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Ferrara F, Castagna T, Pantolini B, Campanardi MC, Roperti M, Grotto A, Fattori M, Dal Maso L, Carrara F, Zambarbieri G, Zovi A, Capuozzo M, Langella R. The challenge of antimicrobial resistance (AMR): current status and future prospects. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024:10.1007/s00210-024-03318-x. [PMID: 39052061 DOI: 10.1007/s00210-024-03318-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/18/2024] [Indexed: 07/27/2024]
Abstract
Antimicrobial resistance (AMR) represents a critical global threat, compromising the effectiveness of antibacterial drugs as bacteria adapt and survive exposure to many classes of these drugs. This phenomenon is primarily fueled by the widespread overuse and misuse of antibacterial drugs, exerting selective pressure on bacteria and promoting the emergence of multi-resistant strains. AMR poses a top-priority challenge to public health due to its widespread epidemiological and economic implications, exacerbated not only by the diminishing effectiveness of currently available antimicrobial agents but also by the limited development of genuinely effective new molecules. In addressing this issue, our research aimed to examine the scientific literature narrating the Italian situation in the common European context of combating AMR. We sought to delineate the current state of AMR and explore future prospects through an analysis of strategies to counter antibacterial drug resistance. Adopting the "One Health" model, our objective was to comprehensively engage diverse sectors, integrate various disciplines, and propose programs, policies, and regulations. This narrative review, based on PubMed research related to antibiotic resistance, emphasizes the urgent need for a coordinated and proactive approach at both national and European levels to mitigate the impact of AMR and pave the way for effective strategies to counter this global health challenge.
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Affiliation(s)
- Francesco Ferrara
- Pharmaceutical Department, Asl Napoli 3 Sud, Dell'amicizia Street 72, 80035, Nola, Naples, Italy.
| | - Tommaso Castagna
- Pharmacy Unit, ASST Di Lecco, Dell'Eremo Street 9/11, 23900, Lecco, Italy
| | | | | | - Martina Roperti
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, 20159, Milan, Italy
| | - Alessandra Grotto
- University of Milan, Festa del Perdono Street 7, 20122, Milan, Italy
| | - Martina Fattori
- Istituto Europeo Di Oncologia, Ripamonti Street 435, 20122, Milan, Italy
| | - Lucia Dal Maso
- Pharmaceutical Department, ASST Santi Paolo E Carlo, Antonio Rudinì Street 8, 20159, Milan, Italy
| | - Federica Carrara
- Pharmaceutical Department, Humanitas Gavazzeni, Mauro Gavazzeni Street 21, 24125, Bergamo, BG, Italy
| | - Giulia Zambarbieri
- Pharmaceutical Department, Humanitas Gavazzeni, Mauro Gavazzeni Street 21, 24125, Bergamo, BG, Italy
| | - Andrea Zovi
- Ministry of Health, Viale Giorgio Ribotta 5, 00144, Rome, Italy
| | - Maurizio Capuozzo
- Pharmaceutical Department, Asl Napoli 3 Sud, Dell'amicizia Street 72, 80035, Nola, Naples, Italy
| | - Roberto Langella
- Italian Society of Hospital Pharmacy (SIFO), SIFO Secretariat of the Lombardy Region, Via Carlo Farini, 81, 20159, Milan, Italy
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Yin L, Lu L, He L, Wang L, Lu G, Cao Y, Zhai X, Wang C. Shift in the dominant sequence type of carbapenem-resistant Klebsiella pneumonia infection from ST278-NDM-1 to ST11-KPC-2 in neonatal patients in a children's hospital in Shanghai, China, 2017-2021. Int Microbiol 2024; 27:871-881. [PMID: 37857932 DOI: 10.1007/s10123-023-00436-z] [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: 05/06/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES To investigate the clinical characteristics and molecular epidemiology of CRKP infection in neonatal patients in a children's hospital in China from 2017 to 2021. METHODS Species identification and antibiotic susceptibilities were tested with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and VITEK 2 systems. The clinical data were collected from medical records. Carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates were investigated by antimicrobial susceptibility testing, carbapenemase genes and multilocus sequence typing. RESULTS Six kinds of resistant genes and 23 STs were detected. BlaNDM-1 (n=83, 55.3%) was the predominant carbapenemase gene, followed by blaKPC-2 (n=45, 30.0%), blaNDM-5 (n=7, 4.7%), blaIMP-38 (n=6, 4.0%). BlaNDM-1 was predominant in 2017 and 2018, whereas blaKPC-2 increased in 2019 and became the predominant gene from 2020 to 2021. ST11 accounted for most infections (n=35, 23.3%), followed by ST278 (n=23, 15.3%), ST17 (n=17, 11. 3%) and ST2735 (n=16, 10.7%). ST278 and ST17 were predominant in 2017 and 2018, whereas ST11 increased in 2019 and became the predominant sequence type from 2020 to 2021. Compared with blaNDM-1, the CRKP strains producing blaKPC-2 were characterized by high resistance to gentamicin, amikacin and levofloxacin and the change trend of drug resistance rate before and after COVID-19 was consistent with that of blaNDM-1 and blaKPC-2. CONCLUSIONS The main sequence type of CRKP infection changed dynamically from ST278-NDM-1 to ST11-KPC-2 during the years 2017-2021 in the newborns. Antibiotic exposure and the prevalence of COVID-19 since 2020 may have led to changes in hospital population and lead to the changes.
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Affiliation(s)
- Lijun Yin
- Department of Nosocomial Infection Control, Children's Hospital of Fudan University, Shanghai, China
| | - Lu Lu
- Department of Nosocomial Infection Control, Children's Hospital of Fudan University, Shanghai, China
| | - Leiyan He
- The Clinical Microbiology Laboratory, Children's Hospital of Fudan University, Shanghai, China
| | - Laishuan Wang
- Department of Neonatal Room, Children's Hospital of Fudan University, Shanghai, China
| | - Guoping Lu
- Department of Pediatric Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China
| | - Yun Cao
- Department of Neonatal Intensive Care Unit, Children's Hospital of Fudan University, Shanghai, China.
| | - Xiaowen Zhai
- Department of Hematology, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 200032, Shanghai, China.
| | - Chuanqing Wang
- Department of Nosocomial Infection Control and the Clinical Microbiology Laboratory, Children's Hospital of Fudan University, Shanghai, China.
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Krithika VM, Ganesan V, Rajendran T. Ceftazidime-Avibactam resistance in clinical isolates of carbapenem-resistant Klebsiella pneumoniae: A phenotypic and genotypic analysis. Indian J Med Microbiol 2024; 49:100603. [PMID: 38705276 DOI: 10.1016/j.ijmmb.2024.100603] [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: 12/05/2023] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To find the prevalence of Ceftazidime-Avibactam (CAZ-AVI) resistant Klebsiella pneumoniae in clinical isolates and to determine the genes responsible for Ceftazidime-Avibactam resistance using PCR. METHODS A total of 89 carbapenem resistant Klebsiella pneumoniae from various clinical samples were included in the study. CAZ-AVI resistance was tested using E-test. CAZ-AVI resistant strains were subjected to conventional PCR for detection of carbapenamase genes blaNDM- 1, blaOXA-48, blaVIM, blaIMP, blaKPC. RESULTS Of the 89 isolates screened for CAZ-AVI resistance, 45(50.5%) isolates were found to be resistant. 42 isolates were subjected to PCR for detection of β lactamase genes.34 isolates were positive for blaNDM-1 and all 42 isolates were positive for blaOXA-48. Co-expression of NDM-1 and OXA-48 was seen in 34 isolates. Sensitivity of mCIM test to identify a carbapenamse compared to PCR was 61.9%. Sensitivity of eCIM test to identify NDM-1 was 80%. CONCLUSION CAZ-AVI was effective in vitro in 49.4% of the isolates. Indicating that CAZ-AVI is a promising addition to antibiotics against CRE as well as a carbapenem sparing drug in ESBL producing organisms. β-Lactamase-related mutations are the main mechanism leading to CAZ-AVI resistance.
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Affiliation(s)
- Varshini M Krithika
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Tamil Nadu, India.
| | - Vithiya Ganesan
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Tamil Nadu, India.
| | - T Rajendran
- Department of Microbiology, Velammal Medical College Hospital and Research Institute, Tamil Nadu, India.
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De R, Mukhopadhyay AK, Ghosh M, Basak S, Dutta S. Emerging resistome diversity in clinical Vibrio cholerae strains revealing their role as potential reservoirs of antimicrobial resistance. Mol Biol Rep 2024; 51:409. [PMID: 38461219 DOI: 10.1007/s11033-024-09313-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/01/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND This is a unique and novel study delineating the genotyping and subsequent prediction of AMR determinants of Vibrio cholerae revealing the potential of contemporary strains to serve as precursors of severe AMR crisis in cholera. METHODS AND RESULTS Genotyping of representative strains, VC1 and VC2 was undertaken to characterize antimicrobial resistance genes (ARGs) against chloramphenicol, SXT, nalidixic acid and streptomycin against which they were found to be resistant by antibiogram analysis in our previous investigation. strAB, sxt, sul2, qace∆1-sul1 were detected by PCR. Genome annotation and identification of ARGs with WGS helped to detect the presence of almG, varG, strA (APH(3'')-Ib), strB (APH(6)-Id), sul2, catB9, floR, CRP, dfrA1 genes. Signatures of resistance determinants and protein domains involved in antimicrobial resistance, primarily, efflux of antibiotics were identified on the basis of 30-100% homology to reference proteins. These domains were predicted to be involved in other metabolic functions on the basis of 100% identity with 100% coverage with reference protein and nucleotide sequences and were predicted to be of a diverse taxonomic origin accentuating the influence of the microbiota on AMR acquisition. Sequence analysis of QRDR (quinolone resistance-determining region) revealed SNPs. Cytoscape v3.8.2 was employed to analyse protein-protein interaction of MDR proteins, MdtA and EmrD-2, with nodes of vital AMR pathways. Vital nodes involved in efflux of different classes of antibiotics were found to be absent in VC1 and VC2 justifying the sensitivity of these strains to most antibiotics. CONCLUSIONS The study helped to examine the resistome of VC isolated from recent outbreaks to understand the underlying reason of sensitivity to most antibiotics and also to characterize the ARGs in their genome. It revealed that VC is a reservoir of signatures of resistance determinants and serving as precursors for severe AMR crisis in cholera. This is the first study, to our knowledge, which has scrutinized and presented systematically, information on prospective domains which bear the potential of serving as AMR determinants in VC with the help of bioinformatic tools. This pioneering approach may help in the prediction of AMR landfalls and benefit epidemiological surveillance and early warning systems.
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Affiliation(s)
- Rituparna De
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases (ICMR), Kolkata, India.
| | - Asish K Mukhopadhyay
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases (ICMR), Kolkata, India
| | - Manisha Ghosh
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Surajit Basak
- National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Shanta Dutta
- Division of Bacteriology, National Institute of Cholera and Enteric Diseases (ICMR), Kolkata, India
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Kumar V, Murali S, Goldberg J, Alonso B, Moretó-Planas L, Reid A, Harshana A, Burza S, Mahajan R. Antibiotic susceptibility patterns of pathogens isolated from hospitalized patients with advanced HIV disease (AHD) in Bihar, India. JAC Antimicrob Resist 2024; 6:dlad151. [PMID: 38170073 PMCID: PMC10759003 DOI: 10.1093/jacamr/dlad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 12/11/2023] [Indexed: 01/05/2024] Open
Abstract
Objectives To describe the prevalence of common bacterial pathogens and antibiotic susceptibility patterns amongst advanced HIV disease (AHD) patients admitted between May 2019 and March 2021 to a Médecins Sans Frontières (MSF)-supported AHD inpatient unit in Bihar, India. Methods A retrospective analysis of routinely collected demographic, clinical and microbiological data. Antibacterial susceptibility testing was done by an accredited referral laboratory using the modified Kirby-Bauer disc diffusion method. Results A total of 238 isolates from 577 patients were identified through culture testing. Patient median (IQR) age was 38 (31-45) years, and 75% were male. Predominant sample types included blood (600; 38%), urine (266; 17%) and sputum (178; 11%). Of the isolated bacteria, Escherichia coli (80; 13.9%) was the most prevalent, followed by Klebsiella pneumonia (54; 9.4%), Pseudomonas aeruginosa (22; 3.8%), Klebsiella oxytoca (10; 1.7%), Proteus mirabilis (9; 1.6%), and Acinetobacter baumannii (7; 1.2%). The resistance pattern showed that most bacterial isolates were highly resistant to commonly prescribed antibiotics such as third-generation cephalosporins, fluoroquinolones and co-trimoxazole. Most pathogens were moderately resistant to antibiotics from the WHO Watch group, such as meropenem and piperacillin/tazobactam. In contrast, isolates were more susceptible to aminoglycosides, such as amikacin, gentamicin and nitrofurantoin. Conclusions In Bihar, inpatients with AHD displayed a concerning array of antibiotic-resistant infections. This study provides a starting point from which further work on antimicrobial resistance in this vulnerable cohort of patients can be conducted.
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Affiliation(s)
- Vikash Kumar
- Operational Centre Barcelona-Athens, Médecins Sans Frontières, New Delhi, India
| | - Shreyas Murali
- Operational Centre Barcelona-Athens, Médecins Sans Frontières, Patna, India
| | - Jacob Goldberg
- Medical Department, Médecins Sans Frontières, London, UK
| | - Beatriz Alonso
- Medical Department, Médecins Sans Frontières, London, UK
| | - Laura Moretó-Planas
- Operational Centre Barcelona-Athens, Médecins Sans Frontières, Barcelona, Spain
| | - Anthony Reid
- Opérationnel Research Unit, Médecins Sans Frontières, Luxembourg, Luxembourg
| | - Amit Harshana
- Operational Centre Barcelona-Athens, Médecins Sans Frontières, New Delhi, India
| | - Sakib Burza
- Operational Centre Barcelona-Athens, Médecins Sans Frontières, New Delhi, India
- London School of Hygiene and Tropical Medicine, London, UK
| | - Raman Mahajan
- Operational Centre Barcelona-Athens, Médecins Sans Frontières, New Delhi, India
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Mehrotra T, Konar D, Pragasam AK, Kumar S, Jana P, Babele P, Paul D, Purohit A, Tanwar S, Bakshi S, Das S, Verma J, Talukdar D, Narendrakumar L, Kothidar A, Karmakar SP, Chaudhuri S, Pal S, Jain K, Srikanth CV, Sankar MJ, Atmakuri K, Agarwal R, Gaind R, Ballal M, Kammili N, Bhadra RK, Ramamurthy T, Nair GB, Das B. Antimicrobial resistance heterogeneity among multidrug-resistant Gram-negative pathogens: Phenotypic, genotypic, and proteomic analysis. Proc Natl Acad Sci U S A 2023; 120:e2305465120. [PMID: 37549252 PMCID: PMC10434301 DOI: 10.1073/pnas.2305465120] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/07/2023] [Indexed: 08/09/2023] Open
Abstract
Microbes evolve rapidly by modifying their genomes through mutations or through the horizontal acquisition of mobile genetic elements (MGEs) linked with fitness traits such as antimicrobial resistance (AMR), virulence, and metabolic functions. We conducted a multicentric study in India and collected different clinical samples for decoding the genome sequences of bacterial pathogens associated with sepsis, urinary tract infections, and respiratory infections to understand the functional potency associated with AMR and its dynamics. Genomic analysis identified several acquired AMR genes (ARGs) that have a pathogen-specific signature. We observed that blaCTX-M-15, blaCMY-42, blaNDM-5, and aadA(2) were prevalent in Escherichia coli, and blaTEM-1B, blaOXA-232, blaNDM-1, rmtB, and rmtC were dominant in Klebsiella pneumoniae. In contrast, Pseudomonas aeruginosa and Acinetobacter baumannii harbored blaVEB, blaVIM-2, aph(3'), strA/B, blaOXA-23, aph(3') variants, and amrA, respectively. Regardless of the type of ARG, the MGEs linked with ARGs were also pathogen-specific. The sequence type of these pathogens was identified as high-risk international clones, with only a few lineages being predominant and region-specific. Whole-cell proteome analysis of extensively drug-resistant K. pneumoniae, A. baumannii, E. coli, and P. aeruginosa strains revealed differential abundances of resistance-associated proteins in the presence and absence of different classes of antibiotics. The pathogen-specific resistance signatures and differential abundance of AMR-associated proteins identified in this study should add value to AMR diagnostics and the choice of appropriate drug combinations for successful antimicrobial therapy.
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Affiliation(s)
- Tanshi Mehrotra
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Dipasri Konar
- Division of Diagnostic Laboratory, Jan Swasthya Sahyog, Ganiyari, Bilaspur495112, India
| | - Agila Kumari Pragasam
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Shakti Kumar
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Pradipta Jana
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Prabhakar Babele
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Deepjyoti Paul
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Ayushi Purohit
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Subhash Tanwar
- Multidisciplinary Clinical and Translational Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Susmita Bakshi
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Santanu Das
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Jyoti Verma
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Daizee Talukdar
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Lekshmi Narendrakumar
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Akanksha Kothidar
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Sonali Porey Karmakar
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Susmita Chaudhuri
- Multidisciplinary Clinical and Translational Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Sujoy Pal
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi110029, India
| | - Kajal Jain
- Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi110029, India
| | - Chittur V. Srikanth
- Laboratory of Gut Infection and Inflammation Biology, Regional Centre for Biotechnology, Faridabad121001, India
| | - M. Jeeva Sankar
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi110029, India
| | - Krishnamohan Atmakuri
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
| | - Ramesh Agarwal
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi110029, India
| | - Rajni Gaind
- Department of Microbiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi110029, India
| | - Mamatha Ballal
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal576104, India
| | - Nagamani Kammili
- Department of Microbiology, Pathogen Biology Division, Gandhi Medical College and Hospital, Secunderabad500003, India
| | - Rupak K. Bhadra
- Infectious Diseases and Immunology Division, Council of Scientific and Industrial Research-Indian Institute of Chemical Biology, Kolkata700 032, India
| | - Thandavarayan Ramamurthy
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
- Division of Bacteriology, Indian Council of Medical Research-National Institute of Cholera and Enteric Diseases, Kolkata700010, India
| | - G. Balakrish Nair
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
- Pathogen Biology Division, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram695014, India
| | - Bhabatosh Das
- Infection and Immunology Division, Functional Genomics Laboratory, Centre for Microbial Research, Translational Health Science and Technology Institute, Faridabad121001, India
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Bhatia M, Shamanna V, Nagaraj G, Sravani D, Gupta P, Omar BJ, Singh A, Rani D, Ravikumar KL. An insight into whole genome sequencing data of methicillin-resistant Staphylococcus aureus circulating in a teaching hospital in North India. Indian J Med Microbiol 2023; 44:100365. [PMID: 37356847 DOI: 10.1016/j.ijmmb.2023.100365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/31/2023] [Accepted: 03/14/2023] [Indexed: 06/27/2023]
Abstract
PURPOSE To provide an insight into the Whole-genome sequencing (WGS) data of MRSA strains circulating in a teaching hospital in north India. METHODS An exploratory study was conducted in which fifty non-repetitive MRSA isolates obtained from pus samples of inpatients from July 2018 to February 2019 were subjected to preliminary identification (ID) and antibiotic susceptibility testing (AST) at our centre. These isolates were later sent to Central Research Laboratory, India for further testing using the VITEK-2 compact system followed by WGS. Only eighteen isolates were eventually considered for final analysis and the rest (n = 32) were excluded due to various technical reasons. RESULTS The WGS confirmed MRSA isolates predominantly belonged to CC22 (56.25%) and CC30 (31.25%). The CC22 MRSA strains carried SCCmec types IVa (77.8%) & IVc (22.2%) and belonged to spa types t005 (44.4%), t4584 (22.2%), t11808 (11.1%), t1328 (11.1%) and t309 (11.1%), respectively. The MRSA isolates of CC30 carried SCCmec types IVa (60%), IVg (20%) & V (20%) and belonged to spa types t021 (80%) & t2575 (20%), respectively. One MRSA isolate carried a novel SCCmec type V. The luk-PV and tsst-1 genes were present in 93.75% and 33.33% of MRSA isolates, respectively. The concordance between the phenotypic and genotypic AST results was 100% for Beta-lactams, Fluoroquinolones, Tetracyclines & Lipoglycopeptides, respectively. CONCLUSIONS Through this study, we intend to embark upon a relatively newer avenue of clinical-genomic surveillance of nosocomial bacterial isolates like MRSA, which would help us improve the existing infection control and antibiotic stewardship practices in our hospital.
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Affiliation(s)
- Mohit Bhatia
- Department of Microbiology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi 110029, India.
| | - Varun Shamanna
- Central Research Laboratory, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka 560070, India
| | - Geetha Nagaraj
- Central Research Laboratory, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka 560070, India
| | - Dharmavaram Sravani
- Central Research Laboratory, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka 560070, India
| | - Pratima Gupta
- Department of Microbiology, All India Institute of Medical Sciences Deoghar, Jharkhand 814142, India
| | - Balram Ji Omar
- Department of Microbiology, All India Institute of Medical Sciences Rishikesh, Uttarakhand 249203, India
| | - Arpana Singh
- Department of Microbiology, All India Institute of Medical Sciences Rishikesh, Uttarakhand 249203, India
| | - Diksha Rani
- Department of Microbiology, All India Institute of Medical Sciences Rishikesh, Uttarakhand 249203, India
| | - K L Ravikumar
- Central Research Laboratory, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka 560070, India
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Prajescu B, Gavriliu L, Iesanu MI, Ioan A, Boboc AA, Boboc C, Galos F. Bacterial Species and Antibiotic Resistance-A Retrospective Analysis of Bacterial Cultures in a Pediatric Hospital. Antibiotics (Basel) 2023; 12:966. [PMID: 37370285 DOI: 10.3390/antibiotics12060966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/19/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
Antimicrobial resistance (AMR) has become a major healthcare concern having a rising incidence, especially in pediatric patients who are more susceptible to infections. The aim of our study was to analyze the bacterial species isolated from patients admitted to our tertiary hospital and their AMR profiles. We conducted a retrospective observational study by examining the bacterial cultures collected from pediatric patients admitted to our hospital over a period of one year. We identified the most common bacterial species from 1445 clinical isolates and their AMR patterns using standard microbiological techniques. Our analysis revealed that the most frequently isolated bacterial species were Escherichia coli (23.73%), Staphylococcus aureus (15.64%), Klebsiella species (12.04%), and Pseudomonas species (9.96%). Additionally, these species exhibited varying levels of resistance to commonly used antibiotics. Notably, we observed high rates of resistance among Gram-negative bacteria, including extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella species. Among Gram-positive bacteria, we observed a high level of methicillin-resistant Staphylococcus aureus. Our findings highlight the urgent need for effective antibiotic management programs and infection control measures to address the rising incidence of AMR in pediatric hospitals. Further research is needed to identify the mechanisms of resistance in these bacterial species and to develop new strategies for preventing and treating infections caused by antibiotic-resistant bacteria in pediatric patients.
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Affiliation(s)
- Bianca Prajescu
- Department of Pediatrics, Marie Curie Emergency Children's Hospital, 041451 Bucharest, Romania
| | - Liana Gavriliu
- Department for Prevention of Healthcare-Associated Infections, Marie Curie Emergency Children's Hospital, 041451 Bucharest, Romania
- Department of Infectious Disease, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Mara Ioana Iesanu
- Department of Pediatrics, Marie Curie Emergency Children's Hospital, 041451 Bucharest, Romania
- Department of Physiology, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Andreea Ioan
- Department of Pediatrics, Marie Curie Emergency Children's Hospital, 041451 Bucharest, Romania
| | - Anca Andreea Boboc
- Department of Pediatrics, Marie Curie Emergency Children's Hospital, 041451 Bucharest, Romania
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Ro-mania
| | - Catalin Boboc
- Department of Pediatrics, Marie Curie Emergency Children's Hospital, 041451 Bucharest, Romania
| | - Felicia Galos
- Department of Pediatrics, Marie Curie Emergency Children's Hospital, 041451 Bucharest, Romania
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Ro-mania
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9
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Chatterjee N, Nirwan PK, Srivastava S, Rati R, Sharma L, Sharma P, Dwivedi P, Jaggi N. Trends in carbapenem resistance in Pre-COVID and COVID times in a tertiary care hospital in North India. Ann Clin Microbiol Antimicrob 2023; 22:1. [PMID: 36597098 PMCID: PMC9808733 DOI: 10.1186/s12941-022-00549-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 12/09/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Carbapenem resistance is endemic in the Indian sub-continent. In this study, carbapenem resistance rates and the prevalence of different carbapenemases were determined in Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa during two periods; Pre-COVID (August to October 2019) and COVID (January to February 2021) in a north-Indian tertiary care hospital. METHODS Details of patient demographics and clinical condition was collated from the Hospital Information System and detection of carbapenemases NDM, OXA-48, VIM, IMP and KPC was done by Polymerase chain reaction (PCR) in 152 and 138 non-consecutive carbapenem resistant isolates during the two study periods respectively. Conjugation assay and sequencing of NDM and OXA-48 gene was done on a few selected isolates. RESULTS As compared to Pre-COVID period, co-morbidities and the mortality rates were higher in patients harbouring carbapenem resistant organisms during the COVID period. The overall carbapenem resistance rate for all the four organisms increased from 23 to 41% between the two periods of study; with Pseudomonas aeruginosa and Klebsiella pneumoniae showing significant increase (p < 0.05). OXA-48, NDM and co-expression of NDM and OXA-48 were the most common genotypes detected. NDM-5 and OXA-232 were most common variants of NDM and OXA-48 family respectively during both the study periods. CONCLUSION Higher rate of carbapenem resistance in COVID times could be attributed to increase in number of patients with co-morbidities. However, genetic elements of carbapenem resistance largely remained the same in the two time periods.
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Affiliation(s)
- Nirupama Chatterjee
- grid.464746.30000 0004 1761 4703Education and Research, Artemis Hospitals, Sector-51, Gurugram, Haryana India
| | - Pushpa K. Nirwan
- grid.464746.30000 0004 1761 4703Education and Research, Artemis Hospitals, Sector-51, Gurugram, Haryana India
| | - Shruti Srivastava
- grid.464746.30000 0004 1761 4703Education and Research, Artemis Hospitals, Sector-51, Gurugram, Haryana India
| | - Ruchi Rati
- grid.464746.30000 0004 1761 4703Department of Microbiology, Artemis Hospitals, Sector-51, Gurugram, Haryana India
| | - Lalit Sharma
- grid.464746.30000 0004 1761 4703Department of Microbiology, Artemis Hospitals, Sector-51, Gurugram, Haryana India
| | - Priyanka Sharma
- grid.464746.30000 0004 1761 4703Education and Research, Artemis Hospitals, Sector-51, Gurugram, Haryana India
| | - Priyambada Dwivedi
- grid.464746.30000 0004 1761 4703Education and Research, Artemis Hospitals, Sector-51, Gurugram, Haryana India
| | - Namita Jaggi
- grid.464746.30000 0004 1761 4703Education and Research, Artemis Hospitals, Sector-51, Gurugram, Haryana India
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Antibiotic-resistant bacteria originating from the gut may modulate the mucosal immune response during sepsis and septic shock. Drug Target Insights 2022; 16:81-87. [PMID: 36755640 PMCID: PMC9886009 DOI: 10.33393/dti.2022.2520] [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: 11/16/2022] [Accepted: 12/30/2022] [Indexed: 12/31/2022] Open
Abstract
The enrichment and diversity of gut microbiota play an important role in sepsis, but the role of gut microbiota composition and early-life colonization in sepsis and septic shock has not yet been characterized. The impact of gut microbiota diversity on host immunological disorders and future treatments of inflammatory diseases are not yet fully elucidated. Further, the association between the microbiota and immune development in sepsis remains unknown, and the underlying mechanisms are not well understood. The altered composition of gut microbiota during sepsis is profoundly associated with a loss of commensal bacteria and an overgrowth of potentially pathogenic bacteria, especially AMR bacteria. Disruptions of gut microbiota diversity are directly associated with susceptibility to sepsis and a higher risk of adverse outcomes. Several studies have confirmed that a mutual association between gut microbiota and the host is important for the metabolism of essential nutrients for the organism, for gut development, and for the maturation and development of a fully functional immune system. Therefore, understanding the gut microbiota diversity, composition, and function during various inflammatory conditions and sepsis may provide a comprehensive knowledge of the mechanisms behind the pathogenesis of gut-derived infection in diseases and the design of new treatment options (e.g., probiotics or fecal microbiota transplantation). Emerging evidence displays an important role of gut microbiota and their derived metabolites in modulating the host mucosal immune response and determining the susceptibility to, as well as outcomes of sepsis.
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11
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Singh A, Ambaru B, Bandsode V, Ahmed N. Panomics to decode virulence and fitness in Gram-negative bacteria. Front Cell Infect Microbiol 2022; 12:1061596. [PMID: 36478674 PMCID: PMC9719987 DOI: 10.3389/fcimb.2022.1061596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/26/2022] [Indexed: 11/22/2022] Open
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12
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Cantón R, Akova M, Langfeld K, Torumkuney D. Relevance of the Consensus Principles for Appropriate Antibiotic Prescribing in 2022. J Antimicrob Chemother 2022; 77:i2-i9. [PMID: 36065724 PMCID: PMC9445850 DOI: 10.1093/jac/dkac211] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background In the late 1990s, as a response to rising antimicrobial resistance (AMR), an independent multinational, interdisciplinary group was formed specifically targeting primary care antibiotic prescribing for community-acquired respiratory tract infections (CA-RTIs). The group comprised senior clinicians from Canada, Israel, Spain, Sweden, UK and USA. The group’s objectives were to provide recommendations for antibiotic stewardship in the community because, whilst it was widely accepted that inappropriate antibiotic use was contributing to AMR, it remained difficult to change prescribing behaviour. The group aimed to identify principles underlying appropriate antibiotic prescribing and guideline formulation to reduce morbidity from CA-RTIs, limit therapeutic failure and, importantly, curb AMR emergence. The group published a report in 2002, which has become known as the Consensus Principles. Objectives (i) To consider the relevance of the Consensus Principles in 2022 by reviewing current global approaches to rising AMR. A wide range of factors, such as antibiotic overuse, most recently seen in COVID-19 patients, are still driving rising AMR even though there has been a high-level international response to the AMR threat; and (ii) as an introduction to this Supplement, which reports the findings of analyses of how AMR is being addressed in nine disparate countries (Brazil, India, Kuwait, Mexico, Pakistan, Russia, Saudi Arabia, Türkiye and Vietnam). Understanding how these initiatives are being pursued in different countries helps identify areas where more information is needed. Conclusions Adherence to the Consensus Principles remains as important now as it was in 2002. Achieving appropriate antibiotic prescribing is a vital objective in order that the right patient receives the right antibiotics at the right time to ensure optimal clinical outcomes while at the same time helping to limit further increases in AMR.
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Affiliation(s)
- Rafael Cantón
- Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS) Madrid, Madrid, Spain.,CIBER de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Murat Akova
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Hacettepe University, Sihhiye, Ankara, Türkiye
| | - Karen Langfeld
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - Didem Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
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Loganathan A, Nachimuthu R. Antibiotic resistance, biofilm forming ability, and clonal profiling of clinical isolates of Staphylococcus aureus from southern and northeastern India. ASIAN BIOMED 2022; 16:191-199. [PMID: 37551171 PMCID: PMC10321179 DOI: 10.2478/abm-2022-0023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Staphylococcus aureus is a pathogen endemic in India and sometimes deadly for patients in intensive care units. Objectives To determine the antibiotic-resistance pattern, biofilm forming ability, and clonal type of S. aureus from isolates collected in Tamil Nadu (south) and the Mizoram (northeast) regions of India. Methods We collected S. aureus isolates from diagnostic laboratories in Tamil Nadu and Mizoram. An antibiotic susceptibility test was performed according to Clinical Laboratory and Standards Institute methods. Antibiotic-resistant determinants such as mecA, mecC, blaZ, vanA, vanB, and vanC were confirmed by polymerase chain reaction (PCR). All isolates were further studied for biofilm forming ability. Enterobacterial repetitive intergenic consensus (ERIC)-PCR was used for clonal analysis. Results A study of 206 clinical isolates showed 52.9% prevalence of methicillin-resistant S. aureus in Tamil Nadu and 49.4% in Mizoram. Minimum inhibitory concentration tests showed a high prevalence of 67% oxacillin resistance in isolates from Tamil Nadu and 49% in isolates from Mizoram. PCR showed 53% mecA in Tamil Nadu and 49% mecA in Mizoram. Vancomycin-intermediate resistance S. aureus (VISA) prevalence was lower in isolates from Tamil Nadu (4%) and Mizoram (5%). All methicillin-resistant S. aureus (MRSA) isolates formed biofilms. Clonal analysis revealed a genetic relatedness between the isolates. Conclusions The prevalence of MRSA is high in the regions studied, with most of the clinical isolates being multidrug resistant. Adopting appropriate community-based preventive measures and establishing antimicrobial stewardship is highly recommended to minimize the dissemination in antibiotic resistance.
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Affiliation(s)
- Archana Loganathan
- Department of Bio-Medical Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu632014, India
| | - Ramesh Nachimuthu
- Department of Bio-Medical Sciences, School of Bio Sciences and Technology, Vellore Institute of Technology, Vellore, Tamil Nadu632014, India
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Holloway B, Chandrasekar H, Purohit M, Sharma A, Mathur A, KC A, Fernandez-Carballo L, Dittrich S, Hildenwall H, Bergström A. Antibiotic Use before, during, and after Seeking Care for Acute Febrile Illness at a Hospital Outpatient Department: A Cross-Sectional Study from Rural India. Antibiotics (Basel) 2022; 11:antibiotics11050574. [PMID: 35625218 PMCID: PMC9138085 DOI: 10.3390/antibiotics11050574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/14/2022] [Accepted: 04/21/2022] [Indexed: 12/26/2022] Open
Abstract
Antibiotic resistance is a naturally occurring phenomenon, but the misuse and overuse of antibiotics is accelerating the process. This study aimed to quantify and compare antibiotic use before, during, and after seeking outpatient care for acute febrile illness in Ujjain, India. Data were collected through interviews with patients/patient attendants. The prevalence and choice of antibiotics is described by the WHO AWaRe categories and Anatomical Therapeutic Chemical classes, comparing between age groups. Units of measurement include courses, encounters, and Defined Daily Doses (DDDs). The antibiotic prescription during the outpatient visit was also described in relation to the patients’ presumptive diagnosis. Of 1000 included patients, 31.1% (n = 311) received one antibiotic course, 8.1% (n = 81) two, 1.3% (n = 13) three, 0.4% (n = 4) four, 0.1% (n = 1) five, and the remaining 59.0% (n = 590) received no antibiotics. The leading contributors to the total antibiotic volume in the DDDs were macrolides (30.3%), combinations of penicillins, including β-lactamase inhibitors (18.8%), tetracyclines (14.8%), fluoroquinolones (14.6%), and third-generation cephalosporins (13.7%). ‘Watch’ antibiotics accounted for 72.3%, 52.7%, and 64.0% of encounters before, during, and after the outpatient visit, respectively. Acute viral illness accounted for almost half of the total DDDs at the outpatient visit (642.1/1425.3, 45.1%), for which the macrolide antibiotic azithromycin was the most frequently prescribed antibiotic (261.3/642.1, 40.7%).
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Affiliation(s)
- Bronwen Holloway
- Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden; (H.C.); (A.K.); (A.B.)
- Correspondence:
| | - Harshitha Chandrasekar
- Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden; (H.C.); (A.K.); (A.B.)
| | - Manju Purohit
- Department of Pathology, Ruxmaniben Deepchand Gardi Medical College, Ujjain 456006, India;
- Department of Global Public Health, Health Systems and Policy, Karolinska Institute, 171 77 Stockholm, Sweden;
| | - Ashish Sharma
- Department of Medicine, Ruxmaniben Deepchand Gardi Medical College, Ujjain 456006, India;
| | - Aditya Mathur
- Department of Paediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain 456006, India;
| | - Ashish KC
- Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden; (H.C.); (A.K.); (A.B.)
| | | | - Sabine Dittrich
- Foundation for Innovative New Diagnostics, 1202 Geneva, Switzerland; (L.F.-C.); (S.D.)
| | - Helena Hildenwall
- Department of Global Public Health, Health Systems and Policy, Karolinska Institute, 171 77 Stockholm, Sweden;
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, 171 64 Solna, Sweden
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, 141 52 Huddinge, Sweden
| | - Anna Bergström
- Department of Women’s and Children’s Health, Uppsala University, 751 85 Uppsala, Sweden; (H.C.); (A.K.); (A.B.)
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Salvia T, Dolma KG, Dhakal OP, Khandelwal B, Singh LS. Phenotypic Detection of ESBL, AmpC, MBL, and Their Co-occurrence among MDR Enterobacteriaceae Isolates in a Tertiary Care Hospital in Sikkim, India. J Lab Physicians 2022; 14:329-335. [PMID: 36119416 PMCID: PMC9473942 DOI: 10.1055/s-0042-1744239] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Abstract
Background Emergence of extended-spectrum beta-lactamases (ESBLs), AmpC β-lactamases, and metallo-β lactamases (MBL), and their co-existence among members of Enterobacteriaceae pose newer diagnostic and therapeutic challenges. The present study examines the ESBL, AmpC, and MBL production by various phenotypic methods and their co-occurrence among the multidrug-resistant (MDR) Enterobacteriaceae clinical isolates.
Materials and Methods Four hundred non-repetitive Enterobacteriaceae clinical isolates were collected from the Central Referral Hospital, Sikkim. The isolates were used for identification and their antibiotic susceptibility tests were performed according to the Clinical and Laboratory Standard Institute (CLSI) guidelines. ESBL was detected by double-disc synergy test (DDST) and phenotypic confirmatory disc-diffusion test (PCDDT), AmpC detection by AmpC E-test, and boronic acid disc diffusion (BD) test. MBL was detected using the imipenem–imipenem/EDTA disc and carba-NP tests.
Results Around 76% were considered MDR. ESBL was seen in 58% and 50.4% based on DDST and phenotypic confirmation disc-diffusion test (PCDDT), respectively. AmpC was detected in 11.8% and 13.1% using a commercial E-test and boronic acid test, respectively. MBL were identified in 12.8% and 14.8% based on MBL imipenem-EDTA and carba-NP tests, respectively. Co-occurrence of ESBL and AmpC, ESBL and MBL, AmpC and MBL was seen in 5.2%, 11.5%, 1.3%, respectively, whereas a combination of these three β-lactamases was observed in only 0.3% of 304 MDR isolates.
Conclusion The findings highlight a high prevalence of β-lactamases and their co-production among the Enterobacteriaceae, mainly in Klebsiella pneumoniae and Escherichia coli isolates. The study further highlights the necessity to identify the MDR β-lactamases stains for effective therapy in severe as well as mild bacterial infections, thereby enabling to reduce the risk of MDR in hospital and community settings.
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Affiliation(s)
- Thounaojam Salvia
- Department of Microbiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Gangtok, Sikkim, India
| | - Karma G. Dolma
- Department of Microbiology, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Gangtok, Sikkim, India
| | - Om Prakash Dhakal
- Department of Medicine, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Gangtok, Sikkim, India
| | - Bidita Khandelwal
- Department of Medicine, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Gangtok, Sikkim, India
| | - Laishram Shantikumar Singh
- Department of Microbiology, Assam Down Town University, Guwahati 781026, Assam, India
- Microbial Resource Division, Institute of Bioresources and Sustainable Development (IBSD) Sikkim Centre, DBT, Tadong, Gangtok, Sikkim, India
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Application of Nanomaterials in the Prevention, Detection, and Treatment of Methicillin-Resistant Staphylococcus aureus (MRSA). Pharmaceutics 2022; 14:pharmaceutics14040805. [PMID: 35456638 PMCID: PMC9030647 DOI: 10.3390/pharmaceutics14040805] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 04/01/2022] [Accepted: 04/04/2022] [Indexed: 01/27/2023] Open
Abstract
Due to differences in geographic surveillance systems, chemical sanitization practices, and antibiotic stewardship (AS) implementation employed during the COVID-19 pandemic, many experts have expressed concerns regarding a future surge in global antimicrobial resistance (AMR). A potential beneficiary of these differences is the Gram-positive bacteria MRSA. MRSA is a bacterial pathogen with a high potential for mutational resistance, allowing it to engage various AMR mechanisms circumventing conventional antibiotic therapies and the host’s immune response. Coupled with a lack of novel FDA-approved antibiotics reaching the clinic, the onus is on researchers to develop alternative treatment tools to mitigate against an increase in pathogenic resistance. Mitigation strategies can take the form of synthetic or biomimetic nanomaterials/vesicles employed in vaccines, rapid diagnostics, antibiotic delivery, and nanotherapeutics. This review seeks to discuss the current potential of the aforementioned nanomaterials in detecting and treating MRSA.
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Chugh TD, Duggal AK, Duggal SD. Patient Safety, Clinical Microbiology, and Collaborative Healthcare. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2022. [DOI: 10.1055/s-0042-1744390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Abstract“Right to health” is a universal right inclusive of a culture of safety. This review aims to highlight how clinical microbiology laboratories can contribute to patient safety. They can bring down medical errors through clinical collaboration and quality control. Timely and accurate inputs from microbiology laboratory help in clinical correlation and aid in safe patient care. Through internet search, using keywords such as “medical errors” and “quality assurance,” global burden of medical errors has been compiled. References have been taken from guidelines and documents of standard national and international agencies, systematic reviews, observational studies, retrospective analyses, meta-analyses, health bulletins and reports, and personal views. Safety in healthcare should lay emphasis on prevention, reporting, analysis, and correction of medical errors. If not recorded, medical errors are regarded as occasional or chance events. Global data show adverse events are as high as 10% among hospitalized patients, and approximately two-thirds of these are reported from low- to middle-income countries (LMICs). This includes errors in laboratories as well. Clinical microbiology can impact patient safety when practiced properly with an aim to detect, control, and prevent infections at the earliest. It is a science that integrates a tripartite relationship between the patient, clinician, and a microbiology specialist. Through collaborative healthcare, all stakeholders benefit by understanding common errors and mitigate them through quality management. However, errors tend to happen despite standardization and streamlining all processes. The aim should be to minimize them, have fair documentation, and learn from mistakes to avoid repetition. Local targets should be set and then extended to meet national and global benchmarks.
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Affiliation(s)
| | - Ashish Kumar Duggal
- Department of Neurology, G. B. Pant Institute of Postgraduate Medical Education and Research, Delhi, India
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Designing Anti-Microbial Peptides Against Major β-Lactamase Enzymes in Clinically Important Gram-Negative Bacterial Pathogens: An In-Silico Study. Probiotics Antimicrob Proteins 2022; 14:263-276. [PMID: 35188617 DOI: 10.1007/s12602-022-09929-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2022] [Indexed: 12/29/2022]
Abstract
Anti-microbial resistance (AMR) creating healthcare concerns worldwide requires ardent exploration of therapeutic alternatives. Although anti-microbial peptides (AMP) are popular for broad-spectrum activity, recent evidence of increasing resistance to membrane-acting AMPs by ESKAPE pathogens has compelled us to design novel AMPs as therapeutic candidates. A library of 60 AMPs comprising natural AMPs and their mutants was constructed through in-silico methods. After physico-chemical property evaluations, each peptide in the library was subjected to flexible molecular docking against four major β-lactamases in Gram-negative ESKAPE pathogens. Among the potent AMP mutants, a Lactoferricin B-Mutant (M4) possessed uniformly high affinity with SHV1, OXA48, NDM1, and AmpC having energies -842.0Kcal/mol, -774.8Kcal/mol, -1103.3Kcal/mol, and -858.8Kcal/mol respectively. Coarse-grained clustering and flexibility analysis further accounted for the residue-level stable configurations of the protein-peptide complexes with high affinity. Highest affinity of Lactoferricin B_M4 was found with NDM1 due to H-bonds, salt-bridges, and hydrophobic interactions with the metallo-β-lactamase domain including crucial active-site residue Asp124. Molecular dynamics simulation further confirmed the stability of Lactoferricin B_M4-NDM1 complex having low residue-level root-mean square deviations (RMSD), atomic-level fluctuations, and radius of gyration (Rg). The study encourages experimental validations and similar methods to identify potential AMPs against drug-resistant pathogens.
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Bharathi SV, Venkataramaiah M, Rajamohan G. Genotypic and Phenotypic Characterization of Novel Sequence Types of Carbapenem-Resistant Acinetobacter baumannii, With Heterogeneous Resistance Determinants and Targeted Variations in Efflux Operons. Front Microbiol 2022; 12:738371. [PMID: 35002996 PMCID: PMC8735875 DOI: 10.3389/fmicb.2021.738371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/16/2021] [Indexed: 01/21/2023] Open
Abstract
Acinetobacter baumannii has emerged as one of the dominant nosocomial human pathogens associated with high morbidity and mortality globally. Increased incidences of carbapenem-resistant A. baumannii (CRAB) have resulted in an enormous socioeconomic burden on health-care systems. Here, we report the genotypic and phenotypic characterization of novel ST1816 and ST128 variants in A. baumannii strains belonging to International clone II (GC2) with capsule types KL1:OCL8 and KL3:OCL1d from India. Sequence analysis revealed the presence of diverse virulome and resistome in these clinical strains, in addition to islands, prophages, and resistance genes. The oxacillinase bla OXA-23 detected in the genomic island also highlighted the coexistence of bla OXA-66 /bla OXA-98 , bla ADC73 /bla ADC-3 , and bla TEM-1D in their mobile scaffolds, which is alarming. Together with these resistance-determining enzymes, multidrug efflux transporters also harbored substitutions, with increased expression in CRAB strains. The hotspot mutations in colistin resistance-conferring operons, PmrAB, LpxACD, and AdeRS, were additionally confirmed. Phenotype microarray analysis indicated that multidrug-resistant strains A. baumannii DR2 and A. baumannii AB067 preferred a range of antimicrobial compounds as their substrates relative to the other. To our knowledge, this is the first comprehensive report on the characterization of A. baumannii variants ST1816 and ST128, with different genetic makeup and genome organization. The occurrence of CRAB infections worldwide is a severe threat to available limited therapeutic options; hence, continued surveillance to monitor the emergence and dissemination of such novel ST variants in A. baumannii is imperative.
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Affiliation(s)
- Srinivasan Vijaya Bharathi
- Molecular Biology Division, Council of Scientific and Industrial Research-Institute of Microbial Technology, Chandigarh, India
| | - Manjunath Venkataramaiah
- Molecular Biology Division, Council of Scientific and Industrial Research-Institute of Microbial Technology, Chandigarh, India
| | - Govindan Rajamohan
- Molecular Biology Division, Council of Scientific and Industrial Research-Institute of Microbial Technology, Chandigarh, India
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Bacterial Epidemiology and Antimicrobial Resistance Profiles in Children Reported by the ISPED Program in China, 2016 to 2020. Microbiol Spectr 2021; 9:e0028321. [PMID: 34730410 PMCID: PMC8567242 DOI: 10.1128/spectrum.00283-21] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
The Infectious Disease Surveillance of Pediatrics (ISPED) program was established in 2015 to monitor and analyze the trends of bacterial epidemiology and antimicrobial resistance (AMR) in children. Clinical bacterial isolates were collected from 11 tertiary care children’s hospitals in China in 2016 to 2020. Antimicrobial susceptibility testing was carried out using the Kirby-Bauer method or automated systems, with interpretation according to the Clinical and Laboratory Standards Institute 2019 breakpoints. A total of 288,377 isolates were collected, and the top 10 predominant bacteria were Escherichia coli, Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Klebsiella pneumoniae, Moraxella catarrhalis, Streptococcus pyogenes, Staphylococcus epidermidis, Pseudomonas aeruginosa, and Acinetobacter baumannii. In 2020, the coronavirus disease 2019 (COVID-19) pandemic year, we observed a significant reduction in the proportion of respiratory tract samples (from 56.9% to 44.0%). A comparable reduction was also seen in the primary bacteria mainly isolated from respiratory tract samples, including S. pneumoniae, H. influenzae, and S. pyogenes. Multidrug-resistant organisms (MDROs) in children were commonly observed and presented higher rates of drug resistance than sensitive strains. The proportions of carbapenem-resistant K. pneumoniae (CRKP), carbapenem-resistant A. baumannii (CRAB), carbapenem-resistant P. aeruginosa (CRPA), and methicillin-resistant S. aureus (MRSA) strains were 19.7%, 46.4%%, 12.8%, and 35.0%, respectively. The proportions of CRKP, CRAB, and CRPA strains all showed decreasing trends between 2015 and 2020. Carbapenem-resistant Enterobacteriaceae (CRE) and CRPA gradually decreased with age, while CRAB showed the opposite trend with age. Both CRE and CRPA pose potential threats to neonates. MDROs show very high levels of AMR and have become an urgent threat to children, suggesting that effective monitoring of AMR and antimicrobial stewardship among children in China are required. IMPORTANCE AMR, especially that involving multidrug-resistant organisms (MDROs), is recognized as a global threat to human health; AMR renders infections increasingly difficult to treat, constituting an enormous economic burden and producing tremendous negative impacts on patient morbidity and mortality rates. There are many surveillance programs in the world to address AMR profiles and MDRO prevalence in humans. However, published studies evaluating the overall AMR rates or MDRO distributions in children are very limited or are of mixed quality. In this study, we showed the bacterial epidemiology and resistance profiles of primary pathogens in Chinese children from 2016 to 2020 for the first time, analyzed MDRO distributions with time and with age, and described MDROs’ potential threats to children, especially low-immunity neonates. Our study will be very useful to guide antiinfection therapy in Chinese children, as well as worldwide pediatric patients.
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Anuradha S, Samaddar A, Maurya A, Hada V, Narula H, Shrimali T, Gupta N, Kumar P, Singh K, Nag VL. Analysis of Blood Culture Data Influences Future Epidemiology of Bloodstream Infections: A 5-year Retrospective Study at a Tertiary Care Hospital in India. Indian J Crit Care Med 2021; 25:1258-1262. [PMID: 34866822 PMCID: PMC8608638 DOI: 10.5005/jp-journals-10071-23922] [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: 11/23/2022] Open
Abstract
Background Blood cultures are the most significant samples received in a microbiology laboratory. Good quality control of pre-analytic, analytic, and post-analytic stages can have a significant impact on patient outcomes. Here, we present the improvements brought about by reviewing blood culture data with clinicians at a tertiary care institute in India. Methods Four-year blood culture data (phase I—February 2014–February 2018) were shared with clinicians in the clinical grand round. Several take-home messages were discussed in a quiz format, and a number of holistic quality control measures were implemented at different levels. Based on observable changes in blood culture reports, another dataset was analyzed and compared in phase II (April 2018–April 2019). Results In phase II, the blood culture contamination rate improved from 6 to 2% along with four times reduction in ICU isolates and three times increased isolation of salmonellae and pneumococci. The development of resistance in Klebsiella pneumoniae to carbapenems and piperacillin–tazobactam was reduced. Colistin resistance in ICU isolates hovered around 15%. Vaccine-preventable pneumococcal serotypes were predominant in the under-five age-group. Typhoidal salmonellae were more commonly isolated from adults with 50% showing sensitivity to pefloxacin and 97% to ampicillin, chloramphenicol, and cotrimoxazole. Candida parapsilosis was the leading non-albicans Candida (NAC). Fluconazole resistance was observed in 50% of NAC. Conclusion Reviewing blood culture data with clinicians mutually helped us to improve the overall quality of blood culture reports. It had a major impact on epidemiological trends and thus, found to be superior to just sharing an antibiogram with the clinicians. How to cite this article Sharma A, Samaddar A, Maurya A, Hada V, Narula H, Shrimali T, et al. Analysis of Blood Culture Data Influences Future Epidemiology of Bloodstream Infections: A 5-year Retrospective Study at a Tertiary Care Hospital in India. Indian J Crit Care Med 2021;25(11):1258–1262.
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Affiliation(s)
- Sharma Anuradha
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Arghadip Samaddar
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Anand Maurya
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vivek Hada
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Himanshu Narula
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Twishi Shrimali
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Neeraj Gupta
- Department of Neonatology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prawin Kumar
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Kuldeep Singh
- Department of Pediatrics, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Vijaya Lakshmi Nag
- Department of Microbiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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22
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Mitchell J, Purohit M, Jewell CP, Read JM, Marrone G, Diwan V, Stålsby Lundborg C. Trends, relationships and case attribution of antibiotic resistance between children and environmental sources in rural India. Sci Rep 2021; 11:22599. [PMID: 34799577 PMCID: PMC8604955 DOI: 10.1038/s41598-021-01174-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/21/2021] [Indexed: 12/29/2022] Open
Abstract
Bacterial antibiotic resistance is an important global health threat and the interfaces of antibiotic resistance between humans, animals and the environment are complex. We aimed to determine the associations and overtime trends of antibiotic resistance between humans, animals and water sources from the same area and time and estimate attribution of the other sources to cases of human antibiotic resistance. A total of 125 children (aged 1-3 years old) had stool samples analysed for antibiotic-resistant bacteria at seven time points over two years, with simultaneous collection of samples of animal stools and water sources in a rural Indian community. Newey-West regression models were used to calculate temporal associations, the source with the most statistically significant relationships was household drinking water. This is supported by use of SourceR attribution modelling, that estimated the mean attribution of cases of antibiotic resistance in the children from animals, household drinking water and wastewater, at each time point and location, to be 12.6% (95% CI 4.4-20.9%), 12.1% (CI 3.4-20.7%) and 10.3% (CI 3.2-17.3%) respectively. This underlines the importance of the 'one health' concept and requires further research. Also, most of the significant trends over time were negative, suggesting a possible generalised improvement locally.
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Affiliation(s)
- Joseph Mitchell
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Manju Purohit
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, 171 77, Stockholm, Sweden.
- Department of Pathology, R.D. Gardi Medical College, Ujjain, 456006, India.
| | - Chris P Jewell
- Faculty of Health and Medicine, Lancaster Medical School, Lancaster University, Lancaster, England, UK
| | - Jonathan M Read
- Faculty of Health and Medicine, Lancaster Medical School, Lancaster University, Lancaster, England, UK
| | - Gaetano Marrone
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Vishal Diwan
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, 171 77, Stockholm, Sweden
- Division of Environmental Monitoring and Exposure Assessment (Water and Soil), ICMR - National Institute for Research in Environmental Health, Bhopal, 462030, India
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, 171 77, Stockholm, Sweden
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23
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Genomic portrait of community-associated methicillin-resistant Staphylococcus aureus ST772-SCCmec V lineage from India. GENE REPORTS 2021. [DOI: 10.1016/j.genrep.2021.101235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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24
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Jain M, Bang A, Meshram P, Gawande P, Kawhale K, Kamble P, Deotale V, Datta V, Dhanireddy R. Institution of an antibiotic stewardship programme for rationalising antibiotic usage: a quality improvement project in the NICU of a public teaching hospital in rural central India. BMJ Open Qual 2021; 10:bmjoq-2021-001456. [PMID: 34344740 PMCID: PMC8336129 DOI: 10.1136/bmjoq-2021-001456] [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: 02/28/2021] [Accepted: 07/14/2021] [Indexed: 11/03/2022] Open
Abstract
Antibiotic misuse is the most common cause of antimicrobial resistance-a globally declared emergency. This necessitates the introduction of rational antibiotic usage management policy. The paediatrics department of a public teaching hospital with around 500 neonatal intensive care unit (NICU) admissions annually revealed 75% of NICU admission exposure to any antibiotics. The aim was to institute antibiotic stewardship programme (ASP) to optimise antibiotic usage from existing 75% to 40% in a 6-month period through a quality improvement (QI) project.A root cause analysis using fishbone diagram was performed to identify the possible reasons for the high antibiotic usage. Six Plan-Do-Study-Act cycles were conducted to implement the protocols for usage of antibiotics for well-defined indications; active laboratory engagement to decrease the turnaround time for blood culture results; a hard stop to all antibiotic orders after 72 hours; streamlining of antibiotic usage; strengthening universal aseptic practices; and confidence building of staff. The outcomes monitored were antibiotic exposure rates, average number of antibiotic days in all NICU admissions, sepsis rates and mortality.Institution of ASP had significantly reduced antibiotic exposure in NICU admissions, that is, from 75% in March to 41% in August 2018. Median (IQR) antibiotic days per infant in NICU went down from 3 to 0 (0-6). The per cent of NICU admission with culture-positive sepsis and all-cause mortality rate in NICU declined from 18% to 11.56% and 25% to 16%, respectively, over these 6 months.Thus, ASP for rationalising antibiotic usage was successfully instituted in NICU of a rural medical college in central India through QI, without any adverse effect on sepsis and mortality.
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Affiliation(s)
- Manish Jain
- Paediatrics, Mahatma Gandhi Institute of Medical Sciences,Sewagram, Wardha, Maharashtra, India
| | - Akash Bang
- Pediatrics, All India Institute of Medical Sciences-Nagpur, Nagpur, Maharashtra, India
| | - Payal Meshram
- Paediatrics, Mahatma Gandhi Institute of Medical Sciences,Sewagram, Wardha, Maharashtra, India
| | - Prachi Gawande
- Paediatrics, Mahatma Gandhi Institute of Medical Sciences,Sewagram, Wardha, Maharashtra, India
| | - Karuna Kawhale
- Paediatrics, Mahatma Gandhi Institute of Medical Sciences,Sewagram, Wardha, Maharashtra, India
| | - Pushpanjali Kamble
- Paediatrics, Mahatma Gandhi Institute of Medical Sciences,Sewagram, Wardha, Maharashtra, India
| | - Vijayshri Deotale
- Microbiology, Mahatma GandhinInstitute of Medical Sciences,Sewagram, Wardha, Maharashtra, India
| | - Vikram Datta
- Neonatology, Lady Hardinge Medical College, New Delhi, Delhi, India
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25
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De R. Mobile Genetic Elements of Vibrio cholerae and the Evolution of Its Antimicrobial Resistance. FRONTIERS IN TROPICAL DISEASES 2021. [DOI: 10.3389/fitd.2021.691604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Vibrio cholerae (VC) is the causative agent of the severe dehydrating diarrheal disease cholera. The primary treatment for cholera is oral rehydration therapy (ORT). However, in case of moderate to severe dehydration, antibiotics are administered to reduce morbidity. Due to the emergence of multidrug resistant (MDR) strains of VC routinely used antibiotics fail to be effective in cholera patients. Antimicrobial resistance (AMR) is encoded in the genome of bacteria and is usually acquired from other organisms cohabiting in the environment or in the gut with which it interacts in the gut or environmental niche. The antimicrobial resistance genes (ARGs) are usually borne on mobile genetic elements (MGEs) like plasmids, transposons, integrons and SXT constin. Horizontal gene transfer (HGT) helps in the exchange of ARGs among bacteria leading to dissemination of AMR. In VC the acquisition and loss of AMR to many antibiotics have been found to be a dynamic process. This review describes the different AMR determinants and mechanisms of resistance that have been discovered in VC. These ARGs borne usually on MGEs have been recovered from isolates associated with past and present epidemics worldwide. These are responsible for resistance of VC to common antibiotics and are periodically lost and gained contributing to its genetic evolution. These resistance markers can be routinely used for AMR surveillance in VC. The review also presents a precise perspective on the importance of the gut microbiome in the emergence of MDR VC and concludes that the gut microbiome is a potential source of molecular markers and networks which can be manipulated for the interception of AMR in the future.
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26
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Taneja N, Tiewsoh JBA, Gupta S, Mohan B, Verma R, Shankar P, Narayan C, Yadav VK, Jayashree M, Singh S. Antimicrobial resistance in Shigella species: Our five years (2015-2019) experience in a tertiary care center in north India. Indian J Med Microbiol 2021; 39:489-494. [PMID: 34148675 DOI: 10.1016/j.ijmmb.2021.06.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/02/2021] [Accepted: 06/04/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE Shigella is the second leading cause of diarrhoeal mortality especially in children <5 years of age in African and Asian countries. Rapid changes are occurring in the epidemiology of shigellosis and Shigella are increasingly becoming highly drug resistant. To determine the serogroup distribution and antimicrobial resistance of Shigella isolated at our tertiary care centre in North India. METHODS A retrospective study was conducted where demographic details along with antimicrobial susceptibility data of Shigella isolated from stool specimens from 1st January 2015 till 31st December 2019 were retrieved from records and analyzed by WHONET 2019 software. RESULTS Shigella species was isolated in 1.31% (n = 137) of a total of 10,456 stool samples. Males predominated (n = 82; 59.8%) and majority of cases were admitted (n = 94; 68.6%). Children ≤5 years of age (n = 47; 34.3%) were the most commonly affected. Adults in the 21-40 age group contributed 27% of cases (n = 37). Overall, Shigella flexneri (n = 87; 63.5%) was the most common serogroup followed by non-agglutinable Shigella (n = 28; 20.4%) while Shigella sonnei (n = 12, 8.8%) and Shigella boydii (n = 9, 6.6%) fluctuated over the years. Shigella dysenteriae reappeared in 2019 after a hiatus of ten years. Overall, 45.3% (n = 62) of isolates were multidrug resistant to CLSI recommended drugs and high resistance was noted for ampicillin/amoxicillin (68.1%), cotrimoxazole (75.8%) ciprofloxacin (61.5%) and ceftriaxone/cefotaxime (45.2%). CONCLUSIONS Shigella have become highly drug resistant to fluoroquinolones and cephalosporins. Community based studies are required to truly assess the burden of AMR in India.
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Affiliation(s)
- Neelam Taneja
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, 160012, India.
| | - Jutang Babat Ain Tiewsoh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, 160012, India.
| | - Swati Gupta
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, 160012, India.
| | - Balvinder Mohan
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, 160012, India.
| | - Ritu Verma
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, 160012, India.
| | - Pinky Shankar
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, 160012, India.
| | - Chandradeo Narayan
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, 160012, India.
| | - Vivek Kumar Yadav
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, 160012, India.
| | - Muralidharan Jayashree
- Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, 160012, India.
| | - Surjit Singh
- Division of Pediatric Allergy & Immunology, Head of Department, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, 160012, India.
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27
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Sugianli AK, Ginting F, Parwati I, de Jong MD, van Leth F, Schultsz C. Antimicrobial resistance among uropathogens in the Asia-Pacific region: a systematic review. JAC Antimicrob Resist 2021; 3:dlab003. [PMID: 34223081 PMCID: PMC8210283 DOI: 10.1093/jacamr/dlab003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 01/04/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) in urinary tract infections (UTI) is a global public health problem. However, estimates of the prevalence of AMR, required for empirical treatment guidelines, are lacking for many regions. OBJECTIVES To perform a systematic review and summarize the available information about AMR prevalence among urinary Escherichia coli and Klebsiella pneumoniae, the two priority uropathogens, in the Asia-Pacific region (APAC). METHODS PubMed, EBSCO and Web of Science databases were searched for articles (2008-20), following PRISMA guidelines. The prevalence of resistance was calculated and reported as point estimate with 95% CI for antimicrobial drugs recommended in WHO treatment guidelines. Data were stratified by country and surveillance approach (laboratory- or population-based surveillance). The quality of included articles was assessed using a modified Newcastle-Ottawa Quality Assessment Scale. RESULTS Out of 2400 identified articles, 24 studies, reporting on 11 (26.8%) of the 41 APAC countries, met the inclusion criteria. Prevalence of resistance against trimethoprim/sulfamethoxazole, ciprofloxacin, and ceftriaxone ranged between 33% and 90%, with highest prevalence reported from Bangladesh, India, Sri Lanka and Indonesia. Resistance against nitrofurantoin ranged between 2.7% and 31.4%. Two studies reported data on fosfomycin resistance (1.8% and 1.7%). Quality of reporting was moderate. CONCLUSIONS We show very high prevalence estimates of AMR against antibiotics commonly used for the empirical treatment of UTI, in the limited number of countries in the APAC for which data are available. Novel feasible and affordable approaches that facilitate population-based AMR surveillance are needed to increase knowledge on AMR prevalence across the region.
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Affiliation(s)
- Adhi Kristianto Sugianli
- Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Franciscus Ginting
- Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Adam Malik General Hospital, Medan, Indonesia
| | - Ida Parwati
- Department of Clinical Pathology, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Menno D de Jong
- Department of Medical Microbiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank van Leth
- Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Constance Schultsz
- Department of Medical Microbiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Department of Global Health, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
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28
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Anwar N, Ahmed NZ, Fathima AF, Begum S, Khan AA. Emergence of antimicrobial resistance and magnitude of Unani medicine - scope and challenges. JOURNAL OF COMPLEMENTARY & INTEGRATIVE MEDICINE 2021; 18:477-483. [PMID: 33544550 DOI: 10.1515/jcim-2020-0092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/08/2020] [Indexed: 11/15/2022]
Abstract
Emergence of antimicrobial resistance, with practically all newly developed and even more potent antibiotics like carbapenem and colistin, has become a matter of great public health concern. A number of common diseases of public health importance are becoming harder and sometimes impossible to treat due to increased resistance of pathogens. These alarming threats seek prime attention of scientific community to develop newer antibiotics with long-lasting efficacy, least side effects, and low economic burden. Unani classical texts have enormous citations on different infectious diseases. Many single drugs and compound formulations are in vogue since ages for the treatment of infectious diseases. Use of Afaviya (spices), Mufarrehat (exhilarants), Tiryaqi Advia (drugs with antidote properties) and Sirka (vinegar) is highly advocated in treating various infectious diseases. Though, enormous research activities have been undertaken worldwide to explore and develop newer antibiotics from natural resources, indicating massive magnitude of natural products in treating various infectious diseases, however, the higher plants, still largely seems to be unexplored. Moreover, elaborated and well controlled clinical studies are still lacking to authenticate their clinical significance. Hence, a rigorous, well-designed & well-structured research is highly paramount to ascertain the provision of newer, relatively safe and cost effective natural antibiotics.
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Affiliation(s)
- Noman Anwar
- Regional Research Institute of Unani Medicine, Chennai, Tamil Nadu, India
| | - N Zaheer Ahmed
- Regional Research Institute of Unani Medicine, Chennai, Tamil Nadu, India
| | - A Farhath Fathima
- Department of Ilm-us-Saidla, National Institute of Unani Medicine, Bangalore, Karnataka, India
| | - Shehnaz Begum
- Regional Research Institute of Unani Medicine, Chennai, Tamil Nadu, India
| | - Asim Ali Khan
- Central Council for Research in Unani Medicine, Ministry of AYUSH, Govt. of India, New Delhi, India
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29
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Singhal T. "Rationalization of Empiric Antibiotic Therapy" - A Move Towards Preventing Emergence of Resistant Infections. Indian J Pediatr 2020; 87:945-950. [PMID: 31912460 DOI: 10.1007/s12098-019-03144-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 11/25/2019] [Indexed: 12/24/2022]
Abstract
Antimicrobial resistance is a key factor leading to emerging/ re-emerging infections. Rational antimicrobial therapy or antimicrobial stewardship is one of the important interventions to prevent emergence of resistance. Choosing correct empiric therapy is crucial not only to prevent antimicrobial resistance but also to achieve good treatment outcomes. Antimicrobial therapy can be broadly classified as empiric, definitive/ targeted and preventive. It is in choice of empiric therapy that the largest margin of error exists. Paradoxically, empiric therapy is the most commonly employed therapy since microbiologic results are either not available at initiation of treatment or cannot be sent due to logistic reasons or are negative. In the Indian setting, where penetration of microbiologic diagnostic methods in small cities, towns and rural areas is still fairly low, therapy is largely empiric. Choice of empiric therapy is governed by various factors including likely pathogens, antimicrobial resistance, degree of sickness, site of infection and host co-morbidities. These principles can be applied to any clinical syndrome whether it is fever without focus, infections of the respiratory tract, gastrointestinal tract, abdomen, central nervous system, bone and joint, skin and soft tissue, urinary tract as well as neonatal sepsis and healthcare associated infections. Adherence to published guidelines for syndromic management such as that by the Indian Academy of Pediatrics and Indian Council of Medical Research is strongly recommended. One can tailor these guidelines and suggestions made in this article to an individual setting.
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Affiliation(s)
- Tanu Singhal
- Department of Pediatrics and Infectious Disease, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, Maharashtra, India.
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Aerobic Bacteriological and Antibiotic Susceptibility Profile of Pus Isolates from A Tertiary Care Hospital, Puducherry. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2020. [DOI: 10.22207/jpam.14.3.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The antibiotic resistance pattern was observed significantly in various geographical locations. Routine surveillance is therefore essential for constant monitoring of AMR rates in the clinically important pathogens. It is imperative to track the changing resistance pattern over time, to guide proper therapeutic strategies to combat infections due to drug-resistant pathogens. This study aims to highlights the distribution of aerobic bacterial isolated from pus samples, and their susceptibility to different antibiotics collected during 2017 (July to December) in a tertiary care hospital. Nearly 637 clinical pus samples were received during July to December 2017 to the Department of Microbiology, Tertiary care hospital, Puducherry. Bacterial identification was performed using standard conventional biochemical tests and antibiotic susceptibility was carried out according to CLSI guidelines 2017 on each one of the aerobic bacterial isolates from the pus samples. Among the isolates 76.5% were Gram-negative bacilli (GNB) as well as 23.5% were Gram-positive cocci (GPC). The most common bacteria isolated were Pseudomonas spp 24.88% (108 in 434), followed by Escherichia coli 21.66% (94 in 434), Staphylococcus aureus 19.82% (86 in 434) and Klebsiella pneumoniae 13.13% (57 in 434). Of the 86 (19.82%) Staphylococcus aureus isolates, 16 (18.40%) were MRSA. Pseudomonas aeruginosa was highly susceptible to the carbapenems and least susceptible to ciprofloxacin. Acinetobacter baumannii was the most resistant organism according to this study and showed the least susceptibility to ceftriaxone and maximum susceptibility to aminoglycosides. This study concluded that the Pseudomonas aeruginosa isolate was found to be a predominant in our clinical pus samples. Gram negative bacteria are more commonly associated with the pyogenic lesion that Gram positive. A high level of an antibiotic resistance was observed in most of our bacterial isolates.
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Bansal Y, Priyadarshi K, Kombade SP, Nag VL. Diagnostic dilemma in a case of Salmonella Typhi sacroiliitis. J Clin Orthop Trauma 2020; 11:S657-S659. [PMID: 32774044 PMCID: PMC7394796 DOI: 10.1016/j.jcot.2020.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022] Open
Abstract
Sacroiliitis is a rare complication of enteric fever, seen in <1% of the cases and its concomitant presence with hepatitis has been reported only once. Incorrect or delayed diagnosis of enteric fever may lead to serious complications. Here, we present a complicated case of enteric fever in a 15 years old female who was misdiagnosed elsewhere to be a case of dengue fever owing to thrombocytopenia at presentation along with a weak positive dengue IgM immunochromatography test. The patient eventually developed a rare combination of complications (sacroiliitis, hepatitis, ascites and pleural effusion) and was transferred to our hospital where specific antimicrobial treatment was instituted after isolation of Salmonella Typhi from the clinical samples. This case demonstrates the importance of establishing the correct diagnosis by optimum utilization of the diagnostic services at the time of admission to prevent potentially life threatening complications in an otherwise treatable condition.
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Affiliation(s)
| | | | - Sarika P. Kombade
- Corresponding author. Department of Microbiology, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, 342005, India.
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