Diabetic Foot Ulcer Infections and Pseudomonas aeruginosa Biofilm Production During the COVID-19 Pandemic

During the different waves of the coronavirus (COVID-19) pandemic, there has been an increased incidence of diabetes mellitus and diabetic foot infections. Among gram-negative bacteria, Pseudomonas aeruginosa is the predominant causative agent for diabetic foot ulcer infections in low-resource countries. P. aeruginosa possesses a variety of virulence factors, including biofilm formation. Biofilm formation is an important benchmark characteristic in the pathophysiology of diabetic foot ulceration. The main objective of the current study was to identify the most commonly isolated organisms and their antibiotic susceptibility patterns in diabetic foot patients during the COVID-19 pandemic. We also determined the genes associated with bacterial persistence and biofilm formation in the predominantly isolated organism. Accordingly, 100 wound swab samples were collected from diabetic foot patients from different hospitals in Alexandria, Egypt. Through phenotypic detection of biofilm formation, 93% (40) of the 43 P. aeruginosa isolates examined were categorized as biofilm producers. Molecular detection of the biofilm-encoding genes among the 43 P. aeruginosa isolates was as follows: algD (100%), pelF (88%) and pslD (49.7%), and this highlights a need for biofilm formation inhibitors to prevent the persistence of bacterial pathogens, and thus achieve better clinical outcomes in diabetic foot ulcer infections.

Bacterial Causes and their Antimicrobial Susceptibility Testing among Urinary Tract Infection Patients in Tobruk Area, Libya

Urinary tract infections are very common among people of all ages, but the disease is more prevalent in women, so proper clinical and laboratory diagnosis, and the right treatment are very important to avoid complications and antimicrobial resistance. This study aimed to determine the bacterial causes and antibiotic susceptibility patterns of UTI patients. Recorded results of 6065 urine sample cultures and their antimicrobial susceptibility tests from the Department of Microbiology in Tobruk Medical Center, Tobruk City, were obtained from September 2016 to December 2018. The data was analyzed and discussed in compare with other studies. The study showed that a UTI is more common in females (78.8%) compared with male patients (21.2%). Gram-negative bacteria accounted for the majority of urinary pathogens (90%), where E. coli alone was (58.4%), klebsiellae (17.4%), Proteus (10.7%), while Pseudomonas species was the least common (3.3%) of the total. While the Gram-positive bacteria S. aureus constituted 9.6% of the total. The study was found statistically significant (P=0.000). The most effective antibiotics against all uropathogens were Imipenem and Amikacin, and less effective antibiotics were Ampicillin and Amoxicillin-clavulanic acid. This study concluded that the most common cause of UTI in Tobruk was Escherichia coli and the most effective antibiotics appear to be Imipenem and Amikacin.

1128. Antibiotic Stewardship in Nonoperative Management of Perforated Appendicitis: Oral Antibiotics Are an Alternative

Background Standard of care of nonoperative appendicitis patients involves ongoing antibiotic therapy. Yet, there is variability regarding the decision to continue outpatient parenteral antibiotic treatment (OPAT) or transition to oral (PO) antibiotics. We review antibiotic susceptibility patterns aiming to help guide antibiotic choice and reduce the need for OPAT. Methods Single center retrospective study reviewing pediatric inpatients who underwent nonoperative management of perforated appendicitis with cultures obtained during drainage by Interventional Radiology (IR). We reviewed age, ethnicity, hospitalization length, antibiotic choice, route and duration, and culture data. Results Forty-six patients underwent nonoperative medical management for appendicitis (23[50%] 5-12 year olds (yo); 16[35%] 12-< 18yo; 23[50%] Latino;13[28%] White, 11[24%] Other; 5[11%] Asian; 1[2%] Black). Thirty-eight [83%] patients went home on OPAT, 6[13%] on PO, and 2[4%] completed therapy while inpatient. Time from admission to IR drainage was 1.9 ± 2.8 days (34[75%] within 24 hours of admission, 3[8%] within 24-48, and 2[5%] within 48-72). Duration of hospital stay was 9.7 ± 4 days (PO) and 5.9 ± 2.7 days (OPAT). Duration on antibiotics was 20 ± 9.3 (PO) and 18.4 ± 4.9 days (OPAT). Labs on admission and discharge are compared in Table 1. Eight [17%] patients were readmitted due to complications, 38[83%] went home with a drain, and 20[43%] had a fecalith on CT scan. Based on culture susceptibilities of the 38 OPAT patients, 29[76%] had oral antibiotics as an option. The three most common organisms in those sent home on OPAT included Enterococcus faecalis (38[100%]), Bacteroides spp (33[87%]) and Escherichia coli (27[71%]) (Figure 1). All patients who grew Pseudomonas aeruginosa had a PO option; similarly with 93% of E. coli, 81% of α-hemolytic Streptococcus spp, and 76% of E. faecalis. Conclusion Nearly 80% of patients sent home on OPAT had PO antibiotic regimens options based on the culture results & susceptibility profiles. This data indicates that using cultures and susceptibility data can help guide antibiotic management, significantly reducing PICC line placement and likely reduce healthcare costs and complications associated with central lines. Disclosures All Authors: No reported disclosures

Pneumococcal carriage and antibiotic susceptibility patterns in mother-baby pairs in a rural community in Eastern Uganda: a cross-sectional study

Background: Pneumococcal carriage predisposes children to pneumonia. Pneumonia poses a significant threat to the lives of children below five years old worldwide, contributing to a high number of hospitalizations and death. Morbidity and morbidity are especially common in children under five and the elderly, although any age group can be affected. This study aimed to estimate pneumococcal carriage and determine antibiotic susceptibility patterns of the pneumococci isolated from mother-baby pairs in Ngora district after the rollout of the pneumococcal vaccine. We hypothesized that high carriage of Streptococcus pneumoniae in mothers leads to carriage in their babies and hence a greater chance of contracting pneumonia. Methods: Consecutive sampling was used to select 152 mother-baby pairs from community visits and those seeking care at the health facility. We collected nasal swabs from both baby and mother for culture and sensitivity testing using Kirby-Bauer’s agar disc diffusion method. Data was also collected from the mothers who consented to take part in the study, using an interviewer-administered questionnaire. Results: This study found that there was a low prevalence of pneumococcal carriage in the mother-baby pair in the Ngora district. Only one mother-baby pair (1/152) was found to be colonized with pneumococci in both mother and baby and the rest of S. pneumoniae colonized either the mother or baby. We also observed high rates of microbial resistance to penicillin, which is the first-line drug for the management of pneumonia in Uganda. Also, high resistance patterns were recorded with chloramphenicol (50%) and tetracycline (50%), whereas the lowest resistance was recorded in clindamycin (17%). Conclusions: The relationship between pneumococcal carriage and immunization status suggests that the pneumococcal vaccine is protective against the pneumococcal carriage. Resistance of S. pneumoniae to commonly used antibiotics was high.

Pneumococcal carriage and antibiotic susceptibility patterns in mother-baby pairs in a rural community in Eastern Uganda: a cross-sectional study

Background: Pneumococcal carriage predisposes children to pneumonia. Pneumonia poses a significant threat to the lives of children below five years old worldwide, contributing to a high number of hospitalizations and death. Morbidity and morbidity are especially common in children under five and the elderly, although any age group can be affected. This study aimed to estimate pneumococcal carriage and determine antibiotic susceptibility patterns of the pneumococci isolated from mother-baby pairs in Ngora district after the rollout of the pneumococcal vaccine. We hypothesized that high carriage of Streptococcus pneumoniae in mothers leads to carriage in their babies and hence a greater chance of contracting pneumonia. Methods: Consecutive sampling was used to select 152 mother-baby pairs from community visits and those seeking care at the health facility. We collected nasal swabs from both baby and mother for culture and sensitivity testing using Kirby-Bauer’s agar disc diffusion method. Results: This study found that there was a low prevalence of pneumococcal carriage in the mother-baby pair in the Ngora district. We also observed high rates of microbial resistance to penicillin, which is the first-line drug for the management of pneumonia in Uganda. Conclusions: The relationship between pneumococcal carriage and immunization status suggests that the pneumococcal vaccine is protective against the pneumococcal carriage. Resistance of S. pneumoniae to commonly used antibiotics was high.

Bacterial Profile and Antimicrobial Susceptibility Pattern of Aerobic Vaginal Pathogens in Gynae Patients Visiting to Khyber Teaching Hospital Peshawar

OBJECTIVES: The aim of this study was to determine the prevalent aerobic vaginal bacteria and their antibiogram to commonly prescribed antibiotics for the treatment of aerobic vaginitis (AV). METHODOLOGY: A total of 200 high vaginal swabs (HVS) samples were collected from different AV suspected patients visiting Khyber Teaching Hospital (KTH) and processed for identification of bacterial isolates followed by antibiotic susceptibility patterns as per CLSI protocols. RESULTS: Out of 200 clinical samples, 70 (35%) HVS isolates yielded bacterial growth. Of the isolates, E.coli was the common pathogen 36 (51.4%) followed by S.aureus 20 (28.5%), Enterobacter spp 08 (11.4%), Pseudomonas spp 04 (5.7%) and Citrobacter spp 02 (2.8%). The highest prevalence was observed in the age group of 21-35 years (31.4%) followed by age groups 16-20 years (25.7%) and 26-30 years. S.aureus isolates (n=20) were resistant to ciprofloxacin (90%), cephradine (70%), erythromycin (70%), gentamicin (50%) and cefotaxime (40%) while 1 (5%) of each isolate was resistant to methicillin and vancomycin. Majority of the gram-negative isolates (n=50) were resistant to cotrimoxazole, cephalosporins, quinolones, aminoglycosides and susceptible to carbapenems, tigecycline, sulbactam and tazobactam. CONCLUSION: Aerobic vaginitis should be treated very selectively in order not to kill the beneficial bacteria. Before treating AV, the causative agents should be accurately identified and tested for drug susceptibility patterns and empirical antibiotic therapy should be avoided.

Isolation, Identification and Characterization of Urinary Tract Infectious Bacteria and the Effect of Different Antibiotics

Etiological patterns of uropathogens is different in different regions due to continuous evolution, of bacteria, antibiotics sensitivity patterns, misuse and overuse of antibiotics. Therefore, it is important to know the antibiotic susceptibility patterns for prescription of suitable antibiotic. This study was conducted to determine the prevalence of uropathogens and their antimicrobial sensitivity pattern from Kohat region of Pakistan. In this study 100 samples were collected from both males and females of all ages in which 70 samples contained microbes. In 30 samples no microbial growth was recorded. The Percentage of positive culture from both male and female were 57% and 43% respectively Both Gram (+) and Gram (-) bacteria were found in UTI but E.coli (34.21%) was predominant followed by K. pneumoniae (10.52%), P. aeruginosa (9.21%), K. oxytoca (6.57%), C. albicans (5.26%), E. faecium (5.26%), E. faecalis (3.94%), S. aureus (3.94%), E. cloacea (2.63%), C. freundii (2.63%), P. mirabalis (2.63%) and A. baumannii (1.31%). Many of the isolates showed resistance to commonly used antibiotics. The sensitivity percentage of different commonly used antibiotics against both Gram (+) and Gram(-) bacteria were Ampicillin 13%, Ceftriaxone 25%, Amikacin 77%, Gentamicin 41%, Augmentin 44.77%, Fosfomycin 64%, Cotrimoxazole 36%, Nitrofurantoin 68%, Ciprofloxacin 37%, Imipenem 78%, Meropenem 67%, Cefepime 25% and Tetracycline 40%. The most effective antibiotics against both Gram (+) and Gram (-) bacteria were Fosfomycin, Imipenem, Meropenem Amikacin and Nitrofurantoin. In light of the findings of this study, it is strongly recommended to discover new antimicrobial compounds and evaluate the resistant pattern at genomic and proteomics level to discover the genes which are responsible for antibiotics resistant pattern.

Isolation, Identification and Antibiotic Susceptibility Patterns of Listeria Monocytogens from Pregnant Women

IntroductionThe present study is made to determine the prevalence rate, isolation, identification and antibioticsusceptibility pattern of L. monocytogens isolated from pregnant women. This research not onlyguides to the clinician for treatment but also help laboratory worker to monitor susceptibilitypattern among the Listeria species. MethodsThe samples were collected from Gynecology department from January 2017 to December 2019and processed in the Department of Microbiology at College of Medical Sciences, Bharatpur Nepal.Two hundred thirty four antenatal mothers having age between 17 and 39 years of gestation periodbetween 7th weeks and 36th weeks patient with a flue like sign and symptoms were screened forL. monocytogens. Bacterial isolation identification and antibiotic sensitivity tests were done as perstandard microbiological guidelines. ResultsIn this present research, the prevalence of L. monocytogens was found 39/234 (16.7%), where high rate of Listeria infection was found 21(53.1%) among the patients of age between 25 and 32 who were mostly from urban area. We found eating meat 38(97.4%) and fish 39(100.0%), non-pasteurized simple boiled milk 39(100.0%) and vegetables like salad eater 32(82.1%) has highest rate of listeriosis. The results showed most of the listeriosis were occurring in a 3rd trimester 17(43.6%) compared with the 2nd and 1st trimester. Overall, the antibiotics resistance pattern found low in L. monocytogens. This investigation also showed less resistance in erythromycin 9(23.1%), ciprofloxacin 8(20.5%), chloramphenicol 16(41.1%). The increased resistance pattern among Listeria species were found in penicillin 31(79.5%), cotrimoxazole 20(51.3%), amoxicillin 21(55.1%) and vancomycin 29(74.4%). ConclusionsIt is very important to consider listeriosis in a clinical practice now a day. Maternal Listeriosis shouldbe considered in all age group of pregnant women. Regular surveillance of antibiotic susceptibility test is very much important for clinician to select best medicine to treat different cases of listeriosis.

Estimation of the Antibiotic Activity against Pseudomonas sppIsolated from Ear Infection

Background: An ear infection, can be classified into otitis externs and otitis media, this affects all age groups especially infants and young. This infection associate with pathogenic microorganism type, frequent antibiotic uses, health care and age. The most common pathogenic bacteria of the ear infection are Pseudomonas spp. Antibiotic resistance represents a serious threat to the health of humans. Methods: 48 ear swabs were collected through the use of wooden sticks in a sterile container for the identification of Pseudomonas, Serratiaand Klebsiella species by VITEK 2 system and biochemical tests. The antibiotic susceptibility against these bacterial species was detected through the method of standard disk diffusion on the Moller Hinton agar. Results: Among ear swabs, the positive growth percentage of the pathogenic gram-negative bacteria was 29.166%, and the percentage of Pseudomonas spp. was 57.142%. Males were found to be more susceptible than females with an infection percentage of 57.142%. Conclusion: The antibiotic susceptibility patterns show the azithromycin, gentamycin, piperacillin, ceftriaxone, cefepime, imipenem, ceftriazon, and gentamycin have activity against Pseudomonas spp.