Wild griffon vultures (Gyps fulvus) fed at supplementary feeding stations: Potential carriers of pig pathogens and pig‐derived antimicrobial resistance?

The carriage of two important pathogens of pigs, that is enterotoxigenic Escherichia coli (ETEC) and Clostridioides difficile, was investigated in 104 cloacal samples from wild griffon vultures (Gyps fulvus) fed on pig carcasses at supplementary feeding stations (SFS), along with their level of antimicrobial resistance (AMR). E. coli was isolated from 90 (86.5%) samples, but no ETEC was detected, likely because ETEC fimbriae confer the species specificity of the pathogen. Resistance to at least one antimicrobial agent was detected in 89.9% of E. coli isolates, with AMR levels being extremely high (>70%) for tetracycline and streptomycin and very high (>50%) for ampicillin and sulfamethoxazole–trimethoprim. Resistance to other critically important antimicrobials such as colistin and extended‐spectrum cephalosporins was 2.2% and 1.1%, respectively, and was encoded by the mcr‐1 and bla_SHV‐12 genes. Multidrug resistance was displayed by 80% of the resistant E. coli, and bla_SHV‐12 gene shared plasmid with other AMR genes. In general, resistance patterns in E. coli from vultures mirrored those found in pigs. Clostridioides difficile was detected in three samples (2.9%); two of them belonged to PCR ribotype 078 and one to PCR ribotype 126, both commonly found in pigs. All C. difficile isolates were characterized by a moderate‐to‐high level of resistance to fluoroquinolones and macrolides but susceptible to metronidazole or vancomycin, similar to what is usually found in C. difficile isolates from pigs. Thus, vultures may contribute somewhat to the environmental dissemination of some pig pathogens through their acquisition from pig carcasses and, more importantly, of AMR for antibiotics of critical importance for humans. However, the role of vultures would likely be much lesser than that of disposing pig carcasses at the SFS. The monitoring of AMR, and particularly of colistin‐resistant and ESBL‐producing E. coli, should be considered in pig farms used as sources of carcasses for SFS.     

Antibiotic resistance of urinary tract pathogens and rationale for empirical intravenous therapy

Empirical antibiotic treatment in urinary tract infection (UTI) in children must rely on surveillance data on the epidemiology and resistance patterns of common uropathogens. A retrospective analysis of bacteria isolated from children with UTI irrespective of underlying disease or pre-treatment was performed at the University Hospital of Freiburg, Germany, in 1997, and from 1999 to 2001. In the first study period, 261 positive urine samples and in the second period 684 positive samples were analyzed. Escherichia coli (57.2%) was the leading uropathogen followed by Enterococcus spp. (13.7%), Pseudomonas aeruginosa (7.0%), Proteus spp. (5.9%), Klebsiella spp. (4.7%), and Enterobacter/Citrobacter spp. (4.3%). Almost 50% of the E. coli isolates were resistant to ampicillin, but effectively no resistance against cephalosporins, aminogylcosides, ciprofloxacin, nitrofurantoin, and imipenem was observed. In Enterococcus spp. the resistance to ampicillin was about 15% and 40% to netilmicin, while none of the latter showed high-level aminoglycoside resistance. In P. aeruginosa, there was no resistance to aminoglycosides. No difference in resistance patterns between the two study periods was observed. We conclude that an empirical combination treatment of ampicillin and gentamicin, netilmicin, or tobramycin is appropriate in children with UTI independent of pre-treatment or underlying disease. This therapy should be clinically efficacious, well tolerated, and cost effective, and should prevent unnecessary development of antimicrobial resistance.     

Population structure and antimicrobial resistance traits of avian‐origin mcr‐1‐positive Escherichia coli in Eastern China, 2015 to 2017

Recent emergence of mcr‐1‐positive Escherichia coli (MCRPEC) is causing serious concern around the world. Due to poultry‐origin E. coli holding zoonotic potential, the improved understandings of MCRPEC population structure and antimicrobial resistance are critical to public health purposes. This study provided novel insights into the molecular epidemiology of avian‐origin MCRPEC. For the mcr genes prevalence study, we analysed 1,360 E. coli recovered from avian colibacillosis in eastern China from 2015 to 2017. The mcr‐1 was present in 172 (12.6%) E. coli isolates. For all of MCRPEC isolates, MICs of colistin were ≥4 mg/L. Avian‐origin MCRPEC was widely distributed throughout phylogroups A, B1, B2, D, and F. Moreover, those isolates were assigned to 52 unique STs, such as ST48, ST117, ST131, and ST648, suggesting substantial horizontal dissemination of mcr‐1 gene through avian‐origin E. coli populations. The susceptibility of MCRPEC isolates was tested with 26 antimicrobial agents from 16 antimicrobial categories. There were high resistance rates of MCRPEC isolates against the clinically used antibiotics. All MCRPEC isolates in this study presented the multidrug‐resistant (MDR) trait were even considered as extensively drug‐resistant (XDR) strains. Resistance genotypes and plasmid replicon profiling showed that a majority of MCRPEC isolates contained plasmid‐mediated resistance genes and exhibited the co‐existence of mcr‐1 with ESBLs and pAmpCs genes. Furthermore, the overlapped distribution of ST types and resistance gene contents was detected among MCRPEC isolates from humans and poultry. Besides mcr‐1, our findings highlighted a significant prevalence of plasmid‐mediated resistance genes among avian‐origin MCRPEC isolates.     

Antimicrobial Resistance of F4+ Escherichia Coli Isolated from Swine in Italy

Four‐hundred and forty‐two F4+ pathogenic Escherichia coli were isolated in a period of 10 years (2002–2011), from pigs that were suffering from diarrhoea belonging to Italian swine herds. The strains were analysed for their susceptibility to 12 antimicrobials using the disc diffusion method. During the study period, a statistically significant proportion of isolates resistant to enrofloxacin (14.5–89.3%), marbofloxacin (5.4–60.7%), flumequine (49.1–92.9%), danofloxacin (21.6–80%), florfenicol (9.8–64.3%), thiamphenicol (50–92%) and cefquinome (3.8–44%) was recorded. An increase in resistance (not statistically significant) to gentamicin (63.6–85.7%), apramycin (61.8–82.1%), trimethoprim‐sulphamethoxazole (75–89.3%), tetracycline (97–100%) and erythromycin (92.4–100%) was also observed. Based on antimicrobial multiresistance, the strains were collected into three groups: I. resistant to 2–5 antimicrobials; II. resistant to 6–8 antimicrobials; III. resistant to 9–12 antimicrobials. The number of isolates belonging to the first group showed a statistically significant decrease (P < 0.05; R² = 0.896; r = −0.9608), while the isolates belonging to the second and third groups showed a statistically significant increase in resistance (P < 0.05; R² = 0.753; r = 0.8890 and P < 0.05; R² = 0.727; r = 0.8701, respectively) over the period of study. The results of this study suggest the need for continued monitoring of the development of resistance.     

Antimicrobial susceptibility profile of selected bacteraemic pathogens from private institutions in South Africa.

OBJECTIVES: The National Antimicrobial Surveillance Forum is a continuous surveillance organisation comprising all academic/public and private sector laboratories in South Africa. METHODS: The antibiotic susceptibility of blood culture isolates of Escherichia coli, Klebsiella pneumoniae, Enterobacter species, Pseudomonas aeruginosa, Acinetobacter baumannii and Staphylococcus aureus from patients in private hospitals in five major centres were investigated. Antimicrobial susceptibility tests were performed by 12 participating laboratories according to the Clinical and Laboratory Standards Institute (CLSI) guidelines. Extended-spectrum b-lactamase (ESBL) production was determined in selected species of Enterobacteriaceae irrespective of source. RESULTS: The overall prevalence of ampicillin resistance in blood culture isolates of E. coli (N = 471) was 84%, and 20% were resistant to the fluoroquinolones. Considerable geographical differences were noted between the centres with regard to the K. pneumoniae (N = 636) resistance rates for ceftriaxone and/or cefotaxime (39 - 87%). The most active agents in the Enterobacter spp. (N = 244) were imipenem/meropenem, ertapenem, ciprofloxacin, levofloxacin and cefepime, with 100%, 94%, 88%, 87% and 80% susceptibility, respectively. Carbapenem resistance in P. aeruginosa (N = 382) varied between 42% and 45%, and in the case of A. baumannii (N = 190) resistance varied between 32% and 33% for meropenem and imipenem respectively. The nationwide incidence of oxacillin resistance in S. aureus (N = 629) was 36%. Overall, the prevalence of ESBL production among all isolates of K. pneumoniae was 26% (N = 7 514), while in Enterobacter spp. it was 12% (N = 4 031) and in E. coli 5% (N = 28 412). CONCLUSIONS: The data highlight the widespread problem of antibiotic resistance among important bacteraemic pathogens in private institutions in South Africa. Continued surveillance is vital to guide appropriate empirical therapy for invasive infections.     

Identifying emerging trends in antimicrobial resistance using Salmonella surveillance data in poultry in Spain

Despite of controls and preventive measures implemented along the food chain, infection with non‐typhoidal Salmonella (NTS) remains one of the major causes of foodborne disease worldwide. Poultry is considered one of the major sources of NTS. This has led to the implementation of monitoring and control programmes in many countries (including Spain) to ensure that in poultry flocks infection is kept to a minimum and to allow the identification and monitoring of circulating NTS strains and their antimicrobial resistance (AMR) phenotypes. Here, we investigated the information from the monitoring programme for AMR in Salmonella from poultry in Spain in 2011–2017 to assess the diversity in phenotypic resistance and to evaluate the programme's ability to detect multi‐resistance patterns and emerging strains in the animal reservoir. Data on serotype and AMR to nine antimicrobials obtained from 3,047 NTS isolates from laying hens (n = 1,060), broiler (n = 765) and turkey (n = 1,222) recovered during controls performed by the official veterinary services and food business operators were analysed using univariate and multivariate methods in order to describe host and serotype‐specific profiles. Diversity and prevalence of phenotypic resistance to all but one of the antimicrobials (colistin) were higher in NTS from broiler and turkey compared with laying hen isolates. Certain combinations of serotype and AMR pattern (resistotype) were particularly linked with certain hosts (e.g. susceptible Enteritidis with laying hens, multi‐drug resistant (MDR) Derby in turkey, MDR Kentucky in turkey and broiler). The widespread presence of certain serotype‐resistotype combinations in certain hosts/years suggested the possible expansion of MDR strains in the animal reservoir. This study demonstrates the usefulness of the analysis of data from monitoring programmes at the isolate level to detect emerging threats and suggests aspects that should be subjected to further research to identify the forces driving the expansion/dominance of certain strains in the food chain.     

The changing pattern of antimicrobial resistance within 42,033 Escherichia coli isolates from nosocomial, community and urology patient-specific urinary tract infections, Dublin, 1999-2009

Study Type – Therapy (practice patterns cohort) Level of Evidence not applicable What's known on the subject? and What does the study add? Epidemiological and resistance patterns of bacterial pathogens in urinary tract infections show large inter‐regional variability, and rates of bacterial resistance are continually changing due to different regional antibiotic treatment regime. In Ireland and the UK, trimethoprim or nitrofurantoin is usually recommended for empirical treatment of uncomplicated cystitis in the community whilst parenteral cephalosporins, aminoglycosides, quinolones and co‐amoxyclav are reserved for complicated UTIs. Neither penicillins nor trimethoprim represent suitable empirical antimicrobial agents for UTI in this study population. The high rate of ciprofloxacin resistance in encountered is suggestive of an over‐reliance on this agent in this population and with resistance rates approaching 30%, empirical use of quinolones for urology patients is inadvisable. E. coli UTIs have remained extremely sensitive to nitrofurantoin across all three patient sample groups in this population and the resistance rate has not changed significantly over the eleven‐year study period.

OBJECTIVE

• ? To investigate the changing pattern of antimicrobial resistance in Escherichia coli urinary tract infection over an eleven year period, and to determine whether E. coli antibiotic resistance rates vary depending on whether the UTI represents a nosocomial, community acquired or urology patient specific infection.

PATIENT AND METHODS

• ? A retrospective analysis of the 42 033 E. coli urine isolates from the 11‐year period 1999–2009 in a single Dublin teaching hospital was performed.
• ? WHONET^TM software was used to analyse the changing pattern of sensitivity and resistance of E. coli to commonly used antibiotics over the study period.
• ? The origins of the urine samples were stratified into three groups: inpatients with nosocomial UTIs; urine originating from the emergency department and general practice (community UTIs); and UTIs in urology patients.

RESULTS

• ? Urinary tract infections in the urology patient population demonstrate higher antibiotic resistance rates than nosocomial or community UTIs.
• ? There were significant trends of increasing resistance over the 11‐year period for ampicillin, trimethoprim, gentamicin and ciprofloxacin, and significant differences in co‐amoxyclav, gentamicin, nitrofurantion and ciprofloxacin resistance rates depending on the sample origin.
• ? Ampicillin and trimethoprim were the least active agents against E. coli, with total 11‐year resistance rates of 58.3 and 33.8%, respectively.
• ? The overall gentamicin resistance rate was 3.4% and is climbing at a rate of 0.7% per year (P < 0.001). Within the urology patient population the resistance rate was 6.4%.
• ? Ciprofloxacin resistance approaches 20% in the nosocomial UTI population and approaches 30% in the urology population; however, it remains a reasonable empirical antibiotic choice in this community, with an 11‐year resistance rate of 10.6%.

CONCLUSIONS

• ? E. coli remains the commonest infecting uropathogen in the community and hospital setting with its incidence climbing from 50 to 60% of UTIs over the 11‐year period.
• ? Neither penicillins nor trimethoprim represent suitable empirical antimicrobials for UTI and ciprofloxacin resistance in this Dublin‐based study renders it unsuitable empirical therapy for nosocomial UTIs and UTIs in the urology population.
• ? The dramatic 11‐year rate increase in gentamicin resistance is of paramount concern.

     

Surviving Sepsis in the Intensive Care Unit: The Challenge of Antimicrobial Resistance and the Trauma Patient

Sepsis in the intensive care unit (ICU) presents a great challenge to any critical care clinician. Patients admitted to the ICU are especially vulnerable to sepsis due to the nature of the underlying pathology that warranted admission to the ICU and deranged physiological function coupled with invasive procedures. Nosocomial infections are common in patients admitted to the ICU, and with these infections come the burden of multidrug-resistant organisms. Antimicrobial resistance (AMR) is now a global emergency that warrants the attention of every health-care professional. AMR has escalated to epic proportions and solutions to this problem are now a matter of “life and death.” The ICU also represents the “breeding ground” of antibiotic-resistant organisms due to the high broad-spectrum antibiotic consumption. Many would argue that broad-spectrum antimicrobials are overprescribed in this patient population, but do all patients admitted to the ICU warrant such therapy? Is there evidence that narrower-spectrum antimicrobial agents can be employed in specific ICU populations coupled with surveillance strategies? The aims of this review are to focus on strategies with the aim of optimizing antimicrobial use within ICUs, and to highlight the importance of differentiating ICU populations with regard to the use of antimicrobial agents.     

Phenotypic and genotypic analyses of antimicrobial resistant bacteria in livestock in Uganda

Antimicrobial resistant bacteria (ARB) in livestock are a global public health concern, not only because they prolong infectious diseases but also they can be transferred from animals to humans via the food chain. Here, we studied ARB in livestock at commercial and subsistence farms (n = 13) in Wakiso and Mpigi districts, Uganda. We enquired from the farmers about the type and the purpose of antimicrobial agents they have used to treat their livestock. After collecting faeces, we isolated antimicrobial resistant Escherichia coli from livestock faeces (n = 134) as an indicator bacterium. These strains showed resistance to ampicillin (44.8%), tetracycline (97.0%), and sulfamethoxazole‐trimethoprim (56.7%). The frequency of ampicillin‐resistance was significantly correlated with the usage of penicillins to livestock in the farms (p = 0.04). The metagenomics data detected 911 antimicrobial resistant genes that were classified into 16 categories. Genes for multidrug efflux pumps were the most prevalent category in all except in one sample. Interestingly, the genes encoding third‐generation cephalosporins (bla_CTX‐M), carbapenems (bla_ACT), and colistin (arnA) were detected by metagenomics analysis although these phenotypes were not detected in our E. coli strains. Our results suggest that the emergence and transmission of cephalosporin, carbapenem, and/or colistin‐resistant bacteria among livestock can occur in future if these antimicrobial agents are used.     

Antimicrobial susceptibility of pediatric uropathogens in Thrace,Greece

The aim of this study was to investigate the bacterial pathogens involved in pediatric urinary tract infections (UTIs) in a tertiary general hospital located in the Thrace province of Northern Greece over a 69-month period (1/2003 to 9/2008), and their antibiotic susceptibility patterns. A total of 622 episodes of UTIs in 508 children were identified. Median age of all children was 16 months (range 1 month to 14 years). Boys were significantly younger than girls (9 months vs. 24 months). Escherichia coli was the most common uropathogen and responsible for 69.1% of UTIs. Approximately half of E. coli isolates were resistant to ampicillin and 20.5% to trimethoprim/sulfamethoxazole (TMP/SMX). E. coli resistance to second-generation and third-generation cephalosporins was <4%, to aminoglycosides <8%, and to nitrofurantoin 4.4%. Pediatric E. coli urine isolates were significantly more resistant to ampicillin and ticarcillin and more sensitive to quinolones compared to adult E. coli uropathogens identified in the same hospital. E. coli resistance to ampicillin and amoxicillin/clavulanic acid was significantly higher in boys 12–23 months-old compared to girls of the same age. In conclusion, nitrofurantoin is a very good choice for chemoprophylaxis. Amoxicillin/clavulanic acid, second-generation cephalosporins, and TMP/SMX are appropriate choices for oral empirical treatment of UTIs. Parenteral aminoglycosides and second and third-generation cephalosporins are excellent treatment choices for inpatient therapy. Finally, sex and age are additional factors that should be taken into account when choosing empirical therapy for children with UTIs.     

外科感染常见菌群分布及致病菌耐药性监测

目的了解武汉地区外科感染致病菌的菌群分布及其对抗生素的耐药现状。方法将武汉地区１３所医院所做的抗生素对外科分离菌的抑菌结果即抑菌圈直径输入计算机。采用“ＷＨＯＮＥＴ３”软件进行统计和分析,根据１９９３年美国临床实验室标准委员会（ＮＣＣＬＳ）发布的标准判断细菌耐药性。结果１９９６年共收集外科感染菌株９５７株。金黄色葡萄球菌、铜绿假单胞菌、大肠杆菌和凝固酶阴性葡萄球菌（ＣＮＳ）是主要菌种。１２４％的金黄色葡萄球菌对苯唑西林耐药,对其它抗生素的耐药性也有所增加。肠杆菌科菌株对氨苄西林的耐药率＞７５％,克雷伯菌属对此的耐药率达９３％。大多数革蓝阴性（Ｇ－）杆菌,包括肠杆菌科和铜绿假单胞菌对亚胺配南、头孢他啶、阿米卡星和环丙沙星敏感。结论在外科领域开展细菌耐药性监测工作,并随时掌握细菌耐药动态具有重要的临床意义     

Defining antimicrobial resistance in cystic fibrosis

Antimicrobial resistance (AMR) can present significant challenges in the treatment of cystic fibrosis (CF) lung infections. In CF and other chronic diseases, AMR has a different profile and clinical consequences compared to acute infections and this requires different diagnostic and treatment approaches. This review defines AMR, explains how it occurs, describes the methods used to measure AMR as well as their limitations, and concludes with future directions for research and development in the area of AMR in CF.     

Febrile urinary tract infection in children: ampicillin and trimethoprim insufficient as empirical mono-therapy

The aim of this study was to characterize the pathogens and their antibiotic susceptibilities in defined groups of children (total number 694) with urinary tract infection (UTI) regarding age, first UTI (FUTI) or recurrent UTI (RUTI), renal abnormalities or vesico-ureteric reflux (VUR) in order to optimize empirical antibiotic therapy and prophylaxis. In patients aged between 1 month and 24 months with a first febrile UTI (FUTI; n = 205) the leading pathogen was Escherichia coli (E. coli) (83.4%). In comparison with patients with FUTI, those with RUTI (n = 24) had more Enterococcus and Enterobacter infections and higher resistance rates of E. coli against trimethoprim (TMP), trimethoprim/sulfamethoxazole (SXT) or ampicillin (AMP). Boys with ultrasound-detected renal abnormalities (n = 71) showed 14.2% Pseudomonas and 59.1% E. coli infections versus girls (n = 48) (2.1% Pseudomonas and 93.7% E. coli). Of 390 patients who underwent voiding cysto-urethrography, 31.5% had VUR. Of them, 45.5% received antimicrobial prophylaxis with SXT (n = 30) or cefazolin (n = 26). There was no difference between girls (n = 242) and boys (n = 148) regarding the frequency of VUR and pathogens. There were more TMP- and SXT-resistant E. coli cultures from patients with VUR (37.8%) than from those without VUR (25.8%). Treatment with TMP, SXT and AMP alone appeared to be insufficient in many cases because of high resistance rates of E. coli and other uropathogens.     

Bioaerosol and surface sampling for the surveillance of influenza A virus in swine

Influenza A virus in swine is of significant importance to human and veterinary public health. Environmental sampling techniques that prove practical would enhance surveillance for influenza viruses in swine. The primary objective of this study was to demonstrate the feasibility of bioaerosol and surface sampling for the detection of influenza virus in swine barns with a secondary objective of piloting a mobile application for data collection. Sampling was conducted at a large swine operation between July 2016 and August 2017. Swine oral fluids and surface swabs were collected from multiple rooms. Room‐level air samples were collected using four bioaerosol samplers: a low volume polytetrafluoroethylene (PTFE) filter sampler, the National Institute for Occupational Safety and Health's low volume cyclone sampler, a 2‐stage Andersen impactor and/or one high volume cyclonic sampler. Samples were analysed using quantitative RT‐PCR. Data and results were reported using a mobile data application. Eighty‐nine composite oral fluid samples, 70 surface swabs and 122 bioaerosol samples were analysed. Detection rates for influenza virus RNA in swine barn samples were 71.1% for oral fluids, 70.8% for surface swabs and 71.1% for the PTFE sampler. Analysis revealed a statistically significant relationship between the results of the PTFE sampler and the surface swabs with oral fluid results (p < 0.001 and p < 0.01 respectively). In addition, both the PTFE sampler (p < 0.01) and surface swabs (p = 0.03) significantly correlated with, and predicted oral fluid results. Bioaerosol sampling using PTFE samplers is an effective hands‐off approach for detecting influenza virus activity among swine. Further study is required for the implementation of this approach for surveillance and risk assessment of circulating influenza viruses of swine origin. In addition, mobile data collection stands to be an invaluable tool in the field by allowing secure, real‐time reporting of sample collection and results.     

Serotype and antimicrobial susceptibility patterns of Haemophilus influenzae isolates from inpatients and outpatients in Johannesburg

During the 6-month period July 1987-January 1988, 934 isolates of Haemophilus influenzae were collected from 6 laboratories in Johannesburg. On the basis of counter-immuno-electrophoresis, 30 of the isolates were serotype b, with 9 of 36 (25%) cerebrospinal fluid isolates being type b. Overall, 11.7% of the isolates produced beta-lactamase. The prevalence of resistance based on a disc diffusion test was ampicillin 14%, chloramphenicol 2.3%, cefaclor 4.4%, erythromycin 84.9%, tetracycline 4.7% and co-trimoxazole 9.7%. Problems were encountered with the disc diffusion testing of augmentin- and minimum inhibitory concentrations (MICs) were determined. The MICs of 40 isolates were compared with their zone diameters. Good correlation between these two methods of antimicrobial susceptibility testing was found with all the antimicrobials tested excluding augmentin (correlation coefficient 0.1234) and cefaclor (correlation coefficient -0.2473).     

Surveillance of antibiotic resistance in ICUs in southeastern Sweden

BACKGROUND: A study was designed to assess a computer-based program for continuous registration of antibiotic resistance, statistics concerning severity of illness, and consumption of antibacterial drugs. METHODS: The frequency of antibiotic resistance among bacteria in eight ICUs in southeastern Sweden was investigated yearly from 1995 through 1997. The antibiotic consumption in the ICUs was registered as defined daily doses (DDD) and compared to severity of illness (APACHE-II scores). RESULTS: There was a statistically significant increase in ampicillin resistance among Enterococcus spp. between 1996 and 1997, which was due to a shift from Enterococcus faecalis to Enterococcus faecium. A high prevalence of resistance among coagulase-negative staphylococci to oxacillin (approximately 70%), ciprofloxacin (approximately 50%), fucidic acid (approximately 50%) and netilmicin (approximately 30%) was seen in all ICUs during the whole study period. There was a statistically significant increase in ciprofloxacin resistance among Escherichia coli and Enterococcus spp. The resistance among Enterobacter spp. to cefotaxime decreased but this change was not statistically significant. Efforts were made to avoid betalactam antibiotics, except carbapenems, for treatment of infections caused by Enterobacter spp. and the consumption of cephalosporins decreased whereas the consumption of carbapenems increased. The total antibiotic consumption decreased by 2.5% during the study period. There was no correlation between APACHE II scores and antibiotic consumption. CONCLUSIONS: Each ICU within a hospital ought to have a program for "on-line" antibiotic resistance surveillance of drugs used in that unit so that changes in empirical treatment can be made when there is an increase in antibiotic-resistant isolates within that unit.     

Antimicrobial resistance of uropathogens in women with acute uncomplicated cystitis from primary care settings

We assessed the antimicrobial resistance patterns of all urine samples submitted for culture from outpatient women aged ≥14 years with diagnosis of uncomplicated cystitis over a 24-month period (2007–2009) in the city of Fortaleza, Brazil. Only bacterial growth of a single uropathogen with ≥10⁵ CFU/mL was considered for analysis. The Pearson’s chi-square test was used for bivariate correlations. Escherichia coli presented the highest prevalence (64.7%). Coagulase-negative staphylococcus was more common in younger than in older women (P = 0.003). Gentamicin presented the lowest overall resistance pattern (3.5% resistant), followed by ceftriaxone (5%) and norfloxacin (7.5%). Ampicillin and trimethoprim-sulfamethoxazole were the least active agents with 63.7% and 39.8% of resistance, respectively. The resistant rate to trimethoprim-sulfamethoxazole was significantly higher among E. coli than non-E. coli isolated. Among ciprofloxacin-resistant E. coli strains, only 3.4% were resistant to nitrofurantoin. We conclude that trimethoprim-sulfamethoxazole follows a worldwide tendency of antimicrobial increasing resistance and it should be avoided as first-line empirical treatment for urinary tract infections.     

Molecular epidemiology and antimicrobial resistance mechanisms of Campylobacter coli from diarrhoeal patients and broiler carcasses in Belgium

The aim of this study was to better understand the molecular epidemiology of Campylobacter coli isolated from multiple sources in Belgium, by studying the genotypic diversity and antimicrobial resistance phenotypes and resistance mechanisms of 59 C. coli isolates. Isolates from broiler carcasses and human cases were genotyped using multilocus sequence typing (MLST), porA typing, flagellin gene A restriction fragment length polymorphism (flaA–RFLP) typing, and by PCR binary typing (P‐BIT). Thirty‐two MLST sequence types, 24 flaA types, 31 porA alleles, and 29 P‐BIT types were identified among the screened isolates. Some types and alleles were shared among strains recovered from both broiler carcasses and diarrhoeal patients. Both porA typing and MLST revealed a similar discriminatory power (0.969), which was the highest discriminatory power when compared to other methods. Minimum inhibitory concentrations against seven different antibiotics (ciprofloxacin, chloramphenicol, nalidixic acid, streptomycin, tetracycline, gentamicin, and erythromycin) were analysed. Strains were most frequently resistant to tetracycline (81.4%), followed by: ciprofloxacin and nalidixic acid (76.3%); streptomycin (33.9%); erythromycin (27.1%); and chloramphenicol (3.4%). All isolates were sensitive to gentamicin. Multidrug resistance was observed in 24 of 59 C. coli isolates (40.7%). Molecular screening of antimicrobial resistance mechanisms revealed the predominance of the gyrA T86I substitution among ciprofloxacin‐ and nalidixic acid‐resistant isolates, the tet(O) gene among tetracycline‐resistant isolates and the 23S rRNA A2075G mutation among erythromycin‐ resistant isolates. Furthermore, some erythromycin‐resistant isolates harboured a diverse array of resistance mechanisms, including the presence of ermB, 23S rRNA A2074G mutation, and point mutations the rplD and rplV ribosomal genes, and the cmeABC multidrug efflux pump genes.     

Associations Between Anti‐Microbial Resistance Phenotypes,Anti‐Microbial Resistance Genotypes and Virulence Genes of Escherichia coli Isolates from Pakistan and China

The objective of this study was to determine the association between phenotypic resistance, genotypic resistance and virulence genes of Escherichia coli isolates in Jiangsu province, China and Punjab province Pakistan. A total of 62 E. coli isolates were characterized for phenotypic resistance, genotypic resistance and virulence factor genes. The anti‐microbial resistance phenotype and genotypes in relation to virulence factor genes were assessed by statistical analysis. Of 20 tested virulence genes, twelve were found and eight were not found in any isolates. sitA and TspE4C2 were the most prevalent virulence genes. Of the 13 anti‐microbial agents tested, resistance to ampicillin, sulphonamide and tetracycline was the most frequent. All isolates were multiresistant, and 74% were resistant to trimethoprim and sulphamethaxazole. Phenotypically, tetracycline‐, cefotaxime‐ and trimethoprim‐resistant isolates had increased virulence factors as compared with susceptible isolates. Genotypically, resistant genes Tem, ctx‐M, Tet, Sul 1, dhfr1, Cat2 and flo‐R showed the association with the virulence genes. Almost all classes of anti‐microbial‐resistant genes have a high association with virulence. Resistant isolates have more virulent genes than the susceptible isolates.