Can risk factors and risk scores help predict colonization and infection in multidrug-resistant gram-negative bacteria?

Antimicrobial resistance (AMR) is positioning as one of the most relevant threats to global public health and threatens the effective treatment of an ever-growing number of bacterial infections in various healthcare settings, particularly in acute care and surgical units, as well as in the community. Among multidrug-resistant (MDR) gram-negative bacteria (MDRGNB), , and require special attention, since they account for most of the mortality associated with bacterial infections and are often MDR. It is clear that there is an important global variation in antibiotic resistance profiles among MDRGNB species.

Antimicrobial Susceptibility Among Gram-Negative Isolates in Pediatric Patients in Latin America, Africa-Middle East, and Asia From 2016-2020 Compared to 2011-2015: Results From the ATLAS Surveillance Study.

Background: Antimicrobial resistance (AMR) data in the pediatric population are limited, particularly in developing countries. This study assessed the AMR profile and key resistance phenotypes and genotypes for Gram-negative bacteria (GNB) isolates collected as part of the Antimicrobial Testing Leadership and Surveillance program from pediatric patients in Latin America, Africa-Middle East, and Asia in 2016-2020 versus 2011-2015.

Methods: Minimum inhibitory concentrations by broth microdilution methodology were interpreted per the Clinical and Laboratory Standards Institute.

In Vitro Activity of Ceftaroline and Comparators against Bacterial Isolates Collected Globally from Patients with Skin and Soft Tissue Infections: ATLAS Program 2019-2020.

The objective of this study was to assess the in vitro activity of ceftaroline and a panel of comparator agents against isolates causing skin and soft tissue infections (SSTIs) collected in Africa/Middle East, Asia-Pacific, Europe, and Latin America from 2019-2020. Minimum inhibitory concentrations (MIC) were determined using European Committee on Antimicrobial Susceptibility Testing criteria. All the methicillin-susceptible (MSSA) isolates were susceptible to ceftaroline.

Ceftazidime-avibactam and comparators against Pseudomonas aeruginosa isolates collected globally and in each geographical region between 2017-2020.

Objectives: The objective of this study was to assess the distribution and antimicrobial susceptibility of Pseudomonas aeruginosa isolates against ceftazidime-avibactam (CAZ-AVI) and a panel of comparator agents collected globally and in each region from 2017-2020 from the Antimicrobial Testing Leadership and Surveillance program.

Methods: Susceptibility and minimum inhibitory concentration of all P. aeruginosa isolates were determined using broth microdilution methodology according to the Clinical and Laboratory Standards Institute guidelines.

Antimicrobial Activity of Ceftazidime-Avibactam and Comparators Against Fluoroquinolone-Resistant Collected Globally from Antimicrobial Testing Leadership and Surveillance: 2018-2019.

This study assessed the antimicrobial activity of ceftazidime-avibactam (CAZ-AVI) and a panel of comparator agents, including aztreonam, cefepime, ceftazidime, meropenem, imipenem, colistin, piperacillin-tazobactam, and tigecycline against isolates of fluoroquinolone-resistant (FQ-R) collected in 2018 and 2019 from the Antimicrobial Testing Leadership and Surveillance (ATLAS) program. Susceptibility and minimum inhibitory concentration were determined using broth microdilution for all antimicrobial agents by a central reference laboratory according to the Clinical and Laboratory Standards Institute guidelines and European Committee on Antimicrobial Susceptibility Testing guidelines. Of all the isolates ( = 10,906), 44.

Early appropriate diagnostics and treatment of MDR Gram-negative infections.

The term difficult-to-treat resistance has been recently coined to identify Gram-negative bacteria exhibiting resistance to all fluoroquinolones and all β-lactam categories, including carbapenems. Such bacteria are posing serious challenges to clinicians trying to identify the best therapeutic option for any given patient. Delayed appropriate therapy has been associated with worse outcomes including increase in length of stay, increase in total in-hospital costs and ∼20% increase in the risk of in-hospital mortality.

Strain Specific Variations in Complement Sensitivity.

The complement system is required for innate immunity against , an important cause of antibiotic resistant systemic infections. strains differ in their susceptibility to the membrane attack complex (MAC) formed from terminal complement pathway proteins, but the reasons for this variation remain poorly understood. We have characterized in detail the complement sensitivity phenotypes of nine clinical strains and some of the factors that might influence differences between strains.

Clinical data from studies involving novel antibiotics to treat multidrug-resistant Gram-negative bacterial infections.

Multidrug-resistant (MDR) Gram-negative bacteria (GNB) pose a critical threat to global healthcare, worsening outcomes and increasing mortality among infected patients. Carbapenemase- and extended-spectrum β-lactamase-producing Enterobacterales, as well as carbapenemase-producing Pseudomonas and Acinetobacter spp., are common MDR pathogens.

In Vitro Activity of Ceftolozane-Tazobactam and Other Antibiotics against Infection-Isolates from an Academic Medical Center in Thailand.

(1) Background: Resistant (PA) infections have limited treatment options. Data on the activity of ceftolozane-tazobactam (C-T) against PA in Thailand are limited. Objectives: The objective of this study was to identify the in vitro activity of C-T against general and resistant PA isolates from patients with real clinical infections from the HRH Princess Maha Chakri Sirindhorn Medical Center (MSMC) compared to other antibiotics and to study the resistant molecular patterns of those PA strains which were resistant to C-T.

Global evolutionary dynamics and resistome analysis of ribotype 017.

PCR ribotype (RT) 017 ranks among the most successful strains of in the world. In the past three decades, it has caused outbreaks on four continents, more than other ‘epidemic’ strains, but our understanding of the genomic epidemiology underpinning the spread of RT 017 is limited. Here, we performed high-resolution phylogenomic and Bayesian evolutionary analyses on an updated and more representative dataset of 282 non-clonal RT 017 isolates collected worldwide between 1981 and 2019.

Antimicrobial-resistant Bacteroides fragilis in Thailand and their inhibitory effect in vitro on the growth of Clostridioides difficile.

Objectives: The aim of this study was to investigate antimicrobial-resistant Bacteroides fragilis in Thailand and possible effects of such strains on human health and disease.

Methods: Phenotypic antimicrobial susceptibility testing was performed on 17 clinical B. fragilis isolates.

In vitro activity of ceftazidime/avibactam and comparators against carbapenemase-producing Enterobacterales and Pseudomonas aeruginosa isolates collected globally between 2016 and 2018.

Objectives: This study reports the antimicrobial activity of ceftazidime/avibactam (CZA) and comparators against carbapenemase-producing Enterobacterales (N = 1992) and carbapenemase-producing Pseudomonas aeruginosa (N = 784) collected in Africa/Middle East, Asia/South Pacific, Europe and Latin America (2016-2018).

Methods: Minimum inhibitory concentrations (MICs) and susceptibility were determined using broth microdilution methodology and EUCAST breakpoints. Carbapenemase-encoding genes were detected using multiplex PCR.

Sequential Vaccination With Heterologous Strains Induces Broadly Reactive Antibody Responses.

Antibody therapy may be an alternative treatment option for infections caused by the multi-drug resistant (MDR) bacterium As has multiple capsular serotypes, a universal antibody therapy would need to target conserved protein antigens rather than the capsular polysaccharides. We have immunized mice with single or multiple strains to induce antibody responses to protein antigens, and then assessed whether these responses provide cross-protection against a collection of genetically diverse clinical isolates. Immunized mice developed antibody responses to multiple protein antigens.

Nationwide Surveillance and Molecular Characterization of Critically Drug-Resistant Gram-Negative Bacteria: Results of the Research University Network Thailand Study.

A large-scale surveillance is an important measure to monitor the regional spread of antimicrobial resistance. We prospectively studied the prevalence and molecular characteristics of clinically important Gram-negative bacilli, including Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii complex (ABC), and Pseudomonas aeruginosa, from blood, respiratory tract, urine, and sterile sites at 47 hospitals across Thailand. Among 187,619 isolates, 93,810 isolates (50.

Molecular Characterization of, and Antimicrobial Resistance in, from Thailand, 2017-2018.

Antimicrobial resistance (AMR) plays an important role in the pathogenesis and spread of infection (CDI). Many antimicrobials, such as fluoroquinolones, have been associated with outbreaks of CDI globally. This study characterized AMR among clinical strains in Thailand, where antimicrobial use remains inadequately regulated.

Mild or Malign: Clinical Characteristics and Outcomes of Clostridium difficile Infection in Thailand.

Little is known about the clinical characteristics of infection (CDI) in Asia in general, and Thailand specifically, with a few studies suggesting that the disease may be milder than elsewhere. This study aimed to describe CDI in Thailand, evaluate treatment options and their outcomes, and explore possible protective factors responsible for any unique disease characteristics. From 2015 to 2018, 469 patients were included in the study.

Infections: Clinical Characteristics and Factors Associated with Mortality of Hospitalized Patients.

Purpose: To study the clinical characteristics and factors associated with mortality of patients who had infections.

Patients And Methods: We conducted a retrospective study to determine the clinical characteristics and factors associated with mortality for infections among hospitalized adult patients at Siriraj Hospital. The clinical and microbiological data were collected from medical records December 2013-December 2016.

Antimicrobial resistance in ribotype 017.

: Antimicrobial resistance (AMR) played an important role in the initial outbreaks of infection (CDI) in the 1970s. ribotype (RT) 017 has emerged as the major strain of in Asia, where antimicrobial use is poorly regulated. This strain has also caused CDI outbreaks around the world for almost 30 years.

Implementation of global antimicrobial resistance surveillance system (GLASS) in patients with bacteriuria.

Background: This study aimed to evaluate the practicality and advantage of Global Antimicrobial Resistance Surveillance System (GLASS) for surveillance of urine culture samples collected from patients with bacteriuria.

Methods: GLASS has been implemented at a tertiary care university hospital in Thailand by using the web application program to collect clinical data and urine culture data from patients with positive urine culture.

Results: There were 5085 urine samples from 3545 patients that were sent to our microbiology laboratory during June-December 2017.

ribotype 017 - characterization, evolution and epidemiology of the dominant strain in Asia.

ribotype (RT) 017 is an important toxigenic RT which, due to a deletion in the repetitive region of the gene, only produces functional toxin B. Strains belonging to this RT were initially dismissed as nonpathogenic and circulated largely undetected for almost two decades until they rose to prominence following a series of outbreaks in the early 2000s. Despite lacking a functional toxin A, RT 017 strains have been shown subsequently to be capable of causing disease as severe as that caused by strains producing both toxins A and B.