Infrared spectroscopy-based machine learning algorithms for rapid detection of Klebsiella pneumoniae isolated directly from patients' urine and determining its susceptibility to antibiotics.

Among the most prevalent and detrimental bacteria causing urinary tract infections (UTIs) is Klebsiella (K.) pneumoniae. A rapid determination of its antibiotic susceptibility can enhance patient treatment and mitigate the spread of resistant strains. In this study, we assessed the viability of using infrared spectroscopy-based machine learning as a rapid and precise approach for detecting K. pneumoniae bacteria and determining its susceptibility to various antibiotics directly from a patient's urine sample. In this study, 2333 bacterial samples, including 636 K. pneumoniae were investigated using infrared micro-spectroscopy. The obtained spectra (27996spectra) were analyzed with XGBoost classifier, achieving a success rate exceeding 95 % for identifying K. pneumoniae. Moreover, this method allows for the simultaneous determination of K. pneumoniae susceptibility to various antibiotics with sensitivities ranging between 74 % and 81 % within approximately 40 min after receiving the patient's urine sample.

Perfil das infecções relacionadas à assistência à saúde na unidade de terapia intensiva de um hospital de referência na mesorregião oeste do Rio Grande do Norte / Profile of health care-related infections in the intensive care unit of a reference hospital in the west mesoregion of Rio Grande do Norte / Perfil de las infecciones relacionadas con la atención a la salud en la unidad de cuidados intensivos de un hospital de referencia en la mesoregión oeste del Rio Grande del Norte

As Infecções Relacionadas à Assistência à Saúde (IRAS) ocorrem com mais frequência em Unidade de Terapia Intensiva (UTI) devido a exposição maior dos pacientes a procedimentos e dispositivos invasivos, quadro clínico debilitado e sua manipulação pela equipe assistencial exigindo uso elevado de antimicrobianos, o que pode promover um risco de desenvolvimento de resistência bacteriana a estes, cujas consequências podem ser a dificuldade de tratamento, internamento prolongado, risco de óbito e maior custo associado. Tem como objetivo descrever as IRAs relacionando os agentes etiológicos e o tratamento antimicrobiano em uma UTI de um hospital de referência da mesorregião do Rio Grande do Norte. Trata-se de um estudo descritivo, retrospectivo e transversal de abordagem quantitativa. Foram inseridos 1.682 pacientes internados na UTI geral do hospital estudado entre 2017-2020. Os dados foram coletados a partir de fichas de registro que foram tabuladas e analisadas nos softwares Microsoft Office Excel® e Statistical Package for the Social Sciences utilizando estatística descritiva simples com apresentação de frequências, tendências e dispersão. A análise dos resultados revelou mediana de idade de 57 anos, prevalência do sexo masculino e existência de comorbidades em 57,9% dos casos, especialmente infecção prévia a admissão na UTI. O tempo médio de permanência na UTI foi 11,4 dias e taxa de mortalidade de 52%. Quanto aos dispositivos invasivos, observou-se uso de sonda vesical de demora (96,8%), ventilação mecânica (79,4%) e cateter venoso central (83,7%). Constatou-se 790 IRAS da UTI com crescimento bacteriano em 48,2%. As principais densidades de incidência (DI) de IRAS/1.000 pacientes-dia foram: IPCSL-CVC 1,8; PAV 27 e ITU-AC 22,3. Quanto aos antibióticos, observou-se Lenght of therapy de 872,5/1.000 pacientes-dia, sendo os mais prescritos: vancomicina (N=633), meropenem (N=625), ceftriaxona (N=479), amicacina (N=463) e polimixina B (N=448). Os valores destaques de Days of therapy/1.000 pacientes-dia: meropenem (N=305,7), amicacina (N=260,4), polimixina B (N=256,4), vancomicina (N=229,3) e imipenem (N=165,3). As bactérias mais isoladas nas culturas foram: Acinetobacter spp., Pseudomonas spp. e Klebsiella spp., as quais apresentaram resistência, principalmente, a: ceftazidima (51,5% - 87,3%); cefepima (61,6% - 85,3%); ciprofloxacino (56% - 84,6%) e meropenem (31,7% - 80,3%). Identificou-se não conformidades no tratamento com antibióticos em 455 pacientes, que envolvem principalmente polimixina B, vancomicina, meropenem e ceftriaxona. Conclui-se que há elevados níveis de tempo de permanência na UTI e uso de dispositivos invasivos, assim como DI de IRAS alta com identificação microbiológica de bactérias importantes, especialmente por seu perfil de resistência acentuado com destaque para antibióticos da classe dos carbapenêmicos e cefalosporinas de 3a e 4a geração. Destaca-se também a presença de não conformidades na administração de antibióticos que podem contribuir para a seleção de bactérias multirresistentes.

Health Care-Related Infections (HAI) occur more frequently in the Intensive Care Unit (ICU) due to the greater exposure of patients to invasive procedures and devices, weakened clinical status and their handling by the care team, requiring high use of antimicrobials, which can promote a risk of developing bacterial resistance to these, whose consequences may be difficult treatment, prolonged hospitalization, risk of death and higher associated costs. It aims to describe the IRAS relating the etiological agents and antimicrobial treatment in an ICU of a reference hospital in the mesoregion of Rio Grande do Norte. This is a descriptive, retrospective and cross-sectional study with a quantitative approach. A total of 1,682 patients admitted to the general ICU of the hospital studied between 2017-2020 were included. Data were collected from registration forms that were tabulated and analyzed in Microsoft Office Excel® and Statistical Package for the Social Sciences software using simple descriptive statistics with presentation of frequencies, trends and dispersion. The analysis of the results revealed a median age of 57 years, prevalence of males and the existence of comorbidities in 57.9% of cases, especially infection prior to admission to the ICU. The average length of stay in the ICU was 11.4 days and the mortality rate was 52%. As for invasive devices, the use of an indwelling urinary catheter (96.8%), mechanical ventilation (79.4%) and central venous catheter (83.7%) was observed. There were 790 IRAS in the ICU with bacterial growth in 21.67%. The main HAI incidence densities (DI)/1,000 patient-days were: IPCSL-CVC 1.8; PAV 27 and UTI-AC 22.3. As for antibiotics, a Length of therapy of 872.5/1,000 patient-days was observed, with the most prescribed being: vancomycin (N=633), meropenem (N=625), ceftriaxone (N=479), amikacin (N= 463) and polymyxin B (N=448). The highlighted values of Days of therapy/1000 patient-days: meropenem (N=305.7), amikacin (N=260.4), polymyxin B (N=256.4), vancomycin (N=229.3) and imipenem (N=165.3). The most isolated bacteria in cultures were: Acinetobacter spp., Pseudomonas spp. and Klebsiella spp., which showed resistance mainly to: Ceftazidime (51.5% - 87.3%); cefepime (61.6% - 85.3%); ciprofloxacin (56% - 84.6%) and meropenem (31.7% - 80.3%). Non-compliance was identified in the treatment with antibiotics in 455 patients, which mainly involve polymyxin B, vancomycin, meropenem and ceftriaxone. It is concluded that there are high levels of ICU length of stay and use of invasive devices, as well as high IRAS ID with microbiological identification of important bacteria, especially due to their accentuated resistance profile, with emphasis on antibiotics from the carbapenem class and cephalosporins from 3rd and 4th generation. Also noteworthy is the presence of non-compliance in the administration of antibiotics that may contribute to the selection of multidrug-resistant bacteria.

Las Infecciones Relacionadas con la Atención de la Salud (IRAS) ocurren con mayor frecuencia en la Unidad de Cuidados Intensivos (UCI) debido a la mayor exposición de los pacientes a procedimientos y dispositivos invasivos, el debilitamiento del estado clínico y su manejo por parte del equipo asistencial, requiriendo un alto uso de antimicrobianos , lo que puede promover un riesgo de desarrollar resistencia bacteriana a estos, cuyas consecuencias pueden ser un tratamiento difícil, hospitalización prolongada, riesgo de muerte y mayores costos asociados. Tiene como objetivo describir las IRAs que relacionan los agentes etiológicos y el tratamiento antimicrobiano en una UTI de un hospital de referencia en la mesorregión de Rio Grande do Norte. Se trata de un estudio descriptivo, retrospectivo y transversal con enfoque cuantitativo. Se incluyeron un total de 1.682 pacientes ingresados en la UCI general del hospital estudiado entre 2017-2020. Los datos fueron recolectados a partir de formularios de registro que fueron tabulados y analizados en el software Microsoft Office Excel® y Statistical Package for the Social Sciences utilizando estadística descriptiva simple con presentación de frecuencias, tendencias y dispersión. El análisis de los resultados reveló una mediana de edad de 57 años, predominio del sexo masculino y la existencia de comorbilidades en el 57,9% de los casos, especialmente infección previa al ingreso en UCI. La estancia media en la UCI fue de 11,4 días y la tasa de mortalidad fue del 52%. En cuanto a los dispositivos invasivos, se observó el uso de catéter urinario permanente (96,8%), ventilación mecánica (79,4%) y catéter venoso central (83,7%). Había 790 IRAS en la UCI con crecimiento bacteriano en el 48,2%. Las principales densidades de incidencia (DI) de IRAS/1.000 pacientes-día fueron: IPCSL-CVC 1,8; PAV 27 y UTI-AC 22.3. En cuanto a los antibióticos, se observó una Duración de la terapia de 872,5/1.000 días-paciente, siendo los más prescritos: vancomicina (N=633), meropenem (N=625), ceftriaxona (N=479), amikacina (N= 463) y polimixina B (N=448). Los valores destacados de Días de terapia/1.000 pacientes-día: meropenem (N=305,7), amikacina (N=260,4), polimixina B (N=256,4), vancomicina (N=229,3) e imipenem (N=165,3). Las bacterias más aisladas en cultivos fueron: Acinetobacter spp., Pseudomonas spp. y Klebsiella spp., que mostraron resistencia principalmente a: ceftazidima (51,5% - 87,3%); cefepima (61,6% - 85,3%); ciprofloxacino (56% - 84,6%) y meropenem (31,7% - 80,3%). Se identificó incumplimiento en el tratamiento con antibióticos en 455 pacientes, los cuales involucran principalmente polimixina B, vancomicina, meropenem y ceftriaxona. Se concluye que existen altos índices de estancia en UCI y uso de dispositivos invasivos, así como elevado IRAS ID con identificación microbiológica de bacterias importantes, especialmente por su acentuado perfil de resistencia, con énfasis en antibióticos de la clase carbapenémicos y cefalosporinas de 3ra y 4ta generación. También es destacable la presencia de incumplimiento en la administración de antibióticos que pueden contribuir a la selección de bacterias multirresistentes.

Bacterias resistente a los antibióticos en aguas mineromedicinales “Santagua Chachimbiro”, Ecuador / Antibiotic resistant bacteria in mineral medicinal waters “Santagua Chachimbiro”, Ecuador

La biodiversidad bacteriana en las aguas mineromedicinales y sus perfiles de resistencia a los antibióticos es un tema en desarrollo en Ecuador. El objetivo del trabajo fue conocer la microbiota bacteriana y la resistencia a los antibióticos en aguas del balneario “Termas de Santagua Chachimbiro”, Provincia de Imbabura-Ecuador. Se recolectaron 16 muestras de agua. El aislamiento de las colonias bacterianas se obtuvo por la técnica de filtración en membrana, utilizando diferentes medios de cultivos. La identificación se realizó de acuerdo con los esquemas propuestos por MacFaddin (2003), complementados con las pruebas de las galerías Microgen. El perfil de resistencia a los antibióticos se determinó por el método de difusión en placas de Kirby y Bauer (1966). Se aislaron e identificaron 85 cepas bacterianas de las cuales el 61 % resultaron Gram negativas y 39 % Gram positivas. Las especies identificadas fueron Aeromonas caviae, Aeromonas eucrenophila, Aeromonas hydróphila, Aeromonas media, Aeromonas salmonicida, Aeromonas schubertii, Bacillus subtilis, Bacillus mycoides, Bacillus spp, Burkholderia cepacia, Citrobacter freundii, Comamonas spp, Pseudomonas aeruginosa, Pseudomonas fluorescens, Pseudomonas putida, Pseudomonas stutzeri, Ralstonia pickettii, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus lugdenensis, Staphylococcus saprophyticus, Staphylococcus spp, Staphylococcus warneri y Staphylococcus xylosus. En cuanto a la resistencia antimicrobiana la mayoría de las Gram negativas fueron resistentes a las penicilinas y cefalosporinas. Las Gram positivas a la oxacilina y penicilinas. El 66,67 % resultaron multirresistentes a más de tres antibióticos. El balneario “Termas de Santagua de Chachimbiro” presenta diversidad de especies bacteriana y la presencia de resistomas ambientales.(AU)

Bacterial biodiversity in mineral medicinal waters and the antibiotic resistance profiles, is a developing topic in Ecuador. The objective of the work was to know the bacterial microbiota and its resistance profiles to antibiotics of the mineral medicinal waters of the Santagua Chachimbiro spa, located in the Province of Imbabura-Ecuador. 16 water samples were collected. The isolation of the bacterial species was carried out by the membrane filtration technique, using different types of culture media. The identification was carried out according to the schemes proposed by MacFaddin (2003), complemented with the tests of the Microgen galleries. The antibiotic resistance profile was determined by the Kirby and Bauer (1966) plate diffusion method. 85 strains were isolate of which 61% were Gram negative and 39% Gram positive. The main species identified were Aeromonas caviae, Aeromonas eucrenophila, Aeromonas hydrophila, Aeromonas media, Aeromonas salmonicida, Aeromonas schubertii, Bacillus subtilis, Bacillus mycoides, Bacillus spp, Burkholderia cepacia, Citrobacter freundii, Comamonas spp, Pseudomonas aeruginosa, Pseudomonas fluorescenscens, Pseudomonas putida, Pseudomonas stutzeri, Ralstonia pickettii, Staphylococcus aureus, Staphylococcus epidermidis, Staphylococcus lugdenensis, Staphylococcus saprophyticus, Staphylococcus spp, Staphylococcus warneri and Staphylococcus xylosus. Regarding antimicrobial resistance, most of the Gram negative strains were resistant to penicillin and cephalosporins. Gram positive to oxacillin and penicillin 66,67% were multiresistant to more than three antibiotics. The “Termas de Santagua de Chachimbiro” spa presents a diversity of bacterial species and the presence of environmental resistomes.(AU)

The Helicobacter pylori single nucleotide polymorphisms SNPs associated with multiple therapy resistance in Colombia.

The eradication of Helicobacter pylori (H. pylori) using multiple therapies is used as a prevention strategy. However, its efficacy has been compromised by the emergence of single nucleotide polymorphisms in genes associated with H. pylori's resistance to multiple antibiotics. To estimate antibiotic resistance rates associated with mutations in H. pylori genes in the high-cancer-risk population in Colombia, we included 166 H. pylori whole genome sequences from a cohort of individuals with a high risk of gastric cancer. By using the reference strain ATCC 26695, we identified mutations in specific genes to evaluate resistance rates for different antibiotics: 23S rRNA for clarithromycin, 16S rRNA for tetracycline, pbp1A for amoxicillin, gyrA for levofloxacin, and rdxA for metronidazole. The phylogenomic analysis was conducted using the core genome consisting of 1,594 genes of H. pylori-ATCC 26695. Our findings revealed that the resistance rate of H. pylori to clarithromycin was 3.62%, primarily associated with mutations A2143G and A2142G in the 23S rRNA gene. For tetracycline, the resistance rate was 7.23%, with mutations A926G, A926T, and A928C observed in the 16S rRNA gene. Amoxicillin resistance was found in 25.9% of cases, with observed mutations in the pbp1A gene, including T556S, T593, R649K, R656P, and R656H. In the gyrA gene, mutations N87K, N87I, D91G, D91N, and D91Y were identified, resulting in a resistance rate of 12.04% to levofloxacin. The most common mutations in the rdxA gene associated with metronidazole resistance were a stop codon, and mutations at D59N and D59S, resulting in a resistance rate of 99.3%. The high resistance rate of H. pylori to metronidazole indicated that this drug should be excluded from the eradication therapy. However, the resistance rates for tetracycline and clarithromycin did not exceed the established resistance threshold in Colombia. The increased resistance rate of H. pylori to levofloxacin and amoxicillin may partially explain the observed therapeutic failures in Colombia. The phylogenomic tree showed that the H. pylori isolate belongs to its own lineage (hspColombia). These findings offer valuable insights to enhance the characterization of treatment protocols for the specific H. pylori lineage (hspColombia) at the local level.

How the adaptation of the human microbiome to harsh space environment can determine the chances of success for a space mission to Mars and beyond.

The ability of human cells to adapt to space radiation is essential for the well-being of astronauts during long-distance space expeditions, such as voyages to Mars or other deep space destinations. However, the adaptation of the microbiomes should not be overlooked. Microorganisms inside an astronaut's body, or inside the space station or other spacecraft, will also be exposed to radiation, which may induce resistance to antibiotics, UV, heat, desiccation, and other life-threatening factors. Therefore, it is essential to consider the potential effects of radiation not only on humans but also on their microbiomes to develop effective risk reduction strategies for space missions. Studying the human microbiome in space missions can have several potential benefits, including but not limited to a better understanding of the major effects space travel has on human health, developing new technologies for monitoring health and developing new radiation therapies and treatments. While radioadaptive response in astronauts' cells can lead to resistance against high levels of space radiation, radioadaptive response in their microbiome can lead to resistance against UV, heat, desiccation, antibiotics, and radiation. As astronauts and their microbiomes compete to adapt to the space environment. The microorganisms may emerge as the winners, leading to life-threatening situations due to lethal infections. Therefore, understanding the magnitude of the adaptation of microorganisms before launching a space mission is crucial to be able to develop effective strategies to mitigate the risks associated with radiation exposure. Ensuring the safety and well-being of astronauts during long-duration space missions and minimizing the risks linked with radiation exposure can be achieved by adopting this approach.

Diversidad y perfiles de resistencia a los antibióticos en especies de Aeromonas aisladas de ecosistema acuático del ecuador / Diversity and profiles of resistance to antibiotics in species of Aeromonas isolated from the aquatic ecosystem of ecuador

Introducción: En Ecuador se desconoce la diversidad de especies de Aeromonas y sus perfiles de resistencia a los antibióticos en la mayoría de ecosistemas acuáticos. Objetivo: Conocer la diversidad de especies del género Aeromonas y sus perfiles de resistencia a los antibióticos presentes en el balneario de aguas mineromedicinales “Santagua de Chachimbiro” y en el agua del lago volcánico cratérico Cuicocha. Metodología: Se analizaron muestras de agua del balneario “Santagua de Chachimbiro” y del lago volcánico cratérico Cuicocha, ubicados en la provincia de Imbabura-Ecuador. El aislamiento de las especies de Aeromonas se realizó por la técnica de siembra en profundidad y por filtración en membrana utilizando como medio de cultivo el agar R2A y el agar almidón ampicilina. Las bacterias se identificaron siguiendo el esquema propuesto Longa et al., (1997), complementadas con pruebas de las galerías Microgen. El perfil de resistencia a los antibióticos se determinó por el método de difusión en placas de Kirby y Bauer (1966) interpretándose según el CLSI (2019). Resultados: Se lograron identificar un total de 19 cepas del género Aeromonas pertenecientes a 6 especies. Los perfiles de resistencia a los antibióticos muestran diferentes patrones para cada una de las especies, aunque prevalecen las especies multiresistentes a los antibióticos amoxicilina, amoxicilina/ácido clavulánico, aztreonam, eritromicina y tetraciclina. Conclusiones: Se demuestra la presencia de diversas especies de Aeromonas en ambientes acuáticos del Ecuador con variados perfiles de resistencias y multiresistencia a los antibióticos. (AU)

Introduction: In Ecuador, the diversity of Aeromonas species and their resistance profiles to antibiotics in most aquatic ecosystems are unknown. Objective: To know the diversity of species of the genus Aeromonas and their resistance profiles to antibiotics present in the mineralmedicinal water spa “Santagua de Chachimbiro” and in the water of the Cuicocha crater volcanic lake. Methodology: Water samples from the “Santagua de Chachimbiro” spa and from the volcanic crater lake Cuicocha, located in the province of Imbabura-Ecuador, were analyzed. The isolation of the Aeromonas species was carried out by the deep seeding technique and by membrane filtration using R2A agar and ampicillin starch agar as the culture medium. The bacteria were identified following the schemes proposed by Longa et al., (1997), complemented with tests of the Microgen galleries. The antibiotic resistance profile was determined by the plate diffusion method of Kirby and Bauer (1966) interpreted according to the CLSI (2019). Results: A total of 19 strains of the genus Aeromonas belonging to 6 species were identified. Antibiotic resistance profiles show different patterns for each of the species, although species multi-resistant to antibiotics amoxicillin, amoxicillin/clavulanic acid, aztreonam, erythromycin and tetracycline prevail. Conclusions: The presence of various species of Aeromonas in aquatic environments of Ecuador with varied profiles of resistance and multi-resistance to antibiotics is demonstrated. (AU)

Ratchet effect in veterinary antibiotic use by contract farmers from the perspective of production risk: Implications for public health.

The current indiscriminate use of antibiotics for veterinary is irresponsible and misguided; it causes antibiotic resistance and adversely affects public health. The terms "habit" and "path dependence" are often used to explain the "excessive" use of agrochemicals. Yet, no research explored where the habit comes from and how it changes. This study investigates how veterinary antibiotic use changed with the production risk based on the multi-period production data set of 1,526 broiler contract farmers. The results show that the production risk has a ratchet effect on farmers' antibiotic use, leading to path dependence of farmers. Specifically, it showed a farmers' habit of steadily increasing antibiotic use and confirmed that the historical broilers' peak mortality was a key determinant to the continuation of this habit. It implies that higher the historical peak mortality, higher the current antibiotic use by farmers. Likewise, the impact of historical peak mortality on antibiotic use gradually increased with the farming experience. The increased historical peak mortality increased farmers' antibiotic use every time. Furthermore, large-scale farmers were more sensitive to historical peak mortality and therefore they increased antibiotic use excessively. The study suggests that improving farmers' production risk management capabilities, especially large-scale farmers, might help prevent extreme events. Moreover, this work contributes to the theoretical and empirical evidence on the ratchet effect, habit formation and farmers' antibiotic use and offers coherent insights for stakeholders to limit antibiotic use.

Cotton and Flax Textiles Leachables Impact Differently Cutaneous Staphylococcus aureus and Staphylococcus epidermidis Biofilm Formation and Cytotoxicity.

Bacteria can bind on clothes, but the impacts of textiles leachables on cutaneous bacteria remain unknown. Here, we studied for the first time the effects of cotton and flax obtained through classical and soft ecological agriculture on the representatives S. aureus and S. epidermidis bacteria of the cutaneous microbiota. Crude flax showed an inhibitory potential on S. epidermidis bacterial lawns whereas cotton had no effect. Textile fiber leachables were produced in bacterial culture media, and these extracts were tested on S. aureus and S. epidermidis. Bacterial growth was not impacted, but investigation by the crystal violet technique and confocal microscopy showed that all extracts affected biofilm formation by the two staphylococci species. An influence of cotton and flax culture conditions was clearly observed. Flax extracts had strong inhibitory impacts and induced the formation of mushroom-like defense structures by S. aureus. Conversely, production of biosurfactant by bacteria and their surface properties were not modified. Resistance to antibiotics also remained unchanged. All textile extracts, and particularly soft organic flax, showed strong inhibitory effects on S. aureus and S. epidermidis cytotoxicity on HaCaT keratinocytes. Analysis of flax leachables showed the presence of benzyl alcohol that could partly explain the effects of flax extracts.

Mecanismos de resistencia bacteriana frente a ceftazidima avibactam. Revisión Sistemática / Mechanisms of bacterial resistance against ceftazidime avibactam. Systematic Review / Mecanismos de resistência bacteriana contra ceftazidima avibactam. Revisão sistemática

La resistencia a los antibióticos representa una problemática a nivel mundial determinada por la capacidad que poseen las bacterias para desarrollar mecanismos de resistencia que les permitan adaptarse y sobrevivir en el entorno en el que se desenvuelven. La combinación ceftazidima-avibactam (CAZ/AVI) desde su aprobación en 2015 por la Food and Drug Administration (FDA) ha demostrado ser muy eficiente frente a bacilos Gram negativos productores de carbapenemasas, pero al igual que otras estrategias frente a bacterias multirresistentes no está exenta del desarrollo de mecanismos de resistencia. Métodos. Se realizó una revisión sistemática de la literatura en las bases de datos Web of Science, PubMed y Scopus siguiendo la metodología PRISMA, se incluyeron 29 artículos en los que se reportó la resistencia a CAZ/AVI en aislados clínicos. Resultados. los mecanismos de resistencia más relevantes fueron las mutaciones en el gen blaKPC en la posición 179 (D179Y) en el bucle conservado omega estimulada por la exposición previa a CAZ/AVI, generando de esta forma nuevas variantes como blaKPC-31 y blaKPC-33. Conclusiones. la evidente presencia de mecanismos de resistencia a CAZ/AVI a pesar de ser una combinación de uso relativamente reciente hace un llamado al uso adecuado de esta combinación.

Antibiotic resistance represents a worldwide problem determined by the ability of batteries to develop resistance mechanisms that allow them to adapt and survive in the environment in which they operate. Since its approval in 2015 by the Food and Drug Administration (FDA), the ceftazidime-avibactam (CAZ/AVI) combination has proven to be very efficient against Gram-negative bacilli that produce carbapenemase, but like other strategies against multiresistant bacteria, it is not exempt from the development of resistance mechanisms. Methods. a systematic review of the literature was carried out in the Web of Science, PubMed and Scopus databases following the PRISMA methodology, including 29 articles in which resistance to CAZ/AVI was reported in clinical isolates. Results. The most relevant resistance mechanisms were mutations in the blaKPC gene at position 179 (D179Y) in the conserved omega loop, stimulated by previous exposure to CAZ/AVI, thus generating new variants such as blaKPC-31 and blaKPC-33. Conclusions. The evident presence of resistance mechanisms to CAZ/AVI, despite being a combination of relatively recent use, calls for the appropriate use of this combination.

A resistência aos antibióticos representa um problema mundial determinado pela capacidade das bactérias desenvolverem mecanismos de resistência que lhes permitem adaptar-se e sobreviver no ambiente em que operam. Desde sua aprovação em 2015 pela Food and Drug Administration (FDA), a combinação ceftazidima-avibactam (CAZ/AVI) tem se mostrado muito eficiente contra bacilos Gram-negativos produtores de carbapenemases, mas como outras estratégias contra bactérias multirresistentes, é não isentos do desenvolvimento de mecanismos de resistência. Métodos. Foi realizada uma revisão sistemática da literatura nas bases de dados Web of Science, PubMed e Scopus seguindo a metodologia PRISMA, incluindo 29 artigos nos quais foi relatada resistência ao CAZ/AVI em isolados clínicos. Resultados. Os mecanismos de resistência mais relevantes foram mutações no gene blaKPC na posição 179 (D179Y) na alça ômega conservada, estimuladas pela exposição prévia ao CAZ/AVI, gerando novas variantes como blaKPC-31 e blaKPC-31. 33. Conclusões. A evidente presença de mecanismos de resistência ao CAZ/AVI, apesar de ser uma combinação de uso relativamente recente, exige o uso adequado dessa combinação.

Mechanisms, Anti-Quorum-Sensing Actions, and Clinical Trials of Medicinal Plant Bioactive Compounds against Bacteria: A Comprehensive Review.

Bacterial strains have developed an ability to resist antibiotics via numerous mechanisms. Recently, researchers conducted several studies to identify natural bioactive compounds, particularly secondary metabolites of medicinal plants, such as terpenoids, flavonoids, and phenolic acids, as antibacterial agents. These molecules exert several mechanisms of action at different structural, cellular, and molecular levels, which could make them candidates or lead compounds for developing natural antibiotics. Research findings revealed that these bioactive compounds can inhibit the synthesis of DNA and proteins, block oxidative respiration, increase membrane permeability, and decrease membrane integrity. Furthermore, recent investigations showed that some bacterial strains resist these different mechanisms of antibacterial agents. Researchers demonstrated that this resistance to antibiotics is linked to a microbial cell-to-cell communication system called quorum sensing (QS). Consequently, inhibition of QS or quorum quenching is a promising strategy to not only overcome the resistance problems but also to treat infections. In this respect, various bioactive molecules, including terpenoids, flavonoids, and phenolic acids, exhibit numerous anti-QS mechanisms via the inhibition of auto-inducer releases, sequestration of QS-mediated molecules, and deregulation of QS gene expression. However, clinical applications of these molecules have not been fully covered, which limits their use against infectious diseases. Accordingly, the aim of the present work was to discuss the role of the QS system in bacteria and its involvement in virulence and resistance to antibiotics. In addition, the present review summarizes the most recent and relevant literature pertaining to the anti-quorum sensing of secondary metabolites and its relationship to antibacterial activity.

Suspected allergy to Beta-Lactam antibiotics: An infectiological perspective.

The administration of alternative broad-spectrum antibiotics because of a suspected allergy to beta-lactam antibiotics (BLA) is one reason for the increase in bacterial resistance to antibiotics and results in further problems, such as reduced efficiency against the causative bacteria, longer hospital stays, higher prices, and more adverse events. Patients with documented BLA allergy experience Clostridium difficile infections and postoperative surgical-site infections more frequently than patients without this label. Yet, in cases of documented and even proven IgE-mediated allergy to a BLA, such as penicillin or cephalosporin, the careful application of a different BLA with dissimilar core and side chains is possible. Cefazolin, e.g., would often be a candidate for skin and soft-tissue infections (e.g., cellulitis) or for perioperative prophylaxis, because it does not share a common side chain with any other BLA and tackles most causative bacteria. In case of severe cellulitis, a carbapenem would be a candidate. After type IV-reactions (benign maculopapular rash), an infectiologist's choice would be to apply another narrow-spectrum BLA. In cases where a long-lasting therapy with penicillin is indicated (e.g., for late syphilis or prophylaxis of erysipelas) in presence of a proven IgE-mediated allergy, desensitization would be the infectiologist's choice.

Infección del tracto urinario por enterobacterias en pacientes del laboratorio San José- Azogues / Enterobacteriaceae infection of the urinary tract in patients of the San José laboratory ­ Azogues / Infecção por Enterobacteriaceae do trato urinário em pacientes do laboratório "San José" - Azogues

La infección del tracto urinario es un proceso inflamatorio de los órganos involucrados, ocasionados por diferentes tipos de microorganismos, especialmente enterobacterias. OBJETIVO: el propósito del presente artículo es conocer la frecuencia de ITU con respecto a género, edad y de ello la presencia bacteriana y su perfil de resistencia en pacientes que acuden al laboratorio San José de la ciudad de Azogues-Ecuador. MATERIALES Y METODOS: se aplicó un estudio de tipo descriptivo de corte transversal, documental - secundario; en pacientes de ambos sexos y diferentes rangos de edad. La muestra final de aislados positivos fue de 210 pacientes, los datos obtenidos fueron procesados en el Software SPSS versión 25.0 para su tabulación y análisis. RESULTADOS: se determinó un mayor porcentaje de aislados positivos en mujeres con 93,7 %. El grupo etario con más afección es la adultez con un 50,5 %, seguido de adultos mayores y jóvenes con un 21,4 % y el 11 % respectivamente. El agente etiológico con mayor incidencia fue Escherichia Coli con un 70,95 % con una resistencia a SXT el porcentaje restante corresponde a Providencia spp, Klebsiella spp, Enterobacter spp y Proteus spp. La opción terapéutica para las enterobacterias fue fosfomicina, amoxicilina + clavulánico y nitrofurantoína. COCLUSION: el estudio viabilizó la obtención de resultados reales al respecto del ITU, confirmado la presencia de Escherichia coli como agente etiológico principal siendo su prevalencia en mujeres.

Urinary tract infection is an inflammatory process of the organs involved, caused by different types of microorganisms, especially enterobacteria. OBJECTIVE: the purpose of this article is to know the frequency of UTI with respect to gender, age and bacterial presence and their resistance profile in patients attending the San José laboratory in the city of Azogues-Ecuador. MATERIALS AND METHODS: a descriptive, cross-sectional, documentary-secondary study was applied in patients of both sexes and different age ranges. The final sample of positive isolates was 210 patients, the data obtained were processed in SPSS software version 25.0 for tabulation and analysis. RESULTS: a higher percentage of positive isolates was determined in women with 93.7%. The age group most affected was adulthood with 50.5 %, followed by the elderly and young adults with 21.4 % and 11 %, respectively. The etiological agent with the highest incidence was Escherichia coli with 70.95 % with resistance to SXT, the remaining percentage corresponded to Providencia spp, Klebsiella spp, Enterobacter spp and Proteus spp. The therapeutic option for enterobacteria was fosfomycin, amoxicillin + clavulanic acid and nitrofurantoin. CONCLUSION: the study made it feasible to obtain real results regarding UTI, confirming the presence of Escherichia coli as the main etiological agent and its prevalence in women

A infecção do trato urinário é um processo inflamatório dos órgãos envolvidos, causado por diferentes tipos de microorganismos, especialmente enterobactérias. OBJETIVO: o objetivo deste artigo é determinar a freqüência de UTI com relação ao sexo, idade e presença de bactérias e seu perfil de resistência em pacientes que freqüentam o laboratório San José, na cidade de Azogues-Equador. MATERIAIS E MÉTODOS: foi realizado um estudo descritivo, transversal e documental-secundário em pacientes de ambos os sexos e diferentes faixas etárias. A amostra final de isolados positivos foi de 210 pacientes, os dados obtidos foram processados no software SPSS versão 25.0 para tabulação e análise. RESULTADOS: uma porcentagem maior de isolados positivos foi encontrada em mulheres com 93,7%. A faixa etária mais afetada foi a adulta com 50,5%, seguida por adultos mais velhos e mais jovens com 21,4% e 11% respectivamente. O agente etiológico com maior incidência foi Escherichia coli com 70,95% de resistência ao SXT. A porcentagem restante corresponde a Providencia spp, Klebsiella spp, Enterobacter spp e Proteus spp. A opção terapêutica para enterobactérias foi fosfomicina, amoxicilina mais ácido clavulânico e nitrofurantoína. CONCLUSÃO: o estudo tornou viável a obtenção de resultados reais em relação à UTI, confirmando a presença da Escherichia coli como o principal agente etiológico e sua prevalência nas mulheres.

Escherichia coli productora de BLEE de origen comunitario e intrahospitalario / BLEE-producing Escherichia coli of community and hospital-acquired origin / Escherichia coli produtora de BLEE de origem comunitária e hospitalar

Escherichia coli (E. coli) constituye una de las principales enterobacterias patógenas causantes de infecciones asociadas a la asistencia en salud, con alto impacto a nivel hospitalario y comunitario por su elevada tasa de morbilidad y mortalidad. El mecanismo de defensa de estas bacterias es mediante la generación de enzimas de resistencia, como la producción de Beta-lactamasas de espectro extendido. OBJETIVO: caracterizar la resistencia a betalactámicos de espectro extendido a partir de su prevalencia en aislados de Escherichia coli de origen comunitario e intrahospitalario de la ciudad de Azogues. MATERIALES Y MÉTODOS: estudio de tipo descriptivo, documental. La población estuvo conformada por 877 registros de la base de datos WHONET de aislados de E. coli procedentes de muestras de origen comunitario e intrahospitalario del laboratorio del Hospital Homero Castanier Crespo. RESULTADOS: el 75,5% de los aislados fueron de mujeres y el 24,5 % de varones. La media de edad fue 43,5 años. La frecuencia de E. coli productora de BLEE fue del 17,7 % con mayor frecuencia en varones (23,7%), en el área de clínica (25,2%), cirugía (16,8%) y en muestras de herida quirúrgica (11,6%). Predominó la resistencia a betalactámicos (84,5%) y cefalosporinas de primera y segunda generación mayor al 48%. Los carbapenemes (imipenen 97,3% y meropenem 96,7%), aminoglucósidos (amikacina 94,9 y gentamicina 80,5), fosfomicina (90,3) y nitrofurantoina (96,7%) mostraron mayor sensibilidad. CONCLUSIONES: la monitorización constante de enzimas BLEE, permite la detección temprana de patrones de sensibilidad y a la vez orienta a un tratamiento terapéutico adecuado, evitando generación de nuevas resistencias y altas tasas de morbilidad y mortalidad.

Escherichia coli (E. coli) is one of the main pathogenic enterobacteria causing infections associated with health care, with high impact at hospital and community level due to its high morbidity and mortality rate. The defense mechanism of these bacteria is through the generation of resistance enzymes, such as the production of extended spectrum beta-lactamases. OBJECTIVE: to characterize extended-spectrum beta-lactam resistance based on its prevalence in Escherichia coli isolates of community and intrahospital origin in the city of Azogues. MATERIALS AND METHODS: descriptive, documentary study. The population consisted of 877 records from the WHONET database of E. coli isolates from community and in-hospital samples from the Homero Castanier Crespo Hospital laboratory. RESULTS: 75.5% of the isolates were from females and 24.5% from males. The mean age was 43.5 years. The frequency of BLEE-producing E. coli was 17.7%, with a higher frequency in males (23.7%), in the clinical area (25.2%), surgery (16.8%) and in surgical wound samples (11.6%). Resistance to beta-lactams predominated (84.5%) and first and second generation cephalosporins was greater than 48%. Carbapenems (imipenem 97.3% and meropenem 96.7%), aminoglycosides (amikacin 94.9 and gentamicin 80.5), fosfomycin (90.3) and nitrofurantoin (96.7%) showed higher sensitivity. CONCLUSIONS: the constant monitoring of BLEE enzymes allows the early detection of sensitivity patterns and at the same time guides to an adequate therapeutic treatment, avoiding the generation of new resistances and high morbidity and mortality rates.

A Escherichia coli (E.coli) é uma das principais enterobactérias patogênicas que causam infecções associadas aos cuidados de saúde, com alto impacto em nível hospitalar e comunitário devido a sua alta taxa de morbidade e mortalidade. O mecanismo de defesa dessas bactérias é através da geração de enzimas de resistência, tais como a produção de beta-lactamases de espectro estendido. OBJETIVO: caracterizar a resistência beta-lactam de amplo espectro com base em sua prevalência em Escherichia coli isolados de origem comunitária e intra-hospitalar na cidade de Azogues. MATERIAIS E MÉTODOS: estudo descritivo, documental. A população consistia de 877 registros do banco de dados WHONET de E. coli isolados de amostras comunitárias e hospitalares do laboratório do Hospital Homero Castanier Crespo. RESULTADOS: 75,5% dos isolados eram de fêmeas e 24,5% de machos. A idade média era de 43,5 anos. A freqüência da E. coli produtora de BLEE foi de 17,7%, com maior freqüência em homens (23,7%), na área clínica (25,2%), na cirurgia (16,8%) e em amostras de feridas cirúrgicas (11,6%). A resistência aos beta-lactâmicos (84,5%) e às cefalosporinas de primeira e segunda geração predominou (mais de 48%). Carbapenems (imipenem 97,3% e meropenem 96,7%), aminoglicosídeos (amikacin 94,9 e gentamicina 80,5), fosfomicina (90,3) e nitrofurantoína (96,7%) mostraram maior sensibilidade. CONCLUSÕES: o monitoramento constante das enzimas BLEE permite a detecção precoce de padrões de sensibilidade e, ao mesmo tempo, orienta para um tratamento terapêutico adequado, evitando a geração de novas resistências e altas taxas de morbidade e mortalidade.

Perfil de resistencia a la tetraciclina de Cutibacterium acnes en pacientes con acné vulgar en un centro dermatológico de Colombia / Cutibacterium Acnes Tetracycline Resistance Profile in Patients with Acne Vulgaris, in a Colombian Dermatologic Center

Introducción El acné es una enfermedad inflamatoria crónica, en cuya patogenia intervienen diferentes actores, siendo Cutibacterium acnes (C. acnes) uno de ellos. La resistencia de esta bacteria a los diferentes fármacos antimicrobianos utilizados en su tratamiento ha sido descrita en diferentes regiones del mundo. El objetivo de este estudio fue estimar la resistencia de C. acnes a las ciclinas en pacientes mayores de 18 años con acné de moderado a severo. Materiales y métodos Se realizó un estudio transversal analítico. Se obtuvieron muestras de las lesiones inflamatorias con un extractor de comedones. Se incubó el contenido de las muestras en ambiente anaeróbico para aislar C. acnes. Por último, se estimó la susceptibilidad de C. acnes a la tetraciclina, minociclina y doxiciclina. Resultados Se obtuvieron muestras de 147 pacientes, observándose crecimiento de C. acnes en 129 de ellos, y encontrándose que el 5,43% de las cepas era resistente a tetraciclina, el 5,43% a doxiciclina, el 0,78% a minociclina, y una resistencia cruzada entre doxiciclina y tetraciclina en todos los casos. Se encontró una asociación entre resistencia y edad igual o superior a 25 años. No se encontró asociación con el uso previo de antibióticos, historia de mal uso de antibióticos orales o tópicos y otras características demográficas y clínicas evaluadas. Conclusiones La resistencia a las ciclinas encontrada en C. acnes fue menor que la reportada en otros estudios. Aunque no se encontró relación con el uso previo de antibióticos, se trata de un factor descrito en estudios previos, por lo que el uso correcto de los mismos es imperativo para evitar la aparición de resistencia (AU)

Introduction Acne is a chronic inflammatory disease, in which different events intervene in its pathogenesis, one of which is Cutibacterium acnes (C. acnes). Resistance of this bacteria to different antimicrobials used in treatment has been described in different regions of the world. The purpose of the study is to estimate the resistance of C. acnes to cyclins in patients with moderate and severe acne over 18 years of age. Materials and Methods An analytical cross-sectional study was carried out. Samples were taken from inflammatory lesions with a comedone extractor. The content of the samples was incubated in an anaerobic atmosphere to grow C. acnes. Finally, the susceptibility of C. acnes to tetracycline, minocycline and doxycycline was determined. Result Samples were taken from 147 patients, of which 129 showed growth of C. acnes, finding that 5.43% of the strains were resistant to tetracycline, 5.43% to doxycycline, 0.78% to minocycline and cross resistance between doxycycline and tetracycline in all the cases. An association was found between resistance and being 25 years of age or older. No association was found with the prior use of antibiotics, a history of misuse of oral or topical antibiotics, and other demographic and clinical characteristics evaluated. Conclusions The resistance found of C. acnes to cyclines was lower than that reported in other studies. Although no relationship was found with the previous use of antibiotics, it is a factor described in previous studies, which is why the proper use of antibiotics is imperative to avoid the appearance of resistance (AU)

Resistencia antimicrobiana en Klebsiella pneumoniae, Ecuador

Resumen Klebsiella pneumoniae representa un gran desafío para los médicos y laboratoristas debido a su crecimiento acelerado, prevalencia en los entornos intrahospitalarios y la resistencia a los antibióticos. Este artículo, proporciona información sobre la vida evolutiva del microorganismo durante los últimos veinte años, así como puntos clave clínicos que se deben considerar para mejorar el manejo farmacológico del paciente, mediante la combinación de antibacterianos, conociendo los principales genes de resistencias y el mecanismo de virulencia. Objetivo. El objetivo de la presente investigación fue analizar la evolución de la resistencia antimicrobiana en Klebsiella pneumoniae a partir de la prevalencia de los principales mecanismos de resistencia que este patógeno presenta en Ecuador, durante el periodo 2000-2020. Materiales y métodos. Se realizó una revisión sistemática de la literatura científica de estudios observacionales, de resistencia antimicrobiana de cohorte retroprospectivo. Con base a la metodología PRISMA (Preferred Reportin Items for Systematic Reviews and Meta-Analyses. Resultados. La evolución de Klebsiella pneumonia durante los últimos veinte años destaca un incremento exponencial de los genes de resistenciaKPC-2, NDM y OXA-48 distribuidos principalmente en las ciudades de Quito, Guayaquil, Cuenca y Esmeralda. El gen KPC-2 se encuentra presente en todas las ciudades que reportan resistencia antimicrobiana para K. pneumonia, por lo tanto, es el gen de mayor prevalencia en el país causante de la falta de eficacia del tratamiento farmacológico. Conclusión. Se observa una rápida diseminación de los genes de virulencia y evolución en los mecanismos de resistencia reportados durante los veinte años de revisiones bibliográficas. Afectando geográficamente a las ciudades más importantes y de mayor tránsito poblacional. Además, hay una relación de los genes de mayor prevalencia (KPC-2) presentes mayoritariamente a nivel intrahospitalario. Estos hallazgos resaltan la importancia y duración de los programas de vigilancia epidemiológica y de resistencia antimicrobiana del Sistema de Salud.

Abstract Klebsiella pneumoniae represent a great challenge for doctors and laboratory workers due to their accelerated growth and prevalence in hospital settings and resistance to antibiotics. In this perspective article, it provides information on the evolutionary life of the microorganism during the last twenty years, as well as clinical key points that should be considered to improve the pharmacological management of the patient, through the combination of antibiotics, knowing the main resistance genes and the mechanism as such. Given the importance of this information, a manuscript is made, which will be detailed below. Objective. The objective of this research was to analyze the evolution of antimicrobial resistance in Klebsiella pneumoniae from the prevalence of the main resistance mechanisms that this pathogen presents in Ecuador, during the period 2000-2020. Materials and methods. A systematic review of the scientific literature of observational studies of antimicrobial resistance from a prospective cohort was carried out. Based on the PRISMA methodology. Results. the evolution of Klebsiella pneumonia during the last twenty years highlights an exponential increase in the resistance genes KPC-2, NDM and OXA-48 distributed mainly in the cities of Quito, Guayaquil, Cuenca and Esmeralda. The KPC-2 gene is present in all cities that report antimicrobial resistance for K. pneumonia, therefore, it is the most prevalent gene in the country, causing greater failure of drug treatment. Conclusion. A rapid dissemination of virulence genes and evolution in the resistance mechanisms reported during the twenty years of bibliographic reviews is observed. Geographically affecting the most important cities with the greatest population transit. In addition, there is a relationship of the KPC-2 genes with the highest prevalence, mainly present at the hospital level. These findings highlight the importance and duration of the epidemiological surveillance and antimicrobial resistance programs of the Health System.

Resumo Klebsiella pneumoniae representa um grande desafio para clínicos e laboratórios devido a seu crescimento acelerado, prevalência em ambientes hospitalares e resistência a antibióticos. Este artigo fornece informações sobre a vida evolutiva do microorganismo durante os últimos vinte anos, bem como pontos clínicos fundamentais a serem considerados para melhorar o manejo farmacológico do paciente, através da combinação de antibacterianos, conhecendo os principais genes de resistência e o mecanismo da virulência. Objetivo. O objetivo desta pesquisa foi analisar a evolução da resistência antimicrobiana em Klebsiella pneumoniae com base na prevalência dos principais mecanismos de resistência que este patógeno apresenta no Equador durante o período 2000-2020. Materiais e métodos. Foi realizada uma revisão sistemática da literatura científica de estudos observacionais de resistência antimicrobiana em uma coorte retroprospectiva. Com base na metodologia PRISMA (Preferred Report Items for Systematic Reviews e Meta-Analyses). Resultados. A evolução da pneumonia por Klebsiella durante os últimos vinte anos destaca um aumento exponencial dos genes de resistência KPC-2, NDM e OXA-48 distribuídos principalmente nas cidades de Quito, Guayaquil, Cuenca e Esmeralda. O gene KPC-2 está presente em todas as cidades relatando resistência antimicrobiana para a pneumonia K., tornando-o o gene mais prevalente no país, causando a falta de eficácia do tratamento medicamentoso. Conclusão. Observa-se uma rápida disseminação dos genes de virulência e evolução nos mecanismos de resistência relatados durante os vinte anos de revisões de literatura. Geograficamente, as cidades mais importantes com o maior tráfego populacional são afetadas. Além disso, há uma relação dos genes mais prevalentes (KPC-2) presentes principalmente a nível intra-hospitalar. Estas descobertas destacam a importância e a duração da vigilância epidemiológica e dos programas de resistência antimicrobiana no sistema de saúde.

Genome features and antibiotic resistance of Pseudomonas aeruginosa strains isolated in patients with cystic fibrosis in the Russian Federation.

Cystic fibrosis (CF) is a common genetic disease, manifested by airway obstruction and chronic respiratory infection. The most prevalent infectious agent in airways of CF patients is Pseudomonas aeruginosa. This study aimed to determine sequence-types, antimicrobial resistance phenotypes and genes defining adaptive antibiotic resistance in P. aeruginosa isolates recovered from CF patients in Russia. In total, 84 P. aeruginosa strains from 64 CF patients were analyzed. Susceptibility to antibiotics was determined by disk diffusion test. Whole-genome sequencing (WGS) was performed on MGISEQ-2000 platform. SPAdes software, Galaxy, ResFinder, PubMLST were used for analysis of WGS data. Examined P. aeruginosa isolates belonged to 53 different sequence-types (STs), including 6 new STs. High-risk epidemic clone ST235 (10%) and clonal CF P. aeruginosa strains ST17, ST242, ST274 (7%) were detected. Non-susceptibility to ticarcillin-clavulanate, cefepime, imipenem was observed in 63%, 12% and 25% of isolates, respectively; to tobramycin - in 24%, to amikacin - in 35%; to ciprofloxacin, levofloxacin - in 35% and 57% of strains, respectively. Multidrug-resistant phenotype was detected in 18% of isolates. In examined strains, genes of beta-lactamases VIM-2 (5 ST235 strains), VEB-1 (two ST2592 strains), GES-1 (1 ST235 strain), PER-1 (1 ST235 strain) were found. Ciprofloxacin-modifying enzyme CrpP gene was detected in 67% of isolates, aminoglycoside-modifying enzymes AAD, ANT, AAC genes - in 7%, 4%, 12% of strains, respectively. P. aeruginosa isolates from CF patients in Russia demonstrate a high clonal diversity, which is similar to other P. aeruginosa infections. The isolates of high-risk clone and clonal CF P. aeruginosa strains are detected.

Clinical and Molecular Findings of Infections Caused by Extended-Spectrum ß-Lactamase-Producing Enterobacterales in Patients with Solid Tumors: A Single-Center Study.

Infectious complications caused by multidrug-resistant bacteria are a serious clinical and therapeutic problem. Our study aimed to analyze the genetic characteristics of extended-spectrum ß-lactamase-producing Enterobacterales (ESBL-E) that cause multidrug-resistant infections in patients with solid tumors. Identification of ESBL-encoding genes was performed by polymerase chain reaction (PCR) and sequencing. The clonal relationship of the isolates was evaluated by pulsed-field gel electrophoresis. Multilocus sequence typing (MLST) was carried out for selected Escherichia coli and Klebsiella pneumoniae isolates. All E. coli strains were classified into phylogenetic groups using the PCR-based approach. There were 735 patients with clinical symptoms of infections tested, of which 44 (6.0%) were positive for ESBL-E on genotypic testing. The most frequent organism was E. coli (n = 24, 54.5%), followed by K. pneumoniae (n = 13, 29.5%), Proteus mirabilis (n = 3, 6.8%), Enterobacter cloacae cplx (n = 2, 4.5%), and Klebsiella oxytoca (n = 2, 4.5%). Overall, 31 (70.5%) of the ESBL-E isolates carried only blaCTX-M-1-like genes, and the genes were found to be blaCTX-M-15 (n = 30, 68.2%) or blaCTX-M-3 (n = 1, 2.3%). Eleven strains (25%) had blaCTX-M-9-like genes, mostly blaCTX-M-27 (n = 10, 22.7%) and unique blaCTX-M-65 (n = 1, 2.3%). One isolate possessed both blaCTX-M-15 and blaCTX-M-27 genes, and another one produced TEM-12 ESBL. MLST analysis revealed E. coli sequence type (ST) 131 and ST361, and K. pneumoniae ST16, ST307, and ST437. Among E. coli isolates, the B2 phylogenetic group was predominant. Most of the strains showed resistance to third-generation cephalosporins and fluoroquinolones, and susceptibility to aminoglycosides and carbapenems. Patients with solid cancer and ESBL-E infections require special management since they are a population with a high threat of antibiotic-resistant infections. Carbapenems and aminoglycosides remain active antibiotics against these infections.

Cutibacterium Acnes Tetracycline Resistance Profile in Patients with Acne Vulgaris, in a Colombian Dermatologic Center. / Perfil de resistencia a la tetraciclina de Cutibacterium acnes en pacientes con acné vulgar en un centro dermatológico de Colombia.

INTRODUCTION: Acne is a chronic inflammatory disease, in which different events intervene in its pathogenesis, one of which is Cutibacterium acnes (C. acnes). Resistance of this bacteria to different antimicrobials used in treatment has been described in different regions of the world. The purpose of the study is to estimate the resistance of C. acnes to cyclins in patients with moderate and severe acne over 18 years of age. MATERIALS AND METHODS: An analytical cross-sectional study was carried out. Samples were taken from inflammatory lesions with a comedone extractor. The content of the samples was incubated in an anaerobic atmosphere to grow C. acnes. Finally, the susceptibility of C. acnes to tetracycline, minocycline and doxycycline was determined. RESULTS: Samples were taken from 147 patients, of which 129 showed growth of C. acnes, finding that 5.43% of the strains were resistant to tetracycline, 5.43% to doxycycline, 0.78% to minocycline and cross resistance between doxycycline and tetracycline in all the cases. An association was found between resistance and being 25 years of age or older. No association was found with the prior use of antibiotics, a history of misuse of oral or topical antibiotics, and other demographic and clinical characteristics evaluated. CONCLUSIONS: The resistance found of C. acnes to cyclines was lower than that reported in other studies. Although no relationship was found with the previous use of antibiotics, it is a factor described in previous studies, which is why the proper use of antibiotics is imperative to avoid the appearance of resistance.

Antibiotic Resistance of Uropathogens Isolated from Patients Hospitalized in District Hospital in Central Poland in 2020.

The aim of this study was to determine antibiotic resistance patterns and the prevalence of uropathogenes causing urinary tract infections (UTIs) in patients hospitalized in January-June 2020 in central Poland. Antimicrobial susceptibility testing was performed using the disk-diffusion method. Escherichia coli (52.2%), Klebsiella pneumoniae (13.7%), Enterococcus faecalis (9.3%), E. faecium (6.2%), and Proteus mirabilis (4,3%) were most commonly isolated from urine samples. E. coli was significantly more frequent in women (58.6%) (p = 0.0089) and in the age group 0-18, while K. pneumoniae was more frequent in men (24.4%) (p = 0.0119) and in individuals aged 40-60 and >60. Gram-negative species showed resistance to ampicillin. K. pneumoniae were resistant to amoxicillin plus clavulanic acid (75.0%), piperacillin plus tazobactam (76.2%), cefotaxime (76.2%), cefuroxime (81.0%), ciprofloxacin (81.0%), and trimethoprim plus sulphamethoxazole (81.0%). Carbapenems were effective against all E. coli and P. mirabilis. Some K. pneumoniae (13.6%) produced metallo-ß-lactamases (MBLs). E. coli (22.6%), K. pneumoniae (81.8%), and all E. faecium were multidrug-resistant (MDR). Some E. coli (26.2%), K. pneumoniae (63.6%), and P. mirabilis (14.3%) isolates produced extended-spectrum beta-lactamases (ESBL). Vancomycin-resistant E. faecium was also found. This study showed that the possibilities of UTIs therapy using available antibiotics become limited due to the increasing number of antibiotic-resistant uropathogens.

Perfil microbiologico y de resistencia antimicrobiana en infecciones adquiridas en la comunidad. Hospital Universitario San José de Popayán / Microbiological profile and resistance spectrum of the community acquired bacterial infection of the San Jose Universitary Hospital in Popayan

Resumen Objetivo. Describir el perfil microbiológico y de resistencia bacteriana de los aislamientos en adultos con infecciones adquiridas en comunidad en el Hospital Universitario San José de junio 2016 a diciembre 2019. Metodología. Se realizó un estudio descriptivo de corte transversal, análisis retrospectivo de los aislamientos microbiológicos en adultos desde junio 2016 a diciembre 2019, basado en la data institucional. Se analizó la información con STATA15,0. Se obtuvo la aprobación del comité de ética del hospital. Resultados. Se incluyeron 5121 aislamientos microbiológicos, el 61% en el servicio de urgencias. El urocultivo fue la muestra más frecuente. Escherichia coli fue el germen más común tanto a nivel general como en urocultivos, hemocultivos y cultivos de líquido peritoneal. La resistencia a ampicilina y amp/sul fue elevada, hasta del 68% para E. coli. El 20% de los Staphylococcus aureus fueron resistentes a meticilina. Se observó una resistencia inusual a carbapenémicos por parte de Pseudomonas aeruginosa. Discusión. El perfil microbiológico concuerda con la literatura mundial y nacional, sin embargo, el HUSJ tiene un comportamiento microbiológico que debe ser estudiado a profundidad. Conclusión. Los porcentajes de resistencia a antibióticos de uso frecuente son elevados. Se requiere ajustes de las guías de manejo institucionales y nacionales.

Abstract Objetive. To describe the microbiological profile and resistance spectrum of the community acquired bacterial infection of the San Jose university hospital from june 2016 to december 2019 Methodology. A retrospective transverse descriptive study of microbial organisms found in adults in the institution from June 2016 to December 2019, the study is based in the hospital data. The analysis of the information was made with SATA 15.0. Results. 5121 samples were included, 61% from the emergency department. Urine culture was the most frequent sample taken. Escherichia coli was the most frequent isolated bacterial, in all samples, urine culture, blood culture, and peritoneal culture. Ampiciline r and ampiciline/sulbactam was high up to 68% of the E. Coli cultures. 20% of Staphylococcus aureus were methicillin resistant. Unusual carbapenemic resistance was found in the Pseudomona aeruginosa isolates.. Discussion. The data of the bacterial resistance spectrum Concord which was is found in the general medical literature, nevertheless the HUSJ, has a microbial behaviour that must be studied thoroughly. Conclusion. The antibiotic bacterial resistance to common used antibiotics is high. Adjustments are required in the instucional and national management guidelines