Comparison of phenotypic characteristics and antimicrobial resistance patterns of clinical Escherichia coli collected from two unrelated geographical areas

Emerging Status of Multidrug-Resistant Bacteria and Fungi in the Arabian Peninsula

Simple Summary

The incidence and developing status of multidrug-resistant bacteria and fungi, as well as their related mortality, is reviewed by a systematic published literature search from nine countries in the Arabian Peninsula. In order to analyse the emerging status and mortality, a total of 382 research articles were selected from a comprehensive screening of 1705 papers. More than 850 deaths reported since 2010 in the Arabian Peninsula due to the infection of multidrug-resistant bacteria and fungi. Multidrug-resistant bacteria Acinetobacter baumannii, Mycobacterium tuberculosis, Staphylococcus aureus, and fungi Candida auris are the most prevalent and causing high deaths. To control these infections and associated deaths in the Arabian Peninsula, continuous preventive measures, accurate methods for early diagnosis of infection, active surveillance, constant monitoring, developing vaccines, eradicating multidrug resistance modulators, and data sharing among countries are required.

Abstract

We aimed to identify the prevalence and emerging status of multidrug-resistant bacteria and fungi and their associated mortality in nine countries in the Arabian Peninsula. Original research articles and case studies regarding multidrug-resistant bacteria and fungi in the Arabian Peninsula, published during the last 10 years, were retrieved from PubMed and Scopus. A total of 382 studies were included as per the inclusion and exclusion criteria, as well as the PRISMA guidelines, from a thorough screening of 1705 articles, in order to analyse the emerging status and mortality. The emerging nature of >120 multidrug-resistant (MDR) bacteria and fungi in the Arabian Peninsula is a serious concern that requires continuous monitoring and immediate preventive measures. More than 50% (n = 453) of multidrug-resistant, microbe-associated mortality (n = 871) in the Arabian Peninsula was due to MDR Acinetobacter baumannii, Mycobacterium tuberculosis and Staphylococcus aureus infection. Overall, a 16.51% mortality was reported among MDR-infected patients in the Arabian Peninsula from the 382 articles of this registered systematic review. MDR A. baumannii (5600 isolates) prevailed in all the nine countries of the Arabian Peninsula and was one of the fastest emerging MDR bacteria with the highest mortality (n = 210). A total of 13,087 Mycobacterium tuberculosis isolates were reported in the region. Candida auris (580 strains) is the most prevalent among the MDR fungal pathogen in the Arabian Peninsula, having caused 54 mortalities. Active surveillance, constant monitoring, the development of a candidate vaccine, an early diagnosis of MDR infection, the elimination of multidrug resistance modulators and uninterrupted preventive measures with enhanced data sharing are mandatory to control MDR infection and associated diseases of the Arabian Peninsula. Accurate and rapid detection methods are needed to differentiate MDR strain from other strains of the species. This review summarises the logical relation, prevalence, emerging status and associated mortality of MDR microbes in the Arabian Peninsula.

Irrational use of antibiotics with representation of antimicrobial resistance patterns in Sudan: a narrative review

Background

Increasing bacterial resistance to antibiotics is a growing menace, mainly caused by the rapid genetic modification of bacterial strains and new alternations in behavior favoring their survival. There is no doubt that the irrational use of antibiotics is one of the factors contributing to the rise of this problem, whether that be in hospitals or at a community level. Although the extent of this influence is yet to be learned, it is definite that this is of great impact on the endemic disease patterns in developing areas specifically and on an expanding global issue generally.

Purpose and scope

This paper will provide a narrative review of relevant previous publications of antibiotic misuse to portray a clearer picture of its causes and consequences in Sudan.

Methodology

The PICO method was used by which evidence-based research websites were scanned for key words. Results were assessed for relevance and then critically appraised. All papers included were summarized and presented in a narrative review format.

Results

From a total of 9 research papers from Pub Med, Scopus, Cochrane and Google Scholar search engines, 7 were selected, presented, and discussed.

Conclusion

Given the facts of high bacterial resistance that has emerged worldwide catastrophically, the implementation of a meticulous surveillance system designed to restrict the irrational use of antibiotics by the public and health sectors alike with adjunct educational and training programs relevant to the regional epidemiology and economy will massively contribute to a lower resistance rate due to antibiotic misuse.

Epidemiology of common resistant bacterial pathogens in the countries of the Arab League

No uniformly organised collection of data regarding antimicrobial resistance has occurred in the countries of the Arab League. 19 countries of the Arab League have published data for antimicrobial susceptibility for the WHO priority organisms, and seven of 14 of these organisms are included in this Review (Escherichia coli, Klebsiella spp, Pseudomonas aeruginosa, Acinetobacter baumannii, Salmonella spp, Staphylococcus aureus, and Streptococcus pneumoniae). Although E coli and Klebsiella spp resistance to third-generation cephalosporins is common in all countries, with prevalence reaching more than 50% in Egypt and Syria, carbapenem resistance is emerging, albeit with a prevalence of less than 10%. Conversely, a large amount of carbapenem resistance has been reported for P aeruginosa and A baumannii across the Arab League, reaching 50% and 88% of isolates in some countries. As for Salmonella spp, the prevalence of fluoroquinolone resistance has exceeded 30% in several areas. With regards to the Gram-positive pathogens, the prevalence of meticillin resistance in S aureus is reported to be between 20% and 30% in most countries, but exceeds 60% in Egypt and Iraq. The prevalence of penicillin non-susceptibility among pneumococci has reached more than 20% in Algeria, Egypt, Morocco, Saudi Arabia, and Tunisia. These findings highlight the need for structured national plans in the region to target infection prevention and antimicrobial stewardship.

Prevalence of current patterns and predictive trends of multidrug-resistant Salmonella Typhi in Sudan

Background

Enteric fever has persistence of great impact in Sudanese public health especially during rainy season when the causative agent Salmonella enterica serovar Typhi possesses pan endemic patterns in most regions of Sudan - Khartoum.

Objectives

The present study aims to assess the recent state of antibiotics susceptibility of Salmonella Typhi with special concern to multidrug resistance strains and predict the emergence of new resistant patterns and outbreaks.

Methods

Salmonella Typhi strains were isolated and identified according to the guidelines of the International Standardization Organization and the World Health Organization. The antibiotics susceptibilities were tested using the recommendations of the Clinical Laboratories Standards Institute. Predictions of emerging resistant bacteria patterns and outbreaks in Sudan were done using logistic regression, forecasting linear equations and in silico simulations models.

Results

A total of 124 antibiotics resistant Salmonella Typhi strains categorized in 12 average groups were isolated, different patterns of resistance statistically calculated by (y = ax − b). Minimum bactericidal concentration’s predication of resistance was given the exponential trend (y = n e^x) and the predictive coefficient R² > 0 < 1 are approximately alike. It was assumed that resistant bacteria occurred with a constant rate of antibiotic doses during the whole experimental period. Thus, the number of sensitive bacteria decreases at the same rate as resistant occur following term to the modified predictive model which solved computationally.

Conclusion

This study assesses the prediction of multi-drug resistance among S. Typhi isolates by applying low cost materials and simple statistical methods suitable for the most frequently used antibiotics as typhoid empirical therapy. Therefore, bacterial surveillance systems should be implemented to present data on the aetiology and current antimicrobial drug resistance patterns of community-acquired agents causing outbreaks.

Electronic supplementary material

The online version of this article (10.1186/s12941-017-0247-4) contains supplementary material, which is available to authorized users.

Antimicrobial resistance in bacterial pathogens among hospitalized children with community acquired lower respiratory tract infections in Dongguan, China (2011-2016)

BACKGROUND

Bacterial pathogens are a major cause of childhood community acquired lower respiratory tract infections (CA-LRTIs), and few data described the impact of antimicrobial resistance on children with CA-LRTIs. This study aims to investigate the antimicrobial resistance in common bacterial agents among hospitalized children with CA-LRTIs between 2011 and 2016 in Dongguan, China.

METHODS

Sputum samples were collected from hospitalized children (0-5 years old) with CA-LRTIs in Dongguan Children's Hospital. Bacterial pathogens were detected using traditional culture methods, and disc diffusion tests were used to determine antibiotic resistance.

RESULTS

Among the 2360 samples analyzed, 342 (14.5%) were positive for bacterial infection. The most prevalent pathogen was MSSA (2.3%), followed by MRSA (1.5%), E. coli (1.7%), E. coli ESBLs (1.2%), K. pneumonia ESBLs (1.5%), K. pneumonia (1.4%) and S. pneumonia (1.3%). Of the hospitalized patients with bacteria causing of CA-LRTIs, 90.1% were less than 1-year-old. MSSA and MRSA were more commonly isolated in infants less than 3 months. E. coli, K. pneumonia and K. pneumonia ESBLs were more common bacteria causing CA-LRTIs in infants less than 1 month. Resistance levels to penicillins, fluoroquinolones, macrolides, cephalosporins, carbapenems and vancomycin varied in different bacteria.

CONCLUSIONS

S. aureus, E coli and K. pneumonia were the common bacterial isolates recovered from chidren with CA-LTRIs during 2011-2015. Age group of under 1 year old was at a high risk of bacterial infections. Many isolates showed antibiotic resistance level was associated with antibiotic usage in clinic. Increasing surveillance of antibiotic resistance is urgently needed and develops better strategies to cure the antibiotic abuse in China.

Antimicrobial resistance in Africa: a systematic review

BACKGROUND

Antimicrobial resistance (AMR) is widely acknowledged as a global problem, yet in many parts of the world its magnitude is still not well understood. This review, using a public health focused approach, aimed to understand and describe the current status of AMR in Africa in relation to common causes of infections and drugs recommended in WHO treatment guidelines.

METHODS

PubMed, EMBASE and other relevant databases were searched for recent articles (2013-2016) in accordance with the PRISMA guidelines. Article retrieval and screening were done using a structured search string and strict inclusion/exclusion criteria. Median and interquartile ranges of percent resistance were calculated for each antibiotic-bacterium combination.

RESULTS

AMR data was not available for 42.6% of the countries in the African continent. A total of 144 articles were included in the final analysis. 13 Gram negative and 5 Gram positive bacteria were tested against 37 different antibiotics. Penicillin resistance in Streptococcus pneumoniae was reported in 14/144studies (median resistance (MR): 26.7%). Further 18/53 (34.0%) of Haemophilus influenza isolates were resistant to amoxicillin. MR of Escherichia coli to amoxicillin, trimethoprim and gentamicin was 88.1%, 80.7% and 29.8% respectively. Ciprofloxacin resistance in Salmonella Typhi was rare. No documented ceftriaxone resistance in Neisseria gonorrhoeae was reported, while the MR for quinolone was 37.5%. Carbapenem resistance was common in Acinetobacter spp. and Pseudomonas aeruginosa but uncommon in Enterobacteriaceae.

CONCLUSION

Our review highlights three important findings. First, recent AMR data is not available for more than 40% of the countries. Second, the level of resistance to commonly prescribed antibiotics was significant. Third, the quality of microbiological data is of serious concern. Our findings underline that to conserve our current arsenal of antibiotics it is imperative to address the gaps in AMR diagnostic standardization and reporting and use available information to optimize treatment guidelines.

Multidrug resistance Acinetobacter species at the intensive care unit, Aseer Central Hospital, Saudi Arabia: A one year analysis

OBJECTIVE

To identify and to determine the antimicrobial susceptibility of Acinetobacter baumannii (A. baumannii) clinical isolates from ICU at Aseer Central Hospital.

METHODS

The study was conducted in the Intensive Care Unit, Aseer Central Hospital, Saudi Arabia over 13 months period (2014-2015). Acinetobacter species (n = 105) were isolated from various clinical samples. Isolates were identified using selected phenotypic criteria and confirmed using the Vitek 2 automated system. This system was used to determine the susceptibilities of 21 antimicrobial agents. Patients, isolates and drug data were analyzed using the SPSS statistical software package to determine some epidemiological and microbiological patterns.

RESULTS

Of the 105 stains, A. baumannii accounted for 49 (46.67%), A. baumannii complex, 19 (18.09%), A. baumannii/haemolyticus 32 (30.47), Acinetobacter haemolyticus 4 (3.81%), Acinetobater lwoffii 1 (0.95%) and unidentified Acinetobater species 2 (1.3%). Of the 105 Acinetobacter strains, 103 (98.1%) were found multidrug resistant (MDR). A. baumannii strain were 100% sensitive to colistin and 74.5% to trimethoprim + sulfamethoxazole. The remaining 19 antimicrobial agents revealed low or no sensitivities: amikacin 16.3%; ampicillin 7.7%; ceftazidime, 7.3%. Distribution of similar sensitivities was shown by other Acinetobacter species. Mean number of isolates from males and females indicates no statistical variation (P = 0.867) whereas age groups showed significant differences (P = 0.008) as it is clear from the high percentage of infected individuals more than 60 years followed by those aged 20-29 years old (19.05%). Upper respiratory tract (30.48%), lower respiratory tract (47.65%) and subcutaneous tissue (9.5%) were the main sources of Acinetobacter spp. but mean numbers of isolates from these specimens indicate no discrepancy between specimens (P = 0.731).

CONCLUSIONS

Acinetobacter species including A. baumannii were found MDR (98.1%) according to the current Acinetobacter spp. antimicrobial categorization. Approximately half of these strains were A. baumannii. All Acinetobacter species were 100% sensitive to colistin and to some extent to trimethoprim + sulfamethoxazole (74.5%). ICU-acquired pneumonia among patients over 60 years of age who spend prolong times at artificial ventilations made up the majority of the cases.