Multidrug Resistant

The study was aimed to study the efficacy of P. granatum ethyl
acetate  extract  against multi  drug  resistant  bacterial  strains and  to
characterize the compounds at tributing synergistic and antibacterial
potential  by  GC-MS  analysis.  Bacterial  strains  were  screened  for
antibiotic resistance by the disk diffusion method. Antibacterial and
synergistic activities of extract were explored by agar well diffusion
method and microdilution method respectively. Synergy testing was
carried  out  with  antibiotics  amikacin,  ampicillin,  ciprofloxacin,
erythromycin,  lincomycin,  nitrofurantoin,  tetracycline  and
trimethoprim. The extract was subjected to Gas chromatography and
Mass  spectroscopy  (GC-MS)  analysis  to  identify  the  bioactive
compounds responsible for the studied activity. All the test bacterial
strains were found to be multidrug resistant. Antibacterial studies
showed  that  the  ethyl  acetate  extract  exhibited  strong  antibacterial
activity  with  zone  of  inhibition  and  minimum  inhibitory
concentration  ranged  from  16-30  mm  and  1.87  to  15  mg/ml
respectively. The results of the synergistic studies revealed that good
synergistic  interaction  was  exhibited  by  the  combination  of  the
extract  and  antibiotic  lincomycin  and  tetracycline.  MICs  of
lincomycin  and  tetracycline  were  declined  from 150  to  5µg/ml  and
250  to  2.5µg/ml  in  combination  with  the  peel  extract.  GC-MS
revealed  the  presence  of  various  medicinally  significant
phytochemicals  like  Citronellol,  5-  Hydroxy  methyl  furfural  and
linoleic  acid  etc.  Synergistic  activity  of  P.  granatum  may  be
attributed  to  the  different mode  of  action  of  the  extract  from  the
antibiotics. The findings provide substantial basis for future use of P.
granatum ethyl acetate extract as potential antibacterial and antibiotic
modulating agent.

Burkholderia cepacia (B. cepacia) is an opportunistic, Gram negative pathogen which causes infection mainly in immunocompromised population and associated with high rate of morbidity and mortality in cystic fibrosis patients. Aim of the present study was to analyze the impact of biofield treatment on multidrug resistant B. cepacia. Clinical sample of B. cepacia was divided into two groups i.e. control and biofield treated. The analysis was done after 10 days of treatment and compared with control group. Control and treated group were analyzed for susceptibility pattern, MIC value, biochemical studies and biotype number using MicroScan Walk-Away® system. Sensitivity assay results showed a change in pattern from resistant to intermediate in aztreonam, intermediate to resistant in ceftazidime, ciprofloxacin, imipenem, and levofloxacin while sensitive to resistant in meropenem and piperacillin/tazobactam. The biofield treatment showed an alteration in MIC values of aztreonam, ceftazidime, chloramphenicol, ciprofloxacin, imipenem, levofloxacin, meropenem, piperacillin/tazobactam and tetracycline. Biochemical reactions of treated group showed negative reaction in colistin, lysine, and ornithine while positive reactions to acetamide, arginine, and malonate as compared to control. Overall results showed an alteration of 38.9% in susceptibility pattern, 30% in MIC values of tested antimicrobials and 18.2% change in biochemical reaction after biofield treatment. A significant change in biotype number (02063736) was reported with green pigment as special characteristics after biofield treatment as compared to control (05041776) group with yellow pigment. In treated group, a new species was identified as Pseudomonas aeruginosa, as compared to control. Study findings suggest that biofield treatment has a significant effect on the phenotypic character and biotype number of multidrug resistant strain of B. Cepacia.

The aim of this study was to assess the in vitro activity of a number of non-traditional antibiotics (colistin, azithromycin, doxycycline and rifampicin) against multidrug-resistant (MDR) strains of Pseudomonas aeruginosa and Acinetobacter baumannii isolated from Intensive Care Units (ICUs). We also used the checkerboard method to determine whether combinations of colistin with another non-traditional antibiotic or meropenem act synergistically against these strains. Thirty-five P. aeruginosa and 25 A. baumannii strains that were found to be MDR were included the study. Isolates were collected from the specimens of patients in ICUs from 2001 to 2003. All isolates were identified by standard methods and stored at −20 °C until use. Antibiotic powders of azithromycin, doxycycline, rifampicin, meropenem and colistin were obtained from their manufacturers. Minimum inhibitory concentrations (MICs) were determined by the agar dilution method on Mueller–Hinton agar. Five strains of A. baumannii and five strains of P. aeruginosa, all of which had different MIC values for colistin, were selected for the synergy study using the checkerboard titration method. The susceptibility results for doxycycline and meropenem were interpreted according to National Committee for Clinical Laboratory Standards guidelines. The susceptibility breakpoints for colistin and rifampicin were established as 4 mg/L and 2 mg/L, respectively, based on previous studies. Pseudomonas aeruginosa ATCC 27853 and Escherichia coli ATCC 25922 were used as control strains. Testing against the P. aeruginosa strains revealed high MIC50 values for all the drugs except colistin. Doxycycline and colistin were both effective against the A. baumannii strains, with high susceptibility rates of 92% and 100%, respectively. Azithromycin had a high MIC50 value against these strains, whilst rifampicin had a moderate effect (susceptibility rate 64%). The combination of colistin and rifampicin was fully synergistic against four A. baumannii and two P. aeruginosa strains. Combinations of colistin with meropenem and of colistin with azithromycin each showed synergistic activity against three A. baumannii isolates, whilst the same combinations resulted in generally additive or indifferent effects against P. aeruginosa strains. The colistin and doxycycline combination was generally partially synergistic or additive against all the isolates. MDR strains of P. aeruginosa and A. baumannii, which cause nosocomial infections with an increasing ratio in recent years, have limited treatment options. According to our in vitro study results, non-traditional antibiotics such as doxycycline and colistin can be an alternative for the treatment of infections caused by these strains. Combinations of colistin with non-traditional antibiotics or meropenem could be promising alternatives for the treatment of infections due to MDR strains of A. baumannii and P. aeruginosa.

Steadily increasing resistance among Shigella to β-lactams, aminoglycosides, and tetracycline has compromised the utility of these commonly used antimicrobial agents. Also, undesirable side effects of certain antibiotics have triggered immense interest in search of alternative therapies using medicinal plants. One such medicinal plant used since ancient times to cure diarrhea is Aegle marmelos. The present study exemplifies the susceptibility of β-lactam–resistant Shigella dysenteriae and Shigella flexneri toward β-lactam antibiotics, when grown in the presence of aqueous extract of A. marmelos (AEAM), by altering porin channels. This was demonstrated by antibiotic sensitivity test using disc diffusion method and MIC test. Susceptibility toward β-lactam antibiotic is associated with changes in outer membrane porins OmpC (∼42 kDa) and OmpF (∼38 kDa) and cytosolic proteins of ∼26 kDa, OmpR, a transcriptional regulator. Expression of ompF is increased in S. dysenteriae and S. flexneri grown in the presence of AEAM due to down-regulation of ompR, which is conformed by reverse transcriptase polymerase chain reaction. In conclusion, AEAM influences susceptibility of β-lactam–resistant Shigella toward β-lactam antibiotics by altering porin channels. Hence, AEAM along with β-lactam can be used for treatment of multidrug-resistant Shigella.

Drug resistance in tuberculosis is a significant problem in countries endemic for tuberculosis. A sensitive, specific, and high-throughput reverse line blot assay (RLBA) for the detection of genotypic resistance to rifampicin (RIF) was designed and evaluated. DNA sequencing done for 72 resistant isolates from Delhi, for baseline data, showed mutations within the rpoB core region in all RIF-resistant strains. The RLBA includes oligonucleotide probes specific for wild-type and mutant sequences, allowing sensitive detection of both genotypes in a single assay. The assay based on reverse hybridization principle simultaneously detects 13 different mutations affecting 6 independent codons, including the most prevalent mutations at positions 531 and 526. Application of the method to a panel of 292 MDR TB isolates and susceptible strains from 5 different cities in India showed 98% concordance with the sequencing results. This rapid, simple, economical, and highly sensitive assay provides a ...

Tuberculosis (TB) remains a global emergency and continues to kill 1.7 million people globally each year. Drug-resistant TB is now well established throughout the world and most TB patients are not being screened for drug resistance due to lack of laboratory resources and rapid accurate point-of-care tests. Accurate and rapid diagnosis of TB and drug-resistant TB is of paramount importance in establishing appropriate clinical management and infection control measures. During the past decade, there have been significant advances in diagnostic technologies for TB and drug-resistant TB. The purpose of this article is to review the current data, recommendations and evidence base for these tests.

Twenty-three Salmonella enterica serovar Typhimurium isolates from marine environments were characterized by phage typing, pulsed-field gel electrophoresis (PFGE) analysis, plasmid analysis, and antibiotic resistance, and the distribution of the different types in the coastal waters were subsequently analyzed. Five phage types were identified among the isolates (PT41, PT135, PT99, DT104, and DT193). PT135 isolates were exclusively detected during the winter months from 1998 to 2000, whereas DT104 and PT41 isolates were detected exclusively in the summer months from 2000 to 2002. XbaI PFGE analysis revealed 9 PFGE types, and plasmid profiling identified 8 plasmid types (with 1 to 6 plasmids) among the isolates. Only three isolates presented multidrug resistance to antibiotics. Two DT104 isolates were resistant to 8 and 7 antibiotics (profiles ACCeFNaSSuT and ACeFNeSSuT), whereas a PT193 isolate presented resistance to 6 antibiotics (profile ACFSSu). In addition, four PT41 isolates we...

objective Kenya, like many resource-constrained countries, has a single mycobacterial laboratory, centrally located in Nairobi, with capacity for drug-susceptibility testing (DST) – the gold standard in diagnosing drug-resistant tuberculosis. We describe and evaluate a novel operational design that attempts to overcome diagnostic delivery barriers. methods Review of the public DST programme identified several barriers limiting access: lack of programme awareness amongst physicians, limited supplies, unreliable transport and no specimen tracking methods. Staff visited 19 clinic sites in western Kenya and trained healthcare providers in regard to the novel diagnostics model. Provincial laboratory registries were reviewed to assess utilization of DST services prior to and after programme modification. results Onsite training consisted of the inclusion criteria for re-treatment patients – the high-priority group for DST. Additionally, infrastructural support established a stable supply ...

To determine the impact of COPD on intensive care unit (ICU) mortality in patients with VAP. This prospective observational study was performed in a mixed ICU during a 3-year period. Eligible patients received mechanical ventilation for >48 h and met criteria for microbiologically confirmed VAP. Risk factors for ICU mortality were determined using univariate and multivariable analyses. Two hundred and fifteen patients with microbiologically confirmed VAP were included. Most VAP episodes were late-onset (88%), and Pseudomonas aeruginosa was the most frequently isolated bacterium (39% of VAP episodes). ICU mortality was significantly lower in non-COPD patients (n = 150) compared to COPD patients (n = 65) (43.3% vs 60%, p = 0.027, OR [95% CI] = 1.96 [1.8-3.54]). Duration (days) of mechanical ventilation and ICU stay median (IQR) in non-COPD patients were 25 (15-42) and 30 (18-48), whereas in COPD patients were 31 (19-45) and 36 (20-48) (p > 0.05). The differences in duration (day...

The study was aimed to study the efficacy of P. granatum ethyl acetate extract against multi drug resistant bacterial strains and to characterize the compounds at tributing synergistic and antibacterial potential by GC-MS analysis. Bacterial strains were screened for antibiotic resistance by the disk diffusion method. Antibacterial and synergistic activities of extract were explored by agar well diffusion method and microdilution method respectively. Synergy testing was carried out with antibiotics amikacin, ampicillin , ciprofloxacin, erythromycin, lincomycin, nitrofurantoin, tetracycline and trimethoprim. The extract was subjected to Gas chromatography and Mass spectroscopy (GC-MS) analysis to identify the bioactive compounds responsible for the studied activity. All the test bacterial strains were found to be multidrug resistant. Antibacterial studies showed that the ethyl acetate extract exhibited strong antibacterial activity with zone of inhibition and minimum inhibitory conce...

Antibiotic susceptibility and minimum inhibitory concentration (MIC) values of antibiotics for the isolated V. cholerae O1 Ogawa (n=12) were determined by disk diffusion and agar dilution methods, respectively, using ampicillin (Am), chloramphenicol (C), trimethoprim (Tm), ...