Antibiogram Profiles of Bacteria Isolated from Different Body Site Infections Among Patients Admitted to GAMBY Teaching General Hospital, Northwest Ethiopia

Use what you have: leveraging microbiology support to develop a cumulative antibiotic susceptibility report for antimicrobial stewardship at a district hospital in Ghana

Background

Antibiograms provide effective support for empirical prescribing and antimicrobial stewardship programmes (ASPs). In low-resource settings, microbiology systems to develop antibiograms may be rudimentary or entirely lacking, which may place such facilities at a disadvantage. Notwithstanding this, facilities should use what they have to support ASPs to inform evidence-based antibiotic use. We report how an antibiogram was developed at a district hospital in Ghana to support its ASP.

Methods

This was a retrospective analysis of antibiotic susceptibility testing (AST) results from the University Hospital, KNUST from January to December 2021. Data were exported from the hospital's laboratory information system to Microsoft Excel (Version 2013). IBM SPSS Statistics (Version 25) and Epi Info™ Version 7 were used for statistical analyses.

Results

Overall, 1949 cultures were performed, 392 (20.1%) growing bacterial pathogens. Per the CLSI M39-A4 standard guidelines for antibiograms, only 360 of the bacterial isolates were used for the analyses. The majority of isolates were from urine (187; 51.9%). Among the Gram-negative bacteria, there was low susceptibility to amoxicillin/clavulanic acid (28%), cephalosporins (11%-35%) and meropenem (21%), but high susceptibility to amikacin (96%) and levofloxacin (81%). Low susceptibility of Gram-positive isolates to amoxicillin/clavulanic acid (34%), meropenem (34%) and penicillins (27%-35%) was also recorded, but high susceptibility to ciprofloxacin (80%), gentamicin (79%) and vancomycin (76%).

Conclusion

High levels of bacterial resistance to cephalosporins and meropenem in the antibiogram were reported. This antibiogram highlighted the urgent need for pragmatic steps to curb antibiotic resistance through ASPs using strategies that positively improve clinicians' knowledge and prescribing practices.

Assessment of bacterial profile, antimicrobial susceptibility status, and associated factors of isolates among hospitalized patients at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia

BACKGROUND

Antimicrobial resistant bacteria among hospitalized patients are becoming a major public health threat worldwide, mainly in developing countries. Infections by these multidrug resistant pathogens cause high rate of mortality, prolong hospital stays, and affect individual and country economies in greater amounts. Thus, this study aimed to assess the bacterial profile, antimicrobial susceptibility status, and associated factors of isolates from hospitalized patients at the Dessie Comprehensive Specialized Hospital.

METHODOLOGY

This hospital-based cross-sectional study was conducted between February and April 2021. Consecutive sampling was used to select the study participants. All bacterial isolates were identified using standard bacteriological techniques. Antibiotic susceptibility testing was performed using disk diffusion technique. The data was analyzed using SPSS version 25. Descriptive statistics and logistic regression were used. A P-value of less than 0.05 was considered statistically significant.

RESULTS

Of 384 clinical samples (blood, urine, stool, wound, vaginal discharge, and ear discharge) processed 180 (46.9%) were culture positive. Overall, Escherichia coli was the predominant isolate (41; 22.8%), followed by Staphylococcus aureus (36; 20%). Most of the isolates were from blood (70; 38.9%). The level of overall drug resistance of the gram-negative bacteria isolates for ampicillin, tetracycline, and cotrimoxazole was (104; 88.1%), (79; 75.9%), and (78; 75.0%), respectively. The overall multidrug rate of isolates was 143 (79.4%). Variables such as history of invasive procedures, chronic underlying diseases, history of hospitalization, and habit of eating raw animal products were statistically significant for the acquisition of bacterial infection.

CONCLUSIONS AND RECOMMENDATION

E. Coli and S. aureus were the most common isolates. Most of the isolates were resistant to commonly prescribed antibiotics. And also, consumption of raw animal products, chronic underlying disease, previous hospitalization, history of invasive procedures, and educational status were associated with the acquisition of bacterial infections. Therefore, routine antimicrobial susceptibility testing, proper patient management, wise use of antibiotics in clinical settings and health education are recommended.

Antibiogram Profiling of Antibiotics in Ear, Nose, and Throat Infections in Tertiary Healthcare Settings

Introduction Antibiotic resistance is an emerging threat in tertiary healthcare settings, with increased usage of antibiotics on patients having ear, nose, and throat (ENT) infections, the bacterial strains are becoming resistant to its treatment causing antibiotic resistance and ineffective treatment. This study focuses on the antibiogram profiling of bacterial pathogens by the conventional disc diffusion method in a tertiary healthcare setting and the recent method using a matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF) to identify bacterial strains isolated from infections of the ENT. Materials and methods Swab samples were collected from patients with ENT infections and were subjected to bacteriological and proteomic studies to assess the status of drug-resistant pathogens. About 125 samples were subjected to an antimicrobial susceptibility test by disc diffusion, and the bacterial isolates were screened on MALDI-TOF for identification. Result The study identified beta-hemolytic Streptococci as the most prevalent bacterial species, followed by Pseudomonas aeruginosa and Staphylococcus aureus. MALDI-TOF analysis yielded high identification accuracy for beta-hemolytic Streptococcus pyogenes, and the antibiogram profile of bacterial isolates indicated that most of the bacteria are resistant to penicillin, amoxicillin, and chloramphenicol.  Conclusion  The study emphasized the importance of appropriate antibiotic selection in treating ENT infections, considering local antibiograms and understanding antibiotic resistance patterns. This shall aid clinicians in choosing effective antibiotics, reducing treatment failure, and preventing the emergence of antibiotic resistance. Overall, the research provides valuable insights into antibiotic resistance in ENT infections.

A multifunctional chitosan composite aerogel based on high density amidation for chronic wound healing

The management of chronic wounds remains a challenging clinical problem worldwide, mainly because of secondary infections, excessive oxidative stress, and blocked angiogenesis. Aerogel is a novel material with high porosity and specific surface area that allows gas exchange and rapid absorption of a large amount of exudate as well as loading bioactive molecules. Therefore, functional aerogel can be an ideal material for chronic wound treatment. The multifunctional aerogel (CG-DA-VEGF) was prepared by a simple and eco-friendly freeze-drying process combined with harmless EDC/NHS as crosslinking agents using chitosan and dopamine-grafted gelatin as raw materials. The physicochemical characterization revealed that the CG-DA-VEGF aerogel had excellent water absorption, water retention, and mechanical properties, and could release VEGF continuously and stably. In vitro experiments demonstrated that the CG-DA-VEGF aerogel exhibited effective antioxidant and antibacterial properties, as well as superb cytocompatibility. In vivo experiments further confirmed that the CG-DA-VEGF aerogel could significantly improve angiogenesis and re-epithelialization, and promote collagen deposition, thus accelerating wound healing with excellent biosafety. These results suggest that the as-prepared CG-DA-VEGF aerogel may be adopted as a promising multifunctional graft for the treatment of chronic wounds.

Co-occurrence of heavy metals and antibiotics resistance in bacteria isolated from metal-polluted soil

The indiscriminate deposition of metal-containing substances into the environment contributes significantly to high concentrations of metals in the soil resulting in resistance to metals and consequentially to antibiotics by inherent microbes which may eventually spread to other pathogenic microbes thereby elevating disease burden due to antibiotic resistance. The study aimed at determining the co-occurrence of resistance of bacteria isolated from metal-contaminated soil to heavy metals and subsequently, antibiotics. Metal-tolerant bacteria were randomly isolated from top soils from a battery waste site using the pour plate method. Selected isolates were identified using biochemical tests, then, subjected to elevating supplemented concentrations of different metal salts at 100-500 μg/mL to determine the minimum inhibitory concentration. Isolates tolerant to minimum three metals up to 400 μg/mL were subjected to Sulfamethoxazole-trimethoprim (25 μg), Imipenem (10 μg), Amoxicillin (30 μg), Ciprofloxacin (10 μg) and Tigecycline (15 μg) and observations interpreted using the guiding principle of the Clinical and Laboratory Standards Institute. Metal concentrations in the soils exceeded permissible limits. In total, 16 isolates were selected and identified as Proteus sp. (1), Pseudomonas spp. (5), Enterobacter spp. (2), Klebsiella spp. (2), Escherichia spp. (3), Raoultella spp. (2) and Rahnella sp. (1). Thirteen (81.25 %) of all isolates showed multi-resistance to the metals and seven exhibited multidrug-resistance, with 4 (57.1 %) showing resistance to three different classes of antibiotics and 3 (42.9 %) showed resistance to four antibiotic classes. Heavy metal-tolerant bacteria isolated from this study possess co-selection potentials as they showed resistance to different metals and antibiotics classes which is a concern to public health.

Analysis of cumulative antibiogram reports in intensive care units at an Egyptian University Hospital

BACKGROUND

Institutions must have access to antibiograms to monitor changes in antimicrobial resistance and direct empirical antibiotic therapy. The first facility-specific cumulative antibiogram was launched in the ICU in 2019. Consequently, many antibiogram-operation-related actions have been adopted in the institution based on reported data. This study aimed to analyze the cumulative antibiogram reports for multiple intensive care units (ICUs) for 2020, and compare the antimicrobial susceptibility testing (AST) patterns between the 2019 and 2020 years in an academic medical center.

METHODS

This cross-sectional study was performed of routine bacterial culture and AST data extracted from a laboratory information system in a 2252-bed capacity hospital. Only the first diagnostic isolate of a given species per patient per year was included in the study. Interpretation and reporting were done in accordance with the applicable Clinical and Laboratory Standards Institute and European Committee on Antimicrobial Susceptibility Testing guidelines.

RESULTS

Of the 46,791 clinical isolates, the Gram-negative bacilli isolation rate witnessed a significant increase: 35,670 isolates in 2020 versus. 33,652 isolates in 2019. Klebsiella pneumoniae showed a statistically significant increase, mainly in pediatric, emergency, and cardiothoracic ICUs (p < 0.001). Neonatal and pediatric ICUs showed statistically significant increases in Pseudomonas aeruginosa and Proteus mirabilis isolates (p < 0.001). A statistically significant decrease was noted in the prevalence of Acinetobacter, Escherichia coli, Burkholderia cepacia, and Enterobacter cloacae. The sensitivities of K. pneumoniae and E. coli to imipenem and tigecycline significantly improved (p < 0.001). The sensitivity to colistin was significantly decreased (p < 0.001). The sensitivity of P. aeruginosa isolates to colistin and carbapenems was improved (p < 0.001). We reported a statistically significant decrease in all Gram-positive cocci (11,121 in 2020 versus. 11,528 in 2019). Staphylococcus aureus showed a statistically significant increase (p < 0.001), particularly in the medical ICU.

CONCLUSION

The high susceptibility rates of Enterobacteriaceae toward colistin and tigecycline, should be cautiously considered in empiric therapy while looking for alternatives. The majority of isolates of Gram-positive cocci were coagulase negative staphylococci (CONS), we still need to confirm whether they are true pathogens or commensals before considering anti-staphylococcal agents in the empirical therapy. We underscored some corrective actions that might have improved the susceptibility rates, such as antibiotic cycling.

Smoothie Drinks: Possible Source of Resistant and Biofilm-Forming Microorganisms

Smoothie drinks are currently very popular drinks sold especially in fast food establishments. However, smoothies are a significant source of microorganisms. The aim of this study was to evaluate the microbiological quality of smoothies purchased in Eastern Bohemia. A higher prevalence of mesophilic aerobic bacteria (5.4-7.2 log CFU/mL), yeast (4.4-5.9 log CFU/mL) and coliform bacteria (3.1-6.0 log CFU/mL) was observed in vegetable smoothies, in which even the occurrence of enterococci (1.6-3.3 log CFU/mL) was observed. However, the occurrence of S. aureus, Salmonella spp. and Listeria spp. was not observed in any samples. Nevertheless, antimicrobial resistance was observed in 71.8% of the isolated strains. The highest level of resistance was found in isolates from smoothie drinks with predominantly vegetable contents (green smoothie drinks). Considerable resistance was observed in Gram-negative rods, especially to amoxicillin (82.2%) and amoxicillin with clavulanic acid (55.6%). Among enterococci, only one vancomycin-resistant strain was detected. The vast majority of isolated strains were able to form biofilms at a significant level, which increases the clinical importance of these microorganisms. The highest biofilm production was found in Pseudomonas aeruginosa, Kocuria kristinae and Klebsiella pneumoniae. Overall, significant biofilm production was also noted among isolates of Candida spp.

Antibiogram of clinical isolates from primary and secondary healthcare facilities: A step towards antimicrobial stewardship

Antibiogram development and use is a core element of antimicrobial stewardship practice, such data is scarce in healthcare settings in developing countries. The study aims to determine the epidemiology of clinical isolates and their antibiograms in secondary healthcare (SHC) and primary healthcare (PHC) facilities in Benin City, Nigeria. This was a retrospective study in three laboratories in SHC and PHC facilities. Microbial culture and susceptibility report over the past 4 years was collated. Ethical Clearance was obtained from the Edo State Ministry of Health and Benin City. Data were entered and analyzed using SPSS version 22. Of the 819 isolates, urine, semen and vagina swab were most represented (50.7%; 16.1%; 13.2%). S.aureus (60.6%) and coliform organism (31.9%) were commonly isolated. High resistance of 75%->90% was seen with penicillin, cephalosporin, macrolide, aminoglycoside and floroquinolone against S. aureus, Ps aeruginosa, coliform and E. coli. Resistance to all antimicrobials was observed in 11.7% of the isolates, multidrug resistance (MDR) was found to be 61.4%. MDR for Ps aeruginosa, coliform, E coli, and staph aureus were 95.5%, 67.3% 25.6% and 82.8% respectively. In the SHC, 15.4% of isolates were resistant to all antibacterial compared to none in the PHC. There was consistent yearly increase in resistance to more than six agents in both centers. Gender difference in antimicrobial resistance was observed. High MDR observed in this study emphasizes the need for routine antibiogram and its use in updating treatment guidelines to reflect the current resistance pattern to available antimicrobials.

Enhancing the empiric antibiotic selection by introducing an antibiogram toolkit in a tertiary care hospital in Southern India - A prospective study

WHAT IS KNOWN AND OBJECTIVE

Antibiograms gives an overview of the cumulative susceptibility of formal antibiotics to bacterial isolates, which reflects the portion of each bacterium susceptible to a given antibiotic formulation by using antimicrobial susceptibility testing. The objective of this study is to gather and analyse data from drug utilization evaluation (DUE) studies and antimicrobial susceptibility tests in order to create an antibiogram toolkit that will help clinicians to select appropriate antimicrobial agents for initial empirical antibiotic therapy at point of care settings and avoid irrational use of antibiotics.

METHODS

A prospective interventional study was conducted at tertiary care hospital, biological samples of infectious patients were collected from various wards as per Clinical & Laboratory Standards Institute CLSI M39-A4 guidelines. Antimicrobial susceptibility results were analysed using WHONET software. Antibiotic stewardship committee was formed and involved in monitoring the usage of antibiotics, measuring outcomes, collecting feedback and finding the scope for improving the application of antibiogram toolkit in the hospital. Antibiotic usage tracking method was followed to know the level of adherence to the prescribing guidelines by the health care professionals.

RESULTS AND DISCUSSION

A total of 157 samples were obtained from various wards of the hospital. In that, Escherichia coli, Staphylococcus aureus and Klebsiella Pneumoniae were isolated in significant numbers. Antibacterial susceptibility results were collected, an initial antibiogram was developed for 18 antibacterial agents with respect to 3 gram-positive (+) and 1 gram-negative (-) organisms. 90% of prescribers mentioned that the antibiogram was useful, and 76% of them adhered to the guidelines. 26% were not adhered due to the patient-related factors.

WHAT IS NEW AND CONCLUSION

In our study, we have used qualitative and quantitative evaluation of drug utilization (DUE) reports to understand the existing prescribing pattern of antibiotics and setting target organisms and antibacterials to develop the hospital antibiogram. Combining DUE studies and antibiogram development was helpful in implementing effective antibiotic policies for the hospital. Further, this study pattern will be continued on a yearly basis and focused on developing cumulative antibiograms to understand the changes in resistance pattern of antimicrobials and utilization of antibiotics in the hospital.