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Journal of Tropical Medicine 2024To determine the incidence of antimicrobial-resistant emerging pathogens, , and its associated risk factors in tertiary care setups of Pakistan. This cross-sectional...
To determine the incidence of antimicrobial-resistant emerging pathogens, , and its associated risk factors in tertiary care setups of Pakistan. This cross-sectional prospective study was conducted from January 2019 to December 2020, to determine the prevalence and antimicrobial resistance patterns of strains isolated from 450 stool specimens of patients suffering from diarrhea hospitalized in tertiary care hospitals in Peshawar, Pakistan. The stool samples of the patients were processed for culture and detection of toxin A and toxin B by enzyme-linked immunosorbent assay (ELISA) and PCR. The drug sensitivity test was performed for antibiotics including ampicillin, cefixime, cefepime, amoxicillin, nalidixic acid, sulpha/TMP (SXT), chloramphenicol, metronidazole, vancomycin, ciprofloxacin, levofloxacin, and imipenem. Of 450 stool specimens, 108 (24%) were positive for by stool culture, whereas 115 (25.5%) were only positive for toxins based on ELISA and PCR (128 (28.6%). Of 108, 90.7% ( = 98) isolates were resistant to one antibiotic, and 90 (83.4%) were resistant to three or more antimicrobials. The highest resistance rates were found against penicillin (83.3%) followed by amoxicillin (70%), nalidixic acid (61%), and metronidazole (38%), and the lowest resistance was found against vancomycin (6.4%) and imipenem (3.7%). CDI was statistically significantly correlated with increased age, use of antibiotics, abdominal surgeries, use of proton pump inhibitors and H2a, and presence of comorbidities. The high frequency of in Peshawar, Pakistan, indicates that CDI is an important nosocomial infection in different hospitals. The results will be helpful for clinicians to redesign control and therapeutic strategies in hospitals.
PubMed: 38784112
DOI: 10.1155/2024/6613120 -
BMC Microbiology May 2024Clostridioides difficile is the main pathogen of antimicrobial-associated diarrhoea and health care facility-associated infectious diarrhoea. This study aimed to...
BACKGROUND
Clostridioides difficile is the main pathogen of antimicrobial-associated diarrhoea and health care facility-associated infectious diarrhoea. This study aimed to investigate the prevalence, toxin genotypes, and antibiotic resistance of C. difficile among hospitalized patients in Xi'an, China.
RESULTS
We isolated and cultured 156 strains of C. difficile, representing 12.67% of the 1231 inpatient stool samples collected. Among the isolates, tcdA + B + strains were predominant, accounting for 78.2% (122/156), followed by 27 tcdA-B + strains (27/156, 17.3%) and 6 binary toxin gene-positive strains. The positive rates of three regulatory genes, tcdC, tcdR, and tcdE, were 89.1% (139/156), 96.8% (151/156), and 100%, respectively. All isolates were sensitive to metronidazole, and the resistance rates to clindamycin and cephalosporins were also high. Six strains were found to be resistant to vancomycin.
CONCLUSION
Currently, the prevalence rate of C. difficile infection (CDI) in Xi'an is 12.67% (156/1231), with the major toxin genotype of the isolates being tcdA + tcdB + cdtA-/B-. Metronidazole and vancomycin were still effective drugs for the treatment of CDI, but we should pay attention to antibiotic management and epidemiological surveillance of CDI.
Topics: Clostridioides difficile; Humans; China; Anti-Bacterial Agents; Genotype; Clostridium Infections; Bacterial Toxins; Hospitals; Feces; Drug Resistance, Bacterial; Prevalence; Microbial Sensitivity Tests; Female; Middle Aged; Male; Aged; Adult; Bacterial Proteins; Diarrhea; Metronidazole; Young Adult; Enterotoxins; Adolescent; Vancomycin; Clindamycin; Aged, 80 and over
PubMed: 38783194
DOI: 10.1186/s12866-024-03327-z -
Frontiers in Cellular and Infection... 2024Quorum-quenching enzyme Est816 hydrolyzes the lactone rings of -acyl homoserine lactones, effectively blocking the biofilm formation and development of Gram-negative...
INTRODUCTION
Quorum-quenching enzyme Est816 hydrolyzes the lactone rings of -acyl homoserine lactones, effectively blocking the biofilm formation and development of Gram-negative bacteria. However, its applications in the oral field is limited. This study aimed to evaluate the efficacy of enzyme Est816 in combination with antibiotics against periodontitis induced by and .
METHODS
The antimicrobial efficacy of enzyme Est816 in combination with minocycline, metronidazole, and amoxicillin was determined using the minimum inhibitory concentration test. The anti-biofilm effect of enzyme Est816 was assessed using scanning electron microscopy, live/dead bacterial staining, crystal violet staining, and real-time quantitative PCR. Biocompatibility of enzyme Est816 was assessed in human gingival fibroblasts (HGF) by staining. A rat model of periodontitis was established to evaluate the effect of enzyme Est816 combined with minocycline using micro-computed tomography and histological staining.
RESULTS
Compared to minocycline, metronidazole, and amoxicillin treatment alone, simultaneous treatment with enzyme Est816 increased the sensitivity of biofilm bacteria to antibiotics. Enzyme Est816 with minocycline exhibited the highest rate of biofilm clearance and high biocompatibility. Moreover, the combination of enzyme Est816 with antibiotics improved the antibiofilm effects of the antibiotics synergistically, reducing the expression of the virulence factor leukotoxin gene () and fimbria-associated gene (). Likewise, the combination of enzyme Est816 with minocycline exhibited a remarkable inhibitory effect on bone resorption and inflammation damage in a rat model of periodontitis.
DISCUSSION
The combination of enzyme Est816 with antibiotics represents a prospective anti-biofilm strategy with the potential to treat periodontitis.
Topics: Animals; Aggregatibacter actinomycetemcomitans; Biofilms; Anti-Bacterial Agents; Periodontitis; Rats; Microbial Sensitivity Tests; Disease Models, Animal; Humans; Metronidazole; Quorum Sensing; Minocycline; Amoxicillin; Rats, Sprague-Dawley; Male; Fibroblasts; Gingiva
PubMed: 38779565
DOI: 10.3389/fcimb.2024.1368684 -
International Journal of Medical... Jun 2024The increasing prevalence of antibiotic-resistant Helicobacter pylori strains poses a significant threat to children's health. This study investigated antibiotic...
BACKGROUND
The increasing prevalence of antibiotic-resistant Helicobacter pylori strains poses a significant threat to children's health. This study investigated antibiotic resistance rates in Helicobacter pylori strains isolated from children in Shanghai and analyzed the presence of virulence genes in these strains.
METHODS
We obtained 201 Helicobacter pylori strains from pediatric patients with upper gastrointestinal symptoms who underwent gastrointestinal endoscopy between 2019 and 2022. Subsequently, we performed antibiotic susceptibility tests and virulence gene PCR assays on these strains.
RESULTS
Helicobacter pylori resistance rates of 45.8%, 15.4%, 1.0%, and 2.5% were detected for metronidazole, clarithromycin, amoxicillin, and levofloxacin, respectively. Among all isolates, 64.7% exhibited resistance to at least one antibiotic. Resistance to metronidazole and clarithromycin increased from 2019 to 2022. The predominant vacA gene subtype was vacA s1a/m2. The prevalence of vacA m2 and dupA exhibited an upward trend, while oipA presented a decreasing trend from 2019 to 2022. The prevalence of dupA was significantly higher in gastritis than peptic ulcer disease, and in non-treatment compared to treatment groups.
CONCLUSIONS
Helicobacter pylori antibiotic resistance remains high in children and has risen in recent years. Therefore, the increasing use of metronidazole and clarithromycin requires increased monitoring in children. No association was observed between antibiotic resistance and virulence gene phenotypes.
Topics: Humans; Helicobacter pylori; China; Child; Helicobacter Infections; Anti-Bacterial Agents; Female; Male; Bacterial Proteins; Microbial Sensitivity Tests; Virulence Factors; Drug Resistance, Bacterial; Adolescent; Child, Preschool; Clarithromycin; Metronidazole; Virulence; Gastritis; Prevalence; Peptic Ulcer; Infant; Amoxicillin; Bacterial Outer Membrane Proteins
PubMed: 38776570
DOI: 10.1016/j.ijmm.2024.151622 -
Heliyon May 2024Emphysematous pyelonephritis and cystitis, rare and potentially life-threatening infections marked by gas accumulation in the urinary tract, are described in a...
Emphysematous pyelonephritis and cystitis, rare and potentially life-threatening infections marked by gas accumulation in the urinary tract, are described in a 32-year-old male with a history of myelomeningocele and a neurogenic bladder managed by a Benchekroune valve. Clinical and radiological findings confirmed emphysematous pyelonephritis and cystitis. A conservative approach, including urinary drainage and four-week antibiotic treatment (ceftriaxone and metronidazole), led to rapid clinical improvement. This case underscores the successful management of emphysematous infections in a neurogenic bladder patient, emphasizing the effectiveness of conservative treatment.
PubMed: 38774088
DOI: 10.1016/j.heliyon.2024.e30893 -
Cureus Apr 2024A black hairy tongue is a benign, self-limiting condition characterized by the discolouration of the tongue due to defective desquamation. Clinical presentation varies,...
A black hairy tongue is a benign, self-limiting condition characterized by the discolouration of the tongue due to defective desquamation. Clinical presentation varies, with most cases being asymptomatic although aesthetically unpleasant to the patient. Prevalence varies geographically, ranging from 0.6% to 11.3%. It can be triggered by various factors such as medications, smoking, alcohol, poor oral hygiene, or even underlying systemic conditions such as malignancy. Several antibiotics such as doxycycline, erythromycin, amoxicillin-clavulanate, metronidazole, and piperacillin-tazobactam, have been reported to cause black hairy tongues. Onset can range from a few weeks to as long as five weeks. Diagnosis relies on clinical assessment with a good history and visual examination. Definitive treatment remains unclear, but the condition typically improves by identifying and discontinuing the causative agent and maintaining adequate oral hygiene. Complications are rare, and the prognosis is excellent. This case report aims to raise awareness of the association between the black hairy tongue and co-amoxiclav, which may impose additional burdens on patients, healthcare providers, and the health system if failed to be recognized and treated appropriately.
PubMed: 38770449
DOI: 10.7759/cureus.58657 -
Scientific Reports May 2024Liver abscess is a potentially life-threatening medical emergency. Prompt empirical antimicrobial with or without percutaneous aspiration or drainage is therapeutic. The... (Randomized Controlled Trial)
Randomized Controlled Trial
Liver abscess is a potentially life-threatening medical emergency. Prompt empirical antimicrobial with or without percutaneous aspiration or drainage is therapeutic. The rational for using empirical intravenous broad-spectrum antimicrobials upfront instead of oral Fluoroquinolone or Cephalosporin is contentious. In this double blind randomized control clinical trial 69 participants received Ciprofloxacin (500 mg q 12 hourly) and 71 participants received Cefixime (200 mg q 12 hourly) orally for 2 weeks. Both the group received oral Metronidazole (800 mg q 8 hourly) for 2 weeks and percutaneous drainage or aspiration of the abscess was done as per indication and followed-up for 8 weeks. Out of 140 participants, 89.3% (N = 125) achieved clinical cure, 59 (85.5%) in Ciprofloxacin group and 66 (93%) in Cefixime group (p = 0.154). Mean duration of antimicrobial therapy was 16.2 ± 4.3 days, 15.1 ± 4.5 days in Ciprofloxacin group and 16.0 ± 4.2 days in Cefixime group (p = 0.223). Total 15 (10.7%) participants had treatment failure, 10 (14.5%) in Ciprofloxacin group and 5 (7.0%) in Cefixime group (p = 0.154). The most common reason for treatment failure was need of prolong (> 4 weeks) antimicrobial therapy due to persistent hepatic collection requiring drainage, which was significantly (p = 0.036) higher in Ciprofloxacin (14.5%, N = 10) group, compared to the Cefixime (4.2%, N = 3) group. In conclusion, both, the Ciprofloxacin or Cefixime plus Metronidazole for duration of 2-3 weeks were efficacious as empirical oral antimicrobial regimen along with prompt percutaneous drainage or aspiration for the treatment of uncomplicated liver abscess with similar efficacy. Oral Cefixime was better than Ciprofloxacin in term of lesser chance of treatment failure due to persistent collection which is required to be investigated further in larger clinical trial.Trial registration: clinicaltrials.gov PRS ID: NCT03969758, 31/05/2019.
Topics: Humans; Ciprofloxacin; Metronidazole; Cefixime; Male; Female; Middle Aged; Adult; Anti-Bacterial Agents; Liver Abscess; Treatment Outcome; Double-Blind Method; Drug Therapy, Combination; Drainage; Aged
PubMed: 38769330
DOI: 10.1038/s41598-024-59607-1 -
Clinical Microbiology and Infection :... May 2024Children account for a significant proportion of antibiotic consumption in low- and middle-income countries, with overuse occurring in formal and informal health...
OBJECTIVES
Children account for a significant proportion of antibiotic consumption in low- and middle-income countries, with overuse occurring in formal and informal health sectors. This study assessed the prevalence and predictors of residual antibiotics in the blood of children in the Mbeya and Morogoro regions of Tanzania.
METHODS
The cross-sectional community-based survey used two-stage cluster sampling to include children aged under 15 years. For each child, information on recent illness, healthcare-seeking behaviour, and use of antibiotics, as well as a dried blood spot sample, were collected. The samples underwent tandem mass spectrometry analysis to quantify the concentrations of 15 common antibiotics. Associations between survey variables and the presence of residual antibiotics were assessed using mixed-effects logistic regression.
RESULTS
In total, 1742 children were surveyed, and 1699 analysed. The overall prevalence of residual antibiotics in the blood samples was 17.4% (296/1699), the highest among children under the age of 5 years. The most frequently detected antibiotics were trimethoprim (144/1699; 8.5%), sulfamethoxazole (102/1699; 6.0%), metronidazole (61/1699; 3.6%), and amoxicillin (43/1699; 2.5%). The strongest predictors of residual antibiotics in the blood were observed presence of antibiotics at home (adjusted odds ratio [aOR] = 2.9; 95% CI, 2.0-4.1) and reported consumption of antibiotics in the last 2 weeks (aOR = 2.5; 95% CI, 1.6-3.9). However, half (145/296) of the children who had residual antibiotics in their blood, some with multiple antibiotics, had no reported history of illness or antibiotic consumption in the last 2 weeks, and antibiotics were not found at home.
DISCUSSION
This study demonstrated a high prevalence of antibiotic exposure among children in Tanzanian communities, albeit likely underestimated, especially for compounds with short half-lives. A significant proportion of antibiotic exposure was unexplained and may have been due to unreported self-medication or environmental pathways. Incorporating biomonitoring into surveillance strategies can help better understand exposure patterns and design antibiotic stewardship interventions.
PubMed: 38740136
DOI: 10.1016/j.cmi.2024.05.004 -
Journal of Primary Care & Community... 2024Clostridioides difficile infection (CDI) is one of the most common and severe nosocomial infections worldwide. It can also affect healthy individuals in the community.... (Review)
Review
Clostridioides difficile infection (CDI) is one of the most common and severe nosocomial infections worldwide. It can also affect healthy individuals in the community. The incidence of CDI has been on the rise globally for the past decade, necessitating a proactive approach to combat its spread; new strategies are being developed to enhance diagnostic accuracy and optimize treatment outcomes. Implementing the 2-step testing has increased diagnostic specificity, reducing the usage of CD-specific antibiotics with no concomitant increase in surgical complication rates. In 2021, the Infectious Diseases Society of America/Society for Healthcare Epidemiology of America (IDSA/SHEA) shifted its preference for initial treatment to fidaxomicin over vancomycin and metronidazole due to its lower recurrence rate. It also prioritized fidaxomicin for the treatment of recurrent CDI. There are new developments on the frontiers of fecal microbiota therapies, with RBX2660 and SER-109 approved recently by the FDA for prevention, with other microbiome-based therapies in various development and clinical trials. This review offers providers an updated and practical guide for CDI management.
Topics: Humans; Clostridium Infections; Anti-Bacterial Agents; Clostridioides difficile; Fecal Microbiota Transplantation; Cross Infection; Practice Guidelines as Topic; Fidaxomicin; Metronidazole
PubMed: 38726585
DOI: 10.1177/21501319241249645 -
Gut Microbes 2024Vancomycin and metronidazole are commonly used treatments for infection (CDI). However, these antibiotics have been associated with high levels of relapse in patients.... (Comparative Study)
Comparative Study
Vancomycin and metronidazole are commonly used treatments for infection (CDI). However, these antibiotics have been associated with high levels of relapse in patients. Fidaxomicin is a new treatment for CDI that is described as a narrow spectrum antibiotic that is minimally active on the commensal bacteria of the gut microbiome. The aim of this study was to compare the effect of fidaxomicin on the human gut microbiome with a number of narrow (thuricin CD) and broad spectrum (vancomycin and nisin) antimicrobials. The spectrum of activity of each antimicrobial was tested against 47 bacterial strains by well-diffusion assay. Minimum inhibitory concentrations (MICs) were calculated against a select number of these strains. Further, a pooled fecal slurry of 6 donors was prepared and incubated for 24 h with 100 µM of each antimicrobial in a mini-fermentation system together with a no-treatment control. Fidaxomicin, vancomycin, and nisin were active against most gram positive bacteria tested , although fidaxomicin and vancomycin produced larger zones of inhibition compared to nisin. In contrast, the antimicrobial activity of thuricin CD was specific to and some spp. The MICs showed similar results. Thuricin CD exhibited low MICs (<3.1 µg/mL) for and , whereas fidaxomicin, vancomycin, and nisin demonstrated lower MICs for all other strains tested when compared to thuricin CD. The narrow spectrum of thuricin CD was also observed in the gut model system. We conclude that the spectrum of activity of fidaxomicin is comparable to that of the broad-spectrum antibiotic vancomycin and the broad spectrum bacteriocin nisin in a complex community.
Topics: Nisin; Anti-Bacterial Agents; Microbial Sensitivity Tests; Humans; Fidaxomicin; Vancomycin; Gastrointestinal Microbiome; Feces; Bacteria; Clostridioides difficile; Clostridium Infections; Bacteriocins
PubMed: 38722061
DOI: 10.1080/19490976.2024.2342583