scholarly journals Profile of pathogens isolated from different clinical samples and their antimicrobial pattern: a retrospective study

2021 ◽  
Author(s):  
M. Anjaneya Swamy ◽  
Jagannath D. Andhale
Keyword(s):  
Escherichia Coli ◽  
Retrospective Study ◽  
Significant Rise ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Resistance Pattern ◽  
Resistant Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Cocci

Background: Since there is a significant rise in resistant bacteria to different antimicrobial agents, there is a need to study the resistance pattern of different isolates from different clinical samples for effective use of available antimicrobials by clinicians. The aim of the present study was to detect the resistance pattern of various antimicrobials against different clinical isolates in hospitalised patients in out setting.Methods: This is a retrospective study involving the collection of the data from the records of microbiology laboratory. All clinical specimens were processed as per standard microbiological procedures. Antibiotic susceptibility testing was performed by Kirby Bauer disc diffusion method on Mueller Hinton agar plate as per CLSI guidelines.Results: A total of 153 isolates were recovered from 219 clinical samples accounting for 69.86% of total positivity. Which includes gram negative bacilli 107/153 (69.93%) gram positive cocci 36/153 (23.53%) and yeast 10/153 (6.54%). Among the total isolates gram negative bacilli account for major number of isolates 69.93% followed by gram positive cocci 23.53% and yeast 6.54%. Gram positive cocci and gram-negative bacilli showed a significant level of antimicrobial resistance. Nitrofurantoin is highly effective against urinary isolates of Escherichia coli. vancomycin and linezolid are most effective antimicrobials against gram positive cocci. Among gram negative bacilli meropenem and amikacin are most effective antimicrobials. Statistical significance of occurrence of Escherichia coli as predominant isolate as compared to other isolates were analysed by chi square test by using GraphPad online calculator. A p value<0.001 was obtained.Conclusions: Significant rise in antimicrobial resistant pathogens were observed. Local antimicrobial policy should be developed for effective selection of available antimicrobials which are the need of the day to reduce the burden of diseases on global health care system.

scholarly journals Antimicrobial and antibiofilm activity of the essential oil from dried leaves of Eucalyptus staigeriana

2019 ◽  
Vol 86 ◽  
Author(s):  
Marcos Saldanha Correa ◽  
Joseli Schwambach ◽  
Michele Bertoni Mann ◽  
Jeverson Frazzon ◽  
Ana Paula Guedes Frazzon
Keyword(s):  
Antimicrobial Activity ◽  
Essential Oils ◽  
Antimicrobial Activities ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Resistant Bacteria ◽  
Antibiofilm Activity ◽  
Gram Positive ◽  
Promising Alternative ◽  
Gram Negative

ABSTRACT: In recent years, compounds with biological properties produced by plants have received attention as an alternative to control microorganisms. Essential oils extracted from green leaves of Eucalyptus sp. have been demonstrated to have antimicrobial activities, but so far there are no reports of antimicrobial activity of essential oils extracted from dried leaves of Eucalyptus staigeriana. So, the objectives of this study were to determine the chemical composition of the essential oils obtained from dried leaves of E. staigeriana (EOdlES) and to evaluate in vitro antimicrobial and antibiofilm activities of EOdlES against gram-positive and gram-negative, resistance and multiresistant Enterococcus faecalis isolated from food and clinical samples. The characterization of EOdlES was performed by gas chromatography-mass spectrometry (GC/MS). For this study, 26 bacterial strains were used, which included 11 reference strains and 15 antibiotic resistant and multiresistant E. faecalis strains. Antimicrobial activities of EOdlES against gram-positive and gram-negative were determined using the disc diffusion method. The minimum inhibitory concentration (MIC) value was evaluated by a microbroth dilution technique. The antibiofilm effects were assessed by microtiter plate method. As a result, 21 compounds were identified, being oxygenated monoterpenes (69.58%) the major chemical family. EOdlES showed only antimicrobial activity against gram-positive strains. E. faecalis resistant and multiresistant strains show the lowest MIC (3.12 to 6.25%), when compared with reference E. faecalis strain. EOdlES has the ability to inhibit the biofilm formation, but little or none ability to inhibit the preformed biofilm. This study demonstrates that EOdlES is a promising alternative to control important foodborne and clinic gram-positive resistant bacteria.

scholarly journals The Antibacterial Activities of NiO Nanoparticles Against Some Gram-Positive and Gram-Negative Bacterial Strains

2019 ◽  
Vol 4 (2) ◽  
pp. 69-74
Author(s):  
Ghazaleh Ilbeigi ◽  
Ashraf Kariminik ◽  
Mohammad Hasan Moshafi
Keyword(s):  
Antibiotic Resistance ◽  
Antibacterial Properties ◽  
Diffusion Method ◽  
Resistance Pattern ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Nio Nanoparticles ◽  
Bacterial Strains ◽  
Gram Positive ◽  
Gram Negative

Introduction: Given the increasing rate of antibiotic resistance among bacterial strains, many researchers have been working to produce new and efficient and inexpensive antibacterial agents. It has been reported that some nanoparticles may be used as novel antimicrobial agents.Here, we evaluated antibacterial properties of nickel oxide (NiO) nanoparticles. Methods: NiO nanoparticles were synthesized using microwave method. In order to control the quality and morphology of nanoparticles, XRD (X-ray diffraction) and SEM (scanning electronmicroscope) were utilized. The antibacterial properties of the nanoparticles were assessed against eight common bacterial strains using agar well diffusion assay. The minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were measured. Antibiotic resistance pattern of the bacteria to nine antibiotics was obtained by Kirby-Bauer disk diffusion method. Results: The crystalline size and diameter (Dc) of NiO nanoparticles were obtained 40-60 nm. The nanoparticles were found to inhibit the growth of both gram-positive and gram-negative bacteria with higher activity against gram-positive organisms. Among bacterial strains, maximum sensitivity was observed in Staphylococcus epidermidis with MIC and MBC of 0.39 and 0.78 mg/mL, respectively. The bacteria had high resistance to cefazolin, erythromycin, rifampicin,ampicillin, penicillin and streptomycin.Conclusion: NiO nanoparticles exhibited remarkable antibacterial properties against gram positive and gram-negative bacteria and can be a new treatment for human pathogenic and antibiotic-resistant bacteria.

scholarly journals Study of Aerobic Bacterial Etiology and Their Antibiogram from Pus Samples in a Tertiary Care Hospital

2021 ◽  
Vol 8 (4) ◽  
pp. 358-362
Author(s):  
T. Kanakadurgamba ◽  
Rama Lakshmi Koripella ◽  
B. Gowtham
Keyword(s):  
Staphylococcus Aureus ◽  
Multidrug Resistant ◽  
Diffusion Method ◽  
Resistant Bacteria ◽  
Klebsiella Pneumonia ◽  
Microbiological Analysis ◽  
Gram Positive ◽  
Gram Negative ◽  
Culture Positive ◽  
Gram Positive Cocci

Introduction: The spread of multidrug resistant bacteria has added a new angel to the problem of wound infections which are a major cause of morbidity. To avoid difficulty in treatment of such infections it is mandatory for every pus sample to undergo Culture and sensitivity. Aim: To isolate and study the antibiogram of the aerobic bacteria from pus samples. Materials and Methods: A total of 426 pus samples received from various wards in the Microbiology department. Andhra Medical College, Visakhapatnam were processed as per standard guidelines in the laboratory. All the aerobic bacterial isolates obtained were kept for antibiogram by Kirby Bauer’s disc diffusion method as per CLSI Guidelines. Results: Out of 426 samples 394 (92.4%) were culture positive. Among culture positive samples 90.6% were pure cultures and 9.4% were mixed isolates. Gram negative bacilli were 72.8% of the total isolates and 27.2% were Gram positive cocci. Escherichia coli and Klebsiella pneumonia were the predominant isolates (30.3% and 28.9%) followed by Pseudomonas aeruginosa (24%), Proteus species (9.7%) and Acinetobacter species (6.9%). Among Gram positive cocci Staphylococcus aureus (62.6%), Enterococci (20.5%) and Coagulase Negative Staphylococcus (11.2%) and Streptococci (3.7%). GNB were more sensitive to Colistin (92%), Amikacin (86%), Imipenem and Meropenem (86% and 84.4%), Piperacillin Tazobactam (84%), Gentamycin (78%), Cefaperazone Sulbactam (76.2%) and Ciprofloxacin (56%). Gram positive cocci were sensitive to Linezolid and Teicoplanin (98% each), Vancomycin (96.2%), Clindamycin (84%), Gentamycin (79%), Azithromycin (76.4%), Ciprofloxacin (66%) and Amoxiclav (54%) out of 62.6% Staphylococcus aureus isolates 31.4% were MRSA and out of 72.8% of Gram negative bacilli 38.2% were ESBLS. Conclusion: As multidrug resistant bacterial strains are emerging in various infectious and pyogenic wound infection is most important cause of morbidity, it is important for a clinician to send all pus samples for microbiological analysis and their antibiogram before putting cases on antibiotics. Keywords: Pus samples, Multidrug resistance, Gram negative bacilli, Gram positive cocci, Antimicrobial sensitivity.

scholarly journals Pyelonephritis in Pediatric Uropathic Patients: Differences from Community-Acquired Ones and Therapeutic Protocol Considerations. A 10-Year Single-Center Retrospective Study

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 436
Author(s):  
Giovanni Parente ◽  
Tommaso Gargano ◽  
Stefania Pavia ◽  
Chiara Cordola ◽  
Marzia Vastano ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Retrospective Study ◽  
Success Rate ◽  
Pediatric Population ◽  
Gram Negative Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Significant Difference ◽  
Klebsiella Spp

Pyelonephritis (PN) represents an important cause of morbidity in the pediatric population, especially in uropathic patients. The aim of the study is to demonstrate differences between PNs of uropathic patients and PNs acquired in community in terms of uropathogens involved and antibiotic sensitivity; moreover, to identify a proper empiric therapeutic strategy. A retrospective study was conducted on antibiograms on urine cultures from PNs in vesicoureteral reflux (VUR) patients admitted to pediatric surgery department and from PNs in not VUR patients admitted to Pediatric Emergency Unit between 2010 and 2020. We recorded 58 PNs in 33 patients affected by VUR and 112 PNs in the not VUR group. The mean age of not VUR patients at the PN episode was 1.3 ± 2.6 years (range: 20 days of life–3 years), and almost all the urine cultures, 111 (99.1%), isolated Gram-negative bacteria and rarely, 1 (0.9%), Gram-positive bacteria. The Gram-negative uropathogens isolated were Escherichia coli (97%), Proteus mirabilis (2%), and Klebsiella spp. (1%). The only Gram-positive bacteria isolated was an Enterococcus faecalis. As regards the antibiograms, 96% of not VUR PNs responded to beta-lactams, 99% to aminoglycosides, and 80% to sulfonamides. For the VUR group, mean age was 3.0 years ± 3.0 years (range: 9 days of life–11 years) and mean number of episodes per patient was 2.0 ± 1.0 (range: 1–5); 83% of PNs were by Gram-negatives bacteria vs. 17% by Gram-positive: the most important Gram-negative bacteria were Pseudomonas aeruginosa (44%), Escherichia coli (27%), and Klebsiella spp. (12%), while Enterococcus spp. determined 90% of Gram-positive UTIs. Regimen ampicillin/ceftazidime (success rate: 72.0%) was compared to ampicillin/amikacin (success rate of 83.0%): no statistically significant difference was found (p = 0.09). The pathogens of PNs in uropathic patients are different from those of community-acquired PNs, and clinicians should be aware of their peculiar antibiotic susceptibility. An empiric therapy based on the association ampicillin + ceftazidime is therefore suggested.

Increasing frequency of gram-positive cocci and gram-negative multidrug-resistant bacteria in spontaneous bacterial peritonitis

2013 ◽  
Vol 33 (7) ◽  
pp. 975-981 ◽  
Author(s):  
Alexandra Alexopoulou ◽  
Nikolaos Papadopoulos ◽  
Dimitrios G. Eliopoulos ◽  
Apostolia Alexaki ◽  
Athanasia Tsiriga ◽  
...  
Keyword(s):  
Spontaneous Bacterial Peritonitis ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Bacterial Peritonitis ◽  
Gram Positive Cocci

scholarly journals Trends of Bloodstream Infections in a University Greek Hospital during a Three-Year Period: Incidence of Multidrug-Resistant Bacteria and Seasonality in Gram-negative Predominance

2017 ◽  
Vol 66 (2) ◽  
pp. 171-180 ◽  
Author(s):  
Fevronia Kolonitsiou ◽  
Matthaios Papadimitriou-Olivgeris ◽  
Anastasia Spiliopoulou ◽  
Vasiliki Stamouli ◽  
Vasileios Papakostas ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Blood Cultures ◽  
Diffusion Method ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Gram Positive ◽  
Gram Negative ◽  
Carbapenem Resistant

The aim of the study was to assess the epidemiology, the incidence of multidrug-resistant bacteria and bloodstream infections’ (BSIs) seasonality in a university hospital. This retrospective study was carried out in the University General Hospital of Patras, Greece, during 2011–13 y. Blood cultures from patients with clinical presentation suggestive of bloodstream infection were performed by the BacT/ALERT System. Isolates were identified by Vitek 2 Advanced Expert System. Antibiotic susceptibility testing was performed by the disk diffusion method and E-test. Resistance genes (mecA in staphylococci; vanA/vanB/vanC in enterococci; blaKPC/blaVIM/blaNDM in Klebsiella spp.) were detected by PCR. In total, 4607 (9.7%) blood cultures were positive from 47451 sets sent to Department of Microbiology, representing 1732 BSIs. Gram-negative bacteria (52.3%) were the most commonly isolated, followed by Gram-positive (39.5%), fungi (6.6%) and anaerobes bacteria (1.8%). The highest contamination rate was observed among Gram-positive bacteria (42.3%). Among 330 CNS and 150 Staphylococcus aureus, 281 (85.2%) and 60 (40.0%) were mecA-positive, respectively. From 113 enterococci, eight were vanA, two vanB and two vanC-positives. Of the total 207 carbapenem-resistant Klebsiella pneumoniae (73.4%), 202 carried blaKPC, four blaKPC and blaVIM and one blaVIM. A significant increase in monthly BSIs’ incidence was shown (R2: 0.449), which may be attributed to a rise of Gram-positive BSIs (R2: 0.337). Gram-positive BSIs were less frequent in spring (P < 0.001), summer (P < 0.001), and autumn (P < 0.001), as compared to winter months, while Gram-negative bacteria (P < 0.001) and fungi (P < 0.001) were more frequent in summer months. BSIs due to methicillin resistant S. aureus and carbapenem-resistant Gram-negative bacteria increased during the study period. The increasing incidence of BSIs can be attributed to an increase of Gram-positive BSI incidence, even though Gram-negative bacteria remained the predominant ones. Seasonality may play a role in the predominance of Gram-negative’s BSI.

scholarly journals Molecular Detection of blaTEM, blaCTX-M and blaSHV Genes in Extended Spectrum β-Lactamase (ESBL) Escherichia Coli from Clinical Samples

2021 ◽  
Author(s):  
Mahesh Kumar Chaudhary ◽  
Indrani Jadhav ◽  
Megha Raj Banjara
Keyword(s):  
Escherichia Coli ◽  
Major Gene ◽  
Polymyxin B ◽  
Cross Sectional Study ◽  
Diffusion Method ◽  
Clinical Samples ◽  
Resistant Bacteria ◽  
Microbiology Laboratory ◽  
Cross Sectional ◽  
Extended Spectrum

Abstract BackgroundExtended spectrum β-lactamases are the group of beta-lactamase enzymes which confer resistance to the oxyimino-cephalosporins and monobactams. Emergence of ESBL producing genes which possess a serious threat for the treatment of infections both in community and hospitals since it is found to be increasing trends of multidrug resistance. This study was focused to find out the ESBLs producing genes.MethodsThis was a cross-sectional study conducted over a period of 2 years (September 2018 to April 2020) at microbiology laboratory of Nepal Mediciti Hospital. Clinical samples were processed in microbiology laboratory and culture isolates were indetified and characterized by standard microbiological techniques. following standard procedures.Antibiotic susceptibility testing was performed by modified Kirby-Bauer disc diffusion method as recommended by Clinical and Laboratory Standard Institute. Extended spectrum beta-lactamases were phenotypically confirmed by combined disc method.ESBL producing genes i.e. blaTEM,blaCTX-M and blaSHV were confirmed by PCR.ResultsOf the 1449 total E.coli isolates, 323/1449(22.29%) isolates were multi -drug resistance.Among total MDR Escherichia coli isolates, 215/323(66.56%) isolates were ESBL producers. The maximum number of ESBL Escherichia coli was isolated from urine 194(90.23%), followed by sputum 12(5.58%), swab 5 (2.32%), pus 2 (0.93%) and blood 2 (0.93%).Antibiotic susceptibility pattern of ESBL E.coli producers showed highest sensitivity towards tigecycline (100%) followed by polymyxin b, colistin and meropenem.Out of 215 phenotypically confirmed ESBL E.coli,only 186(86.51%) isolates were found to positive by PCR.The last 29(13.49%) were negative for any of the resistant genes.Among the ESBL genotypes,most common was blaTEM 118(63.4%) followed by blaCTX-M 68(36.6%).ConclusionThe emergence of MDR and ESBL producing E.coli isolates with high antibiotic resistant rates to commonly used antibiotics and increased predominance of major gene types blaTEM is a serious concern to the clinicians as well as microbiologist. This study forwarded a real massage to all the clinicians for the emergence of XDR and PDR resistant bacteria and preservation of antibiotics for their proper use in near future, if past experience with MDR and ESBLs is any indicator.

scholarly journals Bacteriological Profile of Neonatal Sepsis and Antibiogram of the Isolates

2017 ◽  
Vol 37 (1) ◽  
pp. 5-9
Author(s):  
Roshan Parajuli ◽  
Narayan Dutt Pant ◽  
Raju Bhandari ◽  
Anil Giri ◽  
Suman Rai ◽  
...  
Keyword(s):  
Staphylococcus Epidermidis ◽  
Neonatal Sepsis ◽  
Diffusion Method ◽  
Preliminary Treatment ◽  
Biochemical Tests ◽  
Gram Positive ◽  
Cross Sectional ◽  
Gram Negative ◽  
Bacteriological Profile ◽  
Gram Positive Cocci

Introduction: Neonatal sepsis is a serious problem in developing countries like Nepal. The main objectives of this study were to determine the bacteriological profile of neonatal sepsis, to determine the antimicrobial susceptibility patterns of the causative agents and to evaluate the association between the neonatal sepsis and the different characteristics of the neonates.Methods: A hospital based cross-sectional study was conducted among a total of 450 neonates suspected of suffering from sepsis. Blood culture was performed using statdard microbiological techniques. The colonies grown were identified on the basis of colony morphology, Gram’s stain and biochemical tests. The antimicrobial susceptiblility testing was performed by Kirby Bauer disc diffusion method. Results: Out of total 450 blood samples, 92 (20.4%) were culture positive. Of which,  16 (17.4%) samples contained  gram negative bacteria and 76 (82.6%) samples contained gram positive cocci. The most common bacterial pathogens isolated were Staphylococcus epidermidis (67.4%) followed by Escherichia coli (13%). All gram positive cocci were susceptible to vancomycin, while all gram negative bacilli were sensitive to amikacin. There was statistically significant relationship between neonatal sepsis and gestation age of neonates.Conclusions: Neonatal sepsis is still present as a serious problem in Nepal. Staphylococcus epidermidis was the most common cause of the neonatal sepsis. Prematurely delivered neonates should be given more care, as they are more prone to suffering from neonatal sepsis. Vancomycin and amikacin can be used as the drugs of choice for preliminary treatment of neonatal sepsis in our settings.

scholarly journals Nybomycin Inhibits both Fluoroquinolone-Sensitive and Fluoroquinolone-Resistant Escherichia coli DNA Gyrase

2021 ◽  
Vol 65 (5) ◽  
Author(s):  
Dmitrii I. Shiriaev ◽  
Alina A. Sofronova ◽  
Ekaterina A. Berdnikovich ◽  
Dmitrii A. Lukianov ◽  
Ekaterina S. Komarova ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Bacterial Species ◽  
Dna Gyrase ◽  
Resistant Bacteria ◽  
Mutant Form ◽  
Wild Type ◽  
Topoisomerase Iv ◽  
Gram Positive ◽  
Gram Negative ◽  
Content Type

ABSTRACT Bacterial type II topoisomerases, DNA gyrase and topoisomerase IV, are targets of many antibiotics, including fluoroquinolones (FQs). Unfortunately, a number of bacterial species easily acquire resistance to FQs by mutations in either DNA gyrase or topoisomerase IV genes. The emergence of resistant pathogenic strains is a global problem in health care; therefore, identifying alternative pathways to thwart their persistence is the current frontier in drug discovery. Nybomycins are an attractive class of compounds, reported to be “reverse antibiotics” that selectively inhibit growth of some Gram-positive FQ-resistant bacteria by targeting the mutant form of DNA gyrase while being inactive against wild-type strains with FQ-sensitive gyrases. The strong “reverse” effect was demonstrated only for a few Gram-positive organisms resistant to FQs due to the S83L/I mutation in the GyrA subunit of DNA gyrase. However, the activity of nybomycins has not been extensively explored among Gram-negative species. Here, we observed that in a ΔtolC strain of the Gram-negative Escherichia coli with enhanced permeability, wild-type gyrase and a GyrA S83L mutant, resistant to fluoroquinolones, are similarly sensitive to nybomycin.

Gut Flora in Autistic Children as Biomarker for Autism in Thi-Qar Province/Iraq

2020 ◽  
pp. 73-79
Keyword(s):  
Escherichia Coli ◽  
Enterococcus Faecalis ◽  
The Other ◽  
Bacterial Isolates ◽  
Autistic Children ◽  
Gram Positive ◽  
Gram Negative ◽  
Other Hand ◽  
Significant Difference ◽  
Gram Positive Cocci

This is the first study that investigated the microbial factor as biomarker in autistic children and discuss roles of this factor in the pathogenesis of autism. The participants in current study were 145 persons, only 50 sample of stool could collected (35 autistic children and 15 healthy children). Autistic children were attended to autism unit at Disabled Hospital in Thi-Qar province, Iraq during the period from January to November 2016. The results showed males (81%) more than female (19%) with ratio 4:1 and also results explain the age group of 3-5 years recorded the highest percentage (41.05%). Distribution of autistic children according to sibling showed six were brotherly with occurrence rate 6.3%. Stool samples were subjected to examination and culture. The total aerobic count of isolated bacteria was 140 isolates. Gram-negative isolates were identified by API Enterobacteriaceae system. The results were Escherichia coli, Enterobacter cloacae, Klebsiella pneumonia, Pseudomonas aeruginosa and Proteus mirabilis with percentage 38.5%, 19.23%, 11.53%,7.69%, and 3.84% respectively. On the other hand, gram positive cocci isolates included Enterococcus faecalis, Staphylococcus aureus and Staph. epidermidis with percentage 11.53%, 4.80% and 2.88% respectively. A significant difference (P≤0.05) was recorded between bacterial isolates. Quantity and quality of isolated bacteria (colony/g *104) were done. E.coli isolates were the highest count with 261*104 colony/g while, Staphylococci epidermidis were recorded the worse colony count with 30*104 colony/g. The quality results showed Escherichia coli the most common gram negative bacterial isolates (38.46%). On the other hand, the highest gram positive cocci isolates were included Enterococcus faecalis (11.53%), with significant difference (P≤0.05) between bacterial isolates. The ability of bacterial isolates to produce histidine decarboxylase was examined on Niven medium. The positive result include colonies with purple halo around them. Only 10 isolates (25%) from all isolates were produce histidine belong to E.coli. On other hand, result of parasite examination explain no parasite in all samples. From this study can conclusion the altered gut microflora may play an essential role in the pathogenesis of autism. Despite the accurate evidence, this etiological heterogeneity is still not recognized by autism researchers, and most studies fail to take it into account.

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