Antibacterial agents and the fight against antibiotic resistance: A real-world evidence analysis of consumption and spending by an Italian healthcare company.

INTRODUCTION: The escalating bacterial resistance stands as an increasingly pertinent concern, particularly in the post-pandemic era where the use of antibiotics appears to be relentlessly surging, giving rise to profound apprehensions. The substantial utilization of last-generation penicillins and cephalosporins is anticipated to imminently result in the emergence of superbugs for which therapeutic solutions will be scarce. METHODS: An analysis of antibiotic consumption in the hospital setting has been conducted in an Italian healthcare organization. Querying the internal management system facilitated the calculation of indicators and assessment of prescription trends. RESULTS: A comparison has been made between the first half of 2023 and the first half of 2022, to highlight the exponential growth in the consumption of beta-lactam antibiotics, with consumption doubling compared to the previous year's semester. Overall, considering the prescription averages, there is a prescribing growth of +29% concerning hospitalization and +28% concerning hospital discharge. However, it should be noted that the consumption of certain antibiotics such as sulphonamides and trimethoprim (-103.00%), tetracyclines (-54.00%), macrolides, lincosamides and streptogramins (-50.00%) and colistin (-13.00%) decreased. CONCLUSION: This real-world evidence analysis aimed to support the justified and comprehensible global concerns regarding bacterial resistance. The extensive consumption of antibiotics will inevitably lead to the development of increasingly drug-resistant bacteria for which no antibiotic may be efficacious. National programs addressing antibiotic resistance and the awareness of all healthcare personnel must be accorded the utmost priority to enhance consumption data and, consequently, safeguard future human survival.

SARS-CoV-2 caused a surge in antibiotic consumption causing a silent pandemic inside the pandemic. A retrospective analysis of Italian data in the first half of 2022.

BACKGROUND: The phenomenon of antibiotic resistance shows no sign of stopping, despite global policies to combat it that have been in place for several years. The risk of forms of pathogenic microorganisms that are increasingly resistant to common antibiotics has led health authorities around the world to pay greater attention to the phenomenon. The worrying situation, has led to further recommendations from the World Health Organization (WHO) and national recommendations in Italy through the new National Plan against Antibiotic Resistance 2022-2025 (PNCAR 2022-2025). AIM: This manuscript aims to raise the awareness of all health professionals to follow what is suggested by regulatory agencies and scientific societies. METHOD: We conducted a retrospective study of antibiotic pharmacoutilization in Italy, in the Campania region at the Azienda Sanitaria Locale (ASL) Napoli 3 Sud, on consumption in the first half of 2022 in a population of more than 1 million people. RESULT: The results indicate that consumption, based on defined daily doses (DDDs), is above the national average. Probably the COVID-19 pandemic has influenced this growth in prescriptions. CONCLUSIONS: Our study suggests an informed and appropriate use of antibiotics, so as to embark on a virtuous path in the fight against antibiotic resistance.

[Antimicrobial resistance patterns in pediatric febrile urinary tract infection and empirical antibacterial therapy. An epidemiological study in secondary and tertiary care centers in the north-east of France in 2019-2020]. / Profils de résistance des germes responsables d'infections urinaires fébriles de l'enfant et protocoles d'antibiothérapie probabiliste. Une étude épidémiologique au CHRU de Strasbourg et CH de Saverne sur 2019­2020.

BACKGROUND: Febrile urinary tract infection (UTI) is a common health issue in pediatrics that can lead to serious infectious and renal complications, it requires early diagnosis and a targeted use of antibiotics. The aim of our study was to describe local bacterial agents causing febrile UTIs and their resistance patterns and confront the results with currently used empirical antibacterial therapy in pediatrics emergency departments in Strasbourg and Saverne. PATIENTS AND METHODS: We used billing codes (international classification of diseases) to identify all inpatients treated for febrile UTIs in two French pediatric emergency departments between January 2019 and December 2020. Microbial results of urine cultures were retrieved from the laboratory information system. RESULTS: Among 214 microbial results from 208 patients, the distribution of uropathogens was 82% Escherichia coli, with extended-spectrum beta-lactamase in 2.8%, 7% Enterococcus faecalis, 5% Klebsiella, 2% Proteus mirabilis. E. coli was resistant respectively to amoxicillin, amoxicillin/clavulanic acid and cotrimoxazol in 43, 33 and 14% of samples. A third-generation cephalosporin administered intravenously was mainly used (98%) as empirical treatment. Less than 2% of patients were treated with oral cephalosporin from the start. CONCLUSION: We present the spectrum of uropathogens and susceptibility test results in pediatric UTIs as well as the susceptibility pattern of E. coli, a local treatment protocol was designed based on our results in conformity with national guidelines.

Prevalence and characterization of -methicillin-resistant Macrococcus spp. in food producing animals and meat in Switzerland in 2019.

INTRODUCTION: The prevalence of methicillin-resistant Macrococcus spp. in calves and pigs at slaughterhouses and in retail beef and pork meat was determined using samples taken in 2019 within the framework of the national monitoring of methicillin-resistant Staphylococcus aureus in food producing animals in Switzerland. The isolates were submitted to antimicrobial susceptibility testing of 19 antibiotics and to molecular techniques (e.g. PCR, microarray, WGS) for the identification of resistance genes, elements containing the methicillin resistance genes mec and sequence type (ST). Methicillin-resistant Macrococcus spp. (M. caseolyticus (n=38), M. bohemicus (n=4) and Macrococcus spp. (n=2)) were isolated in 40 of 299 nasal swabs from calves representing a prevalence of 13,38 % (95 % CI, 9,98 % - 17,70 %), and in four of 303 nasal swabs from pigs [1,32 % (95 % CI, 0,36 % - 3,35 %)]. One of 311 samples of Swiss pork meat contained a Macrococcus sp. [0,32 % (95 % CI, 0,01 % - 1,78 %)], and four of 309 beef meat samples (260 domestic and 49 imported) contained M. caseolyticus [1,29 % (95 % CI, 0,35 % - 3,28 %)]. The M. caseolyticus strains belonged to diverse STs, with ST21 being the most common in both pigs and calves. The mecD gene was located on Macrococcus resistance island mecD (McRImecD) in 42 strains and on staphylococcal cassette chromosome mec (SCCmecD) in three strains, while mecB was found on plasmids in four strains. In addition to resistance to ß-lactams, the strains also exhibited resistance to tetracycline (n=17; tet(L), tet(K), tet(M)), streptomycin (n=13; str, ant(6)-Ia, rpsL mutation [K56R in ribosomal protein S12]), kanamycin (n=10; aac(6')-Ie - aph(2'')-Ia, aph(2')-Ib, aph(2')-Ic, ant(4')-Ia), clindamycin (n=9; erm(B), erm(45)), erythromycin (n=9; erm(B), msr(G), erm(45)), fusidic acid (n=9; fusC) and gentamicin (n=1; aac(6')-Ie - aph(2'')-Ia). This study represents the first national prevalence study of methicillin-resistant Macrococcus spp. in pigs, calves, pork and beef meat in Switzerland and revealed a reservoir of genetically diverse strains carrying several resistance traits.

INTRODUCTION: La prévalence des macrococques résistants à la méthicilline chez les veaux et les porcs à l'abattoir et dans la viande de bœuf et de porc au détail a été déterminée à partir d'échantillons prélevés en 2019 dans le cadre du monitoring national des Staphylococcus aureus résistants à la méthicilline chez les animaux de rente en Suisse. Les isolats ont été soumis à des tests de sensibilité à 19 antibiotiques et à des techniques moléculaires (par exemple PCR, microarray, WGS) pour l'identification des gènes de résistance, des éléments contenant les gènes mec responsible de la résistance à la méthicilline, ainsi que du type de séquence (ST). Des macocoques résistants à la méthicilline (M. caseolyticus (n=38), M. bohemicus (n=4) et Macrococcus spp. (n=2)) ont été isolés dans 40 des 299 écouvillons nasaux de veaux, ce qui représente une prévalence de 13,38 % (IC 95 %, 9,98 % ­ 17,70 %), et dans quatre des 303 écouvillons nasaux de porcs [1,32 % (IC 95 %, 0,36 % ­ 3,35 %)]. Un des 311 échantillons de viande de porc suisse contenait un Macrococcus sp. [0,32 % (IC 95 %, 0,01 % ­ 1,78 %)], et quatre des 309 échantillons de viande de bœuf (260 domestiques et 49 importés) contenaient M. caseolyticus [1,29 % (IC 95 %, 0,35 % ­ 3,28 %)]. Les souches de M. caseolyticus appartenaient à divers ST, le ST21 étant le plus fréquent chez les porcs et les veaux. Le gène mecD a été localisé sur des éléments du chromosome McRImecD dans 42 souches et SCCmecD dans trois souches, tandis que le gène mecB se trouvait sur des plasmides dans quatre souches. En plus de la résistance aux ß-lactamines, les souches étaient également résistantes à la tétracycline (n=17 ; tet(L), tet(K), tet(M)), à la streptomycine (n=13 ; str, ant(6)-Ia, mutation rpsL [K56R dans la protéine ribosomale S12]), à la kanamycine (n=10 ; aac(6')-Ie ­ aph(2'')-Ia, aph(2')-Ib, aph(2')-Ic, ant(4')-Ia), clindamycine (n=9 ; erm(B), erm(45)), érythromycine (n=9 ; erm(B), msr(G), erm(45)), acide fusidique (n=9 ; fusC) et gentamicine (n=1 ; aac(6')-Ie ­ aph(2'')-Ia). Cette étude est la première à déterminer prévalence des Macrococcus spp. résistants à la méthicilline chez les porcs, les veaux, la viande de porc et de bœuf en Suisse et a révélé un réservoir de souches génétiquement diverses et portant plusieurs traits de résistance.

Metallo-beta-lactamase-producing Escherichia coli in the sewage of Mexico City: where do they come from?

While monitoring the presence of antibiotic resistance in municipal wastewater bacteria from Mexico City, five Escherichia coli isolates were found to be resistant to carbapenems, antibiotics of "last resort" used mostly in hospitals. Further analysis revealed that these carbapenem-resistant isolates carried the gene encoding a metallo-beta-lactamase, NDM-5. The gene was found to be beared by a large, ∼145 kb conjugative plasmid, which also carries putative genes encoding resistance to sulfonamides, trimethoprim, tetracycline, ciprofloxacin, and chloramphenicol (although no phenotypic chloramphenicol resistance was detected) and quaternary-ammonium compounds. The plasmid also carried gene mobility determinants, such as integron integrase and two transposases. In addition to the direct public health threat posed by the presence of such multi-resistant organisms in wastewater released into the environment and used for crop irrigation; it is particularly concerning that carbapenem-resistant E. coli is rather rare in Mexican hospitals (<1%), but was found in small, 100 mL samples of municipal wastewater. This suggests that these organisms are under-reported by clinical microbiology laboratories, underlining the usefulness of wastewater monitoring, or that there is an unknown source of such carbapenem-resistant organisms that are being dumped into the wastewater. The source of these bacteria must be assessed and controlled to prevent further spread of this multi-resistance plasmid among other environmental and clinical microorganisms.

Identification of plasmids from Brazilian Chromobacterium violaceum strains.

Chromobacterium violaceum is an opportunistic pathogen found in tropical and subtropical regions worldwide. Chromobacterium violaceum infections are difficult to treat, and many strains are resistant to antibiotics. Recently, a novel plasmid (pChV1) was discovered in the type strain ATCC 12472, suggesting that other C. violaceum strains may harbor extra-chromosomal DNA. The aim of the present study was to detect and compare new plasmids in Brazilian strains of C. violaceum using next-generation sequencing techniques. We obtained draft genomes of six plasmids from strains isolated from the Amazon region and aligned them with pChV1. At least three plasmids, CVAC05, CVACO2, and CVT8, were similar to pChV1. Phylogenetic analysis suggested that these new extra-chromosomal DNA sequences have a common origin with pChV1 but have diverged. Many of the ORFs detected were related to plasmid segregation/maintenance, viral structural proteins, and proteins with unknown functions. These findings may enable better genetic manipulation of C. violaceum, which will enhance our ability to exploit this valuable microorganism in industrial and clinical applications.

Effect of sub-inhibitory concentrations of cefepime on biofilm formation by Pseudomonas aeruginosa.

This study investigated the effect of cefepime at sub-minimum inhibitory concentrations (sub-MICs) on in vitro biofilm formation (BF) by clinical isolates of Pseudomonas aeruginosa. The effect of cefepime at sub-MIC levels (½-1/256 MIC) on in vitro BF by six clinical isolates of P. aeruginosa was phenotypically assessed following 24 and 48 h of challenge using the tissue culture plate (TCP) assay. Quantitative real-time polymerase chain reaction (qRT-PCR) was employed to observe the change in expression of three biofilm-related genes, namely, a protease-encoding gene (lasA), fimbrial protein-encoding gene (cupA1), and alginate-encoding gene (algC), in a weak biofilm-producing strain of P. aeruginosa following 24 and 48 h of challenge with sub-MICs of cefepime. The BF morphology in response to cefepime was imaged using scanning electron microscopy (SEM). The TCP assay showed strain-, time-, and concentration-dependent changes in in vitro BF in P. aeruginosa following challenge with sub-MICs of cefepime, with a profound increase in strains with inherently no or weak biofilm-producing ability. RT-PCR revealed time-dependent upregulation in the expression of the investigated genes following challenge with ½ and » MIC levels, as confirmed by SEM. Cefepime at sub-MICs could upregulate the expression of BF-related genes and enhance BF by P. aeruginosa clinical isolates.

[Survey on the use of antibiotics in exotic pets among Swiss veterinarians]. / Umfrage bei Schweizer Tierärzte/-innen über den Einsatz von Antibiotika bei exotischen Heimtieren.

INTRODUCTION: Monitoring programs and guidelines on the use of antibiotics and antibiotic resistance in human and veterinary medicine have been developed worldwide to promote the prudent use of antibiotics in recent years. However, such information on the use of antibiotics in exotic pets is absent. This fact must be taken into account, since the number of exotic pet patients is constantly increasing and the administration of antibiotics is particular challenging due to the diversity of species and the differences in physiology. The present study reports the results of a survey of frequently used antibiotics and the criteria of antibiotic usage in exotic pets (rabbits, rodents, birds and reptiles) among Swiss veterinarians. These data should form the basis for the development of antibiotic usage guidelines in exotic pets. A total of 61 veterinarians returned the questionnaire. The most important decision-making criteria for antibiotic treatment and antibiotic selection were clinical symptoms (55/59, 93% for antibiotic treatment and 40/59, 68% for antibiotic selection), experience (41/59, 69% and 36/59, 61%, respectively) and textbooks (39/59, 66% and 40/59, 68%). The most important decision-making criteria for dosage and duration of therapy were textbooks (59/59, 100%) and experience (31/59, 53%). The use of a microbial culture was used as a decision criterion for both antibiotic treatment and antibiotic selection by 39% of the participants, sensitivity testing was chosen as a decision criterion by 37% for antibiotic treatment and by 46% for antibiotic selection. Fluoroquinolones were used most frequently, 46/56 (82% of the participants) for rabbits, 49/57 (86%) for rodents, 36/37 (97%) for reptiles and 38/46 (83%) for birds. The vast majority of veterinarians (57/58, 98%) would consult a guide for the use of antibiotics. The frequent use of critical antibiotics in exotic pets underscores the need for a guide to the prudent use of antibiotics. The positive influence of such guidelines has already been proven in dogs and cats.

INTRODUCTION: Pour promouvoir une utilisation prudente des antibiotiques, des programmes de surveillance et des lignes directrices sur l'utilisation des antibiotiques et la résistance aux antibiotiques en médecine humaine et vétérinaire ont été élaborés dans le monde entier ces dernières années. Cependant, il n'existe actuellement aucune information de ce type en ce qui concerne les nouveaux animaux de compagnie ainsi que des informations exhaustives sur l'utilisation d'antibiotiques dans la pratique vétérinaire. Ce fait doit être pris en compte, d'autant plus que le nombre d'nouveaux animaux de compagnie est en constante augmentation dans la patientèle et que l'administration d'antibiotiques est un défi particulier en raison de la diversité des espèces et des différences de physiologie. Dans la présente étude, une enquête a été menée pour avoir un aperçu des antibiotiques fréquemment utilisés et de leurs critères d'utilisation chez les nouveaux animaux de compagnie (lapins, rongeurs, oiseaux et reptiles) auprès de vétérinaires suisses. Ces données sont destinées à servir de base à l'élaboration d'un guide sur les antibiotiques pour les animaux exotiques. Au total 61 vétérinaires ont répondu au questionnaire. Les critères de décision les plus importants pour le traitement antibiotique et la sélection d'un antibiotique étaient les symptômes (55/59, 93% pour le traitement antibiotique et 40/59, 68% pour la sélection de l'antibiotique), l'expérience (41/59, 69% et 36/59, 61%, respectivement) et la littérature spécialisée (39/59, 66% et 40/59, 68%). Les critères de décision les plus importants pour e dosage et la durée du traitement étaient la littérature spécialisée (59/59, 100%) et l'expérience (31/59, 53%). L'utilisation d'une culture bactériologique a été donnée par 39% des participants comme critère de décision à la fois pour le traitement antibiotique et le choix de l'antibiotique et un antibiogramme a été choisi par 37% comme critère de décision pour le traitement antibiotique et 46% pour le choix de l'antibiotique. Il a été constaté que les fluoroquinolones sont utilisées le plus fréquemment, chez 46/56 (82% des participants) pour les lapins, 49/57 (86%) pour les rongeurs, 36/37 (97%) pour les reptiles et 38/46 (83%) pour les oiseaux. La grande majorité des vétérinaires (57/58, 98%) a déclaré qu'ils consulteraient un guide pour l'utilisation des antibiotiques. L'utilisation fréquente d'antibiotiques critiques chez les nouveaux animaux de compagnie souligne la nécessité d'un guide sur l'utilisation prudente des antibiotiques. L'influence positive de ces recommandations a déjà été prouvée pour les chiens et les chats.

The progress of type II persisters of Escherichia coli O157:H7 to a non-culturable state during prolonged exposure to antibiotic stress with revival being aided through acid-shock treatment and provision of methyl pyruvate.

Persisters are a form of dormancy in bacteria that provide temporary resistance to antibiotics. The following reports on the formation of Escherichia coli O157:H7 E318 type II persisters from a protracted (8 days) challenge with ampicillin. Escherichia coli O157:H7 followed a multiphasic die-off pattern with an initial rapid decline (Phase I) of susceptible cells that transitioned to a slower rate representing tolerant cells (Phase II). After 24 h post-antibiotic challenge, the E. coli O157:H7 levels remained relatively constant at 2 log CFU/mL (Phase III), but became non-culturable within 8-days (Phase IV). The revival of persisters in Phase III could be achieved by the removal of antibiotic stress, although those in Phase IV required an extended incubation period or application of acid-shock. The carbon utilization profile of persister cells was less diverse compared with non-persisters, with only methyl pyruvate being utilized from the range tested. Inclusion of methyl pyruvate in tryptic soy agar revived non-cultural persisters, presumably by stimulating metabolism. The results suggest that persisters could be subdivided into culturable or non-culturable cells, with the former representing a transition state to the latter. The study provided insights into how to revive cells from dormancy to aid enumeration and control.

[Evidence-based homeopathy and veterinary homeopathy, and its potential to help overcome the anti-microbial resistance problem - an overview]. / Evidenzbasierte Veterinär-/Homöopathie und ihre mögliche Bedeutung für die ­Bekämpfung der Antibiotikaresistenzproblematik ­ ein Überblick.

INTRODUCTION: The basic principles of homeopathy, and its legal and scientific foundations, are discussed in an overview to address the positions of the World Health Organization (WHO) and the commission of the European Union (EU) on complementary medicine. According to the WHO, the antimicrobial resistance problem poses a global threat. The EU Commission's current One Health Action Plan requests research in complementary medicine, the WHO urges member states to include complementary medicine in their national health policies. Regarding external evidence on the general use of human and veterinary homeopathy, evidence level 1a studies are reviewed. Focusing on the external evidence on the use of homeopathy in infections, some evidence level 1a, 1b, 2c studies, and a case report, are described in more detail. In conclusion, evidence for the effectiveness of human and veterinary homeopathy in general, and in particular, of homeopathic treatment for infections, is available. Especially, individualized homeopathy demonstrates effects at all quality levels according to Cochrane criteria, even in the methodologically high-quality studies. As in most areas of veterinary medicine and medicine, further good/excellent studies are necessary. In compliance with the principles of homeopathy, further methodologically high-quality trials focusing on the homeopathic treatment of infections are the next logical step. The selection of the simile (individually fitting homeopathic medicinal product) by appropriately trained homeopathic doctors/veterinarians is essential for the effectiveness of homeopathy. Implementation of studies at university facilities is a prerequisite for quality assurance. Consequently, further integration of homeopathy at universities is a necessary requirement for the patients' best interests.

INTRODUCTION: Les principes de base de l'homéopathie et ses fondements juridiques et scientifiques sont discutés dans cette revue pour répondre aux positions de l'Organisation mondiale de la santé (OMS) et de la commission de l'Union européenne (UE) sur la médecine complémentaire. Selon l'OMS, le problème de la résistance aux antimicrobiens constitue une menace mondiale. Le plan d'action One Health actuel de la Commission européenne demande des recherches en médecine complémentaire et l'OMS exhorte les États membres à inclure la médecine complémentaire dans leurs politiques nationales de santé. En ce qui concerne les preuves externes sur l'utilisation générale de l'homéopathie humaine et vétérinaire, des études de niveau de preuve 1a sont passées en revue. En se concentrant sur les preuves externes de l'utilisation de l'homéopathie dans les infections, certaines études de niveau de preuve 1a, 1b, 2c et un rapport de cas sont décrits plus en détail. En conclusion, des preuves de l'efficacité de l'homéopathie humaine et vétérinaire en général et en particulier du traitement homéopathique des infections, sont disponibles. L'homéopathie individualisée démontre en particulier des effets à tous les niveaux de qualité selon les critères Cochrane, même dans des études de haute qualité méthodologique. Comme dans la plupart des domaines de la médecine et de la médecine vétérinaires, d'autres bonnes voire excellentes études sont nécessaires. Conformément aux principes de l'homéopathie, d'autres essais de haute qualité méthodologique axés sur le traitement homéopathique des infections sont la prochaine étape logique. La sélection des simile (médicament homéopathique adapté individuellement) par des médecins/vétérinaires homéopathes dûment formés est essentielle pour l'efficacité de l'homéopathie. La mise en œuvre d'études dans les établissements universitaires est une condition préalable à l'assurance qualité. Par conséquent, une intégration plus poussée de l'homéopathie dans les universités est une condition nécessaire dans l'intérêt des patients.

[Antibiotic Susceptibility of Haemophilus influenzae in Sfax: Two Years after the Introduction of the Hib Vaccination in Tunisia]. / Sensibilité aux antibiotiques d'Haemophilus influenzae à Sfax deux ans après l'introduction de la vaccination anti-Hib en Tunisie.

A retrospective study was conducted at the Sfax hospitals between 2013 and 2014 to study the susceptibility to antibiotics of Haemophilus influenzae after the introduction of Hib vaccination in Tunisia. Capsular typing was done by PCR. MICs for ß-lactams were determined by E-test®. The blaTEM, blaROB and ftsI genes were searched using PCR. Among the 259 strains of H. influenzae isolated, 248 (95.7%) were non-invasive. Five strains were encapsulated (3 type b and 2 type c). Resistance rates were 33.4% for ampicillin, 10.4% for amoxicillin-clavulanic acid, 2.3% for cefixime, 1.1% for cefotaxime and 1.9% for fluoroquinolones. Among the strains resistant to ß-lactams, 67 produced ß-lactamase type TEM and 40 had a modification of PLP3. This study shows the change in the epidemiology of H. influenzae induced by vaccination with a dramatic decrease of invasive infections. Replacement with other capsular types or with non-typable strains that may be resistant to antibiotics requires continuous surveillance for H. influenzae infections.

Une étude rétrospective a été menée dans les hôpitaux de Sfax en 2013­2014 pour étudier la sensibilité aux antibiotiques d'Haemophilus influenzae après l'introduction de la vaccination anti-Hib en Tunisie. Le typage capsulaire des souches d'H. influenzae a été fait par PCR. Les concentrations minimales inhibitrices des ß-lactamines ont été mesurées par E-test®. Les gènes bla TEM, bla ROB et ftsI ont été recherchés par PCR. Sur 259 souches d'H. influenzae isolées, 248 (95,7 %) étaient non invasives. Cinq souches étaient capsulées (trois de type b et deux de type c). Les taux de résistance étaient de 33,4 % pour l'ampicilline, de 10,4 % pour l'amoxicilline­acide clavulanique, de 2,3 % pour le céfixime, de 1,1 % pour le céfotaxime et de 1,9 % pour les fluoroquinolones. Parmi les souches résistantes aux ß-lactamines, 67 étaient productrices de ß-lactamases de type TEM et 40 avaient une modification de PLP3. Cette étude atteste du changement de l'épidémiologie d'H. influenzae induit par la vaccination avec la quasi-disparition des infections invasives. Le remplacement de Hib par d'autres types capsulaires ou par des souches non typables éventuellement résistantes aux antibiotiques impose une surveillance continue des infections à H. influenzae.

Urinary tract infections in dogs with spontaneous hypercortisolism - frequency, symptoms and involved pathogens.

INTRODUCTION: Dogs with hypercortisolism are predisposed to developing bacteriuria associated either with clinical signs of cystitis or without clinical signs (subclinical bacteriuria). Based on current guidelines, dogs with subclinical bacteriuria should not be treated with antibiotics because there is no evidence that treatment improves outcome and because unnecessary treatments should be avoided. Before these guidelines were published in 2019, dogs with hypercortisolism and bacteriuria were commonly treated with antibiotics irrespective of clinical signs. Comprehensive data on the frequency of bacterial cystitis, subclinical bacteriuria and the outcome of antimicrobial treatment in dogs with hypercortisolism is sparse. The aims of this study were to investigate dogs with hypercortisolism for the presence of bacterial cystitis and subclinical bacteriuria, to address the pathogens involved, and to assess the outcome of antibiotic treatment. Dogs newly diagnosed with hypercortisolism between 2005 and 2015 from which a urine bacterial culture was available were included. Statistical analysis was performed with non-parametric tests. Of the 161 client-owned dogs included, 29 (18%) showed bacteriuria, which was subclinical in 24 (83%) cases. Escherichia coli was the most commonly isolated pathogen (58%). Bacteriuria was not associated with sex or neutering status. In 14 dogs, follow-up data was available, of which 13 (93%) were treated with antimicrobials for 14 to 28 days. Follow-up bacterial culture (1 to 118 days after cessation of therapy) was negative in 10 (77%) treated dogs; a negative follow-up culture was not associated with gender, age or duration of treatment. Bacteriuria persisted in three treated dogs and the one untreated dog. The prevalence of positive bacterial urinary culture in dogs with hypercortisolism was lower than previously reported. In the majority of dogs, bacteriuria was subclinical. Most dogs had a negative bacterial culture result after antimicrobial treatment; however, more resistant bacteria were detected in persistently positive urine.

INTRODUCTION: Les chiens atteints d'hypercortisolisme ont tendance à développer une bactériurie associée avec ou sans signes cliniques de cystite. Selon les recommandations de traitement actuelles, les chiens atteints de bactériurie subclinique ne doivent pas être traités avec des antibiotiques, car il n'y a aucune preuve d'une amélioration du succès du traitement et des traitements inutiles doivent être évités. Avant la publication de ces lignes directrices en 2019, les chiens atteints de hypercortisolisme et de bactériurie étaient traités de façon standard avec des antibiotiques, quels que soient les symptômes cliniques. Les données sur la fréquence de la cystite bactérienne, de la bactériurie subclinique et du résultat du traitement antimicrobien chez les chiens atteints d'hypercortisolisme sont rares. Le but de cette étude était d'examiner des chiens souffrant d'hypercortisolisme quant à la présence d'une cystite bactérienne et d'une bactériurie subclinique, d'identifier les agents pathogènes impliqués et d'évaluer le succès thérapeutique du traitement antibiotique. Cent soixante et un chiens, diagnostiqués avec hypercortisolisme entre 2005 et 2015 et chez qui une culture bactérienne urinaire était disponible, ont été utilisés. L'analyse statistique a été réalisée avec des tests non paramétriques. Une bactériurie a été diagnostiquée chez 29 (18%) des chiens avec hypercortisolisme, de façon subclinique dans 24 (83%) cas. Escherichia coli était le pathogène le plus fréquemment isolé (58%). Il n'y avait aucune association entre la bactériurie et le sexe ou le statut de castration. Des données de suivi étaient disponibles chez 14 chiens, dont 13 (93%) ont été traités avec des antibiotiques pendant 14 à 28 jours. La culture bactérienne (1 à 118 jours après la fin du traitement) a été négative chez 10 chiens (77%) traités. Il n'y avait aucune différence entre le sexe, l'âge ou la durée du traitement. Une bactériurie persistante a été observée chez trois chiens traités et un chien non traité. La prévalence de la culture bactérienne d'urine positive chez les chiens atteints d'hypercortisolisme était moins fréquente que celle publiée précédemment. Chez la majorité des chiens, la bactériurie était subclinique. La plupart des chiens avaient une culture bactérienne négative après un traitement antimicrobien; cependant, les cultures d'urine positives persistantes ont démontré des germes plus résistants aux antibiotiques.

Impact of liquid hog manure applications on antibiotic resistance genes concentration in soil and drainage water in field crops.

Agricultural practices such as manure applications could contribute to the spread of antibiotic resistance genes (ARGs) within the environment. Our objective was to assess the impact of certain fertilization methods (mineral or manure) and tillage practices (reduced or conventional) on the presence of ARGs and bacteria in soil and drainage water under wheat and grain corn crops. Targeted ARGs tet(T), sul1, and blaCTX-M-1 in liquid hog manure, soil, and water samples were quantified by qPCR. Conventional PCR was used to detect mcr-1 and mcr-2. ARGs in control plots were detected despite the absence of manure, representing an environmental reservoir of resistant microorganisms. The manure application rate higher than 39 m3/ha increased tet(T) and sul1 gene concentrations in soil for more than 180 days. Tillage practices had no impact on ARG concentrations in soil and water samples. The blaCTX-M-1 gene was only detected in seven water samples in 2016, but no link was established with the treatments. The mcr-1 and mcr-2 genes were not detected in all tested samples. This study demonstrated that tet(T) and sul1 gene concentrations increased in soil after liquid hog manure application as well as in drainage water in the next weeks.

Groundwater microbial diversity and antibiotic resistance linked to human population density in Yucatan Peninsula, Mexico.

Microbial community composition in selected karst groundwater sites in the Yucatan Peninsula, Mexico, was assessed to determine the environmental variables influencing groundwater microbial diversity. The karst aquifer system is a groundwater-dependent ecosystem and is the world's second largest underwater karst cave system. The area's geology allows precipitation to infiltrate into the groundwater system and prevents accumulation of surface water; as such, groundwater is the only source of fresh water on the peninsula. The sampling locations consisted of three karst sinkholes that extend through the freshwater zone into the saline water, and an abandoned drinking water well of an ocean-side resort, during the dry and rainy seasons. The analysis showed that highly diverse microbial communities are present in the Yucatan groundwater, sustained by permanently warm temperatures and high nutrient input from human activity. Proximity to densely populated areas, such as tourist resorts, is the most important factor influencing both the diversity and presence of fecal bacteria and the antibiotic resistance profile.

[The role of new antibiotics in the treatment of acute adult community acquired pneumonia]. / Place des nouveaux antibiotiques dans le traitement de la pneumonie aiguë communautaire de l'adulte.

INTRODUCTION: Several new antibiotics (ceftaroline, ceftobiprole, omadacycline, solithromycine and delafloxacin) have recently been developed. Their place in the management of community acute pneumonia (CAP) needs to be clarified. STATE OF THE ART: Because multiresistant bacteria are infrequently involved in CAP, usual regimens using third generation cephalosporins, fluoroquinolones or macrolides, alone or in combination, are effective in the overwhelming majority of cases. Several studies have highlighted the non-inferiority of the new molecules regarding their clinical efficacy compared to usual regimens. The use of these new antibiotics could reduce the treatment duration of CAP and in some cases avoid combined therapy. These antibiotics do not offer real benefits in terms of spectrum of activity compared to the current recommended treatment. The anti-toxin effect of ceftaroline and the anti-inflammatory properties of solithromycin could potentially justify their prescription over molecules currently used. CONCLUSION: Results are still pending regarding the efficacy and any possible advantages of these new molecules, and also the emergence of drug resistant bacteria. Although these drugs share some advantages, they should not be selected over antibiotics usually prescribed for the treatment of CAP.

Horizontal transfer of antibiotic resistance genes in clinical environments.

A global medical crisis is unfolding as antibiotics lose effectiveness against a growing number of bacterial pathogens. Horizontal gene transfer (HGT) contributes significantly to the rapid spread of resistance, yet the transmission dynamics of genes that confer antibiotic resistance are poorly understood. Multiple mechanisms of HGT liberate genes from normal vertical inheritance. Conjugation by plasmids, transduction by bacteriophages, and natural transformation by extracellular DNA each allow genetic material to jump between strains and species. Thus, HGT adds an important dimension to infectious disease whereby an antibiotic resistance gene (ARG) can be the agent of an outbreak by transferring resistance to multiple unrelated pathogens. Here, we review the small number of cases where HGT has been detected in clinical environments. We discuss differences and synergies between the spread of plasmid-borne and chromosomal ARGs, with a special consideration of the difficulties of detecting transduction and transformation by routine genetic diagnostics. We highlight how 11 of the top 12 priority antibiotic-resistant pathogens are known or predicted to be naturally transformable, raising the possibility that this mechanism of HGT makes significant contributions to the spread of ARGs. HGT drives the evolution of untreatable "superbugs" by concentrating ARGs together in the same cell, thus HGT must be included in strategies to prevent the emergence of resistant organisms in hospitals and other clinical settings.

Widespread detection of antibiotic-resistant bacteria from natural aquatic environments in southern Ontario.

To elucidate how widespread antibiotic resistance is in the surface water environment, we studied the prevalence of antibiotic resistance bacteria at four locations in southern Ontario. We found that the percentage of bacteria resistant to the antibiotic tetracycline was higher at the river site, which flows through agricultural land, and lower at the lake sites. A total of 225 colonies were selected for further testing of antibiotic disc susceptibility to eight different antibiotics to calculate the multiple antibiotic resistance (MAR) score and the antibiotic resistance index for each site. Although the isolates from the lake site outside the city displayed resistance to fewer antibiotics, their MAR scores were not significantly different from that of the lake sites adjacent to urban beaches, showing that MAR was widespread in the natural water environments tested. Isolation of colonies under selection pressure to tetracycline was found to have a significant effect on the likelihood that the isolates would contain multiple resistance traits for other antibiotics. Identification of isolates selected on tetracycline was compared with that of isolates that were sensitive to tetracycline, and the community composition was found to be distinctly different, although isolates from the genera Chryseobacterium, Pseudomonas, and Stenotrophomonas were found in both communities.

Migratory birds along the Mediterranean - Black Sea Flyway as carriers of zoonotic pathogens.

At the crossroad between Europe, Asia, and Africa, Bulgaria is part of the Mediterranean - Black Sea Flyway (MBSF) used by millions of migratory birds. In this study, bird species migrating through Bulgaria were investigated as carriers of zoonotic pathogens. In total, 706 birds belonging to 46 species were checked for the presence of various bacterial pathogens (Campylobacter, Yersinia, Salmonella, Listeria, Escherichia coli, Staphylococcus aureus, Francisella tularensis, Coxiella burnetii, Borrelia burgdorferi, and Brucella spp.). From 673 birds we investigated fecal samples, from the remaining 33, blood samples. We detected Campylobacter 16S rDNA gene in 1.3% of birds, but none were of pathogenic Campylobacter jejuni and Campylobacter coli species. Escherichia coli 16S rDNA gene was found in 8.8% of the birds. Out of 34 birds that transported Yersinia enterocolitica strains (5.05%), only 1 carried a pathogenic isolate. Three birds (0.4%) were carriers of nonpathogenic Salmonella strains. Four avian samples (0.6%) were positive for Listeria monocytogenes and 1 (0.15%) was positive for Brucella spp. None of the birds tested carried the tick-borne pathogens C. burnetii or B. burgdorferi sensu lato. Antibiotic-resistant strains were detected, suggesting that migratory birds could be reservoirs and spreaders of bacterial pathogens as well as antibiotic resistance genes.

Genome of Serratia nematodiphila MB307 offers unique insights into its diverse traits.

A pigment-producing species of Serratia was isolated from the rhizosphere of a heavy metal resistant Cannabis sativa plant growing in effluent-affected soil of Hattar Industrial Estate, Haripur, Pakistan. Here, we report the genome sequence of this bacterium, which has been identified as Serratia nematodiphila on the basis of whole genome comparison using the OrthoANI classification scheme. The bacterium exhibited diverse traits, including plant growth promotion, antimicrobial, bioremediation, and pollutant tolerance capabilities including metal tolerance, azo dye degradation, ibuprofen degradation, etc. Plant growth-promoting exoenzyme production as well as phosphate solubilisation properties were observed. Genes for phosphate solubilisation, siderophore production, and chitin destruction were identified in addition to other industrially important enzymes like nitrilase and lipase. Secondary metabolite producing apparatus for high value chemicals in the whole genome was also analysed. The number of antibiotic resistance genes was then profiled in silico, through a match with Antibiotic Resistant Gene and CAR database. This is the first report of a S. nematodiphila genome from a polluted environment. This could significantly contribute to the understanding of pollution tolerance, antibiotic resistance, association with nematodes, production of bio-pesticide, and their role in plant growth promotion.