Journal of Global Antimicrobial Resistance

IntroductionIn sub-Saharan Africa, and more specifically in Cameroon, antimicrobial resistance (AMR) represents a major public health threat. This is underlined by the increasing appearance of multidrug-resistant bacteria. Extended-spectrum {beta}-lactamase producing Escherichia coli (ESBL-Ec), a critical priority bacterium, is increasingly implicated in life-threatening infections in hospital and community settings in Cameroon. Data on the genetic composition of ciprofloxacin-resistant Escherichia coli are limited in Cameroon. This study aimed to investigate the prevalence, genetic diversity, resistance mechanisms in multidrug-resistant Escherichia coli organisms isolated from clinical samples in two hospitals in Yaounde, Cameroon. MethodA cross-sectional study was conducted from February to June 2025 in two healthcare facilities in Yaounde, Cameroon. All clinical samples from in- and out-patients were analysed. After culturing, identification was performed using API20E as per the manufacturers instructions and ESBL production was screened in CHROMagarTM ESBL. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method. Polymerase chain reaction (PCR) was used to detect ESBL and plasmid mediated quinolone resistance (PMQR)genes, as well as mutations in quinolone resistance-determining region (QRDR) (gyrA/parC) Horizontal. plasmid transfer was also investigated. Finally, phylogroup analysis was assessed. ResultThe prevalence of MDR E. coli was 50.7% (n=33/65), all of which (100%) were ESBL producers and 91% were ciprofloxacin-resistant. Highest resistance rates were observed for cefotaxime (100%), ceftriaxone (100%), and ciprofloxacin (91%). The most frequent ESBL genes were blaTEM (36.3%; n=12/33). Among PMQR genes, qnrB was detected in 16.6% (n=5/30) of isolates. Only the ESBL genes were carried by plasmids; the most prevalent plasmid-borne gene was blaTEM (40%), followed by blaCTX-M (26.7%). Mutations within the topoisomerase QRDR (parC gene) were identified in 36.6% (n=11/30) of ciprofloxacin-resistant strains. Phylogroup analysis revealed a predominance of phylogroup A, followed by group B. ConclusionThis study reveals a high prevalence of multidrug-resistance, ESBL (blaTEM dominant) and fluoroquinolone resistance in E. coli in Yaounde, with plasmid dissemination of ESBL genes and chromosomal stabilization of PMQR determinants. The predominance of commensal phylogroups in clinical samples underlines the role of the community reservoir. It is urgent to reinforce " real-time One Health" genomic surveillance in Cameroon.

Antimicrobial resistance in Pseudomonas aeruginosa has emerged as a major clinical concern. Ciprofloxacin has potent intrinsic activity against P. aeruginosa, but resistance to this antibiotic is increasingly reported in clinical settings. In this study, P. aeruginosa ATCC 27853 strain was exposed to gradually increasing ciprofloxacin concentrations for 50 passages ([~]100 days). The final selected resistant strain (CIP-R) with 256-fold of minimum inhibitory concentration was studied further. Whole-genome sequencing revealed 12 genomic alterations, including known mutations in the quinolone resistance-determining genes gyrA (Thr83Ile), parC (Thr177Asn), parE (Glu459Lys). A duplication mutation in nfxB (Tyr153_Gly154dup) was also observed. In addition to these genes, we observed mutations in pilA, tadB, psdR, NP446_RS32055 (TRAP transporter permease), multiple dppA3 variants, and a prophage-associated hypothetical gene (NP446_RS24255), which have not been reported previously. The gyrA Thr83Ile substitution was conserved in 86.38% of ciprofloxacin-resistant clinical isolates retrieved from the NCBI database. Resistance acquisition was accompanied by slower growth, impaired swimming and swarming motility, diminished surface attachment, reduced biofilm formation. The resistant strain has enhanced {beta}-lactamase activity, and resistance to levofloxacin, cefepime, and meropenem together with sensitivity to piperacillin-tazobactam and aztreonam. This study highlights the gyrA Thr83Ile mutation as a key genomic marker for molecular screening of ciprofloxacin resistance and reveals secondary adaptive trade-offs that can be targeted for clinical diagnostic and therapeutic decision-making. In conclusion, achieving high-level ciprofloxacin resistance in P. aeruginosa involves non-target-site genomic adaptations and physiological trade-offs beyond classical target mutations.

Objective: To determine the prevalence of S. aureus among clinical specimens processed at MeTRH and assess the antimicrobial susceptibility patterns and proportion of MRSA among confirmed isolates. Methods: A retrospective descriptive cross-sectional study was conducted using microbiology laboratory records for clinical specimens submitted for bacteriological culture at MeTRH during the study period. A census approach was used, whereby all eligible laboratory records were included. Clinical specimens were processed using routine microbiological procedures, and suspected S. aureus isolates were identified using conventional methods and the VITEK(R) 2 Compact automated identification system. Antimicrobial susceptibility testing was performed using VITEK(R) 2 Compact, with interpretation based on Clinical and Laboratory Standards Institute criteria. Methicillin resistance was determined phenotypically using cefoxitin susceptibility as the surrogate marker. Data were analysed using frequencies and percentages. Results: A total of 1,082 clinical specimens were analysed, of which 37 yielded S. aureus, giving an overall prevalence of 3.42%. Among the confirmed isolates, 21 (56.8%) were recovered from male patients and 16 (43.2%) from female patients. Pus was the predominant specimen type, accounting for 25 (67.6%) isolates, followed by other specimens at 8 (21.6%) and urine at 4 (10.8%). Antimicrobial susceptibility varied considerably. Resistance was highest to benzylpenicillin and amoxicillin, with 100% resistance among tested isolates. Resistance to amoxicillin-clavulanic acid was 75.0%, while 63.3% of isolates tested were resistant to oxacillin. Susceptibility was relatively high to gentamicin (82.8%), ciprofloxacin (77.3%) and clindamycin (75.0%). All isolates tested against linezolid and vancomycin were susceptible. Among 30 isolates with methicillin susceptibility results, 19 (63.3%) were classified as MRSA and 11 (36.7%) as methicillin-susceptible S. aureus (MSSA). Conclusion: The prevalence of S. aureus among clinical specimens processed at MeTRH was relatively low; however, a substantial proportion of isolates demonstrated antimicrobial resistance, particularly to commonly used {beta}-lactam antibiotics. The high proportion of MRSA is of clinical and public health importance. Routine antimicrobial susceptibility testing, hospital-specific antibiograms, antimicrobial stewardship and strengthened infection prevention and control measures are recommended to support appropriate treatment and limit the spread of resistant S. aureus.

The minimum inhibitory concentration (MIC) assay is the gold standard for evaluating antimicrobial activity1. However, conventional agar-based MIC methods often underestimate the potency of physicochemically complex compounds[1, 2]. Hydrophobic and adhesive molecules, such as lipoglycopeptide antibiotics, exhibit poor diffusion and non-specific binding to agar, leading to artificially elevated MIC values compared to broth-based methods[3]. This issue complicates accurate potency assessment and is particularly an issue when attempting resistance frequency (FOR) studies, which must be conducted on solid media. Here, we developed a modified miniaturised agar MIC assay using 1% agarose, 0.002% Tween 80-supplemented tryptic soy broth (TSB), and a 24-well plate format[4]. These modifications improved compound dispersion, reduced matrix interactions, and lowered compound requirements. The optimised assay was validated with vancomycin, oritavancin, and dalbavancin against Staphylococcus aureus ATCC 43300 (MRSA) and Streptococcus pneumoniae ATCC 700677. This efficient, cost-effective, high-throughput platform overcomes the limitations of traditional agar methods, enhancing reliability in evaluating challenging antimicrobials and supporting next-generation antibiotic development.

Background: The main cause of urinary tract infections (UTIs) are Gram negative bacteria with Escherichia coli as the leading cause and other important pathogens such as Klebsiella pneumoniae, Pseudomonas aeuriginosa and Enterococcus faecalis. Over the years uropathogens have become resistant to commonly used antibiotics, including penicillin's, cephalosporins and fluoroquinolones. Antimicrobial resistance (AMR) in UTIs is mainly caused by the misuse and overuse of antibiotics, recurrent infections, and healthcare-associated factors such as catheterization. Objectives: The aim of this study was to describe the bacteriological profile and antimicrobial susceptibility patterns of uropathogens isolated from positive urine cultures at Chhatrapati Shivaji Subharti Hospital, Meerut, a tertiary care centre in North India and develop an institutional antibiogram to support empirical prescribing and antibiotic stewardship at this institution. Materials & Methods: The study analysed 50 positive urine culture samples and their antimicrobial susceptibility records from July 2025 to December 2025. The isolates were identified, and antimicrobial susceptibility testing was performed using the disc diffusion method and automated Biomerieux Vitek 2 Compact machine. The collected data was analysed using descriptive statistics and Fisher's exact test. Results: Gram-negative bacteria accounted for 80.0% (40/50) of the culture-positive urine isolates. Escherichia coli was the most frequently isolated uropathogen (n=23, 46.0%), followed by Klebsiella pneumoniae (n=12, 24.0%), Candida spp. (n=6, 12.0%), Enterococcus spp. (n=4,8.0%), Pseudomonas aeruginosa (n=3, 6.0%), and Enterobacter cloacae (n=2, 4.0%). Of the total, 74% (37/50) of isolates came from Inpatient samples. E. coli had a 100% resistance to ampicillin and ceftriaxone, 95.7% to ciprofloxacin and cefepime, and 73.9% to meropenem, with fosfomycin (86.4% sensitive) and colistin (69.6% sensitive) as the only effective antimicrobials. K. pneumoniae had 100% resistance to ceftriaxone, amoxicillin-clavulanate, and piperacillintazobactam; carbapenem resistance ranged from 83.3% to 91.7%, and colistin was the only consistently effective treatment (83.3% sensitive). Of all the 35 tested Enterobacteriaceae isolates, Extended-Spectrum Beta-Lactamases (ESBLs) positivity was 100% with Carbapenem-Resistant Enterobacterales (CRE) positivity at 85.0%. All the bacterial isolates met Multi-drug Resistant (MDR) criteria. 31 of 35 (88.6%) tested Enterobacteriaceae isolates showed ESBL and CRE copositivity. The six strains of Candida demonstrated total sensitivity to all the antifungal drugs used. Conclusion: There is a critical burden of AMR at this hospital with 100% ESBL positivity, 85% CRE, and 100% MDR among all bacterial isolates. This study provides the first baseline institutional antibiogram to guide empirical prescribing and antibiotic stewardship at Chhatrapati Subharti Hospital.

The emergence of antimicrobial resistant pathogens has led to increase in mortality rate, longer hospital stays, and need for complex and expensive treatment regimens. However, it is not very clear from where does the bacteria get the building blocks to develop resistance to these synthetic antimicrobial agents which have been integral part of modern medicine. One hypothesis is that non-coding cryptic genes without any vital function or positive contribution to fitness act as versatile endogenous genetic repertoires that help in bacterial adaptation and evolution of new phenotypes when conditions change. This study reports the presence of putative cryptic metallo beta lactamase gene in the marine bacterium Cytobacillus oceanisediminis isolated from the Gulf of Mannar, India. Using in silico, in vitro and in vivo assay, we demonstrate that putative cryptic metallo beta lactamase encodes an enzyme that can cleave only imipenem, has two characteristic domains: HXHXDH and TPGH, but does not share homology with the other reported Metallo-beta-Lactamase genes. The findings underscore the importance for comprehensive screening of putative cryptic antimicrobial resistance genes to fully address and mitigate the challenges posed by antimicrobial resistance.

Objectives: Klebsiella pneumoniae is a significant global health concern due to its ability to cause diverse infections and its increasing multidrug resistance. This study analyzed the whole-genome sequence of multidrug-resistant K. pneumoniae strain CP4, isolated from a vaginal swab of an infertile woman, to characterize its virulence factors, antibiotic resistance mechanisms, and epidemiological features. Methods: The Kirby-Bauer disk diffusion assay was used to screen antibiotic resistance. Whole genome sequencing was conducted using the Illumina MiSeq platform and followed by comprehensive bioinformatic analysis. Results: Antibiotic susceptibility testing revealed that the K. pneumoniae strain CP4 exhibited resistance to 11 of 18 tested antibiotics, including carbapenems, and displayed a Multiple Antibiotic Resistance (MAR) index of 0.611. Whole-genome sequencing identified an array of putative virulence and metal-resistant genes, classifying it as a human pathogen with a probability score of 0.887. The strain was characterized as sequence type 327 with K16 capsular and O1/O2v1 somatic antigens. The antibiotic resistome included 38 putative genes conferring resistance to a spectrum of antibiotics. Moreover, point mutations were identified in several genes that ResFinder predicted to be associated with resistance to fluoroquinolones, cephalosporins, and carbapenems. Additionally, K. pneumoniae strain CP4 harbored six putative plasmid-replicon types and 454 putative mobile genetic element-associated protein hits among predicted ORFs. Several putative antibiotic resistance genes, including tet(A), floR, mph(A), and aph(6)-Id, were associated with insertion sequences, transposons, and integrons, indicating a potential for horizontal gene transfer. Conclusions: The genomic features of multidrug-resistant K. pneumoniae CP4 highlight its potential for antimicrobial resistance and virulence, emphasizing the need for continued genomic surveillance and targeted interventions. Keywords: Klebsiella pneumoniae, Whole Genome Sequencing, Antimicrobial Resistance, Pangenome analysis

To characterise temporal changes in antimicrobial resistance (AMR) among clinically important bacterial pathogens in Iraq during 2021-2024 and examine their implications for empirical antimicrobial therapy and stewardship. We conducted a retrospective longitudinal analysis of aggregated national AMR surveillance data for Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. Annual resistance proportions were evaluated across clinically relevant antimicrobials. Temporal change was characterised using absolute percentage-point changes and exploratory linear regression. Resistance trajectories were interpreted in relation to empirical treatment options and antimicrobial stewardship. The analysis included 92,338 organism records: 40,496 (43.9%) E. coli, 24,621 (26.7%) S. aureus, 18,223 (19.7%) K. pneumoniae and 8,998 (9.7%) P. aeruginosa. In 2024, ceftriaxone resistance reached 82.9% in E. coli and 65.2% in K. pneumoniae, while ciprofloxacin resistance was 55.4% and 57.9%, respectively. Meropenem resistance reached 37.4% in K. pneumoniae and 62.3% in P. aeruginosa. Conversely, resistance declined for amoxicillin-clavulanate in E. coli (83.5% in 2021 to 57.2% in 2024) and piperacillin-tazobactam in P. aeruginosa (46.4% to 32.9%). Several pathogen-antimicrobial combinations showed marked year-to-year variation, and no temporal trend remained statistically significant after false discovery rate correction. Resistance to several agents central to empirical therapy remains high in Iraq, while substantial carbapenem resistance constrains reliance on carbapenem escalation when resistance to other {beta}-lactams is suspected. Heterogeneous trajectories indicate that empirical recommendations should not rely on single-year national antibiograms alone and support regular integration of national and local resistance surveillance into empirical treatment and antimicrobial stewardship strategies.

Pseudomonas aeruginosa (P. aeruginosa) is the primary pathogen responsible for morbidity and mortality in patients with cystic fibrosis (CF). Its genomic plasticity and constant selective pressure from antimicrobial treatments have favored the emergence of multidrug-resistant clones. This study conducted a comparative genomic analysis of 41 P. aeruginosa isolated from pediatric patients with CF in Mexico from 2015 to 2024, with the aim of characterizing their evolutionary dynamics, resistome, and virulome. Whole-genome sequencing (MGI, Illumina, and PacBio platforms) was used, with de novo assemblies performed using Unicycler v0.4.8 on the BV-BRC platform. The databases used for the resistome were CARD and NDARO, and for the virulome, VFDB. Phylogenetic reconstruction was based on core-genome alignments generated with Roary v3.13.0, with maximum likelihood reconstruction performed in IQ-TREE v2.1.2. The statistical significance of the segregation of resistance and virulence patterns was evaluated using PERMANOVA analysis. The results revealed a significant clonal prevalence of sequence types (ST) 307 and ST 167. Phylogenomic analysis grouped the isolates into three main clades; Clade 1 stood out for having the highest resistance gene load (mean of 75 genes/genome), establishing itself as the main reservoir of multidrug-resistant profiles. Genotype-phenotype concordance reached 65.5% overall, with high accuracy for aminoglycosides (87.8%) and fluoroquinolones (82.9%). Furthermore, virulome analysis identified 67 distinct patterns that were significantly segregated among the clades (PERMANOVA: R2=0.31, p=0.001). These findings demonstrate that the evolution of P. aeruginosa lineages in the pediatric clinical setting involves parallel and coordinated adaptations in both their resistance potential and their virulence arsenal. This study underscores the need to adopt a multidisciplinary approach to the clinical management of chronic P. aeruginosa infections in pediatric patients. The persistence of extensively drug-resistant (XDR) strains calls for the integration of genomic surveillance and functional diagnostics, as well as the search for therapeutic alternatives for the clinical management of patients with cystic fibrosis.

Pseudomonas aeruginosa remains one of the most important clinical pathogens for which new drugs are needed, due to its resistance machinery. Consequently, there is an increasing effort to develop new and effective treatments against this pathogen. We recently showed that tetrasodium ethylenediaminetetraacetic acid (tEDTA) exhibits promising antibacterial and antibiofilm activity against P. aeruginosa in advanced biofilm models. tEDTA is known to chelate divalent cations, with predicted effects on the outer membrane; however, a full understanding of how this kills P. aeruginosa is lacking. Also, it is currently not clear how slowly or rapidly P. aeruginosa will evolve resistance to this treatment. Using membrane disruption assays and RNA-seq, we showed that tEDTA disrupts bacterial membrane potential and permeabilises P. aeruginosa membranes. RNA-seq revealed the significant upregulation of genes involved in the transport of iron, phosphate, potassium, and magnesium ion. The arnABCD operon which is involved in lipid A biosynthesis was also upregulated. Using a 7-day evolutionary ramp approach, we showed that P. aeruginosa could not evolve resistance to tEDTA under strong selection. Lastly, we carried out a cytotoxicity assay with Human Epithelial type 2 (HEp-2) cells and showed that there was reduced cytotoxicity of tEDTA compared to meropenem. This study provides good insight into the mechanism of action of tEDTA and further evidence of its potential as an alternative to antibiotics for P. aeruginosa infections.

Background Rising antimicrobial resistance (AMR) in the African region contributes to high morbidity and mortality. Continuous national AMR surveillance is critical in understanding the spread of AMR and informing policies on containment. We present results of national AMR surveillance in Kenya Methods Passive surveillance was prospectively conducted in 20 sites in Kenya between 2021 and 2025. Sites included national and sub-national level tertiary public and private hospital laboratories. Non-duplicate isolates of WHO priority Gram-negative and Gram-positive pathogens were included in this analysis. Bacterial isolates were identified using either conventional identification methods, Analytical Profile Index or automated systems while antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method or automated systems and interpreted using the Clinical and Laboratory Standards Institute guidelines. The primary outcomes were the proportions of various priority bacteria isolated and the proportions resistant to commonly used antibiotics. Results Between 2021 and 2025, there were 15,124 priority pathogens isolated with 7,592 (50.2%) from urine, 5,430 (35.9%) from blood (35.9%), and 1,784 (11.8%) from respiratory specimens. Escherichia coli and Klebsiella pneumoniae accounted for 76.3% of the priority pathogens. Resistance to 3rd generation cephalosporins was 63.2% for Escherichia coli and 79.1% for Klebsiella pneumoniae for the period 2021 to 2025 while carbapenem-resistance was 30.4% for Klebsiella pneumoniae and 7.2% for Escherichia coli. Resistance to carbapenems by Klebsiella pneumoniae increased from 17.9% in 2021 to 35.9% in 2025 while Methicillin resistance in Staphylococcus aureus increased from 36.5% in 2021 to 56.4% in 2025. Conclusion Resistance to critical antibiotics is a significant problem in Kenya, with alarming rates of Methicillin Resistant Staphylococcus aureus and carbapenem resistant Klebsiella pneumoniae. Ugent and sustained infection prevention and control measures and appropriate antimicrobial stewardship activities should be instituted across all health facilities in the country. There is need for improved access to antibiotics with activity against these resistant pathogens.

BackgroundThe epidemiology of Klebsiella pneumoniae carbapenemase (KPC)-producing Pseudomonas aeruginosa is rapidly evolving in China. While blaKPC-2 remains the predominant KPC variant in P. aeruginosa, blaKPC-3 has rarely been documented in this pathogen. This study investigated the molecular epidemiology, resistance and virulence characteristics, and plasmid features of blaKPC-3-producing CRPA isolates collected from a tertiary hospital in eastern China. MethodsA total of 65 non-duplicate CRPA isolates collected in 2023 were subjected to whole-genome sequencing. Antimicrobial susceptibility testing, phylogenetic analysis, plasmid characterization, conjugation experiments, and virulence assays were performed. ResultsAmong the 65 CRPA isolates, 37 (56.9%) carried blaKPC-3. These blaKPC-3-positive isolates belonged to four sequence types (STs), including ST1076 (62.2%), ST463 (21.6%), ST646 (10.8%), and ST3393 (5.4%). To our knowledge, this is the first report of blaKPC-3 in P. aeruginosa ST463, ST646 and ST3393. All isolates exhibited extensive drug resistance, and 51.8% were resistant to ceftazidime-avibactam. Phylogenetic analysis indicated that blaKPC-3 dissemination was driven by both clonal expansion and horizontal transmission. Comparative genomic analysis identified three kinds of blaKPC-3 -carrying plasmid. A transferable IncP-2 megaplasmid was widely distributed among ST1076, ST646, and ST3393 isolates, whereas non-transferable IncP-10 plasmids were primarily restricted to ST463. The genetic environments and plasmid backbones of blaKPC-3 were highly conserved and closely related to those of blaKPC-2 and its variants, suggesting evolution from pre-existing blaKPC-2-associated plasmids. Virulence analysis demonstrated marked heterogeneity across lineages. ST463 isolates co-harbored exoU and exoS, exhibited enhanced biofilm formation and pyocyanin production, and caused significantly higher mortality in the G. mellonella infection model, indicating a hypervirulent phenotype. ConclusionsThe blaKPC-3 is becoming an increasingly important determinant of carbapenem resistance in P. aeruginosa in China. The IncP-2 megaplasmid and IncP-10 plasmid derived blaKPC-3 spread across multiple lineages. Continuous genomic surveillance and enhanced infection control measures are urgently needed to prevent its further prevalence in clinical settings.

OXA-48-like {beta}-lactamases, such as OXA-163, OXA-181, OXA-405, OXA-505, among others, are class D carbapenem-hydrolyzing enzymes increasingly reported worldwide, yet some variants remain poorly characterized at the phenotypic levels. Here, we report OXA-439, a variant of OXA-163, in a producing uropathogenic Escherichia coli (UPEC) in Uruguay, recovered from a catheter-associated urinary tract infection with discordant routine susceptibility results. The specific contribution of OXA-439, bla-OXA-48, bla-OXA-163, and bla-OXA-439 were cloned into pET24a vector and expressed in Escherichia coli BL21(DE3), and their activity was evaluated by MIC microdilution against a panel of penicillins, ESCs, carbapenems, and {beta}-lactam/{beta}-lactamase inhibitor combinations. OXA-439 exhibited a substrate profile highly similar to OXA-163 conferring resistance to piperacillin and third-generation cephalosporins while remaining susceptible to carbapenems but with globally reduced MIC values and a complete loss of activity toward amoxicillin and clavulanate. These data suggest that the Y123H substitution, located near the catalytic Ser70/Lys73 region, subtly perturbs the active-site environment and decreases penicillinase efficiency.

Introduction Rifampicin-resistant tuberculosis poses a significant threat worldwide. Clofazimine is considered important for the construction of effective individualized multidrug regimens to treat rifampicin-resistant tuberculosis. Our goal was to characterize clofazimine pharmacokinetics in novel combination treatment regimens and to identify participant characteristics associated with variations in drug exposure. Methods Clofazimine pharmacokinetic data were obtained from adults and adolescents enrolled in the PandrTB pharmacokinetic sub-study of the endTB and endTB-Q Phase 3 randomized controlled therapeutic trials for rifampicin-resistant tuberculosis. Plasma concentrations were analyzed using nonlinear mixed-effects modeling to quantify clofazimine exposure and explore the impact of relevant covariates. Results 100 participants from six countries with high burdens of rifampicin-resistant tuberculosis contributed pharmacokinetic data. Their median age was 34 years, 32% were female, 18% were living with diabetes mellitus, and 18% were living with HIV. Clofazimine plasma concentration values were best described by a 2-compartment pharmacokinetic model with first-order absorption. Co-administration with delamanid and HIV co-infection resulted in a 37% increase and 20% decrease in clofazimine bioavailability, respectively. Diabetes was associated with a 43% decrease in clofazimine clearance. Clofazimine remained in the body for a median of 2.5 years (95th percentile: 0.5 to 8) following 9 months of treatment. Conclusion Co-administration with delamanid, diabetes mellitus, and HIV were associated with variation in clofazimine exposure. We estimated that clofazimine remained present in the body for longer than two years in over half of participants following 9 months of treatment. Follow-up studies are recommended to confirm these associations before adjusting clofazimine dose or clinical care decisions.

SynopsisO_ST_ABSBackgroundC_ST_ABSThe complexity of diagnosing and treating biofilm-associated infections necessitates a comprehensive strategy to mitigate the rising rates of antimicrobial resistance (AMR). Microtiter plate methods are used globally for determination of biofilm eradication concentrations (MBEC) but few have been adapted to observe pharmacodynamic observations. Here, we describe a method which allows for both static and pharmacodynamic assays of biofilm evaluation. MethodsA total of 150 clinical isolates from Southmead Hospital were assessed, representing five bacterial species (N=30 per bacterial species): Pseudomonas aeruginosa, Escherichia coli, Streptococcus pneumoniae, Staphylococcus aureus and Klebsiella pneumoniae. MBECs were determined using a developed method using 96 well plates and glass beads. MBECs of seven different antibiotics were compared to those determined using the established Calgary biofilm device (CBD). Dynamic pharmacodynamic evaluations to produce Biofilm Time Kill curve (BTKC) based on published planktonic time kill curve (TKC) data and ISO recommendations were carried out using the glass bead model for K. pneumoniae and ciprofloxacin, S. aureus and levofloxacin and S. pneumoniae and vancomycin. Quantification of biofilm biomass was assessed at 0, 2, 4, 8 and 24 hours and compared to planktonic culture survival under comparable challenge conditions. ResultsComparing MBEC results for all bacterial strains and antibiotic challenges showed no statistical difference between the glass bead and CBD methods (P <0.05). Biofilm BTKC AUBKC were inferior to planktonic equivalents but demonstrated specific pharmacodynamic patterns of biofilm reduction efficacy. MBEC correlated with biofilm BTKC penetration in line with clinical observations for S. aureus vs vancomycin and S. pneumoniae vs levofloxacin. ConclusionsThe glass bead biofilm models provide robust, reproducible alternatives to the traditional methods of determining MBEC and bridge the gap with biofilm pharmacodynamic evaluations. These methods also provide a low-cost option to current methods as only standard laboratory equipment is required, allowing for the generation of comprehensive data sets. This ensures greater translatability to complex in vitro models and clinical scenarios.

Sepsis is a global health problem. Patients in the Intensive Care Unit (ICU) are at risk of having sepsis because of their vulnerability and use of invasive medical devices. Emerging antimicrobial-resistance complicates treatment. Understanding bacterial profiles and antibiotic sensitivity patterns in the ICU plays an important role in managing sepsis, optimizing antimicrobial use, and improving patient outcomes. The aim of this study was to show bacterial profiles and antibiotic sensitivity patterns among patients who were admitted to the ICU at Mbeya Zonal Referral Hospital for 12 months. This was a prospective cross-sectional study among 187 sepsis-suspected patients. Data analysis was performed using SPSS Version 27. Categorical data were summarized by frequency and percentage. Fishers exact test, chi-square test, and modified Poisson regression were used to show the association between patients clinical variables and culture positivity at a 95% CI. Statistical significance was set at a p-value < 0.05. Out of 187 samples, 41.7% were culture positive. Gram-negative bacteria were commonly isolated (65.4%, with Klebsiella pneumoniae and Escherichia coli being commonly isolated. Commonly isolated Gram-positive bacteria were Coagulase-negative Staphylococcus species (19%). 100% of gram-positive bacteria and 96% of gram-negative bacteria were Multi-Drug Resistant (MDR), respectively. In multivariable analysis, patients who were intubated and mechanically ventilated (aPR = 2.208, 95% CI: 1.133-4.305, p = 0.020) and post-laparotomy patients (aPR = 3.241,95% CI: 1.320-7.958, p = 0.010) independently had a higher proportion of Gram-negative bacteria. The study reveals a high level of resistance to commonly used antimicrobials in our setting, necessitating strengthening of the antimicrobial stewardship program and routine surveillance of antimicrobial resistance patterns.

Resistance to the polymyxin antimicrobial colistin in Gram-negative bacteria is associated with a modification of the immunogenic lipid A moiety of the lipopolysaccharide (LPS). Chromosomal and plasmid-borne colistin resistance results in the addition of L-Ara4N and pEtN groups to lipopolysaccharide (LPS), respectively. Here, using THP-1 cells, we studied the impact of different LPS modifications of Klebsiella pneumoniae in stimulating host immune response. K. pneumoniae clinical isolates were screened for colistin resistance using broth microdilution (BMD) and the MALDIxin test. LPS was extracted from colistin-resistant isolates and used to stimulate differentiated THP-1 cells. Luminex cytokine assay measured the immune induction via a panel of proinflammatory cytokines. Out of a collection of 72 clinical K. pneumoniae, eight (11.1%) exhibited phenotypic colistin resistance with a minimum inhibitory concentration (MIC) of 8 to 64 mg/L. In total, five isolates possessed genes associated with polymyxin resistance; three isolates had a mutation in the pmrB gene, and two were mcr-8.1 positive. MALDIxin demonstrated that all eight phenotypic colistin-resistant isolates elaborated peaks at m/z 1,955 and m/z 2,193, indicating an L-Ara4N group of LPS modification. For two mcr-8.1 positive isolates, LPS had a pEtN group. The LPS modification positively correlated with colistin MIC (correlation coefficient, r= 0.6 and R2= 0.4). Compared to the native structure, LPS modification was associated with greater production of IL-1{beta}, IL-6, and CXCL-8 (p<0.001). The pEtN-conjugated LPS triggered a significantly greater production of TNF-, IL-6, and CXCL-8 compared to L-Ara4N (p<0.05). This study reveals that the colistin MIC value can significantly predict lipid A modification in clinical K. pneumoniae, and differences in resistance-mediated lipid A modification result in variation in the immunological response. This study highlights the potential of dynamic host-pathogen interaction in the context of colistin resistance.

Objectives: To investigate whether ethambutol resistance in Mycobacterium avium complex is associated with the emergence of macrolide resistance. Methods: Patients who developed macrolide resistance during guideline-based treatment were included, and longitudinal analyses of minimum inhibitory concentrations and mutations in embB or the upstream region of embA were performed. Clinical, microbiological, and radiological characteristics were compared according to the mutation status of embB or embA upstream region, prior to the emergence of macrolide resistance. We further evaluated the impact of embB mutation on the development of macrolide resistance using in vitro time-kill assays. Results: Sixteen patients developed macrolide resistance during guideline-based treatment. None of these patients had an ethambutol minimum inhibitory concentration >=16 ug/mL or embB or embA upstream mutations at treatment initiation; however, 8/16 patients (50.0%) had an ethambutol minimum inhibitory concentration >=16 ug/mL at the time of macrolide resistance detection, and 7/16 (43.8%) had developed embB or embA upstream mutations prior to the emergence of macrolide resistance. Cavitary lesions were present in 1/7 (14.3%) patients with embB or embA upstream mutations. In strains with embB mutations, the minimum inhibitory concentration of ethambutol increased by 1-2 dilutions relative to that of pretreatment isolates, with a corresponding increase in the concentration required to suppress macrolide resistance. Conclusions: Ethambutol resistance may contribute to the development of macrolide resistance in patients with M. avium complex pulmonary disease, particularly in those without cavitary lesions.

BackgroundEscherichia coli is a common environmental and zoonotic bacterium that serves as an important indicator of fecal contamination and antimicrobial resistance (AMR) in poultry production systems. The emergence of multidrug-resistant (MDR) E. coli in poultry farm environments poses a significant One Health threat to animal, human, and environmental health. ObjectiveThis study aimed to isolate, identify, determine the prevalence, assess the antibiotic susceptibility pattern, and molecularly confirm Escherichia coli isolated from poultry farm environments in Lalmonirhat district, Bangladesh. Materials and MethodsA cross-sectional study was conducted from January to June 2024 using 60 environmental samples comprising water (n = 20), soil (n = 20), and bird-dropping (n = 20) samples collected from poultry farms in five upazilas of Lalmonirhat district. Isolation and identification of E. coli were performed using standard cultural, morphological, and biochemical techniques. Antimicrobial susceptibility was determined by the Kirby-Bauer disc diffusion method following CLSI guidelines. Ten randomly selected isolates were confirmed by polymerase chain reaction (PCR) targeting the species-specific uidA gene. ResultsThe overall prevalence of E. coli was 50% (30/60). Source-wise prevalence was highest in bird-dropping samples (75%), followed by water (45%) and soil (30%). Area-wise prevalence ranged from 33.33% in Patgram to 66.67% in Hatibandha. The isolates exhibited the highest resistance to oxytetracycline (66.67%) and ciprofloxacin (60%), while the highest susceptibility was observed to erythromycin (63.33%), neomycin (56.67%), and amoxicillin (56.67%). All ten isolates subjected to PCR produced the expected 486 bp uidA gene amplicon, confirming their identity as E. coli. ConclusionThe findings demonstrate a considerable prevalence of antimicrobial-resistant E. coli in poultry farm environments of Lalmonirhat district. Strengthening farm biosecurity, improving hygiene and waste management, implementing antimicrobial stewardship, and maintaining continuous molecular surveillance are essential to minimize the dissemination of resistant E. coli within a One Health framework.

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is one the most common cause of post-surgical infections in Malawi and poses a significant public health challenge due to resistance to commonly used antibiotics. We isolated and evaluated the stability and lytic activity of a MRSA-specific bacteriophage (Staphylophage) from Mzuzu Central hospital (MZCH) sewage against MRSA strains isolated from surgical wards. MethodsA prospective in vitro experimental study was conducted using 56 pus swabs collected from post-surgical patients at Mzuzu Central Hospital (MZCH), Malawi. Standard microbiological methods and VITEK analysis were used for bacterial isolation, identification and antimicrobial susceptibility testing of Staphylococcus aureus and MRSA according to the 2024 EUCAST guidelines. A lytic Staphylophage was isolated and purified from sewage wastewater using filtration, enrichment, and double-layer agar techniques. The purified Staphylophage was evaluated for its lytic activity through host range testing and stability under ultraviolet (UV) exposure (up to 60 minutes), different pH levels (2-12), and temperatures (4{degrees}C, -20{degrees}C, and -80{degrees}C). ResultsOut of 56 bacterial isolates, 18 (32.1%) were S. aureus, of which 11 (61.1%) were MRSA. The isolated Staphylophage showed lytic activity against 87% of Staphylococcus species tested. The phage remained stable at temperatures between -80{degrees}C and 4{degrees}C and across a pH range of 2- 12. It also retained viability after UV exposure for up to 15 minutes, although a reduction in phage titre was observed after 30 minutes. ConclusionsA lytic Staphylophage isolated from hospital sewage at MZCH demonstrated activity against Staphylococcus species, including MRSA strains from post-surgical wound infections. These findings illustrate the feasibility of generating candidate phages for alternative therapeutic approaches in a central hospital setting in Malawi.