Neonatal septicemia at intensive care unit, Ayder Comprehensive Specialized Hospital, Tigray, North Ethiopia: Bacteriological profile, drug susceptibility pattern, and associated factors.

BACKGROUND: Neonatal septicemia is a life threatening medical emergency that requires timely detection of pathogens with urgent rational antibiotics therapy. METHODS: A cross-sectional study was conducted between March 2017 to September 2018 among 317 septicemia suspected neonates at neonatal intensive care unit, Ayder Comprehensive Specialized Hospital, Mekelle, Tigray, North Ethiopia. A 3 mL of blood was collected from each participant. Identification of bacterial species was done using the standard microbiological techniques. Antibiotic sensitivity test was done using disk diffusion method. Data were entered and analyzed using computer software SPSS version 22. Bivariate and multivariate regression analysis was applied to determine the association between variables. RESULTS: Of the 317 (190 male and 127 female) neonates, 116 (36.6%) were found to be with culture proven septicemia. Klebsiella species were the predominant etiologic agents. Length of hospital stay (AOR (adjusted odds ratio) = 3.65 (2.17-6.13), p < 0.001) and low birth weight (AOR = 1.64 (1.13-2.78), p = 0.04) were the factors associated with neonatalsepticemia. Most isolates showeda frightening drug resistance rate to the commonly used antimicrobial drugs. K. pneumoniae, E. coli, Enterobacter and Citrobacter species were 57% to100% resistant to ceftazidime, ceftriaxone, gentamycin, amoxacillin-clavulunic acid and ampicillin. All, 9 (100%) isolates of S. aureus were resistant to oxacilline, ampicillin,erythromycin and gentamycin. Furthermore, 55.6% S. aureus isolates were Methicillin Resistant Staphylococcus aureus. CONCLUSION: Neonaltal septicemia is found to be significantly high in the present study. As most of the isolates are potentially related to hospital acquired infections, prevention and control policy should have to be more strengthening in the neonatal intensive care unit.

Bacterial and heavy metal contamination in selected commonly sold herbal medicine in Blantyre, Malawi.

Background: There has been an increase in use of herbal medicine worldwide. It is either used as a stand-alone or complementary therapy to conventional medicine due to past good experience, poverty and family traditions. In Malawi, there are no regulations governing the supply, acquisition, marketing and quality enforcement of herbal medicine. This compromises its safety thereby exposing consumers to avoidable bacteria and heavy metals leading to various adverse health effects. Methods: Cross-sectional laboratory experiments were conducted to determine bacterial and heavy metal contamination of herbal medicine commonly sold in Blantyre, Malawi. A total of 47 samples which were in three formulations namely liquid, powder and tablet were used in the experiments. 29 samples were used for bacterial limit tests and 18 samples were used for heavy metal analysis. Bacterial contamination was determined by streak plate method and biochemical tests while heavy metals were determined by atomic absorption spectroscopy. Descriptive statistics and t-tests were calculated using Microsoft excel and SPSS software programs. Results: Twenty out of the 29 samples (68.9%) were contaminated with Bacillus, coagulase negative Staphylococcus, Klebsiella, Enterobacter, Citrobacter and other-Coliform bacterial species. Most isolated microorganism was Citrobacter spp. (30%), followed by Bacillus spp. (25%). Out of 20 contaminated samples, 75% were contaminated with coliforms. From these 75% which were contaminated with coliforms, 93.3% of them exceeded WHO regulatory limit (103 CFU/g for enterobacteria). Although liquid samples had the highest level of bacterial contaminants, the count was not statistically different from other formulations (P = 0.058). For heavy metals, lead and cadmium were detected and 67% of the samples had lead levels exceeding regulatory limits. Conclusion: Levels of bacterial and lead contamination in herbal medicine from Blantyre markets are far above acceptable limits set by WHO and Canadian guidelines. The use of these herbal medicines is a major risk to the health of consumers.

Treatment Outcomes in Infections Caused by "SPICE" (Serratia, Pseudomonas, Indole-positive Proteus, Citrobacter, and Enterobacter) Organisms: Carbapenem versus Noncarbapenem Regimens.

PURPOSE: Techniques used to identify AmpC ß-lactamases in SPICE (Serratia, Pseudomonas, indole-positive Proteus, Citrobacter, and Enterobacter) organisms are not yet optimized for the clinical laboratory and are not routinely used. Clinicians are often left with an uncertainty on the choice of antibiotic when a SPICE organism is isolated. The purpose of this study was to evaluate the outcomes of carbapenem versus noncarbapenem regimens in treating bacteremia or urinary tract infection from a SPICE organism in clinical practice. METHODS: This single-center, retrospective, cohort study analyzed data from adult patients who had clinical infection with a SPICE organism isolated from blood or urine cultures. Patients were assigned to a carbapenem- or noncarbapenem-treated group. The primary end point was clinical response, defined as a resolution of signs and symptoms of infection at the end of therapy. FINDINGS: A total of 332 patients were assessed, and 145 patients met the inclusion criteria for the study. There were 20 patients who received a carbapenem, while 125 received a noncarbapenem regimen. The percentage of patients who were bacteremic was 46.2%. Clinical response overall was achieved in 80% of patients on a carbapenem versus 90.3% of patients on a noncarbapenem regimen (P = 0.24). The rate of microbiologic cure was 90% in patients on a carbapenem versus 91.2% in patients on a noncarbapenem regimen (P = 1). IMPLICATIONS: In this study in patients treated for infection with a SPICE organism in clinical practice, the rates of clinical response did not differ significantly between the carbapenem and noncarbapenem groups. Current CLSI breakpoints set for SPICE organisms may still be reliable and may not require additional testing for AmpC ß-lactamases.

Anti-microbial resistance profile of Citrobacter species in a tertiary care hospital of Southern India.

BACKGROUND: Recently, the isolation of this pathogen in hospital settings is increasing and multidrug-resistant strains are emerging; these strains present a challenge for clinician and the clinical microbiologist because of their increased occurrence in nosocomial infection. The current study was done to find out the antibiotic sensitivity pattern of Citrobacter species from various clinical specimens. MATERIALS AND METHODS: Samples were collected from patients in accordance with standard protocols. Citrobacter species were identified by conventional biochemical tests. Antibiotic susceptibility of the isolates was done by disc diffusion method according to National Committee for Clinical Laboratory Standards (NCCLS) recommendations. RESULTS: Out of 563 isolates of Citrobacter, majority were from pus (48.1%), followed by urine (24.3%), sputum (20.3%), body fluids (05.2%), blood (02.1%). C. koseri was the predominant species [391 (70%)] isolated. Infection was nosocomialy acquired in 493 (87.4%) patients. The mean age was 39.5 years. Anti-biograms of Citrobacter isolates revealed that effective agent against Citrobacter isolates was imipenem (91.8% sensitive), followed by piperacillin/tazobactam (58.3%) and amikacin (53.4%). CONCLUSION: Citrobacter isolates resistant to multiple anti-microbial agents have emerged, including strains resistant to imipenem, making it an emerging nosocomial pathogen. Therefore, the results of this study suggest that surveillance of anti-microbial resistance in Citrobacter is necessary. Antibiotic policy should be formulated in the hospital. Depending on the antibiotic sensitivity pattern of the Citrobacter isolates, antibiotics should be used, and proper infection control measures should be strictly followed to prevent spread of this pathogen.

[Using antibiotics in urinary tract infection in a first level of attention health care unit in Bogotá, Colombia]. / Uso de antibióticos en infección de vías urinarias en una unidad de primer nivel de atención en salud, Bogotá, Colombia.

OBJECTIVES: Describing using antibiotics for urinary tract infection in a first level of attention health care unit. METHODS: This was an observational and descriptive study of a cohort of register-based patients attending the Universidad Nacional de Colombia's Health Service Unit (UNISALUD) diagnosed as suffering urinary tract infection between July 2002 and June 2003. RESULTS: 6,3 % urinary tract infection incidence was found, especially affecting women (84,4 %). The signs and symptoms were the same as those usually found in this disease. 58% corresponded to lower tract infection, 36 % to non-specific infection, 4 % to infection during pregnancy and 2 % to upper tract infection. The following uropathogens were isolated: E. coli (88.9%), Proteus spp. (5,1%), Klebsiella spp. (3,7 %), Enterobacter spp. (1%), Citrobacter spp. (1 %) and Staphylococcus saprophyticus (0,3 %). There was great variability in the antibiotic schemes being prescribed. Nitrofurantoin, Trimethoprim-sulfamethoxizole and Fluoroquinolones were the most prescribed, per defined daily dose; these antibiotics presented low susceptibility for the uropathogens so isolated. There was a 4:1 ratio of empirical treatment respecting confirmed ones. 98 % of the cases corresponded to patients suffering from a single event or having just 1 to 2 recurrences. DISCUSSION The urinary tract infection studied here presented a similar epidemiological profile to that usually found in the general population. The isolated microorganism's low susceptibility to the prescribed antibiotics could reflect inappropriate use of antibiotics by the health service, inducing selective pressure on bacterial resistance.

Uso de antibióticos en infección de vías urinarias en una unidad de primer nivel de atención en salud, Bogotá, Colombia / Using antibiotics in urinary tract infection in a first level of attention health care unit in Bogotá, Colombia

OBJETIVOS: Describir el uso de antibióticos en infección de vías urinarias, en una unidad de primer nivel de atención en salud. MÉTODOS: Estudio observacional, descriptivo, de una cohorte histórica, basada en registros, de usuarios consultantes en la Unidad de Servicios de Salud-UNISALUD, de la Universidad Nacional de Colombia, sede Bogotá, con diagnóstico de infección de vías urinarias, entre julio de 2002 y junio de 2003. RESULTADOS: La incidencia de infección de vías urinarias fue de 6,3 por ciento, afectando especialmente a las mujeres con 84,4 por ciento. Los signos y síntomas son los típicamente encontrados en esta entidad: 58 por ciento de los casos corresponde a infecciones bajas, 36 por ciento a inespecíficas, 4 por ciento a infecciones durante el embarazo y 2 por ciento a infecciones altas. Los uropatógenos aislados fueron: E. coli (88,9 por ciento), Proteus spp. (5,1 por ciento), Klebsiella spp. (3,7 por ciento), Enterobacter spp. (1 por ciento), Citrobacter spp. (1 por ciento) y Staphylococcus saprophyticus (0,3 por ciento). Hubo una gran variabilidad en la prescripción de esquemas antibióticos. Los de mayor consumo, en dosis diaria definida, fueron: Nitrofurantoína, Trimetoprim-sulfa y Fluoroquinolonas, frente a los cuales, los uropatógenos aislados presentaron perfiles de susceptibilidad bajos. La proporción de tratamientos empíricos con respecto a los confirmados fue de 4:1. El 98 por ciento de los casos correspondió a pacientes con un único evento, o con una o dos recurrencias. DISCUSION: La infección de vías urinarias presentó un comportamiento acorde al perfil epidemiológico de esta entidad patológica en la población general. La baja susceptibilidad de los microorganismos a los antibióticos prescritos, podría reflejar un uso inadecuado, a nivel de la comunidad institucional, induciendo presión selectiva sobre la resistencia bacteriana.

Citrobacter koseri in scalp folliculitis.

Gram-negative folliculitis, an uncommon condition, is most often seen in older patients who have acne and who either have received prolonged courses of antibiotic therapy or have used antibacterial cleansers that selectively inhibit gram-positive organisms. Citrobacter infections are uncommon, and dermatologists seldom encounter them. In the past, these infections occurred in hospitals, particularly in neonatal intensive care units. Bacteremias also occur in elderly or immunocompromised patients. In this article, we present a case of Citrobacter koseri scalp folliculitis in an otherwise healthy patient.

The effects of pentoxifylline treatment on bacterial translocation after hemorrhagic shock in rats.

Bacterial translocation is thought to be responsible for infectious complications after hemorrhagic shock. The aim of this study was to investigate the effects of pentoxifylline treatment on bacterial translocation in animals subjected to hemorrhagic shock. Thirty-one Wistar albino rats (280-360 g) were divided into three groups: sham (n=10), shock (n=11), and shock-pentoxifylline (n=10). Blood was not withdrawn from sham rats. Shock rats were subjected to 30 min of shock followed by reinfusion of shed blood. Shock/pentoxifylline rats received pentoxifylline after reinfusion of shed blood. After hemorrhage and reinfusion (24 h), the mesenteric lymph nodes, liver, spleen, and blood samples were evaluated using quantitative microbiological techniques, and the numbers of colony-forming units were compared between groups. Cecum was removed to evaluate the bacterial population. Ileum and cecum were examined histologically. The incidence of bacterial translocation was higher in the shocked rats (63%) than in the sham shock rats (10%). Pentoxifylline reduced the incidence of shock-induced bacterial translocation to 0%. Cecal bacterial levels were significantly higher in the shock rats than in the sham and shock/pentoxifylline rats. The histological damage caused by hemorrhagic shock was prevented by pentoxifylline treatment. In conclusion, the hemorrhagic shock triggered translocation of bacteria to the mesenteric lymph nodes, spleen, liver, and blood of rats. Pentoxifylline treatment just after shed blood transfusion significantly attenuated this phenomenon.

The use of Escherichia coli bearing a phoN gene for the removal of uranium and nickel from aqueous flows.

A Citrobacter sp. originally isolated from metal-polluted soil accumulates heavy metals via metalphosphate deposition utilizing inorganic phosphate liberated via PhoN phosphatase activity. Further strain development was limited by the non-transformability of this environmental isolate. Recombinant Escherichia coli DH5 alpha bearing cloned phoN or the related phoC acquired metal-accumulating ability, which was compared with that of the Citrobacter sp. with respect to removal of uranyl ion (UO2(2+)) from dilute aqueous flows and its deposition in the form of polycrystalline hydrogen uranyl phosphate (HUO2PO4). Subsequently, HUO2PO4-laden cells removed Ni2+ from dilute aqueous flows via intercalation of Ni2+ into the HUO2PO4 lattice. Despite comparable acid phosphatase activity in all three strains, the E. coli DH5 alpha (phoN) construct was superior to Citrobacter N14 in both uranyl and nickel accumulation, while the E. coli DH5 alpha (phoC) construct was greatly inferior in both respects. Expression of phosphatase activity alone is not the only factor that permits efficient and prolonged metal phosphate accumulation, and the data highlight possible differences in the PhoN and PhoC phosphatases, which are otherwise considered to be related in many respects.

A comparison between single-dose fosfomycin trometamol (Monuril) and a 5-day course of trimethoprim in the treatment of uncomplicated lower urinary tract infection in women.

This study is a comparison of the microbiological and clinical efficacy of single-dose fosfomycin trometamol therapy and a 5 day course of trimethoprim in the treatment of uncomplicated urinary tract infection in female patients. Urine dip-slide samples were obtained from 547 female patients aged 18-65 by 22 General Practitioners (GPs) participating in the study from 21 centres in the UK. All patients were diagnosed as having a urinary tract infection by their GP on the basis of history and clinical examination. Patients were randomised to receive either single dose fosfomycin trometamol or a 5 day course of trimethoprim in a 2:1 ratio. Patients who had significant bacteriuria (> or = 10(5) c.f.u/ml) at the first visit (300) were included in the microbiological analysis. The two commonest urinary pathogens isolated were Escherichia coli and Staphylococcus saprophyticus. Trimethoprim resistance was more frequent amongst E. coli isolates whereas fosfomycin trometamol resistance was more common amongst S. saprophyticus isolates. Microbiological cure was demonstrated in 83.3% of the trimethoprim treated group and 83% of the fosfomycin trometamol treated group. Persistence of the infecting bacteria was seen in 17% of each treatment arm.

A conductance medium to distinguish between Salmonella and Citrobacter spp.

Published methods for detecting Salmonella by conductance methods yield some Citrobacter spp. as false positives. A medium is described which, when used in conjunction with selenite-cystine/trimethylamine oxide/mannitol (SC/T/M) resolves this difficulty. It is based on the ability of Salmonella to decarboxylate lysine in the presence of selenite (4 g/l), after pre-enrichment in buffered peptone water supplemented with glucose and lysine for 7-17 h. Salmonella produced a conductance change of 250-400 microS in 24 h with a maximum rate of conductance change of 10-15 microS/10 min. 299 samples were tested and the only false positives were due to Hafnia alvei which gave no conductance response in the SC/T/M medium. Using both media in a two tube system would lead to a rapid clearance of Salmonella negative samples.

Regional differences in patterns of urinary tract infections.

The identity of 693 pathogenic bacilli isolated from 2,175 urine specimens cultured during a two-year period in southeastern New Mexico is presented along with results of sensitivity testing by Kirby-Bauer technique. The pattern of infections and sensitivity studies in hospitalized patients is compared with that of office patients and contrasted with results noted in other areas.