Spread of Multidrug-Resistant Microorganisms

A special issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: closed (31 December 2021) | Viewed by 36251

Special Issue Editors


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Guest Editor
Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, University of Palermo, 90133 Palermo, Italy
Interests: gram positive and negative microorganisms; multi drug resistance; H. pylori; natural components and their antibiofilm actions
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Department of Pharmacy, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
Interests: study of microbial survival strategies (biofilm, non-cultivable vital state), evaluation of antimicrobial, anti-biofilm and anti-virulence activities of bioactive substances of natural origin; semi-synthesis and innovative biomaterials; the research activity has concerned oral cavity microorganisms; Helicobacter pylori and microorganisms related to chronic wounds (Staphylococcus aureus, Pseudomonas aeruginosa, Candida albicans) and lung infections (Mycobacterium abscessus and other fast-growing mycobacteria)
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Department of Pharmacy, University “G. d’Annunzio” Chieti-Pescara, 66100 Chieti, Italy
Interests: antimicrobial; anti-biofilm and anti-virulence activities of natural compounds alone and combined with antibiotics against multi drug-resistant strains (Helicobacter pylori, Staphylococcus spp., Pseudomonas aeruginosa, Candida albicans, Mycobacterium abscessus and other fast-growing mycobacteria)
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
Department of Experimental and Clinical Medicine, University of Florence; Microbiology and Virology Unit, Careggi University Hospital; 50134 Florence, Italy
Interests: Activity of novel antimicrobials on multi drug resistant strains and characterization of antibiotic resistance mechanisms; clinical parasitology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The prevalence of multidrug-resistant organisms (MDROs) is increasing worldwide, with very large variations across countries, microorganisms, and settings.
MDR bacteria are associated with nosocomial infections. However, some MDR bacteria have become quite prevalent causes of community-acquired infections. The spread of MDR bacteria into the community is a crucial development, and is associated with increased morbidity, mortality, healthcare costs, and antibiotic use.
Antimicrobial resistance is the result of a dynamic process involving microbial interactions in many different environments, and the ability to acquire new determinants of resistance is necessary to maintain their fitness.
The variability of resistance determinants and their expression in different hosts are larger in nature than what is found in human pathogens, which suggests the presence of bottlenecks moderating the transfer, spread, and stability of antibiotic resistance genes.
On the basis of this evidence, this Special Issue will publish papers focusing on the epidemiology of MDROs, the activity of new antimicrobials, the implication of various determinants of resistance, and the strategies to control the diffusions of MDROs.

Dr. Teresa Fasciana
Dr. Mara Di Giulio
Dr. Silvia Di Lodovico
Dr. Alberto Antonelli
Guest Editors

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Keywords

  • MDR
  • spread
  • community
  • nosocomial
  • new marker of resistance

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Published Papers (11 papers)

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Editorial

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4 pages, 195 KiB  
Editorial
Spread of Multidrug-Resistant Microorganisms
by Silvia Di Lodovico, Teresa Fasciana, Mara Di Giulio, Luigina Cellini, Anna Giammanco, Gian Maria Rossolini and Alberto Antonelli
Antibiotics 2022, 11(7), 832; https://doi.org/10.3390/antibiotics11070832 - 21 Jun 2022
Cited by 5 | Viewed by 1480
Abstract
Multidrug-resistant organisms (MDRO) are bacteria that exhibit acquired resistance to multiple antibiotics, reducing the efficacy of antimicrobial therapies [...] Full article
(This article belongs to the Special Issue Spread of Multidrug-Resistant Microorganisms )

Research

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20 pages, 1562 KiB  
Article
Antimicrobial Resistance, Biofilm Formation, and Virulence Genes in Enterococcus Species from Small Backyard Chicken Flocks
by Othman M. Alzahrani, Mahmoud Fayez, Amal S. Alswat, Mohamed Alkafafy, Samy F. Mahmoud, Theeb Al-Marri, Ahmed Almuslem, Hassan Ashfaq and Shaymaa Yusuf
Antibiotics 2022, 11(3), 380; https://doi.org/10.3390/antibiotics11030380 - 13 Mar 2022
Cited by 19 | Viewed by 3674
Abstract
Backyard birds are small flocks that are more common in developing countries. They are used for poultry meat and egg production. However, they are also implicated in the maintenance and transmission of several zoonotic diseases, including multidrug-resistant bacteria. Enterococci are one of the [...] Read more.
Backyard birds are small flocks that are more common in developing countries. They are used for poultry meat and egg production. However, they are also implicated in the maintenance and transmission of several zoonotic diseases, including multidrug-resistant bacteria. Enterococci are one of the most common zoonotic bacteria. They colonize numerous body sites and cause a wide range of serious nosocomial infections in humans. Therefore, the objective of the present study was to investigate the diversity in Enterococcus spp. in healthy birds and to determine the occurrence of multidrug resistance (MDR), multi-locus sequence types, and virulence genes and biofilm formation. From March 2019 to December 2020, cloacal swabs were collected from 15 healthy backyard broiler flocks. A total of 90 enterococci strains were recovered and classified according to the 16S rRNA sequence into Enterococcus faecalis (50%); Enterococcus faecium (33.33%), Enterococcus hirae (13.33%), and Enterococcus avium (3.33%). The isolates exhibited high resistance to tetracycline (55.6%), erythromycin (31.1%), and ampicillin (30%). However, all of the isolates were susceptible to linezolid. Multidrug resistance (MDR) was identified in 30 (33.3%) isolates. The enterococci AMR-associated genes ermB, ermA, tetM, tetL, vanA, cat, and pbp5 were identified in 24 (26.6%), 11 (12.2%), 39 (43.3%), 34 (37.7%), 1 (1.1%), 4 (4.4%), and 23 (25.5%) isolates, respectively. Of the 90 enterococci, 21 (23.3%), 27 (30%), and 36 (40%) isolates showed the presence of cylA, gelE, and agg virulence-associated genes, respectively. Seventy-three (81.1%) isolates exhibited biofilm formation. A statistically significant correlation was obtained for biofilm formation versus the MAR index and MDR. Multi-locus sequence typing (MLST) identified eleven and eight different STs for E. faecalis and E. faecium, respectively. Seven different rep-family plasmid genes (rep1–2, rep3, rep5–6, rep9, and rep11) were detected in the MDR enterococci. Two-thirds (20/30; 66.6%) of the enterococci were positive for one or two rep-families. In conclusion, the results show that healthy backyard chickens could act as a reservoir for MDR and virulent Enterococcus spp. Thus, an effective antimicrobial stewardship program and further studies using a One Health approach are required to investigate the role of backyard chickens as vectors for AMR transmission to humans. Full article
(This article belongs to the Special Issue Spread of Multidrug-Resistant Microorganisms )
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12 pages, 863 KiB  
Article
Massive Spread of OXA-48 Carbapenemase-Producing Enterobacteriaceae in the Environment of a Swiss Companion Animal Clinic
by Kira Schmitt, Michael Biggel, Roger Stephan and Barbara Willi
Antibiotics 2022, 11(2), 213; https://doi.org/10.3390/antibiotics11020213 - 8 Feb 2022
Cited by 7 | Viewed by 2164
Abstract
Background: Companion animal clinics contribute to the spread of antimicrobial resistant microorganisms (ARM) and outbreaks with ARM of public health concern have been described. Methods: As part of a project to assess infection prevention and control (IPC) standards in companion animal clinics in [...] Read more.
Background: Companion animal clinics contribute to the spread of antimicrobial resistant microorganisms (ARM) and outbreaks with ARM of public health concern have been described. Methods: As part of a project to assess infection prevention and control (IPC) standards in companion animal clinics in Switzerland, a total of 200 swabs from surfaces and 20 hand swabs from employees were collected during four days in a medium-sized clinic and analyzed for extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E), carbapenemase-producing Enterobacteriaceae (CPE), vancomycin-resistant enterococci (VRE), and methicillin-resistant staphylococci (MRS). Results: A total of 22 (11.0%) environmental specimen yielded CPE, 14 (7.0%) ESBL-E, and 7 (3.5%) MRS; MR Staphylococcus aureus were isolated from two (10.0%) hand swabs. The CPE isolates comprised Escherichia coli, Klebsiella pneumoniae, Enterobacter hormaechei, Citrobacter braakii, and Serratia marcescens. Whole genome sequencing revealed that all CPE carried closely related blaOXA-48 plasmids, suggesting a plasmidic spread within the clinic. The clinic exhibited major deficits in surface disinfection, hand hygiene infrastructure, and hand hygiene compliance. CPE were present in various areas, including those without patient contact. The study documented plasmidic dissemination of blaOXA-48 in a companion animal clinic with low IPC standards. This poses a worrisome threat to public health and highlights the need to foster IPC standards in veterinary clinics to prevent the spread of ARM into the community. Full article
(This article belongs to the Special Issue Spread of Multidrug-Resistant Microorganisms )
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12 pages, 276 KiB  
Article
Epidemiology and Pattern of Resistance of Gram-Negative Bacteria Isolated from Blood Samples in Hospitalized Patients: A Single Center Retrospective Analysis from Southern Italy
by Paola Di Carlo, Nicola Serra, Sofia Lo Sauro, Vincenza Maria Carelli, Maurizio Giarratana, Juan Camilo Signorello, Alessandro Lucchesi, Giuseppe Manta, Maria Santa Napolitano, Teresa Rea, Antonio Cascio, Consolato Maria Sergi, Anna Giammanco and Teresa Fasciana
Antibiotics 2021, 10(11), 1402; https://doi.org/10.3390/antibiotics10111402 - 16 Nov 2021
Cited by 11 | Viewed by 2582
Abstract
Background: Blood culturing remains the mainstream tool to inform an appropriate treatment in hospital-acquired bloodstream infections and to diagnose any bacteremia. Methods: A retrospective investigation on the prevalence of Gram-negative bacteria (GNB) and their resistance in hospitalized patients by age, sex, and units [...] Read more.
Background: Blood culturing remains the mainstream tool to inform an appropriate treatment in hospital-acquired bloodstream infections and to diagnose any bacteremia. Methods: A retrospective investigation on the prevalence of Gram-negative bacteria (GNB) and their resistance in hospitalized patients by age, sex, and units from blood cultures (BCs) was conducted from January 2018 to April 2020 at Sant’Elia hospital, Caltanissetta, southern Italy. We divided the patient age range into four equal intervals. Results: Multivariate demographic and microbiological variables did not show an association between bacteria distributions and gender and age. The distribution by units showed a higher prevalence of Klebsiella pneumoniae and Acinetobacter baumannii in the intensive care unit (ICU) and Escherichia coli in the non-intensive care units (non-ICUs). The analysis of antibiotic resistance showed that E. coli was susceptible to a large class of antibiotics such as carbapenem and trimethoprim-sulfamethoxazole. K. pneumoniae showed a significant susceptibility to colistin, tigecycline, and trimethoprim-sulfamethoxazole. From the survival analysis, patients with E. coli had a higher survival rate. Conclusions: The authors stress the importance of the implementation of large community-level programs to prevent E. coli bacteremia. K. pneumoniae and E. coli susceptibility patterns to antibiotics, including in the prescription patterns of general practitioners, suggest that the local surveillance and implementation of educational programs remain essential measures to slow down the spread of resistance and, consequently, increase the antibiotic lifespan. Full article
(This article belongs to the Special Issue Spread of Multidrug-Resistant Microorganisms )
16 pages, 632 KiB  
Article
Evaluation of a Biocide Used in the Biological Isolation and Containment Unit of a Veterinary Teaching Hospital
by Catarina Geraldes, Cláudia Verdial, Eva Cunha, Virgílio Almeida, Luís Tavares, Manuela Oliveira and Solange Gil
Antibiotics 2021, 10(6), 639; https://doi.org/10.3390/antibiotics10060639 - 27 May 2021
Cited by 7 | Viewed by 3500
Abstract
Hospital-acquired infections (HAIs) are a rising problem worldwide, and the best way of coping with them is through infection tracking and surveillance systems, combined with prevention strategies, namely efficient disinfection protocols, that employ various biocides. However, increasing reports about reductions in biocide susceptibility [...] Read more.
Hospital-acquired infections (HAIs) are a rising problem worldwide, and the best way of coping with them is through infection tracking and surveillance systems, combined with prevention strategies, namely efficient disinfection protocols, that employ various biocides. However, increasing reports about reductions in biocide susceptibility and the development of cross-resistance to antimicrobials emphasize the need for identifying the factors influencing biocide efficiency. In this study, 29 bacterial isolates (n = 3 E. coli, n = 2 Pseudomonas spp., n = 23 Enterococcus spp., and n = 1 Staphylococcus pseudintermedius), obtained from environmental samples collected from the Biological Isolation and Containment Unit (BICU), of the Veterinary Teaching Hospital of the Faculty of Veterinary Medicine, University of Lisbon, were tested in order to determine their antimicrobial susceptibility to various antibiotics. Thirteen of these isolates were further selected in order to determine their antimicrobial susceptibility to Virkon™ S, with and without the presence of organic matter. Afterward, seven of these isolates were incubated in the presence of sub-lethal concentrations of this formulation and, subsequently, new susceptibility profiles were determined. Fourteen of the 29 isolates (48.3%) were classified as multidrug resistant, all previously identified as enterococci. Concerning Virkon™ S’s susceptibility, the Minimal Bactericidal Concentration (MBC) of this biocide regarding all isolates was at least eight times lower than the concentration regularly used, when no organic matter was present. However, when organic matter was added, MBC values rose up to 23 times. After exposure to sub-lethal concentrations of Virkon™ S, four enterococci presented a phenotypical change regarding antimicrobial susceptibility towards gentamicin. Virkon™ S also resulted in higher MBC values, up to 1.5 times, in the presence of low concentrations of organic matter, but no rise in these values was observed in assays without interfering substance. Virkon™ S seemed to be an efficient formulation in eliminating all bacteria isolates isolated from the BICU. However, organic matter could represent a hindrance to this ability, which emphasizes the importance of sanitization before disinfection procedures. The changes seen in antimicrobial susceptibility could be explained by a general stress-induced response promoted by the sub-lethal levels of Virkon™ S. Additionally, when no organic matter was present, a decrease in susceptibility to this biocide seemed to be non-existent. Full article
(This article belongs to the Special Issue Spread of Multidrug-Resistant Microorganisms )
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8 pages, 2103 KiB  
Communication
Draft Genome Sequence and Biofilm Production of a Carbapenemase-Producing Klebsiella pneumoniae (KpR405) Sequence Type 405 Strain Isolated in Italy
by Teresa Fasciana, Andrea Ciammaruconi, Bernardina Gentile, Paola Di Carlo, Roberta Virruso, Maria Rita Tricoli, Daniela Maria Palma, Giovanna Laura Pitarresi, Florigio Lista and Anna Giammanco
Antibiotics 2021, 10(5), 560; https://doi.org/10.3390/antibiotics10050560 - 11 May 2021
Cited by 11 | Viewed by 1944
Abstract
Rapid identification and characterization of multidrug-resistant Klebsiella pneumoniae strains is essential to diagnose severe infections in patients. In clinical routine practice, K. pneumoniae is frequently identified and characterized for outbreak investigation. Pulsed-field gel electrophoresis or multilocus sequence typing could be used, but, unfortunately, [...] Read more.
Rapid identification and characterization of multidrug-resistant Klebsiella pneumoniae strains is essential to diagnose severe infections in patients. In clinical routine practice, K. pneumoniae is frequently identified and characterized for outbreak investigation. Pulsed-field gel electrophoresis or multilocus sequence typing could be used, but, unfortunately, these methods are time-consuming, laborious, expensive, and do not provide any information about the presence of resistance and virulence genes. In recent years, the decreasing cost of next-generation sequencing and its easy use have led to it being considered a useful method, not only for outbreak surveillance but also for rapid identification and evaluation, in a single step, of virulence factors and resistance genes. Carbapenem-resistant strains of K. pneumoniae have become endemic in Italy, and in these strains the ability to form biofilms, communities of bacteria fixed in an extracellular matrix, can defend the pathogen from the host immune response as well as from antibiotics, improving its persistence in epithelial tissues and on medical device surfaces. Full article
(This article belongs to the Special Issue Spread of Multidrug-Resistant Microorganisms )
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11 pages, 951 KiB  
Article
Ceftolozane-Tazobactam Combination Therapy Compared to Ceftolozane-Tazobactam Monotherapy for the Treatment of Severe Infections: A Systematic Review and Meta-Analysis
by Marco Fiore, Antonio Corrente, Maria Caterina Pace, Aniello Alfieri, Vittorio Simeon, Mariachiara Ippolito, Antonino Giarratano and Andrea Cortegiani
Antibiotics 2021, 10(1), 79; https://doi.org/10.3390/antibiotics10010079 - 15 Jan 2021
Cited by 15 | Viewed by 2853
Abstract
Ceftolozane-tazobactam (C/T) is a combination of an advanced-generation cephalosporin (ceftolozane) with a β-lactamase inhibitor (tazobactam). It is approved for the treatment of complicated urinary-tract/intra-abdominal infections and hospital-acquired/ventilator-associated pneumonia. This systematic review and meta-analysis (registered prospectively on PROSPERO, no. CRD42019134099, on 20 January 2020) [...] Read more.
Ceftolozane-tazobactam (C/T) is a combination of an advanced-generation cephalosporin (ceftolozane) with a β-lactamase inhibitor (tazobactam). It is approved for the treatment of complicated urinary-tract/intra-abdominal infections and hospital-acquired/ventilator-associated pneumonia. This systematic review and meta-analysis (registered prospectively on PROSPERO, no. CRD42019134099, on 20 January 2020) aimed to evaluate the effectiveness of C/T combination therapy compared to C/T monotherapy for the treatment of severe infections and to describe the prevalence of microorganisms in the included studies. We retrieved literature from PubMed, EMBASE, and CENTRAL, until 26 November 2020. Eligible studies were both randomised trials and nonrandomised studies with a control group, published in the English language and peer-reviewed journals. The primary outcome was all-cause mortality; secondary outcomes were (i) clinical improvement and (ii) microbiological cure. Eight nonrandomised studies were included in the qualitative synthesis: Seven retrospective cohort studies and one case-control study. The meta-analysis of the four studies evaluating all-cause mortality (in total 148 patients: 87 patients treated with C/T alone and 61 patients treated with C/T combination therapy) showed a significant reduction of mortality in patients receiving C/T combination therapy, OR: 0.31, 95% CI: 0.10–0.97, p = 0.045. Conversely, the meta-analysis of the studies evaluating clinical improvement and microbiological cure showed no differences in C/T combination therapy compared to C/T monotherapy. The most consistent data come from the analysis of the clinical improvement, n = 391 patients, OR: 0.97, 95% CI: 0.54–1.74, p = 0.909. In 238 of the 391 patients included (60.8%), C/T was used for the treatment of infections caused by Pseudomonas aeruginosa. Full article
(This article belongs to the Special Issue Spread of Multidrug-Resistant Microorganisms )
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22 pages, 12893 KiB  
Article
Snapshot Study of Whole Genome Sequences of Escherichia coli from Healthy Companion Animals, Livestock, Wildlife, Humans and Food in Italy
by Elisa Massella, Cameron J. Reid, Max L. Cummins, Kay Anantanawat, Tiziana Zingali, Andrea Serraino, Silvia Piva, Federica Giacometti and Steven P. Djordjevic
Antibiotics 2020, 9(11), 782; https://doi.org/10.3390/antibiotics9110782 - 6 Nov 2020
Cited by 24 | Viewed by 4492
Abstract
Animals, humans and food are all interconnected sources of antimicrobial resistance (AMR), allowing extensive and rapid exchange of AMR bacteria and genes. Whole genome sequencing (WGS) was used to characterize 279 Escherichia coli isolates obtained from animals (livestock, companion animals, wildlife), food and [...] Read more.
Animals, humans and food are all interconnected sources of antimicrobial resistance (AMR), allowing extensive and rapid exchange of AMR bacteria and genes. Whole genome sequencing (WGS) was used to characterize 279 Escherichia coli isolates obtained from animals (livestock, companion animals, wildlife), food and humans in Italy. E. coli predominantly belonged to commensal phylogroups B1 (46.6%) and A (29%) using the original Clermont criteria. One hundred and thirty-six sequence types (STs) were observed, including different pandemic (ST69, ST95, ST131) and emerging (ST10, ST23, ST58, ST117, ST405, ST648) extraintestinal pathogenic Escherichia coli (ExPEC) lineages. Eight antimicrobial resistance genes (ARGs) and five chromosomal mutations conferring resistance to highest priority critically important antimicrobials (HP-CIAs) were identified (qnrS1, qnrB19, mcr-1, blaCTX-M1,15,55, blaCMY-2, gyrA/parC/parE, ampC and pmrB). Twenty-two class 1 integron arrangements in 34 strains were characterized and 11 ARGs were designated as intI1 related gene cassettes (aadA1, aadA2, aadA5, aad23, ant2_Ia, dfrA1, dfrA7, dfrA14, dfrA12, dfrA17, cmlA1). Notably, most intI1 positive strains belonged to rabbit (38%) and poultry (24%) sources. Three rabbit samples carried the mcr-1 colistin resistance gene in association with IS6 family insertion elements. Poultry meat harbored some of the most prominent ExPEC STs, including ST131, ST69, ST10, ST23, and ST117. Wildlife showed a high average number of virulence-associated genes (VAGs) (mean = 10), mostly associated with an ExPEC pathotype and some predominant ExPEC lineages (ST23, ST117, ST648) were identified. Full article
(This article belongs to the Special Issue Spread of Multidrug-Resistant Microorganisms )
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11 pages, 990 KiB  
Article
The Prevalence of Multidrug Resistance of Helicobacter pylori and Its Impact on Eradication in Korea from 2017 to 2019: A Single-Center Study
by Jae Yong Park, Tae-Seop Shin, Ji Hyun Kim, Hong Jip Yoon, Beom Jin Kim and Jae Gyu Kim
Antibiotics 2020, 9(10), 646; https://doi.org/10.3390/antibiotics9100646 - 27 Sep 2020
Cited by 13 | Viewed by 3552
Abstract
Antimicrobial resistance is one of the major factors determining the efficacy of Helicobacter pylori eradication therapy. This study aimed to estimate the recent prevalence of multidrug resistance of H. pylori and its impact on eradication in Korea. A total of 174 patients were [...] Read more.
Antimicrobial resistance is one of the major factors determining the efficacy of Helicobacter pylori eradication therapy. This study aimed to estimate the recent prevalence of multidrug resistance of H. pylori and its impact on eradication in Korea. A total of 174 patients were prospectively enrolled at Chung-Ang University Hospital from 2017 to 2019. H. pylori strains were isolated from the gastric body and antrum. The minimum inhibitory concentrations of antibiotics were determined by the serial twofold agar dilution method. Eradication results were reviewed and analyzed in connection with antibiotic resistance. The prevalence of H. pylori infection was 51.7% (90/174). The culture success rate was 77.8% (70/90). The resistance rates for clarithromycin, metronidazole, amoxicillin, tetracycline, levofloxacin, and moxifloxacin were 28.6% (20/70), 27.1% (19/70), 20.0% (14/70), 18.6% (13/70), 42.9% (30/70), and 42.9% (30/70), respectively. The multidrug resistance (resistance to two or more classes of antimicrobials) rate was 42.9% (30/70). Dual resistance to clarithromycin and metronidazole was confirmed in 8.6% (6/70). Eradication with a first-line treatment was successful in 75% (36/48), and those who received second-line treatment all achieved successful eradication. The rate of multidrug resistance is increasing, and standard triple therapy (STT) is no longer an acceptable first-line option for H. pylori eradication in Korea. Full article
(This article belongs to the Special Issue Spread of Multidrug-Resistant Microorganisms )
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17 pages, 1024 KiB  
Article
A Retrospective Whole-Genome Sequencing Analysis of Carbapenem and Colistin-Resistant Klebsiella pneumoniae Nosocomial Strains Isolated during an MDR Surveillance Program
by Bernardina Gentile, Antonella Grottola, Gabriella Orlando, Giulia Fregni Serpini, Claudia Venturelli, Marianna Meschiari, Anna Anselmo, Silvia Fillo, Antonella Fortunato, Florigio Lista, Monica Pecorari and Cristina Mussini
Antibiotics 2020, 9(5), 246; https://doi.org/10.3390/antibiotics9050246 - 12 May 2020
Cited by 12 | Viewed by 3593
Abstract
Multidrug-resistant Klebsiella pneumoniae (MDR Kp), in particular carbapenem-resistant Kp (CR-Kp), has become endemic in Italy, where alarming data have been reported on the spread of colistin-resistant CR-Kp (CRCR-Kp). During the period 2013–2014, 27 CRCR-Kp nosocomial strains [...] Read more.
Multidrug-resistant Klebsiella pneumoniae (MDR Kp), in particular carbapenem-resistant Kp (CR-Kp), has become endemic in Italy, where alarming data have been reported on the spread of colistin-resistant CR-Kp (CRCR-Kp). During the period 2013–2014, 27 CRCR-Kp nosocomial strains were isolated within the Modena University Hospital Policlinico (MUHP) multidrug resistance surveillance program. We retrospectively investigated these isolates by whole-genome sequencing (WGS) analysis of the resistome, virulome, plasmid content, and core single nucleotide polymorphisms (cSNPs) in order to gain insights into their molecular epidemiology. The in silico WGS analysis of the resistome revealed the presence of genes, such as blaKPC, related to the phenotypically detected resistances to carbapenems. Concerning colistin resistance, the plasmidic genes mcr 1–9 were not detected, while known and new genetic variations in mgrB, phoQ, and pmrB were found. The virulome profile revealed the presence of type-3 fimbriae, capsular polysaccharide, and iron acquisition system genes. The detected plasmid replicons were classified as IncFIB(pQil), IncFIB(K), ColRNAI, IncX3, and IncFII(K) types. The cSNPs genotyping was consistent with the multi locus sequence typing (MLST) and with the distribution of mutations related to colistin resistance genes. In a nosocomial drug resistance surveillance program, WGS proved to be a useful tool for elucidating the spread dynamics of CRCR-Kp nosocomial strains and could help to limit their diffusion. Full article
(This article belongs to the Special Issue Spread of Multidrug-Resistant Microorganisms )
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Review

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22 pages, 6005 KiB  
Review
Synergistic Therapies as a Promising Option for the Treatment of Antibiotic-Resistant Helicobacter pylori
by Paweł Krzyżek, Emil Paluch and Grażyna Gościniak
Antibiotics 2020, 9(10), 658; https://doi.org/10.3390/antibiotics9100658 - 30 Sep 2020
Cited by 16 | Viewed by 4032
Abstract
Helicobacter pylori is a Gram-negative bacterium responsible for the development of gastric diseases. The issue of spreading antibiotic resistance of H. pylori and its limited therapeutic options is an important topic in modern gastroenterology. This phenomenon is greatly associated with a very narrow [...] Read more.
Helicobacter pylori is a Gram-negative bacterium responsible for the development of gastric diseases. The issue of spreading antibiotic resistance of H. pylori and its limited therapeutic options is an important topic in modern gastroenterology. This phenomenon is greatly associated with a very narrow range of antibiotics used in standard therapies and, as a consequence, an alarmingly high detection of multidrug-resistant H. pylori strains. For this reason, scientists are increasingly focused on the search for new substances that will not only exhibit antibacterial effect against H. pylori, but also potentiate the activity of antibiotics. The aim of the current review is to present scientific reports showing newly discovered or repurposed compounds with an ability to enhance the antimicrobial activity of classically used antibiotics against H. pylori. To gain a broader context in their future application in therapies of H. pylori infections, their antimicrobial properties, such as minimal inhibitory concentrations and minimal bactericidal concentrations, dose- and time-dependent mode of action, and, if characterized, anti-biofilm and/or in vivo activity are further described. The authors of this review hope that this article will encourage the scientific community to expand research on the important issue of synergistic therapies in the context of combating H. pylori infections. Full article
(This article belongs to the Special Issue Spread of Multidrug-Resistant Microorganisms )
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