Effects of antibiotic resistance, drug target attainment, bacterial pathogenicity and virulence, and antibiotic access and affordability on outcomes in neonatal sepsis: an international microbiology and drug evaluation prospective substudy (BARNARDS)

Background Sepsis is a major contributor to neonatal mortality, particularly in low-income and middle-income countries (LMICs). WHO advocates ampicillin–gentamicin as first-line therapy for the management of neonatal sepsis. In the BARNARDS observational cohort study of neonatal sepsis and antimicrobial resistance in LMICs, common sepsis pathogens were characterised via whole genome sequencing (WGS) and antimicrobial resistance profiles. In this substudy of BARNARDS, we aimed to assess the use and efficacy of empirical antibiotic therapies commonly used in LMICs for neonatal sepsis. Methods In BARNARDS, consenting mother–neonates aged 0–60 days dyads were enrolled on delivery or neonatal presentation with suspected sepsis at 12 BARNARDS clinical sites in Bangladesh, Ethiopia, India, Pakistan, Nigeria, Rwanda, and South Africa. Stillborn babies were excluded from the study. Blood samples were collected from neonates presenting with clinical signs of sepsis, and WGS and minimum inhibitory concentrations for antibiotic treatment were determined for bacterial isolates from culture-confirmed sepsis. Neonatal outcome data were collected following enrolment until 60 days of life. Antibiotic usage and neonatal outcome data were assessed. Survival analyses were adjusted to take into account potential clinical confounding variables related to the birth and pathogen. Additionally, resistance profiles, pharmacokinetic–pharmacodynamic probability of target attainment, and frequency of resistance (ie, resistance defined by in-vitro growth of isolates when challenged by antibiotics) were assessed. Questionnaires on health structures and antibiotic costs evaluated accessibility and affordability. Findings Between Nov 12, 2015, and Feb 1, 2018, 36 285 neonates were enrolled into the main BARNARDS study, of whom 9874 had clinically diagnosed sepsis and 5749 had available antibiotic data. The four most commonly prescribed antibiotic combinations given to 4451 neonates (77·42%) of 5749 were ampicillin–gentamicin, ceftazidime–amikacin, piperacillin–tazobactam–amikacin, and amoxicillin clavulanate–amikacin. This dataset assessed 476 prescriptions for 442 neonates treated with one of these antibiotic combinations with WGS data (all BARNARDS countries were represented in this subset except India). Multiple pathogens were isolated, totalling 457 isolates. Reported mortality was lower for neonates treated with ceftazidime–amikacin than for neonates treated with ampicillin–gentamicin (hazard ratio [adjusted for clinical variables considered potential confounders to outcomes] 0·32, 95% CI 0·14–0·72; p=0·0060). Of 390 Gram-negative isolates, 379 (97·2%) were resistant to ampicillin and 274 (70·3%) were resistant to gentamicin. Susceptibility of Gram-negative isolates to at least one antibiotic in a treatment combination was noted in 111 (28·5%) to ampicillin–gentamicin; 286 (73·3%) to amoxicillin clavulanate–amikacin; 301 (77·2%) to ceftazidime–amikacin; and 312 (80·0%) to piperacillin–tazobactam–amikacin. A probability of target attainment of 80% or more was noted in 26 neonates (33·7% [SD 0·59]) of 78 with ampicillin–gentamicin; 15 (68·0% [3·84]) of 27 with amoxicillin clavulanate–amikacin; 93 (92·7% [0·24]) of 109 with ceftazidime–amikacin; and 70 (85·3% [0·47]) of 76 with piperacillin–tazobactam–amikacin. However, antibiotic and country effects could not be distinguished. Frequency of resistance was recorded most frequently with fosfomycin (in 78 isolates [68·4%] of 114), followed by colistin (55 isolates [57·3%] of 96), and gentamicin (62 isolates [53·0%] of 117). Sites in six of the seven countries (excluding South Africa) stated that the cost of antibiotics would influence treatment of neonatal sepsis

Sustainable Management of Green Mold Disease of White Button Mushroom Using Botanicals and Biocontrol Agents under Temperate Conditions

Green mold (caused by Trichoderma harzianum) is a destructive disease in mushrooms which limits commercial production. The present investigation was carried out to verify the in vitro and in vivo effect of locally available botanicals and bacterial biocontrol agents against this disease. The in vitro evaluation of ethanol extract of botanicals against mycelial growth of T. harzianum at 1, 2, and 3% concentrations showed that Juglans regia and Allium sativum exhibited maximum mycelial growth inhibition of 84.9 and 79.8%, respectively. When the same botanicals were tested against the mycelial growth of A. bisporus, it was observed that J. regia, Curcuma longa, and Azadirachta mellea were least inhibitory (4.66–7.4%). From the in vivo evaluation of plant botanicals at 2% concentration, J. regia and C. longa had the highest average weight (11.8–11.9 g) of a single fruit body and a combined button yield of 11.3–11.9 kg/quintal compost. Among the bacterial bioagents evaluated in vitro, Pseudomonas flourescens, Azotobacter sp., and Bacillus subtilis displayed stimulatory effects of varying degrees on the mycelial growth of A. bisporus but exhibited antagonistic effects on T. harzianum. B. subtilis-38, and P. flourescens-104. Azotobacter-108 caused the highest mycelial growth inhibition of 97.6, 97.4, and 90.3% of T. harzianum, respectively. The current study reveals that the integration of botanical and bacterial antagonists in pathogen-infested white button mushroom casing reduces green mold infection with corresponding yield gains

Management of Green Mold Disease in White Button Mushroom (Agaricus bisporus) and Its Yield Improvement

Mycoparasites cause serious losses in profitable mushroom farms worldwide. The negative impact of green mold (Trichoderma harzianum) reduces cropping surface and damages basidiomes, limiting production and harvest quality. The goal of the current study was to evaluate new generation fungicides, to devise suitable management strategies against the green mold disease under prevailing agro-climatic conditions. Six non-systemic and five systemic fungitoxicants were evaluated for their efficacy against pathogen, T. harzianum, and host, Agaricus bisporus, under in vitro conditions. Among non-systemic fungicides, chlorothalonil and prochloraz manganese with mean mycelium inhibition of 76.87 and 93.40 percent, respectively, were highly inhibitory against the pathogen. The least inhibition percentage of 7.16 of A. bisporus was exhibited by chlorothalonil. Under in vivo conditions, use of captan 50 WP resulted in a maximum yield of button mushroom of 14.96 kg/qt. So far, systemic fungicides were concerned, carbendazim proved extremely inhibitory to the pathogen (89.22%), with least inhibitory effect on host mycelium (1.56%). However, application of non-systemic fungitoxicants further revealed that fungicide prochloraz manganese 50 WP at 0.1–0.2 percent or chlorothalonil 50 WP at 0.2 percent, exhibited maximum disease control of 89.06–96.30 percent. Moreover, the results of systemic fungitoxicants showed that carbendazim 50 WP or thiophanate methyl 70 WP at 0.1 percent reduced disease to 2.29–3.69 percent, hence exhibiting the disease control of 80.11–87.66 percent. Under in vivo conditions, fungicide myclobutanil at 0.1 percent concentration produced the maximum button mushroom production of 12.87 kg/q