INTRODUCTION

Community-acquired pneumonia (CAP) is a common acute infection associated with significant morbidity and mortality, particularly in older adults with significant comorbidities. For this reason, an empirical treatment protocol for CAP was developed in a social-health care hospital. The aim of the study is to evaluate compliance with this protocol.

METHODS

Descriptive, retrospective study of all patients admitted to our hospital diagnosed with CAP from September to December 2022.

Demographic variables: age, sex; pharmacological variables: empirical antibiotic treatment according to protocol, change of antibiotic treatment, mean duration of treatment, compliance with criteria and performance of sequential therapy on the third day and after the third day.

RESULTS AND DISUSSION

55 patients were included (mean age 88.9 years (64-103), 58.2% men).

50.9% received empirical antibiotic treatment according to the protocol. The empirical antibiotics prescribed were: amoxicillin/clavulanate (25.5%), ceftriaxone + levofloxacin (23.6%), piperacillin/tazobactam (18.2%), ceftriaxone (14.5%), levofloxacin (7.3%), meropenem (5.5%), ertapenem (1.8%), imipenem (1.8%) and levofloxacin + azithromyzine (1.8%).

Change of antibiotic in 27.3% and mean duration of treatment of 8.3 days.

Sequential therapy: 56.4% met criteria on day 3, but this was only done in 19.3%. Of the remaining patients, 22.45% were switched to oral, in an average of 6 days.

CONCLUSIONS

Compliance with the empirical treatment protocol in CAP occurred in a very low percentage of patients. Moreover, in patients who met the criteria for sequential therapy, it was performed after the third day. Therefore, with the aim of improving these results, new measures and activities have been proposed.

Antibiotic prophylaxis is used to prevent infections related to surgery from the administration of antimicrobials before, during and after the procedure. Its practice is mainly recommended in surgeries classified as contaminated or potentially contaminated. Its use should also be considered in clean surgeries in which the occurrence of infections brings serious consequences, such as mastectomy and mammoplasty. Thus, the present study aims to discuss the use of antibiotic prophylaxis in mammoplasty and mastectomy surgeries. This is a narrative literature review, in which the Health Sciences Descriptors (DeCS) “mammoplasty”, “mastectomy” and “antibiotic prophylaxis” were used to search the MedLine and LILACS databases, included in the Virtual Library in Health (BVS). It was observed that the occurrence of infections after mammoplasties or mastectomies can cause damage, such as delay in recovery, in adjuvant therapy, loss of the reconstructed breast or impaired cosmesis, when applicable, which corroborates the use of antibiotic prophylaxis in these procedures. Patients are screened for methicillin-resistant (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA). The main antibiotics used in prophylaxis were cephalosporins (cefazolin, cefadroxil and cefuroxime), isoxazolylpenicillins (flucloxacillin), aminoglycosides (gentamicin) and glycopeptides (vancomycin) in associations. In the studies found, antimicrobial prophylaxis proved to be promising, therefore, the research ratified the importance of using antibiotic prophylaxis in mammoplasty and mastectomy surgeries to prevent infections, also associated with adequate skin preparation practices, with 2% chlorhexidine and 70% isopropyl alcohol.

Introduction:
Antimicrobial resistance(AMR) has been recorded as a fast-growing One Health challenge globally.
Escherichia coli(E. coli) is one of the most deadly bacteria organisms. A mechanism through which E. coli builds resistance to antibiotics is by genetic mutation which has led to production of Extended Beta Lactamase enzymes. There is limited information on the occurrence of ESBL E. coli in cattle in Ibadan, Nigeria, hence the study.

Methods:
A total of 28 composite fresh feacal samples were collected from farms in four local government areas within Ibadan; Akinyele:7, Ibadan North:12, Ido:4, and Lagelu:5. Standard Microbiological methods were used for Isolation, Antibiotics sensitivity testing, and ESBL production.

Results:
A total of 22(78.6%) E. coli isolates were recovered and the result showed resistance to critically important antibiotics in ascending order; Streptomycin (0.00%), Meropenem (0.00%), Gentamicin (4.55%), Ceftazidime (18.8%), Sulphamethazole (22.73%), Cefotaxime (54.55%), Ampicillin (63.64%), Pefloxacin (81.82%), Amoxicillin-Clavulanic (100%). Of the 22 positive E. coli isolates, 8 (36.4%) were ESBL-producing and 17(60.7%) were Multi-drug resistant.

Discussion:
The ESBL enzymes share the ability to hydrolyze third-generation cephalosporins which makes ESBL-producing E. coli organisms exhibit resistance to antibiotics(especially the Cephalosporins).The presence of multidrug-resistant ESBL E. coli in Cattle in Ibadan was established. The results shows the possibility of AMR becoming a looming pandemic globally.

Conclusion and Recommendation:
Ensuring Antimicrobial stewardship and Prescription-based medication, Alternative therapies to Antibiotics and the adoption of a One health Collaborative approach are measures to preventing the AMR pandemic.

Background: Staphylococcus aureus, particularly methicillin-resistant S. aureus (MRSA), has emerged as a leading antimicrobial-resistant pathogen challenging global health systems and antibiotic therapy. Pigs have been identified as important reservoirs for livestock-associated MRSA. The major concern with MRSA occurrence in pigs is the potential for human transmission. Reports on the prevalence and antibiotic sensitivity pattern of methicillin-susceptible S. aureus (MSSA) and MRSA strains in pigs in Nigeria are still limited, hence, the need for this study. This study was designed to investigate the prevalence of MRSA and Methicillin-sensitive Staphylococcus aureus in pig farms in Ibadan, Oyo State, Nigeria, and to determine their antibiotic resistance patterns.

Methods: We collected 93 composites (n=5; total n=465) of faecal samples from pigs in 25 farms across 5 local government areas in Ibadan, Nigeria. Isolation of S. aureus was done using standard procedures. Antibiotic sensitivity testing was done using the disc diffusion method. The data obtained were analysed using descriptive statistics and compared with the CLSI and EUCAST standards for sensitivity and resistance.

Results: The prevalence of S. aureus was 31.2%, with the proportion of MSSA and MRSA isolates being 23.7% and 7.5% respectively. The antibiotic susceptibility profiles revealed a high multidrug resistance prevalence among both MSSA (86.4%) and MRSA (100%). All MRSA isolates and 40.9% (9/22) of MSSA were found to be resistant to at least five different sub-classes of antibiotics.

Conclusion: This study supports the existing reports on pigs being an important reservoir of highly resistant S. aureus strains. The high multidrug resistance and the occurrence of MRSA may be evidence of continuous antimicrobial exposure and substandard hygienic practices on these farms. This is undesirable because it constitutes a health hazard for farmers, veterinarians, abattoir workers and pork consumers, who may further disseminate these highly resistant strains to their families and society. There is a need for further surveillance and a multisectoral approach involving policymakers, farmers, health practitioners and the public in implementing good infection control practices and safe antibiotic usage from the grassroots level on farms in line with the vision of the one health approach.

The escalating global concern over antimicrobial resistance has necessitated the search for alternative strategies to combat multidrug-resistant bacterial infections. Natural compounds, particularly those derived from plant sources, have emerged as promising alternatives to antibiotics. In this context, this study aimed to explore the antimicrobial potential of phenolic compounds extracted from winemaking by-products of Tinto Cão grapes against 10 multidrug-resistant bacterial strains. Additionally, the antioxidant activity of these compounds was evaluated.

Skin, seed, stem, shoat, and leaf sub-products from Tinto Cão grapes were extracted for their phenolic compounds. The antimicrobial activity was assessed against a panel of multidrug-resistant bacteria, including S. epidermidis, S. aureus, L. monocytogenes, E. faecium, E. faecalis, B. cereus, K. pneumoniae, P. aeruginosa, S. enteritidis and E. coli using MIC values. The antioxidant potential was measured using EC50 values obtained from DPPH, FRAP, and CuPRAC assays.

Among the bacterial strains tested, S. epidermidis, S. aureus, K. pneumoniae, P. aeruginosa, B. ceureus, and L. monocytogenes displayed susceptibility to the extracted phenolic compounds. The shoat extracts showed the highest antimicrobial activity, inhibiting six out of the ten bacterial strains and displaying lower MIC values ranging from 10 to 50 mg/mL. The lowest MIC value obtained was with the shoat extract against S. aureus, with a MIC of 10 mg/mL. Seed extracts demonstrated the highest antioxidant activity with the DPPH and CuPRAC methods (0.63±0.02 and 0.51±0.002, respectively), while leaf extracts exhibited the highest antioxidant activity with the FRAP method (0.55±0.001).

Our study showcases potent antimicrobial activity of phenolic compounds from Tinto Cão grape winemaking by-products against multidrug-resistant bacteria. These findings suggest their potential as a natural solution to combat antimicrobial resistance, promoting sustainable and effective strategies beyond traditional antibiotics.

The increasing prevalence of microorganisms producing extended-spectrum β-lactamases (ESBLs) poses a critical global challenge in combating antibiotic resistance. Rapid and innovative approaches are essential for their detection and identification. Our objective was to optimise a phenotypic method for straightforward and rapid ESBL detection in strains obtained from food environments, employing MALDI-TOF mass spectrometry. A collection of over 150 enterobacterial isolates, including 60 ESBL producers, 60 sensitive strains, and 25 constitutive AmpC producers, was analysed in triplicate using the optimised method. Bacterial colonies were cultured on Mueller-Hinton Agar for 24 hours, mixed with cefotaxime, and incubated at 37 ºC during 60 min by shaking. The suspension was then centrifuged, and the supernatant was directly analysed on the MALDI-TOF MS target, together with an aliquot of HCCA matrix (Bruker). The method targeted two types of peaks: intact antibiotic peaks (456 and 478 m/z) and lysed antibiotic peaks (370 and 414 m/z). The ratio (log value) between the lysed and intact antibiotic peaks determined the strain's ability to degrade the antibiotic. The results robustly differentiated ESBL producers and sensitive isolates. Notably, constitutive AmpC isolates, often overlooked in rapid detection methods, exhibited overlap with both "strongest" sensitive profiles and "weakest" ESBL profiles. Therefore, we established a threshold requiring confirmation by an alternative phenotypic method for these isolates. In conclusion, our optimised method provides a quick and accurate approach to detect ESBL-producing enterobacteria isolated from food environments.

Antimicrobial resistance is a challenge that threatens the whole global community. The burden of antimicrobial resistance is higher in developing countries than anywhere else. The effects of antimicrobial resistance are scantily reported in developing countries. Hence, we tend to pander to the reports from other parts of the world while neglecting the developing regions. This study aims to analyse the published literature on antimicrobial resistance in developing countries.

A systematic review was carried out in PubMed and included recent studies (2013-2023). Article screening used relevant search strategies and strict inclusion and exclusion criteria. The initial search identified 18,958 studies, and after undergoing strict screening, 24 studies were included in the systematic review. Widespread cases of antimicrobial resistance were unearthed across developing nations. The most common pathogens reported for resistance were; Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aureus, and Klebsiella pneumoniae. The continued resistance of these pathogens is due to the overuse and misuse of antimicrobials in both human and animal medicine practices.

Different challenges worsen the threat of antimicrobial resistance in developing countries. Poor surveillance and diagnostic ability hinder the efficient analysis of resistance trends and patterns in these regions. Unregulated use of antibiotics and fragmented healthcare systems that promote self-diagnosis worsen the threat of antimicrobial resistance in developing countries. These challenges can be addressed by strengthening regulations on antimicrobial use, improving surveillance, collaboration between human and animal medical practices, and improving societal awareness. It is important to arrest the effect of antimicrobial resistance in developing countries by adopting a sustainable approach to safeguard the efficacy of these antimicrobials and prevent huge numbers of deaths due to resistance.

In recent years, bacterial infections have become a major global concern, causing significant morbidity and mortality. Unfortunately, the development and commercialization of new antibacterial drugs have been slow, while pathogens continue to rapidly adapt and evolve. To address this challenge, nanotechnology offers a promising strategy by protecting, targeting, and releasing active compounds to fight against these emerging strains. The aim of this study is to explore the antibacterial potential of nanoemulsions (NEs) as reported in the scientific literature. A literature review was carried out using searches performed in May 2023, on databases such as PubMed, Web of Science, and Scopus, utilizing the keywords "nanoemulsion", "antibiotic activity," "antibacterial activity," and "antimicrobial activity." All scientific articles related to the health area and published in the last 5 years were included. Several NE systems proved to be efficient in combating gram-positive and gram-negative bacterial strains in preclinical studies, often employing vegetable or essential oils as a matrix. Some studies use NEs as a vehicle for antibacterial drugs, while others develop NEs based on antibacterial oils and incorporate actives that act synergistically. All studies indicated that oil-based NEs with inherent antibacterial activity, even without the presence of drugs, had superior action against strains compared to non-emulsified oil, as well as other systems incorporating drugs or actives. Although the results are promising, further investigations and testing of formulations against resistant bacterial strains are necessary. This review aims to provide valuable insights for researchers and contribute to future advancements in this field.

Abstract

Background: Disinfectants are an important tool for infection control in hospitals. However, some bacteria are resistant to these disinfectants and/or can indeed be found in them as contaminants. The purpose of this study is to examine the presence of Pseudomonas aeruginosa (P. aeruginosa) as a possible contaminant in disinfectants used in a sample of hospitals in Khartoum, Sudan.

Methods: This cross-sectional study was carried out between November 2020 and October 2021. A total of 45 disinfectant samples from nine hospitals in Khartoum were analyzed. Phenotypic methods including gram staining, culture and biochemical tests along with genotypic methods based on Polymerase Chain Reaction (PCR) were utilized to detect the presence of P. aeruginosa. The disc diffusion method was used to test the antibiotic susceptibility of bacterial isolates. Several ß-lactamase genes were also identified using PCR.

Results: Seven samples (15.5%) of the 45 disinfectant samples were found to be contaminated with P. aeruginosa. These samples were from different types of disinfectants. Samples of chloroxylenol type were found to be predominantly contaminated. P. aeruginosa was also detected in sodium hypochlorite and chlorhexidine gluconate-cetrimide types of disinfectants. Several P. aeruginosa isolates exhibited resistance to agents of both the penicillins and cephalosporins groups of antibiotics and many strains were found to be positive for blaTEM-1 resistance gene.

Conclusions: The investigation showed a considerable amount of contamination with P.aeruginosa. Microbial contamination of disinfectants with P. aeruginosa is considered a matter of concern and poses a great risk to patients in hospitals. It is essential to use different strategies to monitor the spread of this pathogen.

Antibiotic resistance, a growing concern for various reasons, underscores the urgency of discovering new antibiotics. However, the emergence of resistance mechanisms remains a formidable challenge. One such mechanism is the efflux pumps, which actively extrude antibiotics from bacterial cells, reducing their intracellular concentrations. Inhibiting these pumps can restore antibiotic efficacy. Natural sources are actively explored for potential inhibitors. This study aimed to assess the inhibitory potential of a methanol extract from the macrofungus Phellinus hartigii against multidrug-resistant (MDR) E. coli strains known to harbour active efflux pumps. These strains exhibited resistance to Amoxicillin-Clavulanate (AMC) with a MIC >32/2 (R). Inhibition was initially determined using the Ethidium Bromide (EtBr) test. Subsequently, combination studies involving the strain, antibiotic disks, and the extract revealed that the extract effectively arrested microorganism growth. Gas Chromatography-Mass Spectrometry (GC/MS) analysis of the extract identified major components, notably 2-methylhexacosane (59.10%) and Nonadecyl heptafluorobutyrate, which accounted for over 9% of the total area. Fourier transform infrared spectroscopy (FTIR) analysis of the strain treated with a combination of the extract and antibiotic provided insights into the inhibitory mechanism. Significant differences were observed in FTIR peaks, particularly in the region between <900 cm ^-1 and 3000 cm ^-1 . These findings warrant further investigation to elucidate the inhibitory effects comprehensively.
Acknowledgement: This study was supported by the Kastamonu University Scientific Research Project
(KÜBAP-01-2021-47).