Antimicrobial resistance among GLASS priority pathogens from Pakistan: 2006–2018

Abstract Background In 2018 Pakistan initiated its national antimicrobial resistance (AMR) surveillance aligned with Global Antimicrobial Surveillance System (GLASS). To complement this surveillance, we conducted a situational analysis of AMR rates among GLASS organisms in the country. Data from published studies and from antibiograms was compared and role of antibiograms as potential contributors to national AMR surveillance explored. Methods AMR rates for GLASS specified pathogen/antimicrobials combination from Pakistan were reviewed. Data sources included published studies (2006–2018) providing AMR rates from Pakistan (n = 54) as well as antibiograms (2011–2018) available on the Pakistan Antimicrobial Resistance Network (PARN) website. Resistance rates were categorized as follows: Very low: 0–10%, Low: 11–30%, Moderate: 30–50% and High: > 50%. Results Published data from hospital and community/laboratory-based studies report resistance rates of > 50% and 30–50% respectively to 3rd generation cephalosporins, fluoroquinolones and cotrimoxazole amongst Klebsiella pneumoniae and Escherichia coli. Carbapenem resistance rates amongst these organisms remained below 30%. High (> 50%) resistance was reported in Acinetobacter species to aminoglycosides and carbapenems among hospitalized patients. The evolution of ceftriaxone resistant Salmonella Typhi and Shigella species is reported. The data showed > 50% to fluoroquinolones amongst Neisseria gonorrhoeae and the spread of methicillin resistant Staphylococcus aureus (< 30%; 2008) to (> 50%; 2010) in hospital settings. Resistance reported in published studies aligned well with antibiogram data. The latter also captured a clear picture of evolution of resistance over the study period. Conclusion Both published studies as well antibiograms suggest high rates of AMR in Pakistan. Antibiogram data demonstrating steady increase in AMR highlight its potential role towards supplementing national AMR surveillance efforts particularly in settings where reach of national surveillance may be limited.

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ESBL Activity, MDR, and Carbapenem Resistance among Predominant Enterobacterales Isolated in 2019

Antibiotics ◽

10.3390/antibiotics10060744 ◽

2021 ◽

Vol 10 (6) ◽

pp. 744

Author(s):

Altaf Bandy ◽

Bilal Tantry

Keyword(s):

Escherichia Coli ◽

Saudi Arabia ◽

Antimicrobial Resistance ◽

Carbapenem Resistance ◽

Resistant Bacteria ◽

Sociodemographic Characteristics ◽

Chi Square ◽

E Coli ◽

Chi Square Test ◽

Resistance Rates

Antimicrobial-resistance in Enterobacterales is a serious concern in Saudi Arabia. The present study retrospectively analyzed the antibiograms of Enterobacterales identified from 1 January 2019 to 31 December 2019 from a referral hospital in the Aljouf region of Saudi Arabia. The revised document of the Centers for Disease Control (CDC) CR-2015 and Magiorakos et al.’s document were used to define carbapenem resistance and classify resistant bacteria, respectively. The association of carbapenem resistance, MDR, and ESBL with various sociodemographic characteristics was assessed by the chi-square test and odds ratios. In total, 617 Enterobacterales were identified. The predominant (n = 533 (86.4%)) isolates consisted of 232 (37.6%), 200 (32.4%), and 101 (16.4%) Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis, respectively. In general, 432 (81.0%) and 128 (24.0%) isolates were of MDR and ESBL, respectively. The MDR strains were recovered in higher frequency from intensive care units (OR = 3.24 (1.78–5.91); p < 0.01). E. coli and K. pneumoniae resistance rates to imipenem (2.55 (1.21–5.37); p < 0.01) and meropenem (2.18 (1.01–4.67); p < 0.04), respectively, were significantly higher in winter. The data emphasize that MDR isolates among Enterobacterales are highly prevalent. The studied Enterobacterales exhibited seasonal variation in antimicrobial resistance rates towards carbapenems and ESBL activity.

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High Prevalence and Diversity of Cephalosporin-Resistant Enterobacteriaceae Including Extraintestinal Pathogenic E. coli CC648 Lineage in Rural and Urban Dogs in Northwest Spain

Antibiotics ◽

10.3390/antibiotics9080468 ◽

2020 ◽

Vol 9 (8) ◽

pp. 468 ◽

Cited By ~ 2

Author(s):

Fátima Abreu-Salinas ◽

Dafne Díaz-Jiménez ◽

Isidro García-Meniño ◽

Pilar Lumbreras ◽

Ana María López-Beceiro ◽

...

Keyword(s):

High Risk ◽

Antimicrobial Resistance ◽

One Health ◽

Potential Role ◽

Multidrug Resistant ◽

E Coli ◽

Rural And Urban ◽

High Prevalence ◽

Healthy Dogs

The aim of this work was to assess the prevalence of extended spectrum-β-lactamase (ESBL)- and carbapenemase-producing Enterobacteriaceae in fecal samples recovered from rural and urban healthy dogs in Northwest Spain (Galicia) to identify potential high-risk clones and to molecularly characterize positive isolates regarding the genes coding for ESBL/pAmpC resistance and virulence. Thirty-five (19.6%) out of 179 dogs were positive for cephalosporin-resistant Enterobacteriaceae, including Escherichiacoli and Klebsiella pneumoniae (39 and three isolates, respectively). All the isolates were multidrug resistant, with high rates of resistance to different drugs, including ciprofloxacin (71.4%). A wide diversity of ESBL/pAmpC enzymes, as well as E. coli phylogroups (A, B1, C, D, E, F and clade I) were found. The eight isolates (20.5%) found to conform to the ExPEC status, belonged to clones O1:H45-clade I-ST770 (CH11-552), O18:H11-A-ST93-CC168 (CH11-neg), O23:H16-B1-ST453-CC86 (CH6-31), and O83:H42-F-ST1485-CC648 (CH231-58), with the latter also complying the uropathogenic (UPEC) status. The three K. pneumoniae recovered produced CTX-M-15 and belonged to the ST307, a clone previously reported in human clinical isolates. Our study highlights the potential role of both rural and urban dogs as a reservoir of high-risk Enterobacteriaceae clones, such as the CC648 of E. coli and antimicrobial resistance traits. Within a One-Health approach, their surveillance should be a priority in the fight against antimicrobial resistance.

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Current and Emerging Strategies for Prediction and Diagnosis of Prelabour Rupture of the Membranes: A Narrative Review

Malaysian Journal of Medical Sciences ◽

10.21315/mjms2021.28.3.2 ◽

2021 ◽

Vol 28 (3) ◽

pp. 5-17

Author(s):

Saadia Ghafoor

Keyword(s):

Biochemical Markers ◽

Potential Role ◽

Narrative Review ◽

Diagnostic Tools ◽

Published Data ◽

Effective Management ◽

Emerging Trends ◽

Foetal Membranes ◽

Diagnostic Modalities

Prelabour rupture of membranes (PROM) refers to the disruption of foetal membranes before the onset of labour, resulting in the leakage of amniotic fluid. PROM complicates 3% and 8% of preterm and term pregnancies, respectively. Accurate and timely diagnosis is crucial for effective management to prevent adverse maternal- and foetal-outcomes. The diagnosis of equivocal PROM cases with traditional methods often becomes challenging in current obstetrics practice; therefore, various novel biochemical markers have emerged as promising diagnostic tools. This narrative review is sought to review the published data to understand the current and emerging trends in diagnostic modalities in term and preterm pregnancies complicated with PROM and the potential role of various markers for predicting preterm PROM (pPROM) and chorioamnionitis in women with pPROM.

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The potential role of somatostatin analogues in the treatment of gastrointestinal (GI) cancers.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.4_suppl.150 ◽

2011 ◽

Vol 29 (4_suppl) ◽

pp. 150-150

Author(s):

J. Hasskarl ◽

M. Kaufmann ◽

H. Schmid ◽

D. C. Metz

Keyword(s):

Solid Tumors ◽

Potential Role ◽

Somatostatin Receptors ◽

Somatostatin Analogues ◽

Published Data ◽

Antitumor Effects ◽

High Affinity ◽

Antitumor Properties ◽

Gi Cancers

150 Background: Somatostatin receptors (sstr) are expressed in various normal and malignant tissues, including non-neuroendocrine GI solid tumors. Gastric cancer (GC) cells mainly express sstr2 and sstr5, colorectal cancer (CRC) cells predominantly express sstr1 followed by sstr5 and sstr2, and hepatocellular carcinoma (HCC) cells express mainly sstr5 as well as sstr1,2,3. Somatostatin analogues (SAs) may have direct and indirect antitumor activity. Octreotide and lanreotide primarily target sstr2, whereas the new agent pasireotide has high affinity for sstr1,2,3 and sstr5. Methods: Published data evaluating the antitumor properties of SAs in GI tumors were reviewed. Results: The table lists the results of clinical studies in which SAs were evaluated as antitumor therapies in GI cancers. Conclusions: Although octreotide and lanreotide are efficacious in the treatment of symptoms of neuroendocrine tumors, these agents have demonstrated mixed results in the antitumor treatment of non-neuroendocrine GI tumors. Data suggesting potential favorable outcomes with SAs alone or in combination with other agents have been seen in solid tumors with predominant sstr2 expression such as GC. Novel SAs such as pasireotide may have improved antitumor effects in non-neuroendocrine solid tumors expressing multiple sstr compared with octreotide and lanreotide. [Table: see text] [Table: see text]

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Increasing carbapenem resistance due to the clonal dissemination of oxacillinase (OXA-23 and OXA-58)-producing Acinetobacter baumannii: report from the Turkish SENTRY Program sites

Journal of Medical Microbiology ◽

10.1099/jmm.0.2008/002469-0 ◽

2008 ◽

Vol 57 (12) ◽

pp. 1529-1532 ◽

Cited By ~ 29

Author(s):

Deniz Gur ◽

Volken Korten ◽

Serhat Unal ◽

Lalitagauri M. Deshpande ◽

Mariana Castanheira

Keyword(s):

Acinetobacter Baumannii ◽

Antimicrobial Agents ◽

Carbapenem Resistance ◽

Surveillance Program ◽

Carbapenem Resistant ◽

Medical Institutions ◽

Antimicrobial Surveillance ◽

Resistant Strains ◽

Resistance Rates ◽

Encoding Genes

A significant increase in carbapenem-resistance rates among Acinetobacter baumannii isolates collected in two Turkish medical centres was detected in the 2000–2006 period (20–60 %) by the SENTRY Antimicrobial Surveillance Program. Carbapenem-resistant strains from 2006 were evaluated for the presence of encoding genes and epidemic clonality. OXA-58-like and OXA-23-like carbapenemase-producing strains were detected in both medical institutions. Seventeen out of 18 strains from Ankara were positive for bla OXA-58 primers and belonged to the same clone, whilst 26 isolates (25 from Istanbul and one from Ankara) harboured bla OXA-23-like genes and showed identical or similar PFGE patterns. Isolates producing OXA-23-like carbapenemases were more resistant than OXA-58-like carbapenemase producers to non-carbapenem antimicrobial agents. Carbapenem resistance in these institutions was observed to be largely driven by the dissemination of clones producing OXA-type carbapenemases.

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Intravenous Chemotherapy for Retinoblastoma in the Era of Intravitreal Chemotherapy: A Systematic Review

Ocular Oncology and Pathology ◽

10.1159/000510506 ◽

2020 ◽

Vol 7 (2) ◽

pp. 142-148

Author(s):

Vishal Raval ◽

Randy Christopher Bowen ◽

Hansell Soto ◽

Arun Singh

Keyword(s):

Potential Role ◽

Practice Patterns ◽

Survival Rates ◽

Published Data ◽

Intravenous Chemotherapy ◽

Intravitreal Chemotherapy ◽

The Mean ◽

Patterns Of Recurrence ◽

Vitreous Seeding

Purpose: The published data on ocular survival following intravenous chemotherapy of retinoblastoma (RB) seems to be skewed by evolving practice patterns induced by use of intravitreal chemotherapy (iVitc). We aimed to explore potential role of iVitc for vitreous seeding for patients treated with intravenous chemotherapy (IVC). Methods: A literature search was performed to identify cases of RB treated with primary IVC prior to advent of iVitc by various search engines (PubMed, Medline, and Google) from 1992 to 2018. Studies were excluded if number of cases were less than 40 or lacked data related to type of recurrence and its treatment. Rates and patterns of recurrence and its management were categorized. Results: Out of 15 studies identified, only 10 studies (797 eyes) met the inclusion criteria. The mean age at presentation was 15.3 months (range 0–192.8 months). Unilateral cases represented 25% of the cohort. The ocular survival rate with primary IVC was 63% (500/797 eyes). Of the 297 eyes (37%) that failed IVC therapy, additional 99 eyes could be salvaged with EBRT (599/797 eyes, 75%). Remaining 198 eyes were enucleated (198/797 eyes 25%). K-M survival analysis could not be done due lack of sufficient data. Recurrences that occurred (mean 12.2 months) after completion of primary IVC included relapse of retinal tumor (143 eyes [48%]), vitreous seeding (73 eyes [25%]), subretinal seeding (49 eyes [16%]), or any combination (103 eyes [35%]). Out of 73 eyes with vitreous seeding, additional 66 eyes (90%) would have been salvaged with iVitc, potentially improving ocular survival rates to 71% (500 + 66/797). Conclusions: Evolving practice patterns of RB treatment have unfavorably skewed published ocular survival rates following IVC. With incorporation of iVitc, the ocular survival rates with IVC can be potentially improved to be non-inferior to those achieved with intra-arterial chemotherapy.

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Mutation frequency of Escherichia coli isolated from river water: potential role in the development of antimicrobial resistance

Canadian Journal of Microbiology ◽

10.1139/cjm-2020-0547 ◽

2021 ◽

Author(s):

Tomohiro Yamazaki ◽

Junji Matsuo

Keyword(s):

Antimicrobial Resistance ◽

River Water ◽

Mutation Frequency ◽

Potential Role ◽

Relative Increase ◽

Natural Environments ◽

E Coli ◽

Stressful Environment ◽

Antimicrobial Sensitivity

Bacteria acquire genetic variations to adapt to stressful environmental conditions, which may be associated with the development of antimicrobial resistance. Here we investigated the mutation frequencies of 270 E. coli isolates from river water, representing a relatively less stressful environment. As we predicted, mutation frequencies of such E. coli isolates ranged from < 1 ×10-11 to 6.3 ×10-8 (median, 1.7 × 10-9), and a strong mutator (4×10-7 ≤) was not detected. To better understand the role of mutation frequency in the development of antimicrobial resistance, we assessed antimicrobial sensitivity after exposure of the E. coli isolates to subinhibitory concentrations of ciprofloxacin as a surrogate for stress. We found that antimicrobial resistance increased in bacteria with a low mutation frequency after exposure, and the relative increase in antimicrobial resistance generally increased depending on the mutation frequency. Thus, mutation frequency may contribute to the development of antimicrobial resistance of bacteria in natural environments.

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Pharmacokinetic and pharmacodynamic principles of antimicrobials

10.1093/med/9780198758792.003.0009 ◽

2016 ◽

Author(s):

Menino Osbert Cotta ◽

Jason Roberts

Keyword(s):

Antimicrobial Resistance ◽

Protein Binding ◽

Clinical Outcomes ◽

Antimicrobial Therapy ◽

Potential Role ◽

Volume Of Distribution ◽

Pharmacokinetics And Pharmacodynamics ◽

Dosing Regimens ◽

Dosing Strategies

The continual threat of antimicrobial resistance means that optimizing current antimicrobial therapy is of paramount importance. Antimicrobial pharmacokinetics and pharmacodynamics (PK/PD) play a central role in developing dosing regimens that target maximal clinical outcomes and microbiological eradication. This chapter describes the three main PK/PD indices into which current antimicrobials are categorized. Elements of PK that require due consideration when optimizing antimicrobial therapy, including volume of distribution, antimicrobial clearance, and protein binding, are also discussed. Finally, specific attention is paid to antimicrobial dosing among challenging populations, namely the critically ill and obese, and the potential role of alternative dosing strategies, such as use of loading doses and extended/continuous infusions, is also outlined.

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Antimicrobial use in food-producing animals: a rapid evidence assessment of stakeholder practices and beliefs

Veterinary Record ◽

10.1136/vr.104304 ◽

2017 ◽

Vol 181 (19) ◽

pp. 510-510 ◽

Cited By ~ 15

Author(s):

Jo Hockenhull ◽

Andrea E Turner ◽

Kristen K Reyher ◽

David C Barrett ◽

Laura Jones ◽

...

Keyword(s):

Veterinary Medicine ◽

Antimicrobial Resistance ◽

Potential Role ◽

Current Knowledge ◽

Antimicrobial Use ◽

Livestock Industry ◽

Animal Agriculture ◽

The World ◽

Public Pressure

Food-producing animals throughout the world are likely to be exposed to antimicrobial (AM) treatment. The crossover in AM use between human and veterinary medicine raises concerns that antimicrobial resistance (AMR) may spread from food-producing animals to humans, driving the need for further understanding of how AMs are used in livestock practice as well as stakeholder beliefs relating to their use. A rapid evidence assessment (REA) was used to collate research on AM use published in peer-reviewed journals between 2000 and 2016. Forty-eight papers were identified and reviewed. The summary of findings highlights a number of issues regarding current knowledge of the use of AMs in food-producing animals and explores the attitudes of interested parties regarding the reduction of AM use in livestock. Variation between and within countries, production types and individual farms demonstrates the complexity of the challenge involved in monitoring and regulating AM use in animal agriculture. Many factors that could influence the prevalence of AMR in livestock are of concern across all sections of the livestock industry. This REA highlights the potential role of farmers and veterinarians and of other advisors, public pressure and legislation to influence change in the use of AMs in livestock.

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Porcine, murine and human sialoadhesin (Sn/Siglec-1/CD169): portals for porcine reproductive and respiratory syndrome virus entry into target cells

Journal of General Virology ◽

10.1099/vir.0.053082-0 ◽

2013 ◽

Vol 94 (9) ◽

pp. 1955-1960 ◽

Cited By ~ 12

Author(s):

Wander Van Breedam ◽

Mieke Verbeeck ◽

Isaura Christiaens ◽

Hanne Van Gorp ◽

Hans J. Nauwynck

Keyword(s):

Sialic Acid ◽

Potential Role ◽

Respiratory Syndrome Virus ◽

Target Cells ◽

Published Data ◽

Binding Domains ◽

Sialic Acid Binding ◽

Infectious Entry ◽

Binding Lectin

Porcine sialoadhesin (pSn; a sialic acid-binding lectin) and porcine CD163 (pCD163) are molecules that facilitate infectious entry of porcine reproductive and respiratory syndrome virus (PRRSV) into alveolar macrophages. In this study, it was shown that murine Sn (mSn) and human Sn (hSn), like pSn, can promote PRRSV infection of pCD163-expressing cells. Intact sialic acid-binding domains are crucial, since non-sialic acid-binding mutants of pSn, mSn and hSn did not promote infection. Endodomain-deletion mutants of pSn, mSn and hSn promoted PRRSV infection less efficiently, but also showed markedly reduced expression levels, making further research into the potential role of the Sn endodomain in PRRSV receptor activity necessary. These data further complement our knowledge on Sn as an important PRRSV receptor, and suggest – in combination with other published data – that species differences in the main PRRSV entry mediators Sn and CD163 do not account for the strict host species specificity displayed by the virus.

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