Genotypic Distribution and Antimicrobial Susceptibilities of Carbapenemase-Producing Enterobacteriaceae Isolated in Tertiary Care Hospital in South India

Antimicrobial resistance has emerged as a major danger to contemporary medicine around the world. Carbapenems are the highest class of B-lactam drugs which are considered as the most effective and safest antibiotics available. Increasing spread of carbapenemases has been noted across the world which restricts treatment options. The aim of this study was to determine the incidence of carbapenem resistant genotypic pathways in a tertiary care hospital. 130 clinical strains of Enterobacteriaceae were subjected to Kirby-Bauer disk diffusion tests and genotypic methods (PCR) for the identification of the genes NDM, VIM, and OXA-48. Carbapenem resistance was detected in 30% of the isolates by phenotypic methods. These 37 isolates on being subject to PCR showed OXA-48 followed by VIM and NDM as the most frequently isolated genotypes. All isolates had multiple genes encoding carbapenem resistance. Carbapenemases resistance is on the rise and is associated with multi drug resistance pattern. To minimize spread and initiate early appropriate therapy, early detection of carbapenem resistance is essential. Molecular methods remain gold standard for detection

Universal Coronavirus Testing to Control the Pandemic: Ethical Issues and Dilemmas

Every country had to make several difficult decisions in the initial phase of the Coronavirus (COVID-19) pandemic to allocate resources for COVID testing. Decisions on who should be tested for COVID-19 testing are extremely vital for pandemic preparedness. In this article, we highlight the need for prioritization of testing resources including direct-to-consumer testing methods, ethical dilemmas involved in obligatory testing, and testing of refugees and immigrants

The dominant Anopheles vectors of human malaria in the Asia-Pacific region: occurrence data, distribution maps and bionomic précis

<p>Abstract</p> <p>Background</p> <p>The final article in a series of three publications examining the global distribution of 41 dominant vector species (DVS) of malaria is presented here. The first publication examined the DVS from the Americas, with the second covering those species present in Africa, Europe and the Middle East. Here we discuss the 19 DVS of the Asian-Pacific region. This region experiences a high diversity of vector species, many occurring sympatrically, which, combined with the occurrence of a high number of species complexes and suspected species complexes, and behavioural plasticity of many of these major vectors, adds a level of entomological complexity not comparable elsewhere globally. To try and untangle the intricacy of the vectors of this region and to increase the effectiveness of vector control interventions, an understanding of the contemporary distribution of each species, combined with a synthesis of the current knowledge of their behaviour and ecology is needed.</p> <p>Results</p> <p>Expert opinion (EO) range maps, created with the most up-to-date expert knowledge of each DVS distribution, were combined with a contemporary database of occurrence data and a suite of open access, environmental and climatic variables. Using the Boosted Regression Tree (BRT) modelling method, distribution maps of each DVS were produced. The occurrence data were abstracted from the formal, published literature, plus other relevant sources, resulting in the collation of DVS occurrence at 10116 locations across 31 countries, of which 8853 were successfully geo-referenced and 7430 were resolved to spatial areas that could be included in the BRT model. A detailed summary of the information on the bionomics of each species and species complex is also presented.</p> <p>Conclusions</p> <p>This article concludes a project aimed to establish the contemporary global distribution of the DVS of malaria. The three articles produced are intended as a detailed reference for scientists continuing research into the aspects of taxonomy, biology and ecology relevant to species-specific vector control. This research is particularly relevant to help unravel the complicated taxonomic status, ecology and epidemiology of the vectors of the Asia-Pacific region. All the occurrence data, predictive maps and EO-shape files generated during the production of these publications will be made available in the public domain. We hope that this will encourage data sharing to improve future iterations of the distribution maps.</p

Impact of clinical pharmacist's educational intervention tools in enhancing public awareness and perception of antibiotic use: A randomized control trial

Introduction: In most developing countries, antimicrobial resistance is a public threat, and insufficient knowledge of antibiotics among the public adds to it. This study aimed to determine the efficacy of the clinical pharmacist's pamphlets and video-based educational tools to address the public's knowledge, attitude, and practice gaps on antibiotic use. Methods: This was a pre-and post-intervention cohort study of the adult population in South India who can read and understand Tamil or English. The study participants were designated into two groups-usual care group (pamphlet-based) and interventional group (video-based), with a pre-intervention assessment using a self-administered questionnaire, followed by an educational intervention by a clinical pharmacist, and finally, a post-intervention assessment after three months. Result: Of the162 respondents, the majority were female (58%), in the age group of 26–35 (30%), with intermediate education (43%) from a middle-income family. The mean score calculated for each domain among the two groups: knowledge score (Pamphlet based-Pre: 2.26 ± 1.13; post: 3.23 ± 1.02), (Video based-Pre: 2.22 ± 1.45; post: 3.95 ± 0.89), Attitude score (Pamphlet based-Pre: 2.53 ± 1.96; post: 3.23 ± 0.9), (Video based-Pre: 2.39 ± 1.81; post: 4.21 ± 1.35), Practice score (Pamphlet based-Pre: 2.19 ± 1.02; post: 4.46 ± 1.81). A significant improvement was observed in all domains of the video-based counselling group compared to the pamphlet-based (p < 0.001). Conclusion: Clinical pharmacists can effectively help in combating growing catastrophic AMR. Newer technologies need to be deployed in healthcare to educate the unreached. This study gives an insight into the technology-supported educational tool to provide awareness to the public effectively

Susceptibility Profile of Nitrofurantoin and Fosfomycin among Carbapenem-resistant Enterobacteriaceae Isolates in UTI from a Tertiary Care Hospital

UTI is one of the most common infections requiring antibiotic treatment and hospitalization. The rising trend in multidrug resistance to commonly used antibiotics has reduced the therapeutic options for treating these infections. Reexploring older antibiotics like nitrofurantoin and fosfomycin provide treatment options and help combat resistance. This prospective study was conducted in the Department of Microbiology, SRM Medical College Hospital and Research Center, from July 2021 to February 2022. The study included only clean catch midstream urine isolates of Escherichia coli and Klebsiella pneumonia from hospitalized patients and outpatients. Standard microbiological procedures were used to process the urine samples. Direct gram stain and conventional biochemical reactions were performed to identify the isolates. The antimicrobial susceptibility testing was carried out by the Kirby Bauer disk diffusion method and Minimum Inhibitory Concentration by E- test gradient method for fosfomycin. MIC for nitrofurantoin was determined by Micro Broth Well Dilution according to CLSI guidelines 2021. Among 150 urine samples, Escherichia coli 107 (71.3%) was higher than Klebsiella pneumonia 43 (29%). Carbapenemase production was seen in 58 (63.04%) isolates by the Kirby Bauer disc diffusion method. Among the 58 positive carbapenemase producers, E. coli was found to be 33 (56.8%), and Klebsiella pneumonia was 25 (43.1%). Fosfomycin susceptibility rates by E test were reported to be high in Escherichia coli, ranging from 0.5-1mg/L. Klebsiella pneumonia was less susceptible to fosfomycin ranging from 16-32mg/L. Only 7(21%) isolates of Escherichia coli showed MIC of 1-4µg/ml to nitrofurantoin by broth microdilution. 21 (63.63%) isolates of Escherichia coli and 11(44%) isolates of Klebsiella pneumonia were reported to have an intermediate category with MIC of 8-32µg/mL. A higher MIC of 64- > 256µg/ml was shown by 5 (15.15%) isolates of Escherichia coli and 14 (56%) isolates of Klebsiella pneumonia. Older medications may resurface as useful therapeutic choices as resistance to current treatment options grow

Diversity of anopheline species and their <it>Plasmodium</it> infection status in rural Bandarban, Bangladesh

<p>Abstract</p> <p>Background</p> <p>Historically, the Chittagong Hill Tracts (CHT) of Bangladesh was considered hyperendemic for malaria. To better understand the contemporary malaria epidemiology and to develop new and innovative control strategies, comprehensive epidemiologic studies are ongoing in two endemic unions of Bandarban district of CHT. Within these studies entomological surveillance has been undertaken to study the role of the existing anopheline species involved in the malaria transmission cycle throughout the year.</p> <p>Methods</p> <p>CDC miniature light traps were deployed to collect anopheline mosquitoes from the sleeping room of the selected houses each month in a single union (Kuhalong). Molecular identification was carried out for available <it>Anopheles</it> species complexes. Circumsporozoite proteins (CSP) for <it>Plasmodium falciparum</it>, <it>Plasmodium vivax</it>-210 (Pv-210) and <it>Plasmodium vivax</it>-247(Pv-247) were detected by Enzyme-linked immunosorbent assay (ELISA) from the female anopheline mosquitoes. To confirm CSP-ELISA results, polymerase chain reaction (PCR) was also performed.</p> <p>Results</p> <p>A total of 2,837 anopheline mosquitoes, of which 2,576 were female, belonging to 20 species were collected from July 2009 -June 2010. <it>Anopheles jeyporiensis</it> was the most abundant species (18.9%), followed by <it>An. vagus</it> (16.8%) and <it>An. kochi</it> (14.4%). ELISA was performed on 2,467 female mosquitoes of 19 species. 15 (0.6%) female anophelines belonging to eight species were found to be positive for <it>Plasmodium</it> infection by CSP-ELISA. Of those, 11 (0.4%) mosquitoes were positive for <it>P. falciparum</it> and four (0.2%) for Pv-210. No mosquito was found positive for Pv-247. <it>An. maculatus</it> (2.1%, 2/97) had the highest infection rate followed by <it>An. umbrosus</it> (1.7%, 2/115) and <it>An. barbirostris</it> (1.1%, 2/186). Other infected species were <it>An. nigerrimus</it>, <it>An. nivipes, An. jeyporiensis</it>, <it>An. kochi</it>, and <it>An. vagus</it>. Out of 11 <it>P. falciparum</it> CSP positive samples, seven turned out to be positive by PCR. None of the samples positive for Pv-210 was positive by PCR. In terms of abundance and incrimination, the results suggest that <it>An. maculatus</it>, <it>An. jeyporiensis</it> and <it>An. nivipes</it> play important roles in malaria transmission in Kuhalong.</p> <p>Conclusion</p> <p>The findings of this study suggest that even in the presence of an insecticide impregnated bed-net intervention, a number of <it>Anopheles</it> species still play a role in the transmission of malaria. Further investigations are required to reveal the detailed biology and insecticide resistance patterns of the vector mosquito species in endemic areas in Bangladesh in order to assist with the planning and implementation of improved malaria control strategies.</p