Antimicrobials resistance (AMR) in pathogenic micro- organisms is ever challenging global issue. A wide range of antimicrobial compounds and their combination are used to control AMR in the MDR bacteria and the searching of new antimicrobials for MDR species are yet ongoing practices. One of the best substitutions to com- bating the resistant problem in different microbes is use of metal nanoparticles due to the multifaceted antimi- crobial mechanisms of metals nanoparticles against wide range of microbes [36, 37]. Silver is known to be used for centuries as a potent antimicrobial weapon because of its growth hindrance abilities against a diverse microorgan- ism by exerting its effect at multiple site. AgNPs synthe- sized by various routes and of different size and shape was tested against diverse clinical pathogenic MDR strains [4, 8, 12, 13, 16, 25, 31]. Due to failure of first and second line antibiotics, the exploration of AgNPs against various MDR strains is the new emerging trend. These suggest the further exploration of silver or other nanoparticles for treatment of various MDR, extensively drug-resistant (XDR) and pan drug resistance (PDR) pathogens. The remarkable antimicrobial activity of 2.1 µg of AgNPs was reported against S. aureus, B. subtilis, P. aeruginosa, P. vulgaris, M. racemosus, P. chrysogenum and R. stoloni- fer. The minimum inhibitory concentration of AgNPs is found to be varies in literature and it depends on coating medium, route of synthesis, types of strains, different size and shape of nanoparticles [4, 8, 16, 30, 38–40]. Result of antimicrobial activity against E. coli ESBL positive,
10 Read more
Most studies have been found that the main causative agent is Pseudomonas aeruginosa followed by Staphylococcus, (mainly S. aureus), other Gram negative bacteria were also recorded, such as Escherichia coli , Proteus spp , Klebsiella spp, and others either in Iraq or worldwide. [2,6] Antibiotic resistance were developed extensively to antibiotics in use or not in used due to cross-resistance.  The overuse of all types of antibiotics, as well as using broad-spectrum antibiotics can lead to existence of antibiotic-resistant bacteria  and higher medical costs.
10 Read more
Colonization by MDR bacteria during hospitalization Given that some patients were discharged or dead before subsequent clinical specimens were obtained, the num- ber of follow-up specimens decreased over time. Collec- tion of the subsequent specimens was successfully completed in 357 patients (73.3%) at time-2, 162 patients (33.3%) at time-3 and 53 patients (10.9%) at time-4. Overall colonization and colonization by all species of MDR bacteria showed an increasing trend over time as shown in Fig. 2. However, this increasing trend did not reach statistical significance in the test for trend analysis (all p-values > 0.05). The details of colonization by MDR bacteria stratified by MDR bacteria species, colonization site and specimen collection time are shown in Table 3. Due to the small number of new MDR bacteria acquisi- tions, we did not further investigate the risk factors for new acquisitions of these bacteria.
11 Read more
Reversal of multi-drug resistance appears today as an- other attempt to mitigate the spread of resistance in bac- teria. In recent years, many botanicals showed antibiotic-modulation effect in efflux pumps over- expressing MDR bacteria [9, 10, 16, 19, 20, 40–42]. In the present study, we observed that a beneficial effects of the combination of NPB with CHL, KAN as well as that of compound 4 with STR and CIP in all tested bac- teria were achieved. Synergistic or modulating effects of NPB and 4 with other antibiotics were noted on more than 70 % of the tested MDR bacteria in several case (Tables 3 and 4), suggesting that they can act as efflux pump inhibitors . This is strenghten by the fact that no synergistic effect was obtained with beta-lactamines (CEF and AMP) in the preliminary test (Additional file 1: Tables S2 and S3), as their target are located in the bacterial coat and hence, are not generally affected by AcrAB-TolC and MexAB-OprM efflux pumps in Entero- bacteriaceae and P. aeruginosa respectively .
In our continuous search of plant extracts with antibiotic-potentiating activity to combat MDR bacteria, the present work was designed to investigate the anti- bacterial activity of four Cameroonian medicinal plants used traditionally in the treatment of bacterial infections, namely Beilschmiedia acuta Kosterm (Lauraceae), Clau- sena anisata (Willd) Hook (Rutaceae), Newbouldia lae- vis Seem (Bignoniaceae) and Polyscias fulva (Hiern) Harms (Araliaceae), against MDRGN expressing active efflux via the Resistance-Nodulation Cell Division (RND)-type pumps. In the treatment of infectious dis- eases, Beilschmiedia acuta is traditionally used for gastrointestinal infections , Clausena anisata for fungal, bacterial and viral infections, Newbouldia laevis for bacterial and fungal infections [11–14], dysentery, worms, malaria, dental caries and diarrhea  and Polyscias fulva for venereal infections [16, 17].
10 Read more
Exploration of new source of antibiotics to combat multidrug-resistant bacteria is urgently needed. Indonesia as archipelago country has a wide variety of marine organisms with potential as source of new antibacterial compounds against MDRO. Aims of the study were to isolate sponge-associated fungi from sponge Cinachyrella sp. collected from Pandang Island, North Sumatera, Indonesia, to screen potential fungi against clinical pathogenic MDR bacteria, to identify the potential fungi; and to determine the best cultivation time for antibacterial production. Nine sponge- associated fungi were successfully isolated. Result of agar plug method showed fungus PDSP 5.7 was the most potential candidate which inhibited ESBL Escherichia coli, Salmonella enterica ser. Typhi, MRSA, and Staphylococcus haemolyticus strain MDR. This fungus had 100% similarity to Trichoderma reesei. In malt extract broth, T. reesei PDSP 5.7 had stationary phase from day 12 to day 18. In addition, the widest antibacterial was performed by extract from day 15. Furthermore, fungal extract showed best antibacterial activity against S. enterica ser. Typhi strain MDR with inhibition value of 14.72 ± 0.07 mm 2 .
. pinnata showed high antimicrobial potential against isolated MDR bacteria. Several previous studies indicated the antimicrobial potential of these medicinal plant extracts. H. indicus showed a broad spectrum antibacterial activity against MDR bacteria namely E. coli, B. subtilis, S. aureus, Salmonella paratyphi and Shigella dysenteriae . Saritha et al. reported antibacterial potential and mechanism of action of root extract of H. indicus against E. coli . Moreover, methanol seed extracts of H. wightiana (Syn. H. laurifolia) exhibited potent antimicrobial efficacy against E.coli, S. typhi, Proteus mirabilis and Klebsiella pneumoniae . According to Sajid et al., aqueous methanolic seed extracts of P. pinnata exhibited the remarkable antimicrobial activity against several pathogenic microorganisms, including P. aeruginosa, P. stutzeri, E. coli, Aspergillus oryzae, A. niger and Fusarium solani . Another study reported that methanol seed extracts of P. pinnata showed very good antimicrobial potential against clinical bacterial isolates namely P. aeruginosa, S. aureus, S. marcescens, M. luteus, P. vulgaris and K. pneumoniae . The time kill assay was performed to confirm the results of MIC experiment and to evaluate the efficacy of three plant extracts namely HI-ETAC, HL-MeOH and PP-ETAC to alter the normal growth profile of the MDR bacteria and to eliminate its growth in vitro. Data revealed that the MIC and 2×MIC exposure of the extracts cease the growth of test strains within 8-12 h and no subsequent regrowth was seen which confirmed that these extracts exhibited prolonged antimicrobial potential. The time kill experiment helps in the quantification of pharmacodynamics of an antimicrobial agent by estimating the decrease in growth profile of microorganisms as a function of time and concentration of the antimicrobial agent . The formation of biofilm by bacteria is recognized as one of the
11 Read more
LTCFs are important reservoirs for MDR organisms and colonization rates are similar or even higher than those found in acute care hospitals [13, 14], but the great vari- ability in the number of residents and staff members and in the methods used for screening make it difficult to dir- ectly compare the results of various colonization studies. Nevertheless, colonization prevalence with MDR bacteria of LTCF residents has been found to be highly variable, reaching values as high as 37.6 % in France for MRSA  and as high as 55-75 % in Ireland for ESBL produ- cing Enterobacteriaceae [4, 17]. In the few published surveillance studies in Italian LTCF residents similarly high ESBL colonization rates have been reported, whereas MRSA colonization was lower. Especially worrying is the emergence of carbapenemase producers in these facilities, expanding the reservoir of this health care threat. Colonization is frequently the prerequisite for infections ; this has many implications with regard to hospital hygiene measures and therefore reinforced infection con- trol and surveillance programs are urgently needed, though their application in this specific setting is challen- ging . Engaging of LTCFs in antimicrobial stewardship programs, frequently set up in acute care hospitals, is also a critical “hot topic”, focusing on drivers for antimicrobial over-use .
CONCLUSION: Our results describe broad- spectrum antimicrobial and antioxidant activity of C. album (sub sp striatum) crude ethanolic extract and nine different fractions. These properties could indicate the use of C. album (subsp striatum) in medical and pharmaceutical applications as potential antimicrobial and antioxidant agents and as effective preservatives. Additional and complementary studies are required concerning phytochemical screening, physiological analysis, isolation, purification and quatification of bioactive components for its in vivo assessment. This study showed C. album (Sub sp striatum) potential as a novel and cost-effective antibacterial agent against MDR bacteria and also as antioxidant agent.
13 Read more
Results: The mean age of the study population was 68.0 ± 14.8 years. Upon admission, the following prevalence for MDRs was observed: MRSA (methicillin resistant staphylococcus aureus) 7.0% (53/754), ESBL- (extended spectrum beta-lactamase) producing bacteria strains 12.6% (95/754), VRE (vancomycin resistant enterococci) 2.8% (21/754). Patients colonized or infected with MDR bacteria (MDR+) were significantly more frequently diagnosed with a critical illness polyneuropathy – CIP – than non-colonized (MDR-) patients: 29.0% vs. 14.8%. In addition, they were more frequently mechanically ventilated (MDR+: 55/138, 39.9%; MDR- 137/616, 22.2%). MDR+ patients were referred to rehabilitation earlier, had a longer LOS in early rehabilitation, lower BI on admission and at discharge, lower ERI on admission and lower CRS at discharge than MDR- patients. There was a highly significant correlation of the BI upon admission with the BI at discharge (r s = 0.492, p < 0.001). GOSE at discharge differed significantly between
exhibitors, visitors to animal venues and exhibits, and others concerned with disease-control and with minimiz- ing risks associated with animals in public settings . Also, we think that the most important measure to pre- vent introduction of antimicrobial resistance genes through exotic bacteria either to Japan or to any other country is to screen the imported animal flocks (either livestock or wildlife animals) for the presence of resistance genes in the quarantine. No flocks should be approved to enter the country if the screening results showed that they harbored of any clinically important resistance genes. In conclusion, theoretically, wild animals should never have been exposed to antibiotics; however, this study empha- sizes the potential risk of imported zoo animals as a source and reservoir of MDR bacteria. It highlights their potential role in the spread of antimicrobial resistance genes from one country to another. Although, the source of resistance genes in the imported flamingos is unknown, the possibility remains that flamingos may become colo- nized with resistant bacteria during transit (in a possible storage facility in Tanzania, in vehicles, in the Nether- lands, or during air transport). Finally, more research is needed to better understand the role of imported wild birds in transmission of resistance genes and its implica- tions for public health.
In summary, 4 out of 5 recipients developed donor-de- rived infectious complications within 48 h post-trans- plant (Fig. 1). While bacteria of good susceptibility were found during the primary microbiological examination of the donor on the sixth day in ICU, MDR strains (both ESBL Klebsiella pneumoniae and ESBL E. coli) were found in the transport medium in which the organs (kid- ney and Langerhans islets with duodenum) were stored during organ procurement, but not in the blood culture taken before procurement. In the samples of both kidney allograft recipients, the Langerhans islet recipient, and the liver recipient, the same MDR bacteria were detected on the third postoperative day. Pulsed field gel electro- phoresis confirmed the identity of these bacterial strains. Using PCR the presence of extraintestinal virulence fac- tors pap C, sfa/focCD (adhesins) and gimB (invasin) was detected in ESBL E. coli. The graft perfusion solution (Custodiol) was microbially negative. Secondary contam- ination during organ procurement/transplantation was ruled out (Tables 2 and 3).
T he increasing prevalence of multidrug-resistant (MDR) bacte- ria, e.g., methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), or multidrug-resistant Gram-negative bacilli, poses serious challenges to global health (1). Infections caused by MDR bacteria present limited or even no therapeutic options, especially in nosocomial settings. To trace intrainstitutional spread, besides epidemiological investigations that take place, time, and patient information into consideration, molecular typing adds a fourth dimension, i.e., the genotype, to confirm similarity or the absence of similarity among such patho- gens more precisely. However, the resolution of classical typing methods is limited. This changed dramatically with the introduc- tion of next-generation whole-genome sequencing (WGS), which can elucidate the origin and spread of bacterial pathogens in a rapid manner due to the availability of benchtop next-generation sequencers since the large Shiga toxin-producing Escherichia coli (STEC) O104:H4 outbreak in 2011 (2, 3). Currently, WGS not only provides highly discriminatory typing data (4–7) but also enables a richer profiling of virulence traits and antibiotic resis- tance genes in pathogens (8, 9). Furthermore, in contrast to clas- sical typing methods, WGS is a universal method that does not require species-specific protocols. Together, these advantages have generated an abundance of data in support of the theoretical value of molecular typing (10, 11), but these studies have been either retrospective molecular reconstructions of transmission events or used under dedicated study conditions (4, 12). Here, we prospectively applied WGS over two 6-month intervals in a clin- ical diagnostic microbiology laboratory and used these data to inform infection control measures that were applied in the second interval. In interval I, we sequenced the four most common MDR bacterial pathogens at our hospital (MRSA, VRE, Escherichia coli, and Pseudomonas aeruginosa) to determine if prospective and daily real-time WGS is technically feasible and whether results can
bacterial infection. 21 The levels of antibiotic resistance vary among bacteria and include MDR, XDR, and PDR. In this respect, MDR organisms are so important because they are resistant to more than one antibiotic. 21 Researchers de ﬁ ne MDR isolates as resistant to three or more antibiotic classes; however, there is no comprehen- sive agreement on the standard de ﬁ nition of MDR isolates. 21 Some bacteria that are considered as XDR are resistant to nearly all antimicrobial agents. The PDR bac- teria are resistant to all antibiotics used in the experimental treatment. 25 The antibiotic resistance is present in both Gram-negative and Gram-positive pathogenic bacteria. Therefore, there is a need to ﬁ nd an effective solution to control these challenging bacteria and prevent their spread. 26 Various studies in recent years have shown that Gram-positive and Gram-negative bacteria can interfere with antibiotic resistance and cause a high mortality rate among infected patients, such as vancomycin-resistant Enterococci (VRE), methicillin-resistant S. aureus (MRSA), extended spectrum beta-lactamase (ESBL)-producing P. aeruginosa, Enterobacteriaceae, and XDR A. baumannii. Noteworthy, some resistant bacteria such as extensively antibiotic-resistant tuberculosis (XDR- TB), MDR Clostridium dif ﬁ cile, and New Delhi Metallo- β -lactamases (NDM) in Enterobacteriaceae worldwide, especially in developing countries have expanded and can cause greater problems over time. 27 – 30 Reports have shown that infections with high antibiotic resistance can result in increased hospitalization time, delay in antimi- crobial therapy, use of high toxic antibiotics, increase costs, and many other problems for patients. 21,31 Because of the widespread resistance to antibiotics and the decline in the production of new antimicrobial agents, phage ther- apy as a novel, safe and attractive strategy for researchers. 21 Therefore, phage therapy has become more popular after the occurrence of antibiotic resistance, and now many institutes and researchers are looking for new ways to improve phage therapy. Various studies have used phages to inhibit MDR bacteria. For example, in one study, the researchers examined the phage against MDR S. aureus when it posed challenges to treatment. The results indicated that bacteriophage ϕ MR11 rapidly and completely lysed MDR S. aureus under growing condi- tions. Also, the phage killed of MRSA caused infection in mice in vivo. 32 Pallavali et al evaluated bacteriophages (KP DP1, SA DP1, PA DP4, and EC DP3) isolated from wastewater against MDR bacteria, causing septic wound infections, including K. pneumoniae, S. aureus,
17 Read more
Our study investigates the incidence of GI dysfunction that was found to be 63%, which was associated mainly between MDR bacteria positivity and negative fluid balance. In our findings, negative fluid balance and MDR bacteria positivity were independent risk factors for GI dysfunction. We also showed that GI dysfunction was associated with high SOFA score, hypoalbuminemia, catecholamine use, and prolonged LOS. GI dysfunction, on the other hand, can cause some complications including inadequate nutrition, vomiting, and newly developed decubitus ulcers, and these complications may delay patient recovery. Therefore, this study reveals the need for the establishment of a management protocol to treat these complications.
potential compared to none of the controls. Recent literature sug- gests that fecal colonization with MDR bacteria is not uncommon, even in otherwise healthy children in the community setting (36, 37). However, it is clear from this analysis with pediatric controls that healthy children without antibiotic exposure for at least 6 months have minimal colonization with bacterial species and an- tibiotic resistance genes of multiple clinically important MDR FIG 4 Radar graphs comparing the abundances of clinically important species and antibiotic resistance genes for the detection of MDR bacterium potential in high-risk inpatients (red shaded upper left quadrant) and low-risk outpatients (blue shaded upper right quadrant) relative to the abundances in controls (off white shaded lower part of circle) for MRSA (a), VRE (b), AmpC (c), ESBL (d), and CRE (e). The Z-scores for all relevant species and antibiotic resistance genes are plotted on the vertical axes individually in color curated categories for broad visualization. Each stool sample is represented by the radial lines. The abundances of the species and antibiotic resistance genes for each sample relative to controls is depicted by the distance the colored line extends from the core. The central core (dark gray) represents the abundances in controls within 5 standard deviations (Z-score ⬍ 5.0). Samples with a relative abundance of at least one relevant species and antibiotic resistance gene with a Z-score of ⬎ 5.0 were considered positive for MDR bacterium potential by shotgun metagenome sequencing.
10 Read more
All patients with prolonged weaning treated in the weaning unit over the period April 2013 to April 2016 were eligible. Inclusion criteria were at least one episode of VAP (diagnosed using the Clinical Pulmonary Infec- tion Score [CPIS] ) and/or septic pneumonic shock (according to the American College of Chest Physicians [ACCP]/Society of Critical Care Medicine [SCCM] con- sensus criteria ) in the ICU, requiring long-term ven- tilation, followed by prolonged weaning (≥3 spontaneous breathing trials [SBT] or ≥ 7 days of ventilation) ). Pa- tients with community-acquired pneumonia (CAP) and patients with other causes for prolonged weaning, those without prolonged weaning, and patients being admitted from external hospitals were excluded (Fig. 1). In eligible patients, the presence of MDR bacteria was assessed in- vasively and two groups were defined based on the pres- ence or absence of MDR bacteria.
Klebsiella species demonstrated the highest rate of multi-drug resistance (84.62%). Of the 5 S. aureus isolates 3 were ascertained to be methicillin resistant Staphylococcus aureus (MRSA) through molecular detection of the mec A gene (results not shown). A significant proportion of clinically relevant bacterial isolates (75%) procured in this study were ascertained through AST to be multi-drug resistant (MDR) as shown in Table 5. Our findings are in accordance with a study by Tajeddin et al.  from Iran, who reported 79.38% of environmental isolates to be MDR, with the greater part of MDR isolates in their study being obtained from the critical care wards. Lower rates of multi-drug resistance were however, confirmed in other studies from Uganda and Libya with percentage rates of 16.17% and 59.5% respectively [9,50]. Intensive care units
15 Read more
The prevalence of Salmonella spp. was 26.2% which is similar to the studies carried out in USA and South Korea [13, 19]. In contrast, higher prevalence rate of Salmo- nella spp. was found in Southern Thailand (67.5%)  and China (54.0%) . Prevalence of Salmonella spp. in chicken meat indicates that contamination may occur during slaughtering process or evisceration. Salmonella spp. in chicken meat can be considered as important cause of food borne Salmonellosis [13, 21]. Salmonella spp. isolates from this study were resistant to ampicillin (100.0%), nitrofurantion (84.6%) and doxycycline hydro- chloride (84.0%). Similar broad resistant pattern were observed in previous studies [22, 23]. This study showed the prevalence of MDR and ESBL producing Salmonella spp. was 85.2% and 55.2%, respectively. In a study con- ducted in South Korea found 87.2% of Salmonella spp. were MDR isolates . In Thailand, 84.4% isolates of Salmonella spp. were multidrug resistant which were isolated from chicken meat . The prevalence of ESBL producing Salmonella spp. was very high compared to study performed by Wu et al. , which reported only 8.6% prevalence of ESBL producing Salmonella species. Attention should be given to control the presence of high rate of ESBL-producing Salmonella in food.
It is common phenomenon that microorganisms are developing their resistance to many commercial drugs that is major cause of failure to treat bacteria infection diseases( Davies J. 1994), for which current antibiotic therapies are not effective which represent a growing problem, its well-known that the silver ion and silver nanoparticles have strong effect against microbial. In this study we prepare silver Np in chemical reduction methods and tested it on three types of multidrug resistance bacteria: Streptococcus fecalls, Klebsiella oxytoca, and Shigella flexneri The result showed that the sliver Np has a strong effect against gram-positive and gram-negative bacteria.