Journal of Global Antimicrobial Resistance

BackgroundThe rise of antimicrobial resistance (AMR) in the Lake Chad Basin poses a significant threat to global health. While Escherichia coli and Klebsiella pneumoniae are primary concerns for the WHO, Proteus species have emerged as important clinical pathogens and potential reservoirs for genetic resistance. This study aimed to analyze the molecular diversity and horizontal gene transfer (HGT) potential of ESBL-producing Proteus species in the region. MethodsA regional surveillance was conducted with 1,500 clinical samples from Borno, Adamawa, Bauchi, Gombe, Taraba, and Yobe states. Proteus isolates were identified biochemically, and antibiotic susceptibility was assessed using the Kirby-Bauer method. Resistance genes (blaTEM, blaSHV, blaCTX-M) were identified via PCR, and HGT was evaluated through conjugation assays. ResultsA total of 144 Proteus isolates were identified, with a prevalence of 9.6%. P. mirabilis was the dominant species (90.97%). Phenotypic screening indicated that 69.44% produced extended-spectrum beta-lactamases (ESBL), with high resistance rates observed for Cefotaxime (80.56%) and Ampicillin (84.72%). Alarmingly, resistance to Ertapenem reached 54.86%. Molecular analysis showed blaTEM as the predominant gene (81.69%), and the conjugation assay revealed a high HGT rate of 76.92%, confirming blaTEM acquisition by E. coli. ConclusionThese results indicate that Proteus species in North-Eastern Nigeria are significant reservoirs for genetic resistance, facilitating the spread of ESBL markers. The high frequency of HGT raises concerns about the effectiveness of beta-lactam therapies in sub-Saharan Africa, underscoring the need to include Proteus in the GLASS framework and promote regional antimicrobial stewardship efforts. Current UnderstandingAntimicrobial resistance (AMR) in Enterobacteriaceae, particularly with Escherichia coli and Klebsiella pneumoniae, is a significant global issue highlighted by the World Health Organizations Global Antimicrobial Resistance and Use Surveillance System (WHO GLASS). While Proteus species are recognized as opportunistic pathogens, their role as genetic reservoirs in sub-Saharan Africa, especially in the Lake Chad Basin, remains inadequately defined in surveillance data. Study ContributionThis study identifies Proteus species as a critical "Genetic Hub" for the transmission of extended-spectrum beta-lactamases (ESBL) in North-Eastern Nigeria, revealing a high horizontal gene transfer (HGT) rate of 76.92% for the blaTEM genotype to E. coli. It also shows a concerning 54.86% resistance rate to Ertapenem, underscoring the urgent need to include Proteus in regional stewardship and global surveillance efforts.

The well-known discrepancy between the in vitro and in vivo efficacy of {beta}-lactam antibiotics in metallo-{beta}-lactamase (MBL) containing Gram-negative bacteria has during recent years been found to be at least partially explained by zinc levels at infection sites being much lower than those found in conventional cation-adjusted Mueller-Hinton Broth (caMHB) media used for in vitro susceptibility testing. Previous studies have also demonstrated that a high variability exists with respect to zinc content in caMHB from different manufacturers, potentially leading to differences in SIR interpretations for {beta}-lactam antibiotics with MBL-carrying isolates, depending on the brand of caMHB used for testing. APC148 is a zinc-chelating compound acting as an inhibitor of MBL enzymes and is currently undergoing phase one in clinical trials. In this study, ten clinical isolates of Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa and Acinetobacter baumannii harbouring MBLs (NDM, n = 6; VIM, n = 4; IMP, n = 1) were tested in a broth microdilution assay with meropenem and APC148, employing caMHB of various brands. One K. pneumoniae strain carrying only a serine-{beta}-lactamase (KPC-2) was included as control. Antimicrobial susceptibility testing (AST) by broth microdilution was performed according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST). MICs of meropenem alone and in combination with inhibitors were tested in four cation-adjusted Mueller Hinton II (caMHB).The four caMHBs used were analysed by ICP-MS/MS and found to have highly vaiable zinc content (in the range 0.4 to 1.9 {micro}g/mL, corresponding to 5.6 to 29.4 {micro}M). At 16{micro}g/ml APC148 lowered the MIC in nearly all strains and in caMHBs from all manufacturers. At lower concentrations of APC148 (4 or 8 {micro}g/mL), this MIC reduction could however only be retained when the zinc concentration in the broth was low, indicating that higher concentration of inhibitor is needed during in vitro Mic testing when using caMHB from certain manufacturers. The present work clearly shows that not taking the zinc concentration of the caMHB used into consideration when estimating MIC performance of compounds functioning through interactions with zinc may be a considerable source of error, and specifically when investigating potential inhibitors of metallo-{beta}-lactamase (MBL) enzymes. The present work supports the call for standardising zinc content in caMHB to be used for this purpose, to ensure that MIC results for drug combinations involving the use of zinc-chelating compounds are consistent and reproducible across laboratories.

ObjectivesTo develop a population pharmacokinetic (PPK) model of polymyxin B (PMB) for intravenous (IV) and combined intravenous plus inhaled (IV+IH) administration in critically ill patients, and evaluate the association between the 24-h steady-state area under concentration-time curve to minimum inhibitory concentration ratio (AUCss,24h/MIC) and clinical outcomes. MethodsThis prospective cohort was conducted in the ICU of the Third Xiangya Hospital, Central South University (ethics R19048; ChiCTR1900028602). Adults with multidrug-resistant Gram-negative bacterial infections receiving PMB [≥]48 h were enrolled and assigned to IV or IV+IH groups. Serial plasma samples were analyzed by validated LC-MS/MS. The PPK model was developed with NONMEM(R). Clinical efficacy at end of treatment was blindly assessed. ResultsForty-three patients were enrolled (IV, n=22; IV+IH, n=21), with an overall clinical success rate of 66.7%. A two-compartment PPK model best described the data, with typical values of clearance (2.6 L/h), central volume (13.6 L), and peripheral volume (17.6 L). Clearance was influenced by creatinine clearance and total bile acids. In the overall cohort, neither AUCss,24h nor AUCss,24h/MIC differed significantly between clinical success and failure (p=0.591 and 0.143). In the IV group, AUCss,24h/MIC was significantly higher in responders (p=0.005) with an ROC-derived efficacy threshold of 94.37; AUCss,24h showed a non-significant trend (p=0.076). No exposure- response relationship was observed in the IV+IH group (p=0.398 and 0.495). ConclusionsPlasma AUCss,24h/MIC appears to be associated with clinical efficacy during IV monotherapy but not in IV+IH regimens, likely due to high pulmonary exposure. Plasma-based PK/PD targets should be applied cautiously when inhalation is added.

Background: Rising antibiotic resistance challenges empirical therapies for urinary tract infections (UTIs). This study evaluated the microbial etiology, susceptibility profiles, and multidrug resistance (MDR) patterns of uropathogens among outpatients at the Berekum Holy Family Hospital, Ghana. Methods: This cross-sectional study (February to August 2021) screened 263 symptomatic outpatients. Mid-stream urine samples underwent quantitative culture, biochemical identification, and antimicrobial susceptibility testing via the Kirby-Bauer disc diffusion method following the 2021 CLSI guidelines. Results: Significant bacteriuria prevalence was 22.8% (60/263). UTIs predominated in females (78.3%, 47/60; p = 0.1501) and individuals [≥]45 years (33.3%, 20/60). Gram-negative rods accounted for 90.0% of isolates, primarily Escherichia coli (26.7%), Citrobacter spp. (25.0%), and Enterobacter spp. (21.7%); Staphylococcus aureus (10.0%) was the only Gram-positive pathogen. Extreme phenotypic resistance was observed against piperacillin/tazobactam (98.3%), cefotaxime (93.3%), tetracycline (88.3%), and cefoperazone (85.0%). Conversely, highest therapeutic susceptibilities were retained by amikacin (78.3%), levofloxacin (61.7%), and gentamicin (58.3%). Conclusion: The high prevalence of MDR uropathogens against advanced beta-lactamase inhibitor combinations and cephalosporins necessitates an immediate re-evaluation of regional empirical protocols. Amikacin, levofloxacin, and gentamicin remain viable options prior to culture confirmation. These findings establish a crucial phenotypic baseline to guide localized prescribing policies and regional antimicrobial resistance tracking strategies.

Biofilms pose a significant challenge to antimicrobial therapy. Bacteria in biofilms differ from planktonic counterpart in their altered metabolism, collective behavior, protective role of extracellular matrix and diversified microbial subpopulations. These attributions significantly influence bioavailability and activity of antibiotics. The presence of bacterial aggregates during acute infections expands the problem to many other conditions previously not discussed in the biofilm context. Klebsiella pneumoniae is a leading cause of life-threatening hospital-acquired infections and is included in the WHO Bacterial Priority Pathogens List due to increasing antimicrobial resistance. The combination of antimicrobial resistance and the ability to form biofilms severely limits the efficacy of antibiotic treatments. In this study, we investigated the in vitro susceptibility of mature biofilms to 13 antimicrobials of K. pneumoniae clinical isolates from a single hospital. The resistance profiles of the local clinical isolates were consistent with the global epidemiology of K. pneumoniae. Minimal biofilm eradication concentrations (MBEC) for mature biofilms were defined with two assays (biomass and metabolic activity measurements) and brought into relation with susceptibility breakpoints and plasma (Cmax). Colistin sulfate, tigecycline, cephalosporins and combination of imipenem with cilastatin were the most potent biomass eradicators, while suppression of metabolic activity was barely reachable. Moreover, we observed a notable increase in metabolic activity upon exposure to sub-MBEC concentrations of antibiotics. Finally, our data broach a subject of antibiotic prioritization with respect to biofilm tolerance. IMPORTANCEThis study addresses the critical gap between standard antibiotic susceptibility testing and the tolerance of biofilm and microbial aggregates during infections caused by K. pneumoniae. By systematically evaluating mature biofilms from a significant number of clinical isolates, we demonstrate that colistin and tigecycline show potent activity against both biofilm biomass and metabolic activity, whereas cephalosporins primarily reduce biomass without effectively suppressing bacterial metabolism, and other drugs have only weak effects on biofilms at clinically achievable concentrations. Furthermore, the alarming observation that sub-inhibitory biofilm eradication concentration (sub-MBEC) of antibiotic can paradoxically increase the metabolic activity of biofilms highlights a potential risk factor for therapy failure and resistance development. Our findings contribute to the necessary evidence base for prioritizing existing antibiotics in the limited armamentarium against biofilm-forming K. pneumoniae.

Pseudomonas aeruginosa is an opportunistic pathogen that can cause severe infections in immunocompromised individuals, such as patients with cystic fibrosis where it commonly forms biofilms. Ciprofloxacin is used extensively to treat P. aeruginosa infections, but its effectiveness can be significantly reduced due to biofilm formation. Although many individual genes associated with biofilm formation or ciprofloxacin resistance have been characterised, the genetic basis of P. aeruginosa biofilm fitness related to antibiotic challenge remains incompletely understood. In this study we employed a whole genome screen to assay the impact of gene disruptions or altered gene expression on survival of P. aeruginosa biofilms exposed to different concentrations of ciprofloxacin. Genes impacting fitness in the biofilm context were identified by comparing the biofilm samples to planktonic samples harvested at 12h, 24h and 48h with and without ciprofloxacin. Genes associated with c-di-GMP regulation and Gac/Rsm signalling were identified as primary regulators for biofilm formation in the presence and absence of ciprofloxacin. In addition, a group of genes involved in respiration, metabolism (especially polyamine metabolism), and various transporter and efflux systems were identified as important for biofilm fitness. Ciprofloxacin specifically imposed a selective pressure on flagellar function and Psl production which were essential for survival in early biofilms. Moreover, transposon insertions within the CPA gene clusters (PA5448-PA5451 and PA5455-PA5456) and the salvage peptidoglycan recycling pathway showed reduced fitness in late biofilms at high concentration of ciprofloxacin, indicating that cell envelope integrity is beneficial for mature biofilms. This study identifies important determinants of survival for biofilms at different stages of maturity in the presence and absence of ciprofloxacin and implicates potential therapeutic targets for antibiofilm drug development.

We report the isolation and identification of a Paenibacillus polymyxa strain from the citizen science project; Swab and Send. Through whole genome sequencing we are able to describe the biosynthetic gene cluster of polymyxin A produced by P. polymyxa 1G (NCBI accession no. JBVPZV000000000), compare the pmxA, pmxB and pmxE genes to five other polymyxin genes encoding known polymyxin variants, and provide mass spectrometry data that supports the production of polymyxin A1 (1157 m/z) and A2 (1143 m/z). Polymyxins are ranked in the highest priority critically important antimicrobials classification by the WHO and are of particular importance for treating gram-negative multidrug resistant pathogens. Due to the discovery of polymyxins occurring in the 1940s, there is little genetic research around polymyxins, and the literature focusses primarily on clinically used polymyxin E (colistin) and polymyxin B. Previous literature suggests that polymyxin A1 has similar/lower toxicity to clinically used polymyxins E and B. To test if polymyxin A was able to overcome current resistance mechanisms to clinically used polymyxins, the cell free supernatant from P. polymyxa 1G was tested against a panel of clinical isolates with various resistance genes. We found that resistance genes mcr-1 and mcr-4 confer resistance to polymyxin A produced by our isolate meaning that, while polymyxin A has good antimicrobial activity, clinical resistance mechanisms already confer resistance to this variant of polymyxin.

AimsPseudomonas aeruginosa biofilm-associated infections pose a significant clinical challenge due to their inherent antibiotic tolerance. This study aimed to evaluate the antibacterial and antibiofilm activity of Placentrex, a standardised aqueous placental extract, against P. aeruginosa and to elucidate its molecular mechanism of action using RNA sequencing (RNA-seq). Methods and ResultsPlacentrex exhibited potent bactericidal activity against P. aeruginosa at 50 mg/mL. Biofilm formation was significantly inhibited by [~]87% at 50mg/mL after 72 hours. Preformed biofilms were eradicated by [~]93% and [~]89% at 50 and 25 mg/mL, respectively. Interestingly, biofilm viability was reduced by [~]93% and [~]87% upon treatment with 50 mg/mL and 25 mg/mL of Placentrex, respectively. EPS characterisation revealed that the EPS contain a single large polysaccharide, and chromatography data suggested that it is made up of glucose as a monomer. RNA-seq identified coordinated downregulation of seven key genes, namely, flp major pilin (surface attachment), extracellular solute binding protein (ABC transporter-mediated nutrient sensing and biofilm maintenance), gntP permease (carbon metabolism), AraC family transcriptional regulator (quorum sensing and polysaccharide biosynthesis), ureE (urease nickel metallochaperone), aromatic amino acid permease (pyoverdine and PQS biosynthesis), and MFS transporter (efflux and autoinducer export). ConclusionsPlacentrex exerts comprehensive antibiofilm and antibacterial activity through simultaneous disruption of surface attachment, nutrient-sensing-driven biofilm maintenance, quorum sensing, carbon metabolism, urease virulence maturation, and efflux-mediated persistence. This polypharmacological mechanism supports Placentrex as a promising multi-target antibacterial agent against P. aeruginosa biofilm-associated infections. Impact statementPlacentrex is a potential anti-biofilm agent against Pseudomonas aeruginosa.

Rationale: Infections due to Extended-spectrum {beta}-lactamases-producing Enterobacterales (ESBL-PE) require empirical treatment with carbapenems. ESBL-PE carriage is considered as a risk factor for ESBL-PE involvement during ICU infection. Our aim was to determine factors that may predict the actual involvement of ESBL-PE. Methods: A two-periods bicentric ambispective study including ICU ESBL-PE carriers patients from April 2011 to January 2019. All ESBL-PE carriers who developed an infection were analyzed. Results: 6112 patients and 4902 patients were screened during the two periods. 384 and 232 ESBL-PE carriers were identified. Total number of infectious episodes were 146 and 114, respectively. A total of 144 pneumonias, 42 urinary tract infection and 45 digestive infections were studied. An ESBL-PE was involved in 35 (24.3%) episodes of pneumonia, and 44 (37.9%) of extra-pulmonary infections. The most frequent ESBL-PE involved were K. pneumoniae, E. cloacae and E. coli. Similar species and phenotypes were present in colonisation and infection in 29 (82.8%) of pneumonia and in 40 (90.9%) of extra-respiratory infection. Multivariate analysis identified Klebsiella pneumonia or Enterobacter cloacae carriage as risk factor for ESBL-PE involvement in pneumonia and E. coli carriage and detection of ESBL-PE carriage before ICU admission as protective factors. Conclusion: In our study an ESBL-PE involvement is infrequent in pneumonia. A known carriage before ICU admission and E. coli carriage are factors associated with the absence of ESBL-PE un the episode of respiratory infection. A confirmation of our findings could lead to a reduction in the empirical use of carbapenems in this population.

Carbapenemase-producing Enterobacterales represent a growing global threat due to their extensive antimicrobial resistance and rapid dissemination. This study characterized the phenotypic and genomic features of Escherichia coli and Klebsiella pneumoniae isolates collected between 2020 and 2022 from four healthcare institutions in Lima, Peru. A total of 320 non-redundant isolates (61 E. coli and 259 K. pneumoniae) were analyzed through antimicrobial susceptibility testing, polymerase chain reaction, and whole-genome sequencing. The most frequent carbapenemase gene was blaNDM (69%), followed by blaKPC (16.9%) and blaOXA-48-like (4.6%). Eleven K. pneumoniae isolates co-produced NDM and KPC, and one E. coli isolate co-harbored NDM and OXA-48-like. All isolates were multidrug resistant, and 5% were pandrug resistant. Novel {beta}-lactam/{beta}-lactamase inhibitor combinations such as aztreonam/avibactam and cefiderocol showed complete activity against all classes of carbapenemases. Genomic analysis revealed predominant E. coli sequence types ST167 and ST410 and K. pneumoniae lineages ST147, ST15, ST45, and ST273. The blaNDM-5 allele was detected for the first time in Peru, mostly in E. coli ST167, carried on multireplicon IncF-type plasmids. In K. pneumoniae, ST147 was identified as a dominant clone associated with blaNDM-1, indicating sustained local dissemination of high-risk clonal groups. The coexistence of multiple carbapenemases and plasmid backbones highlights the ongoing evolution of resistance mechanisms. These findings provide actionable evidence to guide treatment strategies in settings with high prevalence of metallo-{beta}-lactamases and underscores the need for continuous genomic surveillance and antimicrobial stewardship to mitigate their clinical and epidemiological impact.

Staphylococcus aureus and Streptococcus pyogenes are major causative bacteria responsible for skin and soft-tissue infections (SSTIs) such as impetigo. Increasing resistance to commonly used topical antibiotics necessitates evaluation of newer agents for the treatment of skin infections. Ozenoxacin, a novel non-fluorinated topical quinolone, has shown promise, exhibiting potent activity against a wide range of pathogens, including methicillin-resistant Staphylococcus (MRSA) and Streptococcus pyogenes. The present study compared the in vitro activity of ozenoxacin and comparator agents against clinical isolates of Staphylococcus aureus and Streptococcus pyogenes from multiple sources including skin and soft-tissue, wound, abscess, and blood. Ozenoxacin was assessed for in vitro antimicrobial activity against 109 methicillin-susceptible (MSSA), methicillin-resistant S. aureus (MRSA), and 24 Streptococcus pyogenes isolates by broth microdilution method recommended by the Clinical and Laboratory Standards Institute (CLSI). Ozenoxacin demonstrated potent in-vitro activity against all 109 S. aureus (MIC50/90= 0.125/0.5 {micro}g/ml) and 24 S. pyogenes (MIC50/90= 0.015/0.03 {micro}g/ml) strains. In contrast, higher MICs were observed for fusidic acid and mupirocin among a subset of S. aureus isolates. A comparison of MIC90values demonstrated that ozenoxacin (0.5 {micro}g/ml) was more active against S. aureus isolates than 8 of the 9 comparator agents tested including vancomycin and linezolid (MIC90= 2 & 4 {micro}g/ml) respectively. In vitro studies of ozenoxacin showed potency against staphylococci and streptococci including resistant S. aureus strains. These findings support its role as an effective first-in-class quinolone topical therapeutic option in the management of various SSTIs.

Background: Antimicrobial resistance (AMR) disproportionately affects low- and middle-income countries (LMICs) such as Pakistan, where obstetric and gynaecological (OBGYN) patients carry high antibiotic exposure. Specialty-specific drug utilization data with concurrent stewardship audit remain scarce. This study evaluated antibiotic prescribing patterns, consumption metrics, and antimicrobial stewardship program (AMS) compliance in OBGYN inpatients at a public sector tertiary care hospital. Methods: A prospective cross-sectional study was conducted in OBGYN wards of Dow University Hospital, Karachi, from 1 September to 31 October 2025. Women receiving [≥]1 systemic antibiotic were included. Daily AMS rounds were conducted by an Infectious Diseases physician and pharmacist. Antibiotic consumption was measured as Defined Daily Doses (DDD) and Days of Therapy (DOT) per 1,000 patient-days (total = 821). Antibiotics were classified by WHO AWaRe (2023) framework. Results: Of 812 total admissions, 278 patients (34.2%) received [≥]1 antibiotic and were enrolled (205 obstetric, 73 gynaecological), generating 636 prescriptions (mean 2.29/patient). Surgical prophylaxis was the predominant documented indication (213, 33.5%); 65.1% carried no documented indication. By AWaRe classification, 53.6% were Access-group and 46.1% Watch-group. Ceftriaxone (38.4%) and metronidazole (36.8%) together represented 75.2% of prescriptions. Combined DDD/1,000 patient-days was 1,758.6 and DOT/1,000 patient-days was 1,852.7. AMS compliance was 0%. Conclusions: This study documents high antibiotic prescribing burden, near-universal documentation failure, and zero AMS compliance in OBGYN inpatients at a Pakistani public sector hospital. The predominance of Watch-group antibiotics and undocumented surgical prophylaxis highlights structural stewardship gaps. Findings support urgent need for institutional OBGYN antibiotic guidelines and structured pharmacist-led AMS programs.

SynopsisO_ST_ABSBackgroundC_ST_ABSTime kill curve (TKC) assessments are an essential step in the study of an antimicrobials pharmacodynamic characteristics. Surprisingly TKCs have not be formally standardised, therefore there remain concerns that different testing centres/methodologies may produce different results. Six centres participating in Gram-negative-Antibiotics NOW (GNA-NOW) consortium measured a series of TKCs with meropenem against E. coli to establish: Same-day (SD) vs different-day (DD) replication per centre (intra-site), and centre to centre (inter-site) correlations. MethodsMeropenem was tested against three strains of E. coli (ATCC 25922; ESBL producer C1.55; OXA-48 producer C1.62). An inoculum of 1.5x106 CFU was specified with meropenem concentrations of x0, x1 to x16 MIC; and sampling assessment of bacterial density was determined at 0-24h. Experiments were performed in triplicate, aerobically at 37{degrees}C. Centre-specific methodology was collected. Meropenem, media, bacterial strains, were shipped from one central laboratory to participating laboratories. ANOVA and Friedman tests were used to assess SD, DD and between centre replications. ResultsAssessment of the methodologies between centres revealed many differences, including bacterial inoculum, meropenem preparation, volume of TKC vessel, vessel materials, agitation vs static cultures and sampling volumes. Intra-centre SD and DD analysis for all strains were generally associated with P>0.05 suggesting consistency. Inter-centre SD and DD comparisons resulted in P<0.05, indicating variable total bacterial load measurement between centres. ConclusionsTKC methodologies varied between different centres, and while intra-centre comparison of SD and DD were generally consistent, inter-centre comparisons were not. Standardisation of TKC methodologies is required.

ABSTRACT Background: Self medication with analgesics and non steroidal anti inflammatory drugs (NSAIDs) is common in low- and middle income countries and may expose users to preventable adverse outcomes. Evidence from Guinea remains scarce. This study aimed to estimate the prevalence of self medication with analgesics and NSAIDs among pharmacy clients in urban Conakry, identify associated factors, and describe clinical risk situations. Methods: We conducted a pharmacy based analytical cross sectional study in 30 private pharmacies across Conakry, Guinea. A total of 1,032 participants seeking analgesics or NSAIDs were enrolled between November 3, 2012, and April 5, 2013. Self-medication was defined as acquisition or use without a valid medical prescription. Factors associated with self-medication were analysed using multivariable logistic regression. Results: Among 1,032 participants, 603 reported self medication (prevalence 58.4%). Previous unsupervised use was reported by 78.7%. The most frequently used medicines were paracetamol (56.9%, n=587), diclofenac (21.3%, n=220), ibuprofen (17.9%, n=185), and aspirin (3.9%, n=40). Overall, 68.0% (n=702) reported no knowledge of potential adverse effects. Clinical risk situations were frequent: gastrointestinal disorders (41.3%, n=426), hypertension (9.2%, n=95), and pregnancy exposure among reproductive age women (26.0%). In multivariable analysis, self medication was independently associated with previous analgesic/NSAID use (aOR = 2.8, 95% CI: 2.1 to 3.6), lack of knowledge of adverse effects (aOR = 1.9, 95% CI: 1.4 to 2.5), informal occupation (aOR = 1.6, 95% CI: 1.2 to 2.2), and age 18 to 59 years (aOR = 1.5, 95% CI: 1.1 to 2.1). Conclusions: In this pharmacy based study conducted in urban Conakry, self medication with analgesics and NSAIDs was common and frequently associated with limited awareness of potential adverse effects. These findings support the need for strengthened pharmaceutical regulation, pharmacist-led counselling, health literacy interventions, and improved access to primary care. Keywords: self medication; analgesics; NSAIDs; paracetamol; diclofenac; ibuprofen; pharmacy; Guinea; Conakry; drug safety; public health.

Resistance to {beta}-lactam antibiotics, including carbapenems, mediated by metallo-{beta}-lactamases (MBLs), including the New Delhi metallo-{beta}-lactamase (NDM) MBL subfamily, is increasing. No MBL inhibitors are currently approved for clinical use with most reported MBL inhibitors are metal ion chelators, acting either at the Zn(II) ion active site and/or in solution. The hexokinase inhibitor 3-bromopyruvate (3-BP) is reported to inhibit NDM-1. We found that 3-BP selectively restored the antimicrobial activity of meropenem against carbapenem resistant Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii strains, obtained from clinical and environmental isolates from Tanzania and Malawi, containing genes that encode NDM-1 or NDM-5, but not against strains containing genes encoding for serine {beta}-lactamases. Mass spectrometry studies with NDM-1 and NDM-5 support a mechanism involving covalent reaction of 3-BP with an active site cysteine residue. The results will promote work on the development of covalently reacting MBL inhibitors, a strategy that has been successful for inhibition of the nucleophilic serine {beta}-lactamases.

Background: Multidrug-resistant tuberculosis (MDR-TB) remains a significant public health threat in low- and middle-income countries, including Cameroon. This systematic review and meta-analysis aimed to determine the pooled prevalence of MDR-TB and other specific anti-tuberculosis drug resistance patterns, as well as to identify factors associated with drug-resistant tuberculosis in Cameroon. Methods: A comprehensive literature search was conducted in PubMed, Scopus, Web of Science, Embase, Cochrane Library, and African Journals Online. Additional studies were identified through Google Scholar and reference list screening. Observational studies (cross-sectional, cohort, and case-control) reporting drug resistance among bacteriologically confirmed tuberculosis patients in Cameroon were eligible. Joanna Briggs Institute critical appraisal tools were used to critically assessed the study quality. Pooled prevalence estimates were calculated using random-effects meta-analysis. Subgroup analyses and meta-regression explored sources of heterogeneity. A p-value 0.05 was considered statistically significant. Results: Twenty-eight studies conducted between 1995 and 2022 were included. The pooled prevalence of MDR-TB was 5.2% (95% CI: 2.7-9.6; 21 studies; n = 7,515), with significantly higher acquired resistance (11.6%; 95% CI: 6.3-20.3) than initial resistance (2.0%; 95% CI: 1.1-3.5). The highest pooled MDR-TB prevalence was observed in the most recent studies (38.8%; 95% CI: 33.7-44.2), and the lowest in 2015-2019 (2.7%; 95% CI: 0.4-15.2). Any resistance to anti-tuberculosis drugs was 16.0% (95% CI: 10.3-23.9; 28 studies; n = 9,931), and rifampicin resistance was 4.6% (95% CI: 2.4-8.6; 25 studies; n = 8,728). Monoresistance was highest for streptomycin (6.4%; 95% CI: 3.7-10.8) and isoniazid (4.7%; 95% CI: 3.0-7.4). Previous tuberculosis infection was the strongest predictor of drug resistance (OR = 3.9; 95% CI: 1.8-8.4), followed by alcohol consumption (OR = 1.8; 95% CI: 1.2-2.7) and history of incarceration (OR = 1.7; 95% CI: 1.1-2.6). High heterogeneity was observed across most of the pooled estimates. Conclusions: Drug-resistant tuberculosis, particularly MDR-TB, poses a substantial burden in Cameroon, with acquired resistance significantly exceeding initial resistance. Previous tuberculosis infection, alcohol use, and incarceration are key modifiable risk factors. These findings underscore the urgent need to strengthen routine drug susceptibility testing, scale up rapid molecular diagnostics, enhance treatment adherence strategies, and implement targeted interventions for high-risk populations.

Acinetobacter spp. represents critical opportunistic pathogens driving severe bloodstream infections (BSIs) in intensive care unit (ICU) and neonatal intensive care unit (NICU) settings. The convergence of carbapenem resistance and emerging biocide tolerance, often mediated by mobile genetic elements, has intensified concerns regarding co-selection and persistence in clinical environments. A total of 90 molecularly confirmed Acinetobacter isolates (ICU = 44; NICU = 46) from bloodstream infections were analyzed. Antimicrobial susceptibility was determined using the Kirby-Bauer disk diffusion method in accordance with CLSI M100 (2024) guidelines and extended-spectrum {beta}-lactamase production was assessed by combined disc diffusion. Polymerase chain reaction (PCR) was employed to detect carbapenemase genes (blaVIM, blaNDM, blaIMP, blaOXA-23, blaOXA-58), biocide resistance determinants (qacE, qac{Delta}E1), and the class 1 integron-integrase gene (intI1). Multidrug-resistant (MDR) and extensively drug-resistant (XDR) phenotypes were identified in 71.1% (64/90) and 22.2% (20/90) of isolates, respectively. High resistance (>71%) was observed against meropenem and cephalosporins, whereas colistin (51.1%, 46/90) and amikacin (47.8%, 43/90) showed moderate susceptibility. The most prevalent genotypes were qac{Delta}E1 (76.6%, 69/90) and blaVIM (56.6%, 51/90). Statistical and network analyses revealed significant correlations between biocide and carbapenemase genes, identifying IntI1 as a primary driver of co-resistance. The findings demonstrate that integron-mediated co-carriage of carbapenemase and biocide resistance genes is a major driver of MDR and XDR phenotypes in Acinetobacter BSIs. This co-selection dynamic highlights the urgent need to reassess disinfection strategies alongside antimicrobial stewardship to curb the persistence and spread of highly resistant strains in critical care settings.

Oligella otitidis MSHR-50489EDL strain (ATCC: TSD462; DSMZ: DSM118617) is a new species of the genus Oligella that was isolated from a middle ear discharge swab from a child with chronic suppurative otitis media (CSOM). This Gram-negative coccobacillus produces small, circular, smooth, whitish-opaque and occasionally mucoid colonies. It grows in aerobic conditions at a temperature range from 25-42oC. Phylogenetic analysis demonstrates a relationship to other species of the genera Oligella and average nucleotide identity and digital DNA/DNA hybridization values indicate a distinct species in comparison to other Oligella species. Thus far, the majority of isolates exhibit resistance to ciprofloxacin, the first line treatment for CSOM.

IntroductionEnteric fever, being endemic with seasonal peaks in low- and middle-income countries, is a major health concern. Moreover, the rise in antibiotic resistance has exacerbated the situation. This study was undertaken to investigate the lytic bacteriophages against Salmonella Typhi with a potential for phage therapy. Materials and MethodsA hospital-based cross-sectional study was conducted from October 2023 to March 2024. Blood cultures were processed by the BACTEC automated culture system following standard microbiological techniques to isolate typhoidal Salmonella. Antibiotic susceptibility was tested by the modified Kirby-Bauer disc diffusion method. Lytic bacteriophages isolated by the double-layer agar method were assessed for their host range and lytic ability with spot and turbidimetric assays. ResultsOf the total 1054 blood specimens, 35 (3.2%) were positive for S. Typhi. All the isolates were susceptible to first-line antibiotics--ampicillin, chloramphenicol, and cotrimoxazole. The isolates were also sensitive to nalidixic acid (80%) as well as fluoroquinolones; ciprofloxacin (62.86%), levofloxacin (77.14%), and ofloxacin (80%). Fifteen lytic phages were isolated against S. Typhi Ty2 and CT18 strains. Four phages--vB_SaTy_ST2, vB_SaTy_ST7, vB_SaTy_ST17, and vB_SaTy_ST18--lysed all 35 clinical S. Typhi isolates. While vB_SaTy_ST17 and vB_SaTy_ST18 also lysed 7 out of 20 S. Paratyphi A isolates. Three phages (vB_SaTy_ST2, vB_SaTy_ST7, vB_SaTy_ST17) were tested against S. Typhi isolate S30. Individually, vB_SaTy_ST17 suppressed the growth for 13 hours, vB_SaTy_ST2 and vB_SaTy_ST7 for 10 hours. The phage cocktail vB_SaTy_ST2 + vB_SaTy_ST17 was the most effective, which extended the inhibition time to 15 hours. ConclusionThis study highlights the ongoing burden of enteric fever in Nepal and the increase in susceptibility of S. Typhi to nalidixic acid and fluoroquinolones. It also demonstrates the promising lytic potential of bacteriophages, particularly vB_SaTy_ST17 and the phage cocktail vB_SaTy_ST2 + vB_SaTy_ST17, against clinical S. Typhi, highlighting their potential as alternatives to antibiotics.

Clinically relevant pathogens are often tested for antimicrobial susceptibility using standard laboratory media that poorly reflect the in vivo environments in which they cause infections, leading to poor clinical outcomes. In this study, we aim to understand the impact of media on the global transcriptome, biofilm formation, and antibiotic susceptibility of methicillin-resistant Staphylococcus aureus USA300 when cultivated in a physiologically relevant wound medium, such as simulated wound fluid (SWF), compared to cation-adjusted Mueller-Hinton broth (caMHB), a general-purpose medium. The transcriptomics analysis showed upregulation of 865 genes and downregulation of 792 in SWF compared to caMHB. Upregulated genes in SWF are associated with virulence, such as genes coding for fibronectin-binding proteins (fnaAB), serine proteases (splABCDE), as well as genes involved in antimicrobial resistance, such as multidrug efflux pump genes (norB, norC). Conversely, genes associated with transmembrane ion transport, including phosphate transport (pstSCAB, phoU) and potassium intake (kdpABCF), were significantly downregulated in SWF, as further confirmed by increased membrane disruption upon exposure to a membrane-potential-sensitive dye (DiSC3). Biofilm assay showed reduced surface attached biofilm but increased cell-to-cell attachement in SWF compared to caMHB. Antimicrobial susceptibility testing revealed a 2- to 4-fold increase in tolerance to clinically relevant antibiotics in SWF compared to caMHB. Overall, our findings revealed that media affects gene expression, membrane physiology, virulence, and antibiotic tolerance in MRSA, underscoring the need to use physiologically relevant media in routine antimicrobial susceptibility testing and the drug development pipelines.