Fast and reliable determination of Escherichia coli susceptibility to antibiotics: Infrared microscopy in tandem with machine learning algorithms

Antimicrobial drugs have an important role in controlling bacterial infectious diseases. However, the increasing resistance of bacteria to antibiotics has become a global health care problem. Rapid determination of antimicrobial susceptibility of clinical isolates is often crucial for the optimal antimicrobial therapy. The conventional methods used in medical centers for susceptibility testing are time‐consuming (>2 days). Two bacterial culture steps are needed, the first is used to grow the bacteria from urine on agar plates to determine the species of the bacteria (~24 hours). The second culture is used to determine the susceptibility by growing colonies from the first culture for another 24 hours. Here, the main goal is to examine the potential of infrared microscopy combined with multivariate analysis, to reduce the time it takes to identify Escherichia coli susceptibility to antibiotics and to determine the optimum choice of antibiotic to which the bacteria will respond. E coli colonies of the first culture from patients with urinary tract infections (UTI) were examined for the bacterial susceptibility using Fourier‐transform infrared (FTIR). Our results show that it is possible to determine the optimum choice of antibiotic with better than 89% sensitivity, in the time span of few minutes, following the first culture.      

Incidence, risk factors and mortality of nosocomial pneumonia in Intensive Care Units: A prospective study

Background

Increasing antimicrobial resistance among the key pathogens responsible for community-acquired respiratory tract infections has the potential to limit the effectiveness of antibiotics available to treat these infections. Since there are regional differences in the susceptibility patterns observed and treatment is frequently empirical, the selection of antibiotic therapy may be challenging. PROTEKT, a global, longitudinal multicentre surveillance study, tracks the activity of telithromycin and comparator antibacterial agents against key respiratory tract pathogens.

Methods

In this analysis, we examine the prevalence of antibacterial resistance in 1,336 bacterial pathogens, isolated from adult and paediatric patients clinically diagnosed with acute bacterial sinusitis (ABS).

Results and discussion

In total, 58.0%, 66.1%, and 55.8% of S. pneumoniae isolates were susceptible to penicillin, cefuroxime, and clarithromycin respectively. Combined macrolide resistance and reduced susceptibility to penicillin was present in 200/640 (31.3 %) of S. pneumoniae isolates (128 isolates were resistant to penicillin [MIC >= 2 mg/L], 72 intermediate [MIC 0.12–1 mg/L]) while 99.5% and 95.5% of isolates were susceptible to telithromycin and amoxicillin-clavulanate, respectively. In total, 88.2%, 87.5%, 99.4%, 100%, and 100% of H. influenzae isolates were susceptible to ampicillin, clarithromycin, cefuroxime, telithromycin, and amoxicillin-clavulanate, respectively. In vitro, telithromycin demonstrated the highest activity against M. catarrhalis (MIC₅₀ = 0.06 mg/L, MIC₉₀ = 0.12 mg/L).

Conclusion

The high in vitro activity of against pathogens commonly isolated in ABS, together with a once daily dosing regimen and clinical efficacy with 5-day course of therapy, suggest that telithromycin may play a role in the empiric treatment of ABS.     

Rapid diagnosis of infection etiology in febrile pediatric oncology patients using infrared spectroscopy of leukocytes

Rapid diagnosis of the etiology of infection is highly important for an effective treatment of the infected patients. Bacterial and viral infections are serious diseases that can cause death in many cases. The human immune system deals with many viral and bacterial infections that cause no symptoms and pass quietly without treatment. However, oncology patients undergoing chemotherapy have a very weak immune system caused by leukopenia, and even minor pathogen infection threatens their lives. For this reason, physicians tend to prescribe immediately several types of antibiotics for febrile pediatric oncology patients (FPOPs). Uncontrolled use of antibiotics is one of the major contributors to the development of resistant bacteria. Therefore, for oncology patients, a rapid and objective diagnosis of the etiology of the infection is extremely critical. Current identification methods are time‐consuming (>24 h). In this study, the potential of midinfrared spectroscopy in tandem with machine learning algorithms is evaluated for rapid and objective diagnosis of the etiology of infections in FPOPs using simple peripheral blood samples. Our results show that infrared spectroscopy enables the diagnosis of the etiology of infection as bacterial or viral within 70 minutes after the collection of the blood sample with 93% sensitivity and 88% specificity.     

Potential Probiotics Bacillus subtilis KATMIRA1933 and Bacillus amyloliquefaciens B-1895 Co-Aggregate with Clinical Isolates of Proteus mirabilis and Prevent Biofilm Formation

A urinary tract infection (UTI) is a multi-factorial disease including cystitis, pyelonephritis, and pyelitis. After Escherichia coli, Proteus mirabilis is the most common UTI-associated opportunistic pathogen. Antibiotic resistance of bacteria and infection recurrence can be connected to biofilm formation by P. mirabilis. In this study, human and sheep isolates of P. mirabilis were investigated for antibiotic sensitivity using an antibiotic disk test. Co-aggregation of the tested potential probiotic bacilli, Bacillus amyloliquefaciens B-1895 and Bacillus subtilis KATMIRA1933, with the isolated pathogen was also evaluated. Then, the anti-biofilm activity of naturally derived metabolites, such as subtilin and subtilosin, in the bacilli-free supernatants was assessed against biofilms of P. mirabilis isolates. The isolated pathogens were sensitive to 30 μg of amikacin and 5 μg of ciprofloxacin but resistant to other tested antibiotics. After 24 h, auto-aggregation of B. amyloliquefaciens B-1895 was at 89.5% and higher than auto-aggregation of B. subtilis KATMIRA1933 (59.5%). B. amyloliquefaciens B-1895 strongly co-aggregated with P. mirabilis isolates from human UTIs. Cell-free supernatants of B. amyloliquefaciens B-1895 and B. subtilis KATMIRA1933 showed higher antimicrobial activity against biofilms of P. mirabilis isolated from humans as compared with biofilms of sheep isolates. According to our knowledge, this is the first report evaluating the anti-biofilm activity of probiotic spore-forming bacilli against clinical and animal UTI isolates of P. mirabilis. Further studies are recommended to investigate the anti-biofilm activity and the mode of action for the antimicrobial substances produced by these bacilli, subtilosin and subtilin.

     

A Note on the Anti-Pseudomonas Activity of Cephalosporins with Chlorhexidine

Thirty clinical isolates of Pseudomonas aeruginosa were tested for susceptibility to cephaloridine, cefuroxime, cefotaxime and cefoxitin with and without chlorhexidine in agar dilution 'chequerboard' titrations and antibiotic disc tests. A synergistic response (σFIC = < 0.7) in combined titration with chlorhexidine was seen in 50% of the strains with cefuroxime and cefoxitin and 13% with cefotaxime. Cephaloridine MICs mostly exceeded the tested range but a definite reduction in combination was shown with 33% of strains. Susceptibility to cephaloridine, cefuroxime and cefoxitin was not enhanced to clinically useful levels and the effect was seen only in chlorhexidine concentrations close to the MIC. Disc tests failed to show the antibacterial activity of the combinations. It is suggested that the level of the principal lesion induced by chlorhexidine in the inner membrane might be too deep to affect the penetration of β-lactam antibiotics to their site of action.     

Antibiotic resistance of <Emphasis Type="Italic">Stenotrophomonas maltophilia</Emphasis> strains isolated from captive snakes

The minimum inhibitory concentrations (MICs) of 24 antibiotics were determined for 45 Stenotrophomonas maltophilia strains by the microdilution method at 37 and 30 °C (after 24 h and 48 h of incubation). The isolates were obtained from mouth swabs and pus of 116 captive snakes whereas the identical strains (based on PFGE) of the same origin were discarded. At 37 °C, the isolates showed a low frequency of resistance to levofloxacin (0 and 8.9 % of resistant strains after 24 and 48 h, MICs₅₀ 0.5 and 1 mg/L, MICs₉₀ 1 and 2 mg/L) and cotrimoxazole (2.2 % of resistant strains for 24 and 48 h, MICs₅₀ 4 mg/L for both time periods, MICs₉₀ 4 and 8). At 30 °C, the most effective drugs were also cotrimoxazole (2.2 and 6.7 %, MICs₅₀ 4 and 8, MICs₉₀ 8 and 32) and levofloxacin (8.9 and 46.7 %, MICs₅₀ 1 and 2, MICs₉₀ 2 and 4). The isolates were either identically or more susceptible to antibiotics than strains acquired from patients hospitalized at Olomouc University Hospital (the same region) with the exception of ciprofloxacin, cefoperazone, cefoperazone/sulbactam and ceftazidime.     

Extended spectrum beta-lactamases in <Emphasis Type="Italic">Escherichia coli</Emphasis> strains isolated from homemade white cheeses: prevalence and antibiotic susceptibility

The present study included 223 E. coli strains isolated from homemade white cheeses and was undertaken to determine the prevalence of extended spectrum β-lactamases (ESBL)-producing strains and antibiotic susceptibility. ESBL production was detected using three methods: the NCCLS disk diffusion test, the double disk synergy test and the NCCLS confirmatory test. By the disk diffusion test, 48% isolates were determined as potential ESBL producers. ESBL production by the double disk test and the phenotypic confirmatory test was found to be 16.1 and 9.9%, respectively. Susceptibility of all isolates against 16 antimicrobials was tested by the disk diffusion method. All strains were imipenem- and cefepime-susceptible. Susceptibility of E. coli to ceftazidime, ceftriaxon, cefotaxime and aztreonam was found to be 93.7, 96.4, 81.2, 90.6%, respectively. The least effective antibiotics were ampicillin with a rate of 68.6% and cefuroxime with a rate of 69.1%.     

Susceptibility of Arcobacter butzleri isolates to 23 antimicrobial agents

AIMS: The objective of this study was to determine the susceptibility of Arcobacter butzleri isolates to various antimicrobial agents used in the treatment of infectious diseases in humans and animals. METHODS AND RESULTS: Thirty-nine A. butzleri strains isolated from broiler chickens were tested for their susceptibility to 23 antimicrobial agents using a disc diffusion method. All isolates were resistant to aztreonam, cefuroxime sodium, cephalothin, orbenin, oxacillin, penicillin G and trimethoprim/sulphamethoxazol. Of the 39 isolates tested, 26 were also found resistant to amoxycillin, amoxycillin/clavulanic acid and ampicillin. One isolate was resistant to, and four showed intermediate level of resistance to, erythromycin. All isolates were susceptible to amikacin, chloramphenicol, danofloxacin, enrofloxacin, nitrofurantoin, nalidixic acid, tetracyclines and tobramycin. CONCLUSIONS: The majority of the isolates were found resistant to antibiotics commonly used for the treatment of infectious bacterial diseases in humans and animals. SIGNIFICANCE AND IMPACT OF THE STUDY: This study shows that A. butzleri strains vary in their resistance to certain kinds of antibiotics and caution should be taken when choosing a suitable antibiotic for the treatment of disease(s) caused by this organism.     

Susceptibility to Antibiotics of Vibrio sp. AO1 Growing in Pure Culture or in Association with its Hydroid Host Aglaophenia octodonta (Cnidaria, Hydrozoa)

Vibrio harveyi is the major causal organism of vibriosis, causing potential devastation to diverse ranges of marine invertebrates over a wide geographical area. These microorganisms, however, are phenotypically diverse, and many of the isolates are also resistant to multiple antibiotics. In a previous study, we described a previously unknown association between Vibrio sp. AO1, a luminous bacterium related to the species V. harveyi, and the benthic hydrozoan Aglaophenia octodonta. In this study, we analyzed the susceptibility to antibiotics (ampicillin, streptomycin, tetracycline, or co-trimoxazole = mix of sulfamethoxazole and trimetoprim) of Vibrio sp. AO1 growing in pure culture or in association with its hydroid host by using microcosm experiments. The results of minimum inhibitory concentration (MIC) experiments demonstrated that Vibrio sp. AO1 was highly resistant to ampicillin and streptomycin in pure culture. Nevertheless, these antibiotics, when used at sub-MIC values, significantly reduced the hydroid fluorescence. Co-trimoxazole showed the highest inhibitory effect on fluorescence of A. octodonta. However, in all treatments, the fluorescence was reduced after 48 h, but never disappeared completely around the folds along the hydrocaulus and at the base of the hydrothecae of A. octodonta when the antibiotic was used at concentration completely inhibiting growth in vitro. The apparent discrepancy between the MIC data and the fluorescence patterns may be due to either heterogeneity of the bacterial population in terms of antibiotic susceptibility or specific chemical–physical conditions of the hydroid microenvironment that may decrease the antibiotic susceptibility of the whole population. The latter hypothesis is supported by scanning electron microscope evidence for development of bacterial biofilm on the hydroid surface. On the basis of the results obtained, we infer that A. octodonta might behave as a reservoir of antibiotic multiresistant bacteria, increasing the risk of their transfer into aquaculture farms.     

Sodium dodecylbenzenesulfonate–based silver nanoparticles and their potent application as antibiofilm,antimicrobial agent,and trace level determination of amlodipine

Herein, we presented the synthesis and application of sodium dodecylbenzenesulfonate–based silver nanoparticles (termed as SDBS-AgNPs). The SDBS reverse micelles (RMs) in ethanol was used as nanoreactor for green AgNPs synthesis. The size, structure, and shape of SDBS-AgNPs were well distinct by UV/visible (UV/Vis), Fourier transform infrared (FTIR) spectroscopy, dynamic light scattering (DLS), and atomic force microscopy (AFM) techniques. The SDBS-AgNPs were quite stable even at high temperature (80 °C), salt concentration (up to 300 μM), and wide pH range (2 to 12). Moreover, SDBS-AgNPs were found to be highly sensitive and selective colorimetric sensor for antihypertensive drug amlodipine (AML). The interaction of AML with SDBS-AgNPs resulted as a substantial increase in the absorbance and a prominent blue shift in wavelength from 426 to 400 nm. DLS results were further confirmed that the SDBS-AgNPs break into smaller sized particles. Similarly, FTIR results also verified the SDBS-AgNPs etching–based sensing of AML molecules due to the strong attraction by amine and carbonyl functional groups on the target drug. The proposed sensor exhibited linear response in the range of 0.001–200 μM (R² = 0.9917) with limit of detection (LOD) and quantification (LOQ) of 0.161 and 0.49 μM, respectively. The probe remained selective against AML, even in the presence of equimolar interfering species (including other drugs and metal ions). Furthermore, findings proposed that the SDBS-AgNPs might be used as effective substitute to minimize infection severity by obstructing the biofilm formation against nosocomial and urinary tract infection (UTI) causing pathogens.

Graphical abstract

     

Discrimination of single‐porin Escherichia (E.) coli mutants by ATR and transmission mode FTIR spectroscopy

Vibrational spectroscopy has long been used in bacterial identification with different levels of taxonomic discrimination but its true potential for intra‐species differentiation remains poorly explored. Herein, both transmission Fourier‐transform infrared (FTIR) and attenuated total reflectance (ATR)‐FTIR spectroscopy are used to analyse E. coli strains that differ solely in their porin expression profile. In this previously unreported approach, the applicability of both FTIR‐spectroscopy techniques is compared with the same collection of unique strains. ATR‐FTIR spectroscopy proved to reliably distinguish between several E. coli porin mutants with an accuracy not replicated by FTIR in transmission mode (using previously optimized procedures). Further studies should allow the identification of the individual contribution of the single porin channel to the overall bacterial infrared spectrum and of molecular predictive patterns of porin alterations. (© 2013 WILEY‐VCH Verlag GmbH & Co. KGaA, Weinheim)     

Intraspecific differentiation of sandflies specimens by optical spectroscopy and multivariate analysis

Lutzomyia longipalpis and Lutzomyia cruzi are the main sandflies species involved in the transmission of Leishmania infantum protozoan in Brazil. The morphological characteristics can be used for species identification of males specimens, while females are indistinguishable. Although, sandflies identification is essential to understand vectorial capacity, and susceptibility to infectious agents or insecticides, there is a lack of new strategies for specimen identification. In this study, Fourier transform infrared photoacoustic spectroscopy combined with multivariate analysis identified intraspecific differences between Lutzomyia populations. Successfully group clustering was achieved by principal component analysis. The main differences observed can be related to the protein content of the specimens. A classification with 100% accuracy was obtained using machine learning approach, allowing the identification of sandflies specimens.     

Synergy of fluconazole with macrophages for antifungal activity againstCandida albicans

The possible synergy between macrophages and fluconazole for antifungal activity against different isolates ofC. albicans was studied. The susceptibility ofC. albicans isolates to fluconazole (FCZ), when incubated in RPMI-1640 with 10% fetal bovine serum (FBS) and 10% fresh mouse serum (test medium, TM) was determined by using a quantative culture methodology. Multiplication of isolate Sh27 was strongly inhibited by FCZ, even at 1.0 µg/ml. However, FCZ even at 100 µg/ml was not fungicidal. Resident murine peritoneal macrophages (MP) incubated for 48 h in RPMI-1640+10% FBS (tissue culture medium, TCM), then challenged with Sh27 in TM for 24 h, were fungistatic (20±9%,n=4). Cultured macrophages synergized with FCZ (10 µg/ml) for fungicidal activity when co-cultured with Sh27 in TM for 24 h (46±8%) and for 48 h (74±5%),n=3. Macrophages and FCZ (10 µg/ml) could not synergize for significant killing of a less FCZ-sensitiveC. albicans isolate 94-164. Multiplication of a FCZ-resistant isolate (94–20) was not inhibited by FCZ at 10 µg/ml TM; however, macrophages and FCZ (10 µg/ml) could synergize for fungistatic (64%), but not fungicidal, activity.     

Effect of hemolysis on Fourier transform infrared and Raman spectra of blood plasma

Hemolysis is a very common phenomenon and is referred as the release of intracellular components from red blood cells to the extracellular fluid. Hemolyzed samples are often rejected in clinics due to the interference of hemoglobin and intracellular components in laboratory measurements. Plasma and serum based vibrational spectroscopy studies are extensively applied to generate spectral biomarkers for various diseases. However, no studies have reported the effect of hemolysis in blood based vibrational spectroscopy studies. This study was undertaken to evaluate the effect of hemolysis on infrared and Raman spectra of blood plasma. In this study, prostate cancer plasma samples (n = 30) were divided into three groups (nonhemolyzed, mildly hemolyzed, and moderately hemolyzed) based on the degree of hemolysis and FTIR and Raman spectra were recorded using high throughput (HT)‐FTIR and HT‐Raman spectroscopy. Discrimination was observed between the infrared and Raman spectra of nonhemolyzed and hemolyzed plasma samples using principal component analysis. A classical least square fitting analysis showed differences in the weighting of pure components in nonhemolyzed and hemolyzed plasma samples. Therefore, it is worth to consider the changes in spectral features due to hemolysis when comparing the results within and between experiments.     

Antimicrobial resistance in Staphylococcus spp., Escherichia coli and Enterococcus spp. in dogs given antibiotics for chronic dermatological disorders, compared with non-treated control dogs

   

The aim of this study was to evaluate antimicrobial resistance in canine staphylococci, Escherichia coli and enterococci, which were isolated from 22 dogs with pyoderma and a history of previous antibiotic treatment, compared to bacterial isolates from 56 non-treated control dogs. Two isolates of each bacterial species per dog were investigated, if detected. Staphylococcal isolates from dogs with pyoderma (35 isolates) were more resistant to sulphatrimethoprim than the isolates from controls (56 isolates) (57% vs. 25%, p < 0.004). Multiresistance in staphylococci was also more common in dogs with pyoderma (29% vs. 9%, p = 0.02). A similar trend among isolates of E. coli was detected (24 and 74 isolates from treated and control dogs, respectively), but the differences were not significant. Resistance for macrolide-lincosamides was approximately 20% among staphylococci in both groups. Resistance to ampicillin among enterococci was 4%–7%. The age of the dogs might have an impact on resistance: multiresistance among staphylococcal isolates from younger dogs (≤5 years) was more common than in older dogs (≥6 years) (24%, vs. 0%, 63 and 27 isolates, respectively, p = 0.02). Staphylococci in younger dogs were more resistant to tetracycline (48% vs. 11%, p < 0.001) and sulphatrimethoprim (48% vs. 15%, p < 0.01) than those in older dogs. In contrast, the isolates of E. coli from older dogs tended to be more resistant, although a significant difference was detected only in resistance to tetracycline (13% vs. 2% of 40 and 50 isolates respecthely, p = 0.04)). The results of this small study indicate that resistance in canine staphylococci in the capital area of Finland is comparable with many other countries in Europe. Resistance in indicator bacteria, E. coli and enterococci, was low.     

Differentiation of Pectobacterium and Dickeya spp. phytopathogens using infrared spectroscopy and machine learning analysis

Pectobacterium and Dickeya spp. are soft rot Pectobacteriaceae that cause aggressive diseases on agricultural crops leading to substantial economic losses. The accurate, rapid and low‐cost detection of these pathogenic bacteria are very important for controlling their spread, reducing the consequent financial loss and for producing uninfected potato seed tubers for future generations. Currently used methods for the identification of these bacterial pathogens at the strain level are based mainly on molecular techniques, which are expensive. We used an alternative method, infrared spectroscopy, to measure 24 strains of five species of Pectobacterium and Dickeya. Measurements were then analyzed using machine learning methods to differentiate among them at the genus, species and strain levels. Our results show that it is possible to differentiate among different bacterial pathogens with a success rate of ~99% at the genus and species levels and with a success rate of over 94% at the strain level.     

香港养殖海鲷弧菌致病菌药物敏感性及耐药质粒研究

从发病海鲷(Sparus sarba)中共分离到51株弧菌(\%Vibrio)\%,经API20E细菌快速鉴定系统及Alsina和Blanch关键生理生化特性分析鉴定为7个种,它们分别是：溶藻胶弧菌(\%V.alginolyticus)(24株),创伤弧菌(V.vulnificus)(12株)和副溶血弧菌(V.parahaemolyticus)(7株),火神弧菌(V.logei)(4株),远洋弧菌Ⅱ菌(V.pelagius Ⅱ)(2株),河弧菌(V.fluvialis)(1株)和地中海弧菌(V.mediterranei)(1株)\%。其中3种优势菌溶藻胶弧菌创伤弧菌和副溶血弧菌证实对海鲷有致病性。另外采用平板稀释法检测了51株菌对16种抗菌素的敏感性。发现所有菌株对ceftriaxone,链霉素,萘啶酮酸和利福霉素敏感,几乎所有菌株对ceftazidime, netilimicin,氯霉素和sulfamethoxazole敏感.大部分菌株对氨苄青霉素 (60.8%),cefuroxime(667%),丁胺卡那霉素(55%),卡那霉素(588%)和三甲氧苄氨嘧啶(765%)等具有较强的耐药性。通过对菌株中所含有的耐药质粒进行分析,发现15株菌株含有1～4个质粒,分子量范围为9～123kb之间,对12株既含有较大分子量质粒又具有耐药性的菌株进行了质粒转化试验,结果其中9株菌的质粒具有转化能力,转化率为１０－１１～１０－９,表明所分离的菌株的抗药性是由于细菌染色体相关突变造成的。     

Infectivity and resistance to antibiotics of bacterial strains isolated from patients hospitalised in intensive care units

The aim of this study was to evaluate the frequency of isolation and antimicrobial resistance testing of bacterial strains isolated from clinical specimens from patients hospitalized in three Intensive Care Units in Wroc?aw. The susceptibility of bacteria (107 strains) to selected antibiotics was determined. The results clearly show that non-fermentative rods were identified as the main agents causing pneumonia (58% of isolates). The second commonest pathogens were Gram-positive cocci (29%). The P. aeruginosa and E. cloacae strains were resistant to ampicillin, amoxicillin/clavulanate, cefuroxime and cefotaxime. All isolates of A. baumanii were susceptible only to imipenem. The rods of K. pneumoniae and E. coli were resistant to ampicillin, about 55% strains of both bacteria were sensitive to other antibiotics, except piperacillin/tazobactam, imipenem and ciprofloxacin. About 90% of methicillin resistant S. epidermidis strains were resistant to all antibiotics, except vancomycin (100% isolates were sensitive). ESBL were detected among E. cloace, K. pneumoniae and E. coli. We found P. aeruginosa rods producing MBL.     

Different microbial biofilm formation on polymethylmethacrylate (PMMA) bone cement loaded with gentamicin and vancomycin

We studied the in vitro effects of gentamicin and vancomycin alone and in combination added to polymethylmethacrylate (PMMA) cement specimens on the bacterial adhesion of multiresistant clinical isolates.The PMMA specimens (discs) loaded with gentamicin (1.9%) or vancomycin (1.9%) or with a combination of the two were placed in Mueller-Hinton Broth inoculated with bacterial strains. After incubation, bacterial growth was determined by optical density (OD₅₄₀) and sub-cultures. The biofilm PMMA-associated dye (crystal violet) was measured. Antibiotic concentrations in broth were determined by fluorescence polarisation immunoassay.All antibiotic-loaded PMMA cement specimens released high, inhibitory concentrations of gentamicin and vancomycin. However, differences in strain growth and adhesion were recorded. The clinical isolates Met-R/Gent-R CoNS showed no adhesion to gentamicin-loaded specimens for 24 h; strains with Gent-Intermediate susceptibility exhibited growth after 48 h but reduced adhesion. Some Gent-R strains exhibited growth and adhesion to antibiotic-loaded specimens similar to controls (plain discs). Only the VRSA strain (Staphylococcus aureus 5/7) and Escherichia coli were able to grow and adhere to vancomycin-loaded specimens after 24 h of incubation. The specimens loaded with the gentamicin + vancomycin combination showed a synergistic inhibitory effect against all tested strains (no bacterial growth). The degree of bacterial adhesion to PMMA cement loaded with gentamicin or vancomycin may be reduced in spite of a normal growth rate and is different for the tested strains.The effect of gentamicin and vancomycin on bacterial growth and adhesion to PMMA bone cement depends on the antibiotic concentrations, on the characteristics of each specific strain and on its ability to produce biofilm and adhere to antibiotic-loaded PMMA bone cement.     

Analysis of antibiotic resistance and virulence patterns in Klebsiella pneumoniae isolated from human urinary tract infections in India

In this study, 504 urine samples collected from patients suffering from urinary tract infection (UTIs) were screened for the presence of Klebsiella pneumoniae. The overall occurrence of Klebsiella spp. and K. pneumoniae was found to be 23·2% (117/504) and 16·8% (85/504) respectively. Antibiotic susceptibility testing of 85 K. pneumoniae isolates was carried out by disc diffusion which revealed alarming levels of antibiotic resistance (ABR). Antimicrobial resistance was prominently observed against cefpodoxime (76·47%) followed by ampicillin (70·59%), ceftriaxone (52·94%), cefoxitin (50·59%), amoxyclav (48·24%), ofloxacin (45·88%), cefotaxime (44·71%), cefepime (43·53%) and doxycycline hydrochloride (40%). A small percentage of strains also exhibited resistance to other antimicrobials in the range of 7–35%. Around 77·6% of the isolates were found to be resistant to three or more antibiotic classes and 66·7% of the isolates had multiple antibiotic resistance index values >0·2. Screening of virulence genes in 85 K. pneumoniae isolates revealed that uge gene was the most predominant (11/85, 12·9%), followed by rmpA (9/85, 10·5%), kfu (4/85, 4·7%) and aerobactin genes (2/85, 2·35%). Further, the overall percentage of biofilm producers were found to be 17·65% (15/85). This study warrants hospitals and health care centres to reduce misuse of antibiotics and manage UTI with appropriate treatment after performing antibiotic susceptibility testing.