Antibacterial and antioxidant activities of endophytic fungi and nettle (Urtica dioica L.) leaves as their host.

Nettle (Urtica dioica L), as a plant rich in biologically active compounds, is one of the most important plants used in herbal medicine. Studies have shown that this plant has antioxidant, antiplatelet, hypoglycemic and hypocholesterolemia effects. In this study, we characterized three Alternaria endophytic fungi isolated from their host U. dioica. We hypothesized that these endophytic fungi can produce new bioactive metabolites, which may possess the bioactive property with potential application in the medical and pharmaceutical industries. The antibacterial activity was evaluated against reference and isolated strains, including Methicillin-Resistant Staphylococcus aureus. A wide range of antimicrobial activities similar to those measured in nettle leaves was detected especially for Alternaria sorghi. Furthermore, the highest antioxidant activity detected with DPPH free radical scavenging was measured for A. sorghi and nettle leaves ethyl acetate extracts. In addition, whereas catalase activity was similar in the three isolated fungi and nettle leaves, total thiol content and superoxide dismutase activity were significantly higher in leaves. A. sorghi showed the best activities compared to other isolated fungi. The characterization and further production of bioactive compounds produced by this endophyte should be investigated to fight bacteria and especially those that develop drug multi-resistance.

Antimicrobial, antioxidant and cytotoxic properties of Chenopodium glaucum L.

We evaluated phytochemical composition, antibacterial, antifungal, anti-oxidant and cytotoxic properties of aqueous (water) and organic extracts (methanol, ethyl acetate and n-hexane) of Chenopodium glaucum. Highest phenolic content 45 mg gallic acid equivalents (GAE)/g d.w was found in aqueous extract followed by ethyl acetate (41mg GAE/g d.w) and methanol extract (34.46 mg GAE/g d.w). Antibacterial potential of aqueous and organic extracts of C. glaucum was examined against Acinetobacter baumannii, Klebsiella pneumoniae, Escherichia coli and Staphylococcus epidermidis. The aqueous, methanolic, ethyl acetate, and n-hexane extract showed antibacterial activity against A. baumannii, K. pneumoniae, E. coli and S. epidermidis. However, against A. baumannii significantly higher inhibition zone (19 mm and 18.96 mm respectively) was shown by ethyl acetate and methanol extracts. Aqueous extract possessed highest growth inhibition (11 mm) against E. coli. Aqueous, ethyl acetate and methanol extracts showed 9 mm, 10 mm, and 10.33 mm zone of inhibition against the K. pneumoniae. For antifungal activity, the extracts were less effective against Aspergillus niger but showed strong antifungal activity against Aspergillus flavus (A. flavus). The antioxidant activity was measured as DPPH (2, 2-diphenyl-1-picrylhydrazyl), H2O2 and ABTS (2, 2'-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) scavenging activity of free radicals. All the organic extracts of C. glaucum possessed ABTS, DPPH and H2O2 scavenging properties. The highest cytotoxic activity measured as half maximal inhibitory concentration (IC50) against human lungs carcinoma cells was recorded for methanolic (IC50 = 16 µg/mL) and n-hexane (IC50 = 25 µg/mL) extracts, respectively. The Gas chromatography-mass spectrometry (GC-MS) analysis showed 4 major and 26 minor compounds in n-hexane extract and 4 major and 7 minor compounds in methanol extract of the C. glaucum. It is concluded that aqueous and organic extracts of C. glaucum would be potential therapeutic agents and could be exploited on a pilot scale to treat human pathogenic diseases.

Bruguiera gymnorhiza (L.) Lam. at the Forefront of Pharma to Confront Zika Virus and Microbial Infections-An In Vitro and In Silico Perspective.

The recent emergence of Zika virus (ZIKV) in Brazil and the increasing resistance developed by pathogenic bacteria to nearly all existing antibiotics should be taken as a wakeup call for the international authority as this represents a risk for global public health. The lack of antiviral drugs and effective antibiotics on the market triggers the need to search for safe therapeutics from medicinal plants to fight viral and microbial infections. In the present study, we investigated whether a mangrove plant, Bruguiera gymnorhiza (L.) Lam. (B. gymnorhiza) collected in Mauritius, possesses antimicrobial and antibiotic potentiating abilities and exerts anti-ZIKV activity at non-cytotoxic doses. Microorganisms Escherichia coli ATCC 25922, Pseudomonas aeruginosa ATCC 27853, Klebsiella pneumoniae ATCC 70603, methicillin-resistant Staphylococcus aureus ATCC 43300 (MRSA), Salmonella enteritidis ATCC 13076, Sarcina lutea ATCC 9341, Proteus mirabilis ATCC 25933, Bacillus cereus ATCC 11778 and Candida albicans ATCC 26555 were used to evaluate the antimicrobial properties. Ciprofloxacin, chloramphenicol and streptomycin antibiotics were used for assessing antibiotic potentiating activity. ZIKVMC-MR766NIID (ZIKVGFP) was used for assessing anti-ZIKV activity. In silico docking (Autodock 4) and ADME (SwissADME) analyses were performed on collected data. Antimicrobial results revealed that Bruguiera twig ethyl acetate (BTE) was the most potent extract inhibiting the growth of all nine microbes tested, with minimum inhibitory concentrations ranging from 0.19-0.39 mg/mL. BTE showed partial synergy effects against MRSA and Pseudomonas aeruginosa when applied in combination with streptomycin and ciprofloxacin, respectively. By using a recombinant ZIKV-expressing reporter GFP protein, we identified both Bruguiera root aqueous and Bruguiera fruit aqueous extracts as potent inhibitors of ZIKV infection in human epithelial A549 cells. The mechanisms by which such extracts prevented ZIKV infection are linked to the inability of the virus to bind to the host cell surface. In silico docking showed that ZIKV E protein, which is involved in cell receptor binding, could be a target for cryptochlorogenic acid, a chemical compound identified in B. gymnorhiza. From ADME results, cryptochlorogenic acid is predicted to be not orally bioavailable because it is too polar. Scientific data collected in this present work can open a new avenue for the development of potential inhibitors from B. gymnorhiza to fight ZIKV and microbial infections in the future.

Redirection of the central metabolism of Klebsiella pneumoniae towards dihydroxyacetone production.

BACKGROUND: Klebsiella pneumoniae is a bacterium that can be used as producer for numerous chemicals. Glycerol can be catabolised by K. pneumoniae and dihydroxyacetone is an intermediate of this catabolism pathway. Here dihydroxyacetone and glycerol were produced from glucose by this bacterium based a redirected glycerol catabolism pathway. RESULTS: tpiA, encoding triosephosphate isomerase, was knocked out to block the further catabolism of dihydroxyacetone phosphate in the glycolysis. After overexpression of a Corynebacterium glutamicum dihydroxyacetone phosphate dephosphorylase (hdpA), the engineered strain produced remarkable levels of dihydroxyacetone (7.0 g/L) and glycerol (2.5 g/L) from glucose. Further increase in product formation were obtained by knocking out gapA encoding an iosenzyme of glyceraldehyde 3-phosphate dehydrogenase. There are two dihydroxyacetone kinases in K. pneumoniae. They were both disrupted to prevent an inefficient reaction cycle between dihydroxyacetone phosphate and dihydroxyacetone, and the resulting strains had a distinct improvement in dihydroxyacetone and glycerol production. pH 6.0 and low air supplement were identified as the optimal conditions for dihydroxyacetone and glycerol production by K, pneumoniae ΔtpiA-ΔDHAK-hdpA. In fed batch fermentation 23.9 g/L of dihydroxyacetone and 10.8 g/L of glycerol were produced after 91 h of cultivation, with the total conversion ratio of 0.97 mol/mol glucose. CONCLUSIONS: This study provides a novel and highly efficient way of dihydroxyacetone and glycerol production from glucose.

Anti-adhesive activity of a Vaccinium corymbosum polyphenolic extract targeting intestinal colonization by Klebsiella pneumoniae.

The therapeutic effect of Vaccinium polyphenols against uropathogens has been widely studied. Most attention has focused on the antimicrobial activity against P-fimbriated Escherichia coli strains. The present study investigated the anti-adhesive and anti-biofilm activity of a saline extract of blueberry (Vaccinium corymbosum) targeting intestinal colonization by a highly adherent Klebsiella pneumoniae strain. This strain, responsible for a large outbreak of infection in Spain, was selected on the basis of its remarkable capacity to colonize the gastrointestinal tract of patients. The blueberry extract was obtained using a medium scale ambient temperature system (MSAT) in a novel approach based on the use of an aqueous solvent and addition of mineral salts. The polyphenolic content was determined by liquid chromatography coupled to tandem mass-spectrometry (LC-MS/MS). The findings confirmed that the blueberry extract is a rich source of phenolic compounds, including the most polar polyphenols (mostly non-flavonoids), intermediate polarity compounds (flavan-3-ols and most procyanidins) and low polarity compounds (flavonols and anthocyanins). The extract significantly inhibited biofilm formation and bacterial adhesion to HT-29 colorectal cells by a highly adherent multidrug-resistant K. pneumoniae. Although some individual anthocyanidins (malvidin, delphinidin and cyanidin) and one hydroxycinnamic acid (caffeic acid) proved capable of reducing bacterial adhesion, the unfractionated extract was more active than any of the individual polyphenolic compounds. In addition, the extract displayed considerable potential as an intestinal decolonization treatment in a murine model. The study findings demonstrate the potential value of the V. corymbosum extract as an alternative treatment for K. pneumoniae infections.

A coup d'état by NDM-producing Klebsiella pneumoniae overthrows the major bacterial population during KPC-directed therapy.

The objective of this study was to utilize a co-culture hollow-fiber infection model (HFIM) to characterize the interplay between a small, difficult-to-detect, New Delhi metallo-ß-lactamase-producing Klebsiella pneumoniae (NDM-Kp) minor population and a larger K. pneumoniae carbapenemase (KPC)-producing K. pneumoniae population in the presence of KPC-directed antibacterial therapy. Selective plating onto agar with ceftazidime-avibactam was used to track the density of the NDM-Kp population. Susceptibility testing and the Verigene System failed to identify the small initial NDM-Kp population. However, a ceftazidime-avibactam Etest detected resistant colonies that were confirmed to be NDM-Kp. In the HFIM, all of the investigated drug regimens caused regrowth within 24 h and resulted in >109 CFU/mL of NDM-Kp. Our study demonstrates that the HFIM is a powerful tool for studying the population dynamics of multiple pathogens during antimicrobial exposure and also highlights that difficult-to-detect minor populations of drug-resistant bacteria may cause treatment failure without appropriate antibacterial therapy.

In Vitro and In Vivo Effects of the Polymyxin-Vorinostat Combination Therapy Against Multidrug-Resistant Gram-Negative Pathogens.

With the stagnancy of antibiotics development, polymyxins have become the last defense for treatment of multidrug-resistant (MDR) Gram-negative bacteria, whereas the effect of polymyxin monotherapy is limited by resistance. The objective of this study was to evaluate the effects of polymyxin B (PMNB)-vorinostat (SAHA) combination therapy against Gram-negative pathogens in vitro and in vivo. The antibacterial activities of PMNB and SAHA were evaluated by susceptibility testing. The synergistic effect was assessed by checkerboard tests and time-killing kinetics experiments. Cellular morphology studies and reactive oxygen species (ROS) assay were conducted to explore potential mechanisms. Also, Galleria mellonella models were made to evaluate the antibacterial effects in vivo. PMNB-SAHA had the synergistic effect against all tested isolates, reducing >2 log10 colony-forming units (CFU)/mL at 40 minutes, and showed more powerful antibacterial effects than PMNB alone in the 24-hour window. Cellular morphology study showed the change of membrane and disruption of integrity. ROS assay showed more oxidative stress in combination than PMNB or SAHA monotherapy. In animal models, PMNB-SAHA showed a higher survival rate than that of monotherapy. This study is the first to report the synergistic antibacterial effect of PMNB-SAHA therapy against MDR Gram-negative bacteria. Further clinical research is needed to confirm the results.

Laboratory-based versus population-based surveillance of antimicrobial resistance to inform empirical treatment for suspected urinary tract infection in Indonesia.

Surveillance of antimicrobial resistance (AMR) enables monitoring of trends in AMR prevalence. WHO recommends laboratory-based surveillance to obtain actionable AMR data at local or national level. However, laboratory-based surveillance may lead to overestimation of the prevalence of AMR due to bias. The objective of this study is to assess the difference in resistance prevalence between laboratory-based and population-based surveillance (PBS) among uropathogens in Indonesia. We included all urine samples submitted to the laboratory growing Escherichia coli and Klebsiella pneumoniae in the laboratory-based surveillance. Population-based surveillance data were collected in a cross-sectional survey of AMR in E. coli and K. pneumoniae isolated from urine samples among consecutive patients with symptoms of UTI, attending outpatient clinics and hospital wards. Data were collected between 1 April 2014 until 31 May 2015. The difference in percentage resistance (95% confidence intervals) between laboratory- and population-based surveillance was calculated for relevant antibiotics. A difference larger than +/- 5 percent points was defined as a biased result, precluding laboratory-based surveillance for guiding empirical treatment. We observed high prevalence of AMR ranging between 63.1% (piperacillin-tazobactam) and 85% (ceftriaxone) in laboratory-based surveillance and 41.3% (piperacillin-tazobactam) and 74.2% (ceftriaxone) in population-based surveillance, except for amikacin and meropenem (5.7%/9.8%; 10.8%/5.9%; [laboratory-/population-based surveillance], respectively). Laboratory-based surveillance yielded significantly higher AMR prevalence estimates than population-based surveillance. This difference was much larger when comparing surveillance data from outpatients than from inpatients. All point estimates of the difference between the two surveillance systems were larger than 5 percent points, except for amikacin and meropenem. Laboratory-based AMR surveillance of uropathogens, is not adequate to guide empirical treatment for community-based settings in Indonesia.

Green synthesis and characterization of silver nanoparticles from Moringa oleifera flower and assessment of antimicrobial and sensing properties.

The present study aimed to explore the biosynthesis and characterization of silver nanoparticles (AgNPs) from Moringa oleifera flower (MOF) extract and its antimicrobial and sensing properties. The prepared AgNPs were characterized by Transmission Electron Microscopy (TEM), UV-visible spectral analysis (UV-vis), X-Ray Diffraction (X-RD), Energy Dispersive Spectroscopy (EDS), and Fourier Infra-Red Spectroscopy (FTIR) respectively. Antimicrobial and sensing properties of the prepared nanoparticles were also determined. Face-Centered Cubic (FCC) lattice of the AgNPs was observed in X-RD pattern. FTIR measurement evidenced the band pattern at 686, 1653, 2062 and 3456 cm-1 proved the presence of proteins and phenolic components in MOF responsible for reduction. TEM analysis indicated the formation of monodispersed spherical particles with 8 nm. UV-vis of the prepared AgNPs authenticated the surface plasmon resonance (SPR) at 429 nm and stable for six months. AgNPs have produced highest zone of inhibition (ZOI) of 17 mm and 29 mm against Klebsiella pneumoniae and Staphylococcus aureus respectively. In addition, the AgNPs effectively detected the presence of Copper ions from 1 mM to 12 mM concentrations. Copper sensitivity of these biosynthesized nanoparticles was carried out by optical sensor based SPR. Thus the obtained antimicrobial and optical properties, suggested the use of obtained AgNPs in water purification.

Sub-acute toxicological and behavioural effects of two candidate therapeutics, cinnamaldehyde and eugenol, for treatment of ESBL producing-quinolone resistant pathogenic Enterobacteriaceae.

Present study deals with evaluation of antibacterial activity of cinnamaldehyde and eugenol against both extended-spectrum-ß-lactamase (ESBL)-producing and quinolone resistant (QR) (ESBL-QR) pathogenic Enterobactericeae along with determination of its in vivo toxicity level in a murine model to investigate their pharmacological potential. Broth microdilution assay was used to determine minimum inhibitory concentrations (MICs) of cinnamaldehyde (CIN), eugenol (EG) and traditional antibiotics against ESBL-QR Enterobactericeae. Sub-acute oral toxicity study (14 days) was carried out in Swiss albino mice to evaluate any toxicological and behavioural effect viz novelty suppressed feeding (NSF), novel object recognition (NOR), tail suspension test (TST) and social interaction test of cinnamaldehyde and eugenol. Cinnamaldehyde and eugenol demonstrated mode-MIC of 7.28 and 7.34 µg/mL among maximum numbers of Escherichia coli (32.1%) and 0.91 and 3.67 µg/mL among maximum numbers of Klebsiella  pneumoniae (24.2%) isolates, respectively. For haematological and toxicological analyses, after 14 days of oral administration of cinnamaldehyde (0.91-10 mg/kg) and eugenol (7.34-70 mg/kg), blood was collected from the murine model, while histological examinations were performed on liver and kidney. There was no alteration in food and water intake among treated animals. Toxicological and behavioural studies displayed good safety profiles of cinnamaldehyde and eugenol. The results indicated potential antibacterial efficacy of cinnamaldehyde and eugenol against pathogenic ESBL-QR Enterobacteriaceae, without any significant toxicological and behavioural effects.

Lavender essential oil induces oxidative stress which modifies the bacterial membrane permeability of carbapenemase producing Klebsiella pneumoniae.

Misuse of antibiotics in the clinical and agricultural sectors has caused the emergence of multidrug-resistant (MDR) Klebsiella pneumoniae which contributes a threat to human health. In this study, we assessed the feasibility of lavender essential oil (LVO) as an antimicrobial agent in combinatory therapy with meropenem in suppressing the growth of carbapenemase-producing K. pneumoniae (KPC-KP). Synergistic interactions between LVO and meropenem were detected, which significantly reduce the inhibitory concentration of both LVO and meropenem by 15 and 4-fold respectively. Comparative proteomic profiling identified a disruption in the bacterial membrane via oxidative stress that was indicated by loss of membrane and cytoplasmic proteins and the upregulation of oxidative regulators. As a proof of concept, zeta potential measurements showed a change in cell surface charge while outer membrane permeability measurement indicated an increase in membrane permeability following exposure to LVO. This was indicative of a disrupted outer membrane. Ethidium bromide influx/efflux assays demonstrated no significant efflux pump inhibition by LVO, and scanning electron microscopy revealed irregularities on the cell surface after exposure to LVO. Oxidative stress was also detected with increased level of ROS and lipid peroxidation in LVO-treated cells. In conclusion, our data suggest that LVO induced oxidative stress in K. pneumoniae which oxidizes the outer membrane, enabling the influx of generated ROS, LVO and meropenem into the bacterial cells, causing damage to the cells and eventually death.

Preparation of antimicrobial gold and silver nanoparticles from tea leaf extracts.

Gold and silver nanoparticles were prepared from the green tea and black tea extracts of the leaves of Camellia sinensis. The metal nanoparticle solutions were obtained by reacting HAuCl4 or AgNO3 aqueous solutions with aqueous NaHCO3 and tea leaf extracts, which were obtained from used tea leaves at low temperature, under ambient conditions. The nanoparticles were stable at room temperature and had a uniform particle size (Au: ∼10 nm, Ag: ∼30 nm). Nanoparticle-immobilized cotton cloths were then prepared, which displayed high antibacterial activity and a characteristic color, thereby showing potential application as antimicrobial pigments. This study provides a means of utilizing used tea leaves, which would otherwise be considered waste products.

In vitro pharmacological effects of Astragalus eremophilus and Melilotus parviflora.

Traditional medicines are composed of herbal formulations and their active ingredients and constituents which play a crucial role in the treatment of various human ailments. Astragalus eremophilus and Melilotus indicus (L.) All. (syn. Melilotus parviflora Desf.) are used traditionally as antiperspirant, tonic, diuretic, laxative and narcotic agents. The current study was designed to investigate the Astragalus eremophilus and Melilotus indicus (L.) All. (syn. Melilotus parviflora Desf.) methanol extracts for their antioxidant, antibacterial and antifungal activities. Fine powder of A. eremophilus and M. parviflora was extracted with 70% methanol to get crude methanol extract. Extract was characterized for antioxidant, antibacterial and antifungal activities. Antioxidant activity of various concentrations (3 mg/ml, 1.5 mg/ ml, 0.75 mg/ml, and 0.38 mg/ml) of both plant extracts was analyzed using 2,2-Diphenyl-1-picrylhydrazyl (DPPH) free radical. Salmonella typhemorium, Klebsiella pneumoniae (gram-negative) and Staphylococcus aureus, Enterococcus faecalis (gram-positive) bacterial strains were used for assessment of antibacterial activities. Antifungal activities of 7.5 mg/ml, 5.0 mg/ml, 2.5 mg/ml (A. eremophilus and M. parviflora) were conducted using Aspergillus niger, Aspergillus flavus, Aspergillus fumigatus and Candida albicons. At high concentration (3 mg/ml), all the tested fractions of A. eremophilus and M. parviflora methanol extracts showed potent antioxidant activities, ranging between 83.8 and 63.33%. Antibacterial activities revealed that A. eremophilus showed a maximum zone of inhibition (8.1 ± 0.1) on Salmonella typhenorium followed by Enterococcus faecalis (7.2 ± 0.1), Klebsellesa pneumonia (6.1 ± 0.6), and Staphylococcus aureus (5.1 ± 0.4), and at highest concentration (7.5 mg/ml), however, maximum zone of inhibition of Melilotus parviflora was at 7.5 mg/ml followed by 5.0 mg/ml and 2.5 mg/ml against Klebsiella pneumonia, Staphylococcus aureus, Salmonella typhemorium and Enterococcus faecalis. Antifungal assessment of both plant extracts showed that the higher concentration (7.5 mg/ml) has significant inhibitory effect as compared to control. The results can lead to the conclusion that A. eremophilus and M. parviflora methanol extracts are indeed sources of potential therapeutic compounds against antibacterial, antifungal and free radical associated disorders.

Impact of different solvent extracts from leaves and fruits of Eucalyptus globulus on growth of different bacteria and fungi.

The present research investigates the antimicrobial activities of the samples extracted from the leaves and fruits of Eucalyptus globulus through disc diffusion susceptibility assay using 1, 2 and 3mg disc-1 concentrations. Different extracted samples from the leaves and fruits of Eucalyptus globulus exhibited different degrees of antimicrobial. The data indicated that n-butanol and ethyl acetate extracted fraction of both the leaves and fruits inhibited the growth of all microorganisms at all the tested concentrations. Aqueous extracted sample of the leaves inhibited the growth of Candida albicans while the same fraction from the fruits showed no activity against Bacillus subtilis at any concentration. N-hexane extracted samples of the leaves inhibited the growth of Bacillus subtilis, E. coli and Pseudomonas aeruginosa at the tested concentrations while no activity was recorded against Klebsiella pneumonia, Candida albicans and Stephylococcus aureus. N-butanol extracted samples from the leaves and fruits showed activity against Pseudomonas aeruginosa at the tested concentrations. In case of leaves, the most susceptible bacteria was Bacillus subtilis (gram positive) and Stephylococcus aureus (gram positive) was the most resistant one. In case of fruits the most susceptible bacteria was Stephylococcus aureus (gram positive) and E. coli (Gram negative) was the most resistant one.

Collateral damage of using colistin in hospitalized patients on emergence of colistin-resistant Escherichia coli and Klebsiella pneumoniae colonization and infection.

Background: Colistin has been used for therapy of carbapenem-resistant Gram-negative infections in Thailand, especially carbapenem-resistant A. baumannii and P. aeruginosa, for more than 10 years. However, the prevalence of colistin-resistant A. baumannii or P. aeruginosa is still less than 5%. Colistin-resistant Enterobacteriaceae has been increasingly reported globally over the past few years and the use of colistin in food animals might be associated with an emergence of colistin resistance in Enterobacteriaceae. This study aimed to determine the effect of colistin exposure in hospitalized patients who received colistin on development of colistin-resistant (CoR) Escherichia coli (EC) or Klebsiella pneumoniae (KP) colonization and infection. Methods: A prospective observational study was performed in adult hospitalized patients at Siriraj Hospital who received colistin for treatment of infections during December 2016 and November 2017. The surveillance culture samples were collected from the stool and the site of infection of each patient who received colistin at the study enrollment, days 3 and 7 after the study enrollment, and once a week thereafter for determination of CoR EC and CoR KP. CoR EC and CoR KP were also tested for a presence of mcr-1 gene. Results: One hundred thirty-nine patients were included. Overall prevalence of CoR EC or CoR KP colonization was 47.5% among 139 subjects. Prevalence of CoR EC or CoR KP colonization was 17.3% of subjects at study enrollment, and 30.2% after study enrollment. Use of fluoroquinolones, aminoglycosides, and colistin was found to be significantly associated with CoR EC or CoR KP colonization. The mcr-1 gene was detected in 13.0% of CoR EC or CoR KP isolates, and in 27.3% of subjects with CoR EC or CoR KP colonization. CoR EC or CoR KP colonization persisted in 65.2% of the subjects at the end of the study. Five patients with CoR KP infections received combination antibiotics and they were alive at hospital discharge. Conclusions: Prevalence of CoR EC or CoR KP colonization in hospitalized patients receiving colistin was high and it was associated with the use of colistin. Therefore, patients who receive colistin are at risk of developing CoR EC or CoR KP colonization and infection.

Risk Factors for Gastrointestinal Colonization and Acquisition of Carbapenem-Resistant Gram-Negative Bacteria among Patients in Intensive Care Units in Thailand.

This study was conducted to investigate the prevalence of and risk factors for colonization and acquisition of carbapenem-resistant (CR) Gram-negative bacteria (GNB) among patients admitted to intensive care units (ICUs) in two tertiary care hospitals in northern Thailand. Screening of rectal swab specimens for CR-GNB was performed on patients at ICU admission and discharge. The phenotypes and genotypes of all isolates were determined. Risk factors were analyzed by logistic regression analysis. The overall carriage rate of CR-GNB at admission was 11.6% (32/275), with the most predominant species carried being Acinetobacter baumannii (n = 15), followed by Klebsiella pneumoniae (n = 9). The risk factor for CR-GNB colonization was hospitalization within the previous 6 months (P = 0.002). During the ICU stay, the rate of CR-GNB acquisition was 25.2% (52/206), with the most predominant species carried being A. baumannii (n = 28) and K. pneumoniae (n = 13). Risk factors associated with CR-GNB acquisition were the use of an enteral feeding tube (P = 0.008) and administration of third-generation cephalosporins (P = 0.032) and carbapenems (P = 0.045). The most common carbapenemase genes in A. baumannii and K. pneumoniae were blaOXA-23/51 and blaNDM, respectively. Patient-to-patient transmission was demonstrated in three cases, resulting in the acquisition of CR A. baumannii (2 cases) and K. pneumoniae (1 case) isolates from other patients who were admitted during the same period of time. This is the first Indochinese study screening patients, examining patients for the carriage of CR-GNB, and further demonstrating the transfer of CR-GNB isolates in ICUs. Our study suggests that effective infection control measures are required to limit the spread of CR-GNB within hospitals.

Carbapenems vs. alternative ß-lactams for the treatment of nosocomial pneumonia: A systematic review and meta-analysis.

BACKGROUND: Carbapenems have shown efficacy in treating nosocomial pneumonias in clinical trials despite a reported low lung penetration compared with other ß-lactams. Preserving the clinical activity of carbapenems through stewardship efforts is essential. The aim of this review was to identify any differences in outcomes potentially as a function of decreased penetration. METHODS: PubMed and the Cochrane Library were systematically searched for clinical trials comparing carbapenems with other anti-pseudomonal ß-lactams for treatment of nosocomial pneumonia through to end December 2016. Trials reporting clinical and microbiological outcomes associated with treatment were included. Pediatric studies and those with uneven comparators (e.g., carbapenem vs. combination Gram-negative therapy) were excluded. Fixed effects models were used to evaluate the impact of treatment on the odds of clinical failure, death, or microbiological failure. RESULTS: 252 unique articles were identified; five met inclusion criteria and comprised 640 patients in the carbapenem group and 634 patients in the ß-lactam group. No differences in clinical failure (odds ratio [OR] 1.08, 95% confidence interval [CI] [0.81-1.44], I2=16%) or mortality (OR 0.75, CI 0.57-1.11, I2=0%) were noted between groups. Patients infected with P. aeruginosa and treated with imipenem were more likely to experience clinical failure (OR 4.21, CI 1.51-11.12, I2=44%) and to develop resistance to the study carbapenem (OR 2.86, CI 1.08-6.44, I2= 13%) than those treated with alternative ß-lactams. CONCLUSIONS: No differences in clinical outcomes were observed between carbapenems and non-carbapenem ß-lactams in nosocomial pneumonias. Those infected with P. aeruginosa fared worse and were more likely to have resistance develop if they were treated with imipenem. Additional studies are warranted.

Molecular ß-lactamase characterization of Gram-negative pathogens recovered from patients enrolled in the ceftazidime-avibactam phase 3 trials (RECAPTURE 1 and 2) for complicated urinary tract infections: Efficacies analysed against susceptible and resistant subsets.

This study characterized the ß-lactamase content of baseline pathogens recovered from patients with complicated urinary tract infections (cUTI), including acute pyelonephritis, who were enrolled in two phase 3 clinical trials of ceftazidime-avibactam (RECAPTURE 1 and 2), and correlated the clinical efficacy of ceftazidime-avibactam and the comparator doripenem according to resistance mechanisms. A total of 26.2% (93/355) ceftazidime-avibactam and 26.8% (101/377) doripenem patients had baseline isolates that met the MIC screening criteria. The majority of Enterobacteriaceae (87.5%; 154/176) carried blaCTX-M. This pattern was mainly observed in Escherichia coli (96.8%; 92/95) and Klebsiella pneumoniae (96.0%; 48/50), whereas most Proteus mirabilis (80.0%; 8/10) carried plasmid AmpC genes. Two K. pneumoniae and 1 Klebsiella oxytoca carried blaOXA-48 and 1 K. pneumoniae carried blaNDM-1. Five (13/35; 37.1%) Pseudomonas aeruginosa isolates were screened, and 2 carbapenemase producers (IMP-18 and VIM-2) were detected. Among patients enrolled in the ceftazidime-avibactam arm who were infected by MIC screen-positive Enterobacteriaceae, clinical cure occurred in 85.7-95.5%, regardless of ß-lactamase content; the respective rate in the doripenem arm was 82.1-92.5%. A total of 75.0% in the ceftazidime-avibactam arm and 100.0% in the doripenem arm of patients infected by P. aeruginosa with MIC screen-positive criteria were clinically cured. Ceftazidime-avibactam efficacy was comparable to doripenem efficacy for treating cUTI caused by uropathogens producing extended-spectrum and/or AmpC ß-lactamases.

Combination of essential oil and ciprofloxacin to inhibit/eradicate biofilms in multidrug-resistant Klebsiella pneumoniae.

AIM: This study aimed to test biofilm inhibition activities of each of essential oils (EOs), main compounds of EOs and enzymes against pathogenic Klebsiella pneumoniae. METHODS AND RESULTS: The effect of seven EOs and three enzymes was tested on formation and eradication of K. pneumoniae biofilm. Peppermint oil showed a robust biofilm inhibitory effect, causing inhibition that ranged from 69·2 to 98·2% at 5 µl ml-1 . Thyme oil was found to have the best biofilm eradication ability, causing eradication that ranged from 80·1 to 98·0% at 10 µl ml-1 . The most effective EOs were analysed by GC/MS, to determine the major chemical constitutes of each oil. Pure menthol was found to cause 75·3-97·5% biofilm inhibition at 2·5 µg ml-1 , whereas thymol caused 85·1-97·8% biofilm eradication at 5 µg ml-1 . However, moderate inhibition activity was detected for α-amylase and bromelain, while poor activity was detected for ß-amylase. Ciprofloxacin combination with thyme oil and thymol was found to enhance antibiotic activity, and affect biofilm cell viability. The observed inhibitory/eradication activity on K. pneumoniae biofilms was confirmed by scanning electron microscopy. CONCLUSIONS: Thyme and peppermint EOs, and their active components are promising antibiofilm agents alone and/or in combination with ciprofloxacin to inhibit/eradicate biofilms of K. pneumoniae. SIGNIFICANCE AND IMPACT OF THE STUDY: The presented results suggest the potential application of EOs against infections, caused by biofilm-producing K. pneumoniae, to prevent biofilm formation or decrease their resistance threshold. Moreover, the combination of EOs with ciprofloxacin minimizes the antibiotic concentration used and accordingly the potential accompanying toxic side effects.