Antimicrobial Resistance among Neonates with Bacterial Sepsis and Their Clinical Outcomes in a Tertiary Hospital in Kathmandu Valley, Nepal

Globally, antibiotic resistance in bacteria isolated from neonatal sepsis is increasing. In this cross-sectional study conducted at a medical college teaching hospital in Nepal, we assessed the antibiotic resistance levels in bacteria cultured from neonates with sepsis and their in-hospital treatment outcomes. We extracted data of neonates with sepsis admitted for in-patient care from June 2018 to December 2019 by reviewing hospital records of the neonatal intensive care unit and microbiology department. A total of 308 neonates with sepsis were admitted of which, blood bacterial culture antibiotic sensitivity reports were available for 298 neonates. Twenty neonates (7%) had bacteriologic culture-confirmed neonatal sepsis. The most common bacterial species isolated were Staphylococcus aureus (8), followed by coagulase-negative Staphylococcus (5). Most of these bacteria were resistant to at least one first-line antibiotic used to manage neonatal sepsis. Overall, there were 7 (2%) deaths among the 308 neonates (none of them from the bacterial culture-positive group), and 53 (17%) neonates had left the hospital against medical advice (LAMA). Improving hospital procedures to isolate bacteria in neonates with sepsis, undertaking measures to prevent the spread of antibiotic-resistant bacteria, and addressing LAMA’s reasons are urgently needed.

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Bacterial Etiology and Antibiotic Resistance Profile of Community-Acquired Urinary Tract Infections in a Cameroonian City

International Journal of Microbiology ◽

10.1155/2016/3240268 ◽

2016 ◽

Vol 2016 ◽

pp. 1-6 ◽

Cited By ~ 6

Author(s):

Rolf Nyah-tuku Nzalie ◽

Hortense Kamga Gonsu ◽

Sinata Koulla-Shiro

Keyword(s):

Antibiotic Resistance ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Common Knowledge ◽

Bacterial Species ◽

Antibiotic Sensitivity ◽

Diffusion Method ◽

Cross Sectional ◽

Geographical Variations ◽

Tract Infections

Introduction. Community-acquired urinary tract infections (CAUTIs) are usually treated empirically. Geographical variations in etiologic agents and their antibiotic sensitivity patterns are common. Knowledge of antibiotic resistance trends is important for improving evidence-based recommendations for empirical treatment of UTIs. Our aim was to determine the major bacterial etiologies of CAUTIs and their antibiotic resistance patterns in a cosmopolitan area of Cameroon for comparison with prescription practices of local physicians.Methods. We performed a cross-sectional descriptive study at two main hospitals in Yaoundé, collecting a clean-catch mid-stream urine sample from 92 patients having a clinical diagnosis of UTI. The empirical antibiotherapy was noted, and identification of bacterial species was done on CLED agar; antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion method.Results. A total of 55 patients had samples positive for a UTI. Ciprofloxacin and amoxicillin/clavulanic acid were the most empirically prescribed antibiotics (30.9% and 23.6%, resp.); bacterial isolates showed high prevalence of resistance to both compounds.Escherichia coli(50.9%) was the most common pathogen, followed byKlebsiella pneumoniae(16.4%). Prevalence of resistance for ciprofloxacin was higher compared to newer quinolones.Conclusions.E. coliandK. pneumoniaewere the predominant bacterial etiologies; the prevalence of resistance to commonly prescribed antibiotics was high.

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Development of an Immunochromatographic Strip Using Conjugated Gold Nanoparticles for the Rapid Detection of Klebsiella pneumoniae Causing Neonatal Sepsis

Pharmaceutics ◽

10.3390/pharmaceutics13081141 ◽

2021 ◽

Vol 13 (8) ◽

pp. 1141

Author(s):

Noha M. Elhosseiny ◽

Tamer M. Samir ◽

Aliaa A. Ali ◽

Amani A. El-Kholy ◽

Ahmed S. Attia

Keyword(s):

Gold Nanoparticles ◽

Klebsiella Pneumoniae ◽

Causative Agent ◽

Neonatal Sepsis ◽

Bacterial Species ◽

Resistant Bacteria ◽

Immunochromatographic Strip ◽

Amino Acid Peptide ◽

Negative Results ◽

Drug Resistant Bacteria

Neonatal sepsis is a leading cause of death among newborns and infants, especially in the developing world. The problem is compounded by the delays in pinpointing the causative agent of the infection. This is reflected in increasing mortality associated with these cases and the spread of multi-drug-resistant bacteria. In this work, we deployed bioinformatics and proteomics analyses to determine a promising target that could be used for the identification of a major neonatal sepsis causative agent, Klebsiella pneumoniae. A 19 amino acid peptide from a hypothetical outer membrane was found to be very specific to the species, well conserved among its strains, surface exposed, and expressed in conditions simulating infection. Antibodies against the selected peptide were conjugated to gold nanoparticles and incorporated into an immunochromatographic strip. The developed strip was able to detect as low as 105 CFU/mL of K. pneumoniae. Regarding specificity, it showed negative results with both Escherichia coli and Enterobacter cloacae. More importantly, in a pilot study using neonatal sepsis cases blood specimens, the developed strip selectively gave positive results within 20 min with those infected with K. pneumoniae without prior sample processing. However, it gave negative results in cases infected with other bacterial species.

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Prevalence of Mastitis and Antibiotic Resistance of Bacterial Isolates from CMT Positive Milk Samples Obtained from Dairy Cows, Camels, and Goats in Two Pastoral Districts in Southern Ethiopia

Animals ◽

10.3390/ani11061530 ◽

2021 ◽

Vol 11 (6) ◽

pp. 1530

Author(s):

Amanuel Balemi ◽

Balako Gumi ◽

Kebede Amenu ◽

Sisay Girma ◽

Muuz Gebru ◽

...

Keyword(s):

Antibiotic Resistance ◽

Dairy Cows ◽

Raw Milk ◽

Multidrug Resistant ◽

Southern Ethiopia ◽

Resistant Bacteria ◽

Coagulase Negative Staphylococcus ◽

Bacterial Isolates ◽

E Coli ◽

Milk Samples

A study was carried out from August 2017 to February 2018 on lactating dairy cows, one-humped dromedary camels, and goats to determine mastitis in the Bule Hora and Dugda Dawa districts of in Southern Ethiopia. Milk samples from 564 udder quarters and udder halves from 171 animals consisting of 60 dairy cows, 51 camels, and 60 goats were tested for mastitis. Sixty-four positive udder milk samples were cultured, and bacterial mastitis pathogens were isolated and identified. The antibiotic resistance of bacterial isolates from milk with mastitis was tested against nine antimicrobials commonly used in the study area. Cow- and quarter-level prevalence of mastitis in dairy cows, camels, and goats was 33.3%, 26.3%, and 25% and 17.6%, 14.5%, and 20%, respectively. In cattle, the prevalence was significantly higher in Dugda Dawa than in Bule Hora. Major bacterial isolates were coagulase-negative Staphylococcus species (39.1%), S. aureus (17.2%), S. hyicus (14.1%), and S. intermedius and Escherichia coli (9.4% each). In camels, udder abnormality and mastitis were significantly higher in late lactation than in early lactation. Mastitis tends to increase with parity in camels. E. coli isolates were highly resistant to spectinomycin, vancomycin, and doxycycline, whereas most S. aureus isolates were multidrug-resistant. Most of the rural and periurban communities in this area consume raw milk, which indicates a high risk of infection with multidrug-resistant bacteria. We recommend a community-focused training program to improve community awareness of the need to boil milk and the risk of raw milk consumption.

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Time to Positivity of Bacteria Cultures in Peritoneal Dialysis Fluid: Evaluation of Different Laboratory Techniques

Peritoneal Dialysis International ◽

10.3747/pdi.2016.00174 ◽

2017 ◽

Vol 37 (3) ◽

pp. 342-344

Author(s):

Roberta M. Katzap ◽

Vany Elisa Pagnussatti ◽

Ana Elizabeth Figueiredo ◽

Julia Gabriela Motta ◽

Domingos O. d'Avila ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Peritoneal Fluid ◽

Antibiotic Sensitivity ◽

Positive Culture ◽

Cross Sectional Study ◽

Essential Elements ◽

Coagulase Negative Staphylococcus ◽

Cross Sectional ◽

Peritoneal Dialysis Fluid

Patients with chronic kidney disease on peritoneal dialysis (PD) are susceptible to infections, with peritonitis being the primary cause of dropout. Peritoneal fluid culture is one of the essential elements for proper diagnosis and peritonitis treatment. The aim of this study was to compare the time required to obtain a positive culture using different laboratory methods. An in vitro cross-sectional study was conducted comparing different techniques for preparation and culture of bacteria in peritoneal fluid. The research was carried out with 21 sterile dialysis bags and 21 PD bags containing peritoneal fluid drained from patients without peritonitis. Fluids from the 42 PD bags were contaminated by injecting a coagulase-negative Staphylococcus suspension and then prepared for culture using 4 distinct techniques: A - direct culture; B - post-centrifugation culture; C - direct culture after 4 h sedimentation; and D - culture after 4 h sedimentation and centrifugation. This was followed by seeding. In the 21 contaminated sterile bags, mean times to obtain a positive culture with techniques D (19.6 h ± 2.6) and C (19.1 h ± 2.3) were longer than with technique A (15.8 h ± 3.0; p < 0.01), but not statistically different from group B (19.0 h ± 3.2). The same occurred in the 21 bags drained from patients, with mean times for techniques D (14.0 h ± 1.9) and C (14.5 h ± 1.7) being longer than technique A (12.22 h ± 1.94; p < 0.05) but not statistically different from technique B (13.2 h ± 1.3). The sedimentation and centrifugation steps seem to be unnecessary and may delay antibiotic sensitivity test results by approximately 8 hours.

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Bacteria and Their Antibiotic Resistance Profiles in Ambient Air in Accra, Ghana, February 2020: A Cross-Sectional Study

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6030110 ◽

2021 ◽

Vol 6 (3) ◽

pp. 110

Author(s):

Godfred Saviour Kudjo Azaglo ◽

Mohammed Khogali ◽

Katrina Hann ◽

John Alexis Pwamang ◽

Emmanuel Appoh ◽

...

Keyword(s):

Antibiotic Resistance ◽

Pathogenic Bacteria ◽

Ambient Air ◽

Cross Sectional Study ◽

Bacillus Species ◽

Resistant Bacteria ◽

Cross Sectional ◽

Antibiotic Resistant ◽

Bacterial Counts ◽

Inappropriate Use

Inappropriate use of antibiotics has led to the presence of antibiotic-resistant bacteria in ambient air. There is no published information about the presence and resistance profiles of bacteria in ambient air in Ghana. We evaluated the presence and antibiotic resistance profiles of selected bacterial, environmental and meteorological characteristics and airborne bacterial counts in 12 active air quality monitoring sites (seven roadside, two industrial and three residential) in Accra in February 2020. Roadside sites had the highest median temperature, relative humidity, wind speed and PM10 concentrations, and median airborne bacterial counts in roadside sites (115,000 CFU/m3) were higher compared with industrial (35,150 CFU/m3) and residential sites (1210 CFU/m3). Bacillus species were isolated in all samples and none were antibiotic resistant. There were, however, Pseudomonas aeruginosa, Escherichia coli, Pseudomonas species, non-hemolytic Streptococci, Coliforms and Staphylococci species, of which six (50%) showed mono-resistance or multidrug resistance to four antibiotics (penicillin, ampicillin, ciprofloxacin and ceftriaxone). There was a positive correlation between PM10 concentrations and airborne bacterial counts (rs = 0.72), but no correlations were found between PM10 concentrations and the pathogenic bacteria nor their antibiotic resistance. We call for the expansion of surveillance of ambient air to other cities of Ghana to obtain nationally representative information.

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The Inactivation of Enzymes Belonging to the Central Carbon Metabolism Is a Novel Mechanism of Developing Antibiotic Resistance

mSystems ◽

10.1128/msystems.00282-20 ◽

2020 ◽

Vol 5 (3) ◽

Author(s):

Teresa Gil-Gil ◽

Fernando Corona ◽

José Luis Martínez ◽

Alejandra Bernardini

Keyword(s):

Antibiotic Resistance ◽

Stenotrophomonas Maltophilia ◽

Bacterial Species ◽

Bacterial Metabolism ◽

Resistant Bacteria ◽

Uridine Diphosphate ◽

Biosynthesis Pathway ◽

Content Type ◽

Peptidoglycan Biosynthesis ◽

Central Carbon

ABSTRACT Fosfomycin is a bactericidal antibiotic, analogous to phosphoenolpyruvate, that exerts its activity by inhibiting the activity of MurA. This enzyme catalyzes the first step of peptidoglycan biosynthesis, the transfer of enolpyruvate from phosphoenolpyruvate to uridine-diphosphate-N-acetylglucosamine. Fosfomycin is increasingly being used, mainly for treating infections caused by Gram-negative multidrug-resistant bacteria. The mechanisms of mutational resistance to fosfomycin in Stenotrophomonas maltophilia, an opportunistic pathogen characterized by its low susceptibility to commonly used antibiotics, were studied in the current work. None of the mechanisms reported so far for other organisms, which include the production of fosfomycin-inactivating enzymes, target modification, induction of an alternative peptidoglycan biosynthesis pathway, and the impaired entry of the antibiotic, are involved in the acquisition of such resistance by this bacterial species. Instead, the unique cause of resistance in the mutants studied is the mutational inactivation of different enzymes belonging to the Embden-Meyerhof-Parnas central metabolism pathway. The amount of intracellular fosfomycin accumulation did not change in any of these mutants, showing that neither inactivation nor transport of the antibiotic is involved. Transcriptomic analysis also showed that the mutants did not present changes in the expression level of putative alternative peptidoglycan biosynthesis pathway genes or any related enzyme. Finally, the mutants did not present an increased phosphoenolpyruvate concentration that might compete with fosfomycin for its binding to MurA. On the basis of these results, we describe a completely novel mechanism of antibiotic resistance based on mutations of genes encoding metabolic enzymes. IMPORTANCE Antibiotic resistance has been largely considered a specific bacterial response to an antibiotic challenge. Indeed, its study has been mainly concentrated on mechanisms that affect the antibiotics (mutations in transporters, efflux pumps, and antibiotic-modifying enzymes, or their regulators) or their targets (i.e., target mutations, protection, or bypass). Usually, antibiotic resistance-associated metabolic changes were considered a consequence (fitness costs) and not a cause of antibiotic resistance. Herein, we show that alterations in the central carbon bacterial metabolism can also be the cause of antibiotic resistance. In the study presented here, Stenotrophomonas maltophilia acquires fosfomycin resistance through the inactivation of glycolytic enzymes belonging to the Embden-Meyerhof-Parnas pathway. Besides resistance to fosfomycin, this inactivation also impairs the bacterial gluconeogenic pathway. Together with previous work showing that antibiotic resistance can be under metabolic control, our results provide evidence that antibiotic resistance is intertwined with the bacterial metabolism.

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Antibiotic sensitivity and resistant pattern of bacteria isolated from table eggs of commercial layers considering food safety issue

Asian Journal of Medical and Biological Research ◽

10.3329/ajmbr.v4i4.40103 ◽

2018 ◽

Vol 4 (4) ◽

pp. 323-329 ◽

Cited By ~ 1

Author(s):

Mahfuzul Islam ◽

Mirza Synthia Sabrin ◽

Md Hazzaz Bin Kabir ◽

Md Aftabuzzaman

Keyword(s):

Food Safety ◽

Safety Issue ◽

Antibiotic Sensitivity ◽

Health Concern ◽

Resistant Bacteria ◽

Coagulase Negative Staphylococcus ◽

Biochemical Tests ◽

Salmonella Spp ◽

Pseudomonas Spp ◽

Coagulase Positive Staphylococcus

The present study was carried out during the period of June 2016 to June 2017 to evaluate the antibiotic sensitivity and resistant pattern of bacteria isolated from table eggs of commercial layers considering food safety issue. A total of 200 egg samples (100 for egg shell surface and 100 for egg content) were collected from different retail markets of Dhaka city in sterile polythene bags in a view to prevent extraneous contamination and transported to the laboratory immediate after collection using icebox. The samples were inoculated onto nutrient broth and nutrient agar plates aerobically at 37°Cfor isolation. The isolated organisms were identified based on staining, motility, colony morphology and biochemical tests. The isolated bacteria were also subjected to characterize their antibiotic sensitivity. About 74% egg samples (148 out of 200 samples) were positive for microbial contamination. Among them 100 (100 %) samples had their shells contaminated with microbes of different genera; however, only 48 (48%) growths were observed from the egg contents. The major contaminants are Escherichia coli (34.64%), Coagulase positive Staphylococcus (24.29%), Salmonella spp. (20.71%) followed by Coagulase negative Staphylococcus (10%), Pseudomonas spp. (6.43%) and Bacillus spp. (3.93%). The isolated bacteria E. coli, Coagulase positive Staphylococcus, Salmonella spp. and Pseudomonas spp. showed their greatest sensitivity against ciprofloxacin, ceftriaxone and azithromycin whereas resistant against tetracycline, amoxicillin and ampicillin. There is potential for these antibiotic-resistant bacteria to be transferred to humans through contaminated eggs and are of public health concern from food safety point of view. Asian J. Med. Biol. Res. December 2018, 4(4): 323-329

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Phage steering of antibiotic-resistance evolution in the bacterial pathogen, Pseudomonas aeruginosa

Evolution Medicine and Public Health ◽

10.1093/emph/eoaa026 ◽

2020 ◽

Vol 2020 (1) ◽

pp. 148-157 ◽

Cited By ~ 1

Author(s):

James Gurney ◽

Léa Pradier ◽

Joanne S Griffin ◽

Claire Gougat-Barbera ◽

Benjamin K Chan ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Antibiotic Resistance ◽

Bacterial Pathogen ◽

Antibiotic Sensitivity ◽

Resistant Bacteria ◽

Phage Resistance ◽

Antibiotic Resistant ◽

Trade Off

Abstract Background and objectives Antimicrobial resistance is a growing global concern and has spurred increasing efforts to find alternative therapeutics. Bacteriophage therapy has seen near constant use in Eastern Europe since its discovery over a century ago. One promising approach is to use phages that not only reduce bacterial pathogen loads but also select for phage resistance mechanisms that trade-off with antibiotic resistance—so called ‘phage steering’. Methodology Recent work has shown that the phage OMKO1 can interact with efflux pumps and in so doing select for both phage resistance and antibiotic sensitivity of the pathogenic bacterium Pseudomonas aeruginosa. We tested the robustness of this approach to three different antibiotics in vitro (tetracycline, erythromycin and ciprofloxacin) and one in vivo (erythromycin). Results We show that in vitro OMKO1 can reduce antibiotic resistance of P. aeruginosa (Washington PAO1) even in the presence of antibiotics, an effect still detectable after ca.70 bacterial generations in continuous culture with phage. Our in vivo experiment showed that phage both increased the survival times of wax moth larvae (Galleria mellonella) and increased bacterial sensitivity to erythromycin. This increased antibiotic sensitivity occurred both in lines with and without the antibiotic. Conclusions and implications Our study supports a trade-off between antibiotic resistance and phage sensitivity. This trade-off was maintained over co-evolutionary time scales even under combined phage and antibiotic pressure. Similarly, OMKO1 maintained this trade-off in vivo, again under dual phage/antibiotic pressure. Our findings have implications for the future clinical use of steering in phage therapies. Lay Summary: Given the rise of antibiotic-resistant bacterial infection, new approaches to treatment are urgently needed. Bacteriophages (phages) are bacterial viruses. The use of such viruses to treat infections has been in near-continuous use in several countries since the early 1900s. Recent developments have shown that these viruses are not only effective against routine infections but can also target antibiotic resistant bacteria in a novel, unexpected way. Similar to other lytic phages, these so-called ‘steering phages’ kill the majority of bacteria directly. However, steering phages also leave behind bacterial variants that resist the phages, but are now sensitive to antibiotics. Treatment combinations of these phages and antibiotics can now be used to greater effect than either one independently. We evaluated the impact of steering using phage OMKO1 and a panel of three antibiotics on Pseudomonas aeruginosa, an important pathogen in hospital settings and in people with cystic fibrosis. Our findings indicate that OMKO1, either alone or in combination with antibiotics, maintains antibiotic sensitivity both in vitro and in vivo, giving hope that phage steering will be an effective treatment option against antibiotic-resistant bacteria.

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Bacteriological profile and sensitivity pattern of neonatal sepsis

Northern International Medical College Journal ◽

10.3329/nimcj.v8i1.32391 ◽

2017 ◽

Vol 8 (1) ◽

pp. 174-177

Author(s):

Rowshan Jahan Akhter ◽

Md Mahbubul Hoque ◽

BH Nazma Yasmeen ◽

MAK Azad Chowdhury

Keyword(s):

Antibiotic Resistance ◽

Neonatal Sepsis ◽

Antibiotic Sensitivity ◽

Neonatal Morbidity ◽

Diffusion Method ◽

Bacteriological Profile ◽

Sensitivity Pattern ◽

Haematological Profile ◽

Resistance Patterns ◽

Antibiotic Resistance Patterns

Introduction : Neonatal sepsis remains an important cause of neonatal morbidity and mortality in NICU setup and a major challenge for the neonatologists. The prevalent organisms and their antibiotic resistance patterns evolve with time and with the usage of antimicrobials.Aims and Objectives : To analyze the bacteriological profile and antibiotic resistance patterns of proven neonatal sepsis cases in Dhaka Shishu Hospital.Materials and Methods : The study was Prospective observational study. All the clinically suspected cases of Neonatal Sepsis admitted to the Neonatal word from January 2015 to December 2015 were included in the study. Clinically suspected cases of neonatal sepsis further evaluated with blood cultures and antibiotic susceptibility testing using the Kirby Bauer disc diffusion method. Data was collected for the following variables: Demographic profile, haematological profile, blood culture result and antibiotic sensitivity patterns.Results : Total 96 cases clinically suspected neonatal sepsis were included in the study. Among them 29 cases (30.21%) was culture positive septicemia. Klebsiella pneumoniae was the most common isolate accounting for 31.03% cases followed by Escherichia coli 27.59%. In Klebsiella infection most common sensitivity were Imipenum and Ciprofloxacin which were 77.78 and 33.33% respectively. In E.coli common sensitive drugs were Imipenum and Amikacin. In serratia common sensitive drugs were Imipenum, Netlmicin and Ciprofloxacin.Conclusion : K. pneumoniae was the most common pathogen. Most common sensitivity was Imipenum, Amikacin, Ciprofloxacin, Gentamicin, Netlmicin, and Ceftazidime,.Northern International Medical College Journal Vol.8(1) July 2016: 174-177

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Antibiotic Resistant Enterobacteriaceae in Milk Alternatives

Foods ◽

10.3390/foods10123070 ◽

2021 ◽

Vol 10 (12) ◽

pp. 3070

Author(s):

Winnie Mukuna ◽

Abdullah Ibn Mafiz ◽

Bharat Pokharel ◽

Aniume Tobenna ◽

Agnes Kilonzo-Nthenge

Keyword(s):

Bacterial Species ◽

Antibiotic Sensitivity ◽

Enterobacter Cloacae ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Limited Data ◽

Antibiotic Resistant ◽

Predominant Species ◽

Diffusion Technique ◽

Dairy Milk

The consumption of non-dairy milk is on the rise due to health benefits. Although there is increasing inclination towards milk alternatives (MA), there is limited data on antibiotic resistant bacteria in these substitutes. The aim of this study was to investigate antimicrobial resistance of bacteria isolated from MA. A total of 138 extracts from almonds (n = 63), cashew nuts (n = 36), and soybeans (n = 39) were analyzed for Enterobacteriaceae. The identification of the bacteria was based on biochemical and PCR methods. Antibiotic sensitivity was determined by using the Kirby-Bauer disk diffusion technique. Overall, 31% (43 of 138) of extracts were positive for Enterobacteriaceae. Ten bacterial species were identified, of which Enterobacter cloacae (42.7%) and Enterobacter cancerogenus (35.4%) were the most predominant species (p < 0.05). Antibiotic resistance was exhibited to vancomycin (88.3%), novobiocin (83.8%), erythromycin (81.1%), which was significantly higher (p < 0.05) than in tetracycline (59.5%), cefpodoxime (30.6%), and nalidixic acid (6.3%). There was no resistance displayed to kanamycin and imipenem. ERY-NOV-VAN-TET and ERY-NOV-CEP-VAN-TET were the most common resistant patterns displayed by Enterobacter cloacae. The findings of this study suggest that MAs, though considered healthy, may be a reservoir of multidrug resistant opportunist pathogens.

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