, wound infections, urinary tract, or surgical site nosocomial infections. Socio-demographic and other variables of interest were collected using a structured check list from a patient record data. Data were analyzed using SPSS version 26 software. P value <0.05 was considered statistically significant. Results A total of 1622 A. baumanii and P. aeruginosa were isolated from various clinical specimens recorded from the year 2017-2021. Out of which A. baumanni was 893 (60.6%) and P. aeruginosa was 729 (39.4%). Blood was the major source of the isolates (18.3%), followed by urine (16%), and tracheal aspirate (10.6%). Antimicrobial resistance among A. baumanni over the five years were; ampicillin (86% to 92%), ceftriaxone (66.7% to 82.2%), and ciprofloxacin (58.5% to 66.7%). In P. aeruginosa a significant increase in resistance was seen from 2017 to 2021 to Amoxicillin-clavulanate (74.1% to 84.2%), chloramphenicol (62% to 81.9%), and gentamicin (40% to 44.8%). Conclusion A five-year antimicrobial resistance trend analysis of A. baumanni and P. aeruginosa showed increasing multi drug resistance and resistance to highly potent antimicrobial agents in Ethiopia. It should be addressed with infection control measures, surveillance, and alternative new therapeutic strategies to circumvent the spread of multi-drug resistance.
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Affiliation(s)
- Shambel Araya
- Department of Medical Laboratory Science, College of Health Science Addis Ababa University Addis Ababa, Addis Ababa, 9086, Ethiopia
- Correspondence: Shambel Araya, Tel +251 939459529, Email
| | - Zenebe Gebreyohannes
- Department of Medical Microbiology, Parasitology and Immunology St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Getachew Tadlo
- Department of Medical Laboratory Science, St. Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Gebreab Teklebirhan Gessew
- Department of Medical Laboratory Science, College of Health Science Addis Ababa University Addis Ababa, Addis Ababa, 9086, Ethiopia
| | - Abebe Edao Negesso
- Department of Medical Laboratory Science, College of Health Science Addis Ababa University Addis Ababa, Addis Ababa, 9086, Ethiopia
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Sharma S, Das A, Garg R, Pramanik S, Marndi P, Singh R, Banerjee T, Yadav G, Kumar A. Reservoir of Carbapenem-Resistant Acinetobacter baumannii in the Hospital Environment and Colonization Pressure: A Surveillance-Based Study in Indian Intensive Care Unit. Microb Drug Resist 2022; 28:1079-1086. [DOI: 10.1089/mdr.2022.0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Swati Sharma
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Arghya Das
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Rahul Garg
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Sangita Pramanik
- Applied Microbiology, Department of Botany, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Pooja Marndi
- Applied Microbiology, Department of Botany, Institute of Science, Banaras Hindu University, Varanasi, India
| | - Ravindra Singh
- Institute of Medical Sciences, Sir Sunderlal Hospital, Banaras Hindu University, Varanasi, India
| | - Tuhina Banerjee
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ghanshyam Yadav
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashok Kumar
- Department of Pediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Kumkar SN, Kamble EE, Chavan NS, Dhotre DP, Pardesi KR. Diversity of resistant determinants, virulence factors, and mobile genetic elements in Acinetobacter baumannii from India: A comprehensive in silico genome analysis. Front Cell Infect Microbiol 2022; 12:997897. [PMID: 36519127 PMCID: PMC9742364 DOI: 10.3389/fcimb.2022.997897] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/07/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction The frequency of infections associated with multidrug resistant A. baumannii has risen substantially in India. The use of next-generation sequencing (NGS) techniques combined with comparative genomics has great potential for tracking, monitoring, and ultimately controlling the spread of this troublesome pathogen. Here, we investigated the whole genome sequences of 47 A. baumannii from India. Methods In brief, A. baumannii genomes were analyzed for the presence of antibiotic resistance genes (ARGs), virulence factors genes (VFGs), and mobile genetic elements (MGEs) using various in silico tools. The AbaR-type resistance islands (AbaRIs) were detected by examining the genetic environment of the chromosomal comM gene. Multilocus sequence types were determined using the Pasteur scheme. The eBURST and whole genome SNPs-based phylogenetic analysis were performed to analyze genetic diversity between A. baumannii genomes. Results and discussion A larger number of A. baumannii isolates belonging to the ST2 genotype was observed. The SNPs-based phylogenetic analysis showed a diversity between compared genomes. The predicted resistome showed the presence of intrinsic and acquired ARGs. The presence of plasmids, insertion sequences, and resistance islands carrying putative ARGs conferring resistance to antibiotics, quaternary ammonium compounds, and heavy metals was predicted in 43 (91%) genomes. The presence of putative VFGs related to adherence, biofilm formation and iron uptake was observed in the study. Overall, the comprehensive genome analysis in this study provides an essential insight into the resistome, virulome and mobilome of A. baumannii isolates from India.
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Affiliation(s)
- Shital N. Kumkar
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra State, India
| | - Ekta E. Kamble
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra State, India
| | - Nikeeta S. Chavan
- National Centre for Cell Science, Savitribai Phule Pune University Pune, Maharashtra State, India
| | - Dhiraj P. Dhotre
- National Centre for Cell Science, Savitribai Phule Pune University Pune, Maharashtra State, India,*Correspondence: Dhiraj P. Dhotre, ; Karishma R. Pardesi,
| | - Karishma R. Pardesi
- Department of Microbiology, Savitribai Phule Pune University, Pune, Maharashtra State, India,*Correspondence: Dhiraj P. Dhotre, ; Karishma R. Pardesi,
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12
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Differential Binding of Carbapenems with the AdeABC Efflux Pump and Modulation of the Expression of AdeB Linked to Novel Mutations within Two-Component System AdeRS in Carbapenem-Resistant Acinetobacter baumannii. mSystems 2022; 7:e0021722. [PMID: 35735748 PMCID: PMC9426577 DOI: 10.1128/msystems.00217-22] [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] [Indexed: 11/20/2022] Open
Abstract
Resistance-nodulation-division-type efflux system AdeABC plays an important role in carbapenem resistance among Acinetobacter baumannii. However, a knowledge gap is observed regarding the role of its regulator AdeRS in carbapenem-resistant A. baumannii (CRAB). This study effectively combines microbiological analysis with an in-silico structural approach to understand the contribution of AdeRS among CRAB (n = 38). Additionally, molecular docking was performed for the first time to study the interaction of FDA-approved carbapenems and pump inhibitor PAβN with the open and closed structure of AdeB at the three binding sites (periplasmic, proximal, distal). It was observed that open conformation of AdeB facilitates the binding of carbapenems and PAβN at entrance and proximal sites compared to the closed conformation. PAβN was found to block carbapenem interacting residues in AdeB, establishing its role as a competitive inhibitor of AdeB substrates. Overexpression of AdeABC was detected by q-RT-PCR among 29% of CRABs, and several mutations within AdeS (GLY186VAL, SER188PHE, GLU121LYS, VAL255ILE) and AdeR (VAL120ILE, ALA136VAL) were detected by sequencing. The sequence and structure-based study of AdeRS was performed to analyze the probable effect of these mutations on regulation of the two-component system (TCS), especially, utilizing its three-dimensional structure. AdeS mutations inhibited the transfer of a phosphate group to AdeR, preventing the binding of AdeR to the intercistronic region, leading to overexpression of AdeABC. The elucidation of the role of mutations in AdeRS improves our understanding of TCS-based regulation. Identification of the key residues of AdeB interacting with carbapenems and PAβN may help in future designing of novel inhibitors. IMPORTANCE AdeABC is an important efflux pump in A. baumannii that plays a role in resistance toward different antibiotics including the “last resort” antibiotic, carbapenem. This pump is regulated by a two-component system, AdeRS. To understand the binding of carbapenems with AdeABC and pump inhibition by PAβN, we analyzed for the first time the possible atomic level interactions of carbapenems and PAβN with AdeB. In the current study, AdeRS-associated novel mutations in clinical A. baumannii are reported for the first time, and a sequence-structure based in-silico approach was used to interpret their role in AdeABC overexpression, leading to carbapenem resistance. None of the previous studies had undertaken both these aspects simultaneously. This study analyzes the open and closed conformation of AdeB, their binding with carbapenems, and key residues involved in it. This helps in visualizing the plausible atomic level causes of pump inhibition driving the discovery of novel inhibitors.
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13
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Soontarach R, Srimanote P, Enright MC, Blundell-Hunter G, Dorman MJ, Thomson NR, Taylor PW, Voravuthikunchai SP. Isolation and Characterisation of Bacteriophage Selective for Key Acinetobacter baumannii Capsule Chemotypes. Pharmaceuticals (Basel) 2022; 15:443. [PMID: 35455440 PMCID: PMC9027227 DOI: 10.3390/ph15040443] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/25/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
Nineteen bacteriophages against five main capsular types of multidrug-resistant Acinetobacter baumannii were isolated from tertiary care hospital sewage. Eight representative phages from each capsular type were characterized and tested for their biological properties. The biological features revealed that phages T1245, T444, and T515 had a large burst size of more than 420 pfu/mL, together with a short latent period lasting less than 6 min, and were readily adsorbed to a bacterial host within 10 min. Moreover, these phages demonstrated host specificity and stability over a broad range of temperatures (-20 to 60 °C) and pH (5.0-9.0). A whole-genome analysis of six lytic and two temperate phages revealed high genomic similarity with double-stranded DNA between 40 and 50 kb and G + C content of 38-39%. The protein compositions disclosed the absence of toxin-coding genes. The phylogenic results, together with morphological micrographs, confirmed that three selected phages (T1245, T444, and T515) belong to the Podoviridae family within the order Caudovirales. The biological data and bioinformatics analysis indicated that these novel A. baumannii phages possess important enzymes, including depolymerase and endolysin, which could be further developed as promising alternative antibacterial agents to control A. baumannii infections.
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Affiliation(s)
- Rosesathorn Soontarach
- Division of Biological Science, Faculty of Science and Natural Product Research Center of Excellence, Prince of Songkla University, Songkhla 90110, Thailand;
- Center of Antimicrobial Biomaterial Innovation-Southeast Asia, Prince of Songkla University, Songkhla 90110, Thailand
| | - Potjanee Srimanote
- Graduate Program, Faculty of Allied Health Sciences, Thammasat University, Pathum Thani 12121, Thailand;
| | - Mark C. Enright
- Department of Life Sciences, Manchester Metropolitan University, Chester Street, Manchester M1 5GD, UK;
| | | | - Matthew J. Dorman
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SA, UK; (M.J.D.); (N.R.T.)
| | - Nicholas R. Thomson
- Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire CB10 1SA, UK; (M.J.D.); (N.R.T.)
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
| | - Peter W. Taylor
- School of Pharmacy, University College London, London WC1N 1AX, UK; (G.B.-H.); (P.W.T.)
| | - Supayang P. Voravuthikunchai
- Division of Biological Science, Faculty of Science and Natural Product Research Center of Excellence, Prince of Songkla University, Songkhla 90110, Thailand;
- Center of Antimicrobial Biomaterial Innovation-Southeast Asia, Prince of Songkla University, Songkhla 90110, Thailand
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14
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Singh R, Capalash N, Sharma P. Vaccine development to control the rising scourge of antibiotic-resistant Acinetobacter baumannii: a systematic review. 3 Biotech 2022; 12:85. [PMID: 35261870 PMCID: PMC8890014 DOI: 10.1007/s13205-022-03148-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 02/11/2022] [Indexed: 03/02/2023] Open
Abstract
Acinetobacter baumannii has emerged as one of major nosocomial pathogen and global emergence of multidrug-resistant strains has become a challenge for developing effective treatment options. A. baumannii has developed resistance to almost all the antibiotics viz. beta-lactams, carbapenems, tigecycline and now colistin, a last resort of antibiotics. The world is on the cusp of post antibiotic era and the evolution of multi-, extreme- and pan–drug-resistant A. baumannii strains is its obvious harbinger. Various combinations of antibiotics have been investigated but no successful treatment option is available. All these failed efforts have led researchers to develop and implement prophylactic vaccination for the prevention of infections caused by this pathogen. In this review, the advantages and disadvantages of active and passive immunization, the types of sub-unit and multi-component vaccine candidates investigated against A. baumannii viz. whole cell organism, outer membrane vesicles, outer membrane complexes, conjugate vaccines and sub-unit vaccines have been discussed. In addition, the benefits of Reverse vaccinology are emphasized here in which the potential vaccine candidates are predicted using bioinformatic online tools prior to in vivo validations.
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15
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Green-microfluidics synthesis of thermally stable silver–chitosan composites for antibacterial activity. CHEMICAL PAPERS 2022. [DOI: 10.1007/s11696-022-02144-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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16
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Chandra P, V R, M S, Cs S, Mk U. Multidrug-resistant Acinetobacter baumannii infections: looming threat in the Indian clinical setting. Expert Rev Anti Infect Ther 2021; 20:721-732. [PMID: 34878345 DOI: 10.1080/14787210.2022.2016393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The recent increase in multidrug-resistant strains of A. baumannii has increased the incidences of ventilator-associated pneumoniae, catheter-associated urinary tract infections, and central line-associated blood stream infections, together increasing hospital stay, treatment cost, and mortality. Resistance genes blaOXA and blaNDM are dominant in India. Carbapenem-resistant A. baumannii (CRAB) International clone-2 (IC-2) are rising in India. High dependency on carbapenems and last-resort combination of tigecycline and polymyxins have aggravated outcomes. Despite nursing barriers, ward closure, environmental disinfections etc for detecting and controlling transmission, MDR isolates and CRAB nosocomial outbreaks continue. Treatment cost overruns by AMR adversely affect 80% of Indians without insurance cover. AREA COVERED This narrative review will cover epidemiology, resistance pattern, genetic diversity, device-related infection, cost, and mortality due to multidrug-resistant and CRAB in India. A comprehensive literature search in PubMed and Google Scholar using appropriate keywords at different time points yielded relevant articles. EXPERT OPINION It is challenging to enforce policies to control MDR A. baumannii in India. Government and hospitals should enforce stringent infection control measures, surveillance, and antimicrobial stewardship to prevent further spread and emergence of more virulent and resistant strains. Knowledge on antibiotic resistance mechanisms can help design novel antibiotics that can evade, resistance.
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Affiliation(s)
- Prashant Chandra
- Department of Pharmacy Practice, Centre for Pharmaceutical care, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Rajesh V
- Department of Pharmacy Practice, Centre for Pharmaceutical care, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India.,Department of Pharmacy Practice, Nitte Gulabi Shetty Memorial Institute of Pharmaceutical Sciences, Nitte University, Mangaluru, India
| | - Surulivelrajan M
- Department of Pharmacy Practice, Centre for Pharmaceutical care, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, India
| | - Shastry Cs
- Department of Pharmacy Practice, Nitte Gulabi Shetty Memorial Institute of Pharmaceutical Sciences, Nitte University, Mangaluru, India
| | - Unnikrishnan Mk
- Department of Pharmacy Practice, Nitte Gulabi Shetty Memorial Institute of Pharmaceutical Sciences, Nitte University, Mangaluru, India
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17
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Ababneh Q, Aldaken N, Jaradat Z, Al Sbei S, Alawneh D, Al-Zoubi E, Alhomsi T, Saadoun I. Molecular epidemiology of carbapenem-resistant Acinetobacter baumannii isolated from three major hospitals in Jordan. Int J Clin Pract 2021; 75:e14998. [PMID: 34714567 DOI: 10.1111/ijcp.14998] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/27/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In the last decade, incidences of carbapenem-resistant Acinetobacter baumannii have been increasingly reported worldwide. Consequently, A. baumannii was included in the World Health Organization's new list of critical pathogens, for which new drugs are desperately needed. The objective of this research was to study the molecular epidemiology and antimicrobial susceptibility of clinical carbapenem-resistant A. baumannii isolated from Jordanian hospitals. METHODS A total of 78 A. baumannii and 8 Acinetobacter spp. isolates were collected from three major hospitals in Jordan during 2018. Disc diffusion and microdilution methods were used to test their susceptibility against 19 antimicrobial agents. Multilocus sequence typing (MLST) was performed using the Pasteur scheme, followed by eBURST analysis for all isolates. PCR was used to detect β-lactam resistance genes, blaOXA-23-like , blaOXA-51-like , and blaNDM-1 . RESULTS Of the 86 tested isolates, 78 (90.6%) exhibited resistance to carbapenems, whereas no resistance was recorded to tigecycline or polymyxins. Based on the resistance profiles, 10.4% and 84.8% of isolates were classified into multidrug resistant (MDR) or extensively drug resistant (XDR), respectively. The most prevalent carbapenems resistance genes amongst isolates were blaOXA-51-Like (89.5%), followed by blaOXA-23-Like (88.3%) and blaNDM-1 (10.4%). MLST revealed the presence of 19 sequence types (STs), belonging to eight different international complexes. The most commonly detected clonal complex (CC) was CC2, representing 64% of all typed isolates. CONCLUSIONS This is the first study to report the clonal diversity of A. baumannii isolates in Jordan. A high incidence of carbapenem resistance was detected in the isolates investigated. In addition, our findings provided evidence for the widespread of blaOXA-23-like harbouring carbapenem-resistant A. baumannii and belonging to CC2. The number of XDR isolates identified in this study is alarming. Thus, periodic surveillance and molecular epidemiological studies of resistance factors are important to improve treatment outcomes and prevent the spread of A. baumannii infections.
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Affiliation(s)
- Qutaiba Ababneh
- Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan
| | - Neda'a Aldaken
- Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan
| | - Ziad Jaradat
- Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan
| | - Sara Al Sbei
- Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan
| | - Dua'a Alawneh
- Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan
| | - Esra'a Al-Zoubi
- Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan
| | - Tasnim Alhomsi
- Department of Biotechnology and Genetic Engineering, Faculty of Science and Arts, Jordan University of Science and Technology, Irbid, Jordan
| | - Ismail Saadoun
- Department of Applied Biology, College of Sciences, University of Sharjah, Sharjah, UAE
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18
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A One Health Review of Community-Acquired Antimicrobial-Resistant Escherichia coli in India. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212089. [PMID: 34831844 PMCID: PMC8625392 DOI: 10.3390/ijerph182212089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 11/17/2022]
Abstract
Antimicrobial resistance (AMR) threatens to undermine nearly a century of progress since the first use of antimicrobial compounds. There is an increasing recognition of the links between antimicrobial use and AMR in humans, animals, and the environment (i.e., One Health) and the spread of AMR between these domains and around the globe. This systematic review applies a One Health approach-including humans, animals, and the environment-to characterize AMR in Escherichia coli in India. E. coli is an ideal species because it is readily shared between humans and animals, its transmission can be tracked more easily than anaerobes, it can survive and grow outside of the host environment, and it can mobilize AMR genes more easily than other intestinal bacteria. This review synthesized evidence from 38 studies examining antimicrobial-resistant E. coli (AR-E) across India. Studies of AR-E came from 18 states, isolated from different sample sources: Humans (n = 7), animals (n = 7), the environment (n = 20), and combinations of these categories, defined as interdisciplinary (n = 4). Several studies measured the prevalence of AMR in relation to last-line antimicrobials, including carbapenems (n = 11), third-generation cephalosporins (n = 18), and colistin (n = 4). Most studies included only one dimension of the One Health framework, highlighting the need for more studies that aim to characterize the relationship of AMR across different reservoirs of E. coli.
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19
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Longjam LA, Tsering DC, Das D. A Microbiological Study of Acinetobacter calcoaceticus baumannii with Special Reference to Multidrug Resistance. J Lab Physicians 2021; 14:169-174. [PMID: 35982877 PMCID: PMC9381315 DOI: 10.1055/s-0041-1735583] [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] [Indexed: 11/25/2022] Open
Abstract
Introduction
The outbreak of
Acinetobacter calcoaceticus baumannii
(
ACB
) is mainly reported to be a notorious pathogens at health-care settings. It is the major problem on the health-care system with high morbidity and mortality rates because of the broad range of antibiotic resistance and lack of understanding the mechanism of developing new antibiotic resistance rapidly. It emphasizes the importance of local surveillance in describing or understanding and predicting microbial resistance patterns so that there will be limited use of antibiotics by developing strategies to control the extensive use of antimicrobial chemotherapy in clinical environment, which is still considered as one of the factors in the emergence of multidrug resistance microorganisms.
Objectives
The study aims to detect the occurrence rate of
ACB
infections from various clinical samples, identify the resistance levels to different groups of antimicrobial agents, and the occurrence rate of multidrug resistant (MDR)
ACB
clinical isolates from a tertiary hospital in Durgapur, West Bengal, India.
Material and Methods
The study was performed in the Department of Microbiology of the IQ City Medical College and Hospital, Durgapur, West Bengal, India, for the 24 months duration, that is, from January 1, 2018 to December 31, 2019. Altogether 15,800 clinical samples consisting of endotracheal tube aspirates, sputum, pus, blood, catheter tips, urine, tissue, and other body fluids were studied.
ACB
from clinical samples were identified by its characteristic colonies (nonlactose fermenting, glistening, small mucoid colonies), Gram-staining pattern (Gram-negative coccobacillus), and standard biochemical reactions. It was further confirmed in the Department of Microbiology of the Healthworld Hospital, Durgapur, West Bengal, India, by Vitek2 compact system (bioMerieux, Inc., Durham, North Carolina, United States). Antibiotic susceptibility testing was performed using automated broth microdilutions by Vitek2 compact system (bioMerieux, Inc.) and Kirby-Bauer disk diffusion test on Mueller-Hinton Agar (HiMedia).
Results
Nonrepetitive 289
ACB
were isolated from various clinical samples. A total of 277 (96%) isolates of
ACB
were MDR strains.
Conclusion
ACB
was mostly isolated from the intensive care unit department and was found to be the most MDR type in the tertiary care hospital by this study.
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Affiliation(s)
- Langamba Angom Longjam
- Department of Microbiology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
| | - Dechen Chomu Tsering
- Department of Microbiology, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim, India
| | - Dipmala Das
- Department of Microbiology, IQ City Medical College and Hospital, Durgapur, West Bengal, India
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Kumari M, Verma S, Venkatesh V, Gupta P, Tripathi P, Agarwal A, Siddiqui SS, Arshad Z, Prakash V. Emergence of blaNDM-1 and blaVIM producing Gram-negative bacilli in ventilator-associated pneumonia at AMR Surveillance Regional Reference Laboratory in India. PLoS One 2021; 16:e0256308. [PMID: 34495985 PMCID: PMC8425556 DOI: 10.1371/journal.pone.0256308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/03/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Ventilator-associated pneumonia (VAP) may be a life threatening nosocomial infection encountered in intensive care units. Currently the emergence of carbapenem-resistant Gram-negative pathogens has become worrisome threat worldwide. Material and methods Endotracheal aspirates samples were collected from patients who were under mechanical ventilation for > 48 h. The bacterial isolates were identified by MALDI-TOF-MS and antibiotic susceptibility testing performed. All carbapenem resistant isolates were tested by Modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), and EDTA-CIM (eCIM) and PCR were performed to detect blaIMP, blaVIM and blaNDM producing MBL genes. Results VAP occurred in 172/353(48.7%), 23.3% had early-onset VAP and 76.7% had late-onset VAP. Males (69.2%) were found to suffer more from VAP. Prior antibiotic therapy, CPI>6, prior surgery and tracheostomy were associated with VAP. The mortality in VAP (58.1%) contrasted with non-VAP (40%). 99/169 (58.6%) Gram-negative isolates were resistant to carbapenems. Acinetobacter baumannii, Pseudomonas aeruginosa and Klebsiella pneumoniae were common pathogens found in late onset VAP, whereas K. pneumoniae, A. baumannii and Staphylococcus aureus were common in early onset VAP. The PCR results detected blaNDM in 37/172(21.5%) and blaVIM in 30/172(17.4%); 15/172(8.7%) isolates carried both genes. Conclusion The blaNDM-1 and blaVIM genes are the main antibiotic-resistance genes that induce resistance patterns to carbapenems in VAP, highlighting CRE strains of potential public health concern and therapeutic challenge. Diagnostic laboratories in India must get on high caution for early MBL detection as it may limit the wide dispersal of MBL genes.
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Affiliation(s)
- Mithlesh Kumari
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sheetal Verma
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vimala Venkatesh
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Prashant Gupta
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Piyush Tripathi
- Department of Microbiology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Avinash Agarwal
- Department of Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Suhail Sarwar Siddiqui
- Department of Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Zia Arshad
- Department of Anesthesiology & Critical Care, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Ved Prakash
- Department of Pulmonary & Critical Care Medicine, King George's Medical University, Lucknow, Uttar Pradesh, India
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Sharma S, Singh A, Banerjee T. Antibacterial agents used in COVID-19: A systematic review and meta-analysis. ENVIRONMENTAL SUSTAINABILITY (SINGAPORE) 2021; 4:503-513. [PMID: 38624829 PMCID: PMC8181540 DOI: 10.1007/s42398-021-00194-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 05/20/2021] [Accepted: 05/29/2021] [Indexed: 12/21/2022]
Abstract
There have been speculations regarding rise in antimicrobial resistance (AMR) globally owing to indiscriminate antibiotic usage during the COVID-19 pandemic. To curb the menace through decisive policies, it is essential to assess the antibiotics, particularly the antibacterial agents. This systematic review and meta-analysis were performed to assess antibiotic use in COVID-19 patients. A thorough systematic search was undertaken in databases like PubMed, Cochrane library, Google Scholar, World Health Organization (WHO) database and clinicaltrials.gov by two independent reviewers for articles in English published from January 1, 2019 to October 31, 2020. Studies were included if they assessed confirmed COVID-19 cases and mentioned the use of antibiotics. The primary outcome was the proportion of COVID-19 patients subjected to specific antibacterial agents. An attempt to stratify the data based on study settings and disease severity was also performed. Of the total 6012 studies screened, 40 were eligible for qualitative review and 19 for meta-analysis. Specific antibacterial agents were mentioned in 23 studies (57.5%). In the random effect meta-analysis, pooled prevalence of azithromycin use was 24.5% (95% CI 22.9-26.2%) followed by cephalosporins as 26.6% (95% CI 24.9-28.4). None of the studies clearly specified indications for antibiotic use. Ten studies (25%) mentioned empirical use of antibiotics. Bacterial co-infections/secondary infections were documented in four studies with mean prevalence of infection of 1.9% (95% CI 1.2-2.8%). There is lack of data on use of specific antibacterial agents, indications for their use based on severity of infections and microbiological evidence of bacterial co-infections.
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Affiliation(s)
- Swati Sharma
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
| | - Aradhana Singh
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
| | - Tuhina Banerjee
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, 221005 India
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22
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A Comprehensive Study of the Relationship between the Production of β-Lactamase Enzymes and Iron/Siderophore Uptake Regulatory Genes in Clinical Isolates of Acinetobacter baumannii. Int J Microbiol 2021; 2021:5565537. [PMID: 33815505 PMCID: PMC7990553 DOI: 10.1155/2021/5565537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/25/2021] [Accepted: 03/12/2021] [Indexed: 11/28/2022] Open
Abstract
Background The iron/siderophore uptake system (IUS) involved in the Acinetobacter baumannii pathogenicity. However, IUS's role in antibiotic resistance and the production of β-lactamase enzymes of A. baumannii are unclear. This study aimed to investigate the relationship between the production of β-lactamase enzymes and IUS regulatory genes in clinical isolates of A. baumannii. Methods. A. baumannii isolates were collected from clinical isolates using biochemical tests. The antibiotic resistance patterns and β-lactamase-producing strains were identified using the disk diffusion method (DDM). Also, IUS genes were detected by the polymerase chain reaction (PCR) method. Results Seventy-two (72) A. baumannii isolates were collected from a different clinical specimen. Gentamicin-resistant strains (43%) had the highest frequency, and aztreonam-resistant strains (12.5%) had the lowest frequency. Also, the distribution of AmpC and MBL producing isolates were 27.7% and 35%, respectively. Moreover, the frequencies of basD, bauA, pld, paaE, entA, feoB, hemO, and tonB genes were as follows: 12.5%, 15.2%, 11.1%, 15.2%, 19.4%, 16.6%, 23.6%, and 6.9%. Further, a strong correlation was observed between the abundance of β-lactamase-producing strains and IUS genes. Conclusions Based on our knowledge from this study, the association between β-lactamase production and IUS genes in A. baumannii plays an essential role in the emergence of drug-resistant strains.
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Sharma S, Das A, Banerjee T, Barman H, Yadav G, Kumar A. Adaptations of carbapenem resistant Acinetobacter baumannii (CRAB) in the hospital environment causing sustained outbreak. J Med Microbiol 2021; 70. [PMID: 33739918 DOI: 10.1099/jmm.0.001345] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Introduction. Carbapenem resistance in Acinetobacter baumannii (A. baumannii) is an emerging global threat.Gap statement. The adaptation strategies of A. baumannii for this emergence as a nosocomial pathogen has been less studied.Aim. This prospective study analysed a sustained outbreak of carbapenem resistant Acinetobacter baumannii (CRAB) in the intensive care unit (ICU) with reference to antimicrobial resistance and virulence in the colonizing and pathogenic isolates under carbapenem stress.Results. The CRAB isolates from initial and sustained outbreak were found harbouring multiple carbapenemase genes. These genes included bla OXA-23 ,bla IMP, bla VIM and bla NDM. From NICU environment three phenotypically carbapenem susceptible isolates were found carrying bla OXA-23, bla IMP, bla VIM genes. Prior imipenem therapy was one of the risk factors (P=0.0016). The outbreak was polyclonal. Under imipenem stress, outbreak isolates showed no loss of carbapenemase genes against stress free conditions (23.7±1.33 days). Biofilm formation increased with imipenem concentration, with outbreak isolates producing highest biomass. While the pathogens showed a slow growth rate on imipenem exposure, the colonisers grew rapidly (P <0.0001).Methods. Sustained outbreak of CRAB was identified in the ICU (July 2015 to December 2017). Risk factors for acquisition of CRAB was studied. A. baumannii isolates were also collected from the environments of ICU and neonatal ICU (NICU) and blood cultures of septic neonates. Isolates were characterized based on antimicrobial susceptibility, genetic profile, integrons carriage and clonality. Biofilm formation and growth kinetics were studied under varying carbapenem stress.Conclusion. Intense carbapenem exposure in the ICU facilitates persistence of CRAB by several adaptations causing sustained outbreaks.
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Affiliation(s)
- Swati Sharma
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Arghya Das
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Tuhina Banerjee
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Hiranmay Barman
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ghanshyam Yadav
- Department of Anaesthesiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ashok Kumar
- Department of Paediatrics, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Kurihara MNL, de Sales RO, da Silva KE, Maciel WG, Simionatto S. Multidrug-resistant Acinetobacter baumannii outbreaks: a global problem in healthcare settings. Rev Soc Bras Med Trop 2020; 53:e20200248. [PMID: 33174956 PMCID: PMC7670754 DOI: 10.1590/0037-8682-0248-2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/02/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION The increase in the prevalence of multidrug-resistant Acinetobacter baumannii infections in hospital settings has rapidly emerged worldwide as a serious health problem. METHODS This review synthetizes the epidemiology of multidrug-resistant A. baumannii, highlighting resistance mechanisms. CONCLUSIONS Understanding the genetic mechanisms of resistance as well as the associated risk factors is critical to develop and implement adequate measures to control and prevent acquisition of nosocomial infections, especially in an intensive care unit setting.
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Affiliation(s)
| | - Romário Oliveira de Sales
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa
em Ciências da Saúde, Dourados, MS, Brasil
| | - Késia Esther da Silva
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa
em Ciências da Saúde, Dourados, MS, Brasil
| | - Wirlaine Glauce Maciel
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa
em Ciências da Saúde, Dourados, MS, Brasil
| | - Simone Simionatto
- Universidade Federal da Grande Dourados, Laboratório de Pesquisa
em Ciências da Saúde, Dourados, MS, Brasil
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Sharma S, Banerjee T, Yadav G, Palandurkar K. Mutations at Novel Sites in pmrA/B and lpxA/D Genes and Absence of Reduced Fitness in Colistin-Resistant Acinetobacter baumannii from a Tertiary Care Hospital, India. Microb Drug Resist 2020; 27:628-636. [PMID: 33085934 DOI: 10.1089/mdr.2020.0023] [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: 10/23/2022] Open
Abstract
Background: Colistin resistance in Acinetobacter baumannii, the last resort drug for serious infections, is emerging worldwide. There has been paucity of data on this aspect from India, which is one of the largest producers of colistin. We studied colistin resistance in A. baumannii and characterized the isolates with respect to resistance mechanisms and virulence. Methods: A total of 365 A. baumannii isolates were studied. Antimicrobial susceptibility testing was performed as per standards. Colistin resistance mechanisms were studied by mutation detection in pmrA/B and lpxA/C/D genes, phenotypic loss of lipopolysaccharide, presence of mcr1-5 genes, and carbonyl cyanide 3-chlorophenylhydrazone (CCCP) effects. Biofilm formation, desiccation survival, and growth kinetics were studied and statistically analyzed for colistin-resistant and colistin-susceptible isolates. Results: All the colistin-resistant isolates (9, 2.5%) showed multiple mutations at novel sites in pmrA/B and/or lpxA/D genes with reversion of resistance with CCCP. Majority of these isolates (6, 66.6%) were from patients without prior colistin therapy. All received prior carbapenems. The resistant isolates demonstrated no significant difference in biofilm formation and desiccation survival but were slow growers. Conclusion: Mutations in pmrA/B and/or lpxA/D genes were the main resistance mechanism in these colistin-resistant isolates that showed no reduction in fitness.
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Affiliation(s)
- Swati Sharma
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Tuhina Banerjee
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Ghanshyam Yadav
- Department of Anesthesiology, and Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
| | - Kamlesh Palandurkar
- Department of Biochemistry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India
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Lukovic B, Gajic I, Dimkic I, Kekic D, Zornic S, Pozder T, Radisavljevic S, Opavski N, Kojic M, Ranin L. The first nationwide multicenter study of Acinetobacter baumannii recovered in Serbia: emergence of OXA-72, OXA-23 and NDM-1-producing isolates. Antimicrob Resist Infect Control 2020; 9:101. [PMID: 32631451 PMCID: PMC7338125 DOI: 10.1186/s13756-020-00769-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/30/2020] [Indexed: 12/16/2022] Open
Abstract
Background The worldwide emergence and clonal spread of carbapenem-resistant Acinetobacter baumannii (CRAB) is of great concern. The aim of this nationwide study was to investigate the prevalence of CRAB isolates in Serbia and to characterize underlying resistance mechanisms and their genetic relatedness. Methods Non-redundant clinical samples obtained from hospitalized patients throughout Serbia were included in the prospective, observational, multicenter study conducted from January to June 2018. Samples were initially screened for the presence of Acinetobacter baumannii-calcoaceticus (Acb) complex using conventional bacteriological techniques. Acb complexes recovered from clinical samples obtained from inpatients with confirmed bacterial infections were further evaluated for the presence of A. baumannii. Identification to the species level was done by the detection of the blaOXA-51 gene and rpoB gene sequence analysis. Susceptibility testing was done by disk diffusion and broth microdilution method. CRAB isolates were tested for the presence of acquired carbapenemases (blaOXA-24-like, blaOXA-23-like,blaOXA-58-like, blaOXA-143-like, blaIMP, blaVIM, blaGIM, blaSPM, blaSIM, blaNDM) by PCR. Clonal relatedness was assessed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Results Acb complex was isolated in 280 out of 2401 clinical samples (11.6%). Overall, A. baumannii was identified in 237 out of 280 Acb complex (84.6%). CRAB prevalence was found to be 93.7% (237/222). The MIC50/MIC90 for imipenem and meropenem were 8/> 32 μg/mL and 16/> 32 μg/mL, respectively. Although susceptibility was high for colistin (95.7%; n = 227) and tigecycline (75.1%; n = 178), ten isolates (4.3%) were classified as pandrug-resistant. The following carbapenemases-encoding genes were found: 98 (44.2%) blaOXA-24-like, 76 (34.5%) blaOXA-23-like, and 7 (3.2%) blaNDM-1. PFGE analysis revealed six different clusters. MLST analysis identified three STs: ST2 (n = 13), ST492 (n = 14), and ST636 (n = 10). Obtained results evaluated that circulating CRAB clones in Serbia were as follows: blaOXA66/blaOXA23/ST2 (32.4%), blaOXA66/blaOXA23/blaOXA72/ST2 (2.7%), blaOXA66/blaOXA72/ST492 (37.8%), and blaOXA66/blaOXA72/ST636 (27.1%). Conclusion This study revealed extremely high proportions of carbapenem resistance among A. baumannii clinical isolates due to the emergence of blaOXA-72, blaOXA-23, and blaNDM-1 genes among CRAB isolates in Serbia and their clonal propagation.
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Affiliation(s)
- Bojana Lukovic
- Institute of Microbiology and Immunology, Medical Faculty, University of Belgrade, Doktora Subotica starijeg 1, Belgrade, 11000, Serbia.
| | - Ina Gajic
- Institute of Microbiology and Immunology, Medical Faculty, University of Belgrade, Doktora Subotica starijeg 1, Belgrade, 11000, Serbia.
| | - Ivica Dimkic
- Faculty of Biology, University of Belgrade, Belgrade, Serbia
| | - Dusan Kekic
- Institute of Microbiology and Immunology, Medical Faculty, University of Belgrade, Doktora Subotica starijeg 1, Belgrade, 11000, Serbia
| | - Sanja Zornic
- Department of Microbiology, Clinical Center Kragujevac, Kragujevac, Serbia
| | - Tatjana Pozder
- Department of Microbiology, General Hospital Subotica, Subotica, Serbia
| | | | - Nataša Opavski
- Institute of Microbiology and Immunology, Medical Faculty, University of Belgrade, Doktora Subotica starijeg 1, Belgrade, 11000, Serbia
| | - Milan Kojic
- Laboratory for Molecular Microbiology, Institute of Molecular Genetics and Genetic Engineering, University of Belgrade, Belgrade, Serbia
| | - Lazar Ranin
- Institute of Microbiology and Immunology, Medical Faculty, University of Belgrade, Doktora Subotica starijeg 1, Belgrade, 11000, Serbia
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Raut S, Rijal KR, Khatiwada S, Karna S, Khanal R, Adhikari J, Adhikari B. Trend and Characteristics of Acinetobacter baumannii Infections in Patients Attending Universal College of Medical Sciences, Bhairahawa, Western Nepal: A Longitudinal Study of 2018. Infect Drug Resist 2020; 13:1631-1641. [PMID: 32606814 PMCID: PMC7293404 DOI: 10.2147/idr.s257851] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 05/17/2020] [Indexed: 12/31/2022] Open
Abstract
Background Acinetobacter baumannii is one of the major organisms causing nosocomial infections and is intrinsically resistant to multiple classes of antibiotics. The main objective of this study was to investigate the trend and characteristics of A. baumannii infections including its resistance pattern among patients attending Universal College of Medical Sciences, Teaching Hospital (UCMSTH) in Western Nepal, between January and December 2018. Patients and Methods A total of 4862 clinical samples received at the microbiology laboratory of UCMSTH over a period of a year were analyzed. Following bacterial culture on the samples, culture-positive isolates were tested for antibiotic susceptibility using a modified Kirby–Bauer method. The demographic profile of the patient, information about samples, and the antibiotic profile of the A. baumannii isolated from different samples were recorded and analyzed. Results A total of 1180 (24.2%; 1180/4862) organisms were isolated from the total samples. Acinetobacter baumannii (12.4%; 147/1180) was the third most common organism. Prevalence of A. baumannii was found to be high in late summer/early winter (July: 15.9%; 18/113 and December: 18.8%; 13/69). The majority 71.4% (n=105) of A. baumannii isolates were multidrug resistant (MDR). None of the isolate was pan-drug resistant. Colistin, polymyxin B, and tigecycline were 100% sensitive to A. baumannii. MDR bacteria were significantly associated with the gender of the patients [female: 51.4% (54/105) versus male: 48.6% (51/105); p=0.05], clinical specimens [swab: 40% (42/105) sputum: 21.9% (23/105) and urine: 10.5% (11/105); p=0.02] and different wards of the hospital [surgery: 30.5% (32/105); ICU: 21.9% (23/105) and medicine: 19.0% (20/105); p< 0.03]. Conclusion The high burden of MDR Acinetobacter isolates in clinical specimens shows an alarming presence of antimicrobial resistance. Two-thirds of the specimens showed MDR and were associated with demographic and clinical characteristics of the patients. In the management of infectious diseases at UCMSTH, there should be a high suspicion of Acinetobacter infection, and isolation and treatment should be carried out based on an antibiotic susceptibility test.
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Affiliation(s)
- Shristi Raut
- Department of Microbiology, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Komal Raj Rijal
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, Nepal
| | - Sulochana Khatiwada
- Department of Microbiology, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Subash Karna
- Department of Microbiology, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Rita Khanal
- Department of Microbiology, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Janak Adhikari
- B.P. Koirala Institute of Health Sciences, Dharan, Nepal
| | - Bipin Adhikari
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Ma Y, Wang C, Li Y, Li J, Wan Q, Chen J, Tay FR, Niu L. Considerations and Caveats in Combating ESKAPE Pathogens against Nosocomial Infections. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2020; 7:1901872. [PMID: 31921562 PMCID: PMC6947519 DOI: 10.1002/advs.201901872] [Citation(s) in RCA: 139] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/04/2019] [Indexed: 05/19/2023]
Abstract
ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) are among the most common opportunistic pathogens in nosocomial infections. ESKAPE pathogens distinguish themselves from normal ones by developing a high level of antibiotic resistance that involves multiple mechanisms. Contemporary therapeutic strategies which are potential options in combating ESKAPE bacteria need further investigation. Herein, a broad overview of the antimicrobial research on ESKAPE pathogens over the past five years is provided with prospective clinical applications.
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Affiliation(s)
- Yu‐Xuan Ma
- State Key Laboratory of Military StomatologyNational Clinical Research Center for Oral DiseasesShaanxi Key Laboratory of StomatologyDepartment of ProsthodonticsSchool of StomatologyThe Fourth Military Medical University145 Changle West RoadXi'anShaanxi710032P. R. China
| | - Chen‐Yu Wang
- State Key Laboratory of Military StomatologyNational Clinical Research Center for Oral DiseasesShaanxi Key Laboratory of StomatologyDepartment of ProsthodonticsSchool of StomatologyThe Fourth Military Medical University145 Changle West RoadXi'anShaanxi710032P. R. China
| | - Yuan‐Yuan Li
- State Key Laboratory of Military StomatologyNational Clinical Research Center for Oral DiseasesShaanxi Key Laboratory of StomatologyDepartment of ProsthodonticsSchool of StomatologyThe Fourth Military Medical University145 Changle West RoadXi'anShaanxi710032P. R. China
| | - Jing Li
- State Key Laboratory of Military StomatologyNational Clinical Research Center for Oral DiseasesShaanxi Key Laboratory of StomatologyDepartment of ProsthodonticsSchool of StomatologyThe Fourth Military Medical University145 Changle West RoadXi'anShaanxi710032P. R. China
| | - Qian‐Qian Wan
- State Key Laboratory of Military StomatologyNational Clinical Research Center for Oral DiseasesShaanxi Key Laboratory of StomatologyDepartment of ProsthodonticsSchool of StomatologyThe Fourth Military Medical University145 Changle West RoadXi'anShaanxi710032P. R. China
| | - Ji‐Hua Chen
- State Key Laboratory of Military StomatologyNational Clinical Research Center for Oral DiseasesShaanxi Key Laboratory of StomatologyDepartment of ProsthodonticsSchool of StomatologyThe Fourth Military Medical University145 Changle West RoadXi'anShaanxi710032P. R. China
| | - Franklin R. Tay
- State Key Laboratory of Military StomatologyNational Clinical Research Center for Oral DiseasesShaanxi Key Laboratory of StomatologyDepartment of ProsthodonticsSchool of StomatologyThe Fourth Military Medical University145 Changle West RoadXi'anShaanxi710032P. R. China
- The Graduate SchoolAugusta University1430, John Wesley Gilbert DriveAugustaGA30912‐1129USA
| | - Li‐Na Niu
- State Key Laboratory of Military StomatologyNational Clinical Research Center for Oral DiseasesShaanxi Key Laboratory of StomatologyDepartment of ProsthodonticsSchool of StomatologyThe Fourth Military Medical University145 Changle West RoadXi'anShaanxi710032P. R. China
- The Graduate SchoolAugusta University1430, John Wesley Gilbert DriveAugustaGA30912‐1129USA
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Dolati M, Alavi-Moghaddam M, Javadi A, Saki B, Karami-Zarandi M, Khoshnood S. Molecular detection of oxacillinase genes and typing of clinical isolates of Acinetobacter baumannii in Tehran, Iran. JOURNAL OF ACUTE DISEASE 2020. [DOI: 10.4103/2221-6189.274016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Amin M, Navidifar T, Saleh Shooshtari F, Goodarzi H. Association of the genes encoding Metallo-β-Lactamase with the presence of integrons among multidrug-resistant clinical isolates of Acinetobacter baumannii. Infect Drug Resist 2019; 12:1171-1180. [PMID: 31190906 PMCID: PMC6526166 DOI: 10.2147/idr.s196575] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 04/11/2019] [Indexed: 12/21/2022] Open
Abstract
Background: Metallo-β-Lactamases (MBL) are usually encoded on the gene cassettes harboring integrons and disseminated easily among Acinetobacter baumannii isolates. This study was aimed to investigate the association of the genes encoding MBL with the presence of class 1 and 2 integrons among multidrug-resistant (MDR) A.baumannii isolates. Methodology: A total of 85 non-duplicated A.baumannii isolates were collected and evaluated for the amplification of blaOXA-51. The presence of genes encoding MBLs, including blaIMP, blaVIM, blaSIM, blaSPM, blaGIM, blaDIM and blaNDM, as well as intI 1 and intI 2 was evaluated by PCR. Also, the production of MBLs was screened phenotypically by the combination of EDTA and meropenem. Results: In this study, 77 out of 85 isolates were MDR. Also, 34 isolates had only intI 1, 10 had only intI 2 and 15 had both intI 1 and intI 2. The phenotypic detection of MBLs was found in 30 isolates, among which blaVIM was as the most common the gene encoding MBL followed by blaIMP, blaSPM and blaSIM. The gene cassettes analysis revealed that class 1 integron is often responsible for transferring the genes harboring MBLs. Conclusion: The production of MBLs among A. baumannii strains is one of the main mechanisms of resistance to carbapenems. Therefore, the development of inexpensive screening methods for the phenotypic detection of MBLs in clinical laboratories settings is essential. Also, our data revealed that the class 1 integron is often responsible for the dissemination of the MBL genes among A. baumannii isolates.
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Affiliation(s)
- Mansour Amin
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.,Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Tahereh Navidifar
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Farkhondeh Saleh Shooshtari
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Hamed Goodarzi
- Department of Microbiology, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Caselli E, D'Accolti M, Soffritti I, Lanzoni L, Bisi M, Volta A, Berloco F, Mazzacane S. An Innovative Strategy for the Effective Reduction of MDR Pathogens from the Nosocomial Environment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1214:79-91. [PMID: 31321750 DOI: 10.1007/5584_2019_399] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Antimicrobial resistance (AMR) is currently one of the main concerns for human health.Due to its rapid increase and global diffusion, several common microbial infections might become not curable in the future decades, making it impossible to apply other lifesaver therapies, such as transplant or chemotherapy.AMR is frequently observed in hospital pathogens, due to selective pressure exerted by antibiotic use, and consistently with this, in the recent years, many actions have been proposed to limit AMR spread, including hygiene measures for hospital professionals and a wiser antibiotic usage.Indeed, the hospital environment itself represents a reservoir of pathogens, whose control was so far addressed by conventional sanitation procedures, which however cannot prevent recontamination and might further favour the selection of resistant strains.Here we report the results collected by studying an innovative sanitation strategy based on the use of probiotic bacteria, capable of reducing in a stable way the surface load of pathogens and their AMR. Collected data suggest that this system might contribute significantly to AMR control and might be thus considered as one of the tools for AMR and infection prevention and control.
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Affiliation(s)
- Elisabetta Caselli
- Section of Microbiology and Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy. .,CIAS Research Center, University of Ferrara, Ferrara, Italy.
| | - Maria D'Accolti
- Section of Microbiology and Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,CIAS Research Center, University of Ferrara, Ferrara, Italy
| | - Irene Soffritti
- Section of Microbiology and Medical Genetics, Department of Medical Sciences, University of Ferrara, Ferrara, Italy.,CIAS Research Center, University of Ferrara, Ferrara, Italy
| | - Luca Lanzoni
- CIAS Research Center, University of Ferrara, Ferrara, Italy
| | - Matteo Bisi
- CIAS Research Center, University of Ferrara, Ferrara, Italy
| | | | - Filippo Berloco
- Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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Haque M, Sartelli M, McKimm J, Abu Bakar M. Health care-associated infections - an overview. Infect Drug Resist 2018; 11:2321-2333. [PMID: 30532565 PMCID: PMC6245375 DOI: 10.2147/idr.s177247] [Citation(s) in RCA: 541] [Impact Index Per Article: 90.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Health care-associated infections (HCAIs) are infections that occur while receiving health care, developed in a hospital or other health care facility that first appear 48 hours or more after hospital admission, or within 30 days after having received health care. Multiple studies indicate that the common types of adverse events affecting hospitalized patients are adverse drug events, HCAIs, and surgical complications. The US Center for Disease Control and Prevention identifies that nearly 1.7 million hospitalized patients annually acquire HCAIs while being treated for other health issues and that more than 98,000 patients (one in 17) die due to these. Several studies suggest that simple infection-control procedures such as cleaning hands with an alcohol-based hand rub can help prevent HCAIs and save lives, reduce morbidity, and minimize health care costs. Routine educational interventions for health care professionals can help change their hand-washing practices to prevent the spread of infection. In support of this, the WHO has produced guidelines to promote hand-washing practices among member countries.
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Affiliation(s)
- Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia,
| | - Massimo Sartelli
- Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy
| | - Judy McKimm
- Swansea University School of Medicine, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK
| | - Muhamad Abu Bakar
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia,
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