Current update on the antibiotic resistance profile and the emergence of colistin resistance in Enterobacter isolates from hospital-acquired infections

Srishti Singh , Alok Kumar Singh , Sudhir Kumar Singh , Virendra Bahadur Yadav , Akshay Kumar , Gopal Nath
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Abstract

Introduction

Bacterial pathogens are becoming a growing concern as antibiotic resistance among Gram-negative bacteria rises globally. The gram-negative, facultative anaerobic, rod-shaped bacteria belonging to the Enterobacteriaceae family, Enterobacter is a nosocomial pathogen, having ubiquitous distribution in natural environments, including sewage and dairy products. These bacteria increasingly exhibit a multidrug resistance phenotype, thus becoming resilient to available treatment therapies. The fact mentioned above has resulted in them being included in the “ESKAPE” group of opportunistic pathogens, which represents a group for which no effective therapeutic options would be available in a given scenario. So, this study aimed to identify antibiotic resistance patterns in Enterobacter species collected from the bacteriological section of the Institute of Medical Sciences, Banaras Hindu University, Varanasi.

Materials and Methods

Fifty-one isolates were collected from clinical samples, including urine, pus, blood, cerebrospinal fluid, sputum, and stool. All isolates were phenotypically identified using VITEK-2 automated systems (ID GNB cards). Additionally, the isolates were genotypically characterised with species-specific primers via PCR, and whole genome sequencing was performed for two isolates, followed by antimicrobial susceptibility testing using the Kirby-Bauer disc diffusion method. Concurrently, broth dilution methods were used to determine the minimum inhibitory concentration (MIC) according to CLSI 2020 guidelines. The Multiple Antibiotic Resistance Index (MARI) was calculated by dividing the number of drugs to which the bacterial isolate is resistant by the total number of antibiotics used in the experiment.

Results

The highest resistance rates were observed against levofloxacin (94 %), ciprofloxacin, and ampicillin, with 92 % (47/51) of isolates demonstrating resistance. Cefazolin also exhibited a high resistance rate, with 82 % (42/51) of resistant isolates. Notably, 96.07 % of isolates showed a multiple antibiotic resistance (MAR) index greater than 0.2, indicating a significant burden of multidrug-resistant Gram-negative bacteria. In contrast, 21.56 % had an index greater than 1.0, indicating resistance to all antibiotics tested.

Conclusion

This paper highlights the latest information regarding drug resistance patterns in Enterobacter isolates. The last resort for treating gram-negative bacteria is increasingly losing its effectiveness due to the emergence of colistin-resistant strains. Therefore, alternative therapies, such as phage treatment or other antimicrobial agents, must be developed to combat these superbugs.
医院获得性感染肠杆菌分离株中抗生素耐药性概况和粘菌素耐药性的最新情况
随着全球革兰氏阴性菌的抗生素耐药性上升,细菌病原体正日益受到关注。肠杆菌属革兰氏阴性,兼性厌氧,杆状细菌,属于肠杆菌科,是一种医院病原菌,普遍分布在自然环境中,包括污水和乳制品。这些细菌越来越多地表现出多药耐药表型,因此对现有的治疗方法变得有弹性。上述事实导致它们被列入“ESKAPE”机会致病菌组,这代表了在特定情况下无法获得有效治疗选择的群体。因此,本研究旨在确定从瓦拉纳西巴纳拉斯印度大学医学科学研究所细菌学部门收集的肠杆菌物种的抗生素耐药性模式。材料与方法从尿、脓、血、脑脊液、痰、粪便等临床标本中采集51株分离株。所有分离株均采用VITEK-2自动化系统(ID GNB卡)进行表型鉴定。此外,利用物种特异性引物对分离株进行基因型鉴定,并对两株分离株进行全基因组测序,随后采用Kirby-Bauer圆盘扩散法进行抗菌药敏试验。同时,根据CLSI 2020指南,采用肉汤稀释法测定最低抑制浓度(MIC)。多重抗生素耐药指数(Multiple Antibiotic Resistance Index, MARI)的计算方法是将细菌分离物耐药的药物数量除以实验中使用的抗生素总数。结果对左氧氟沙星(94 %)、环丙沙星和氨苄西林的耐药率最高,其中92 %(47/51)的菌株出现耐药。头孢唑林也表现出较高的耐药率,有82 %(42/51)耐药菌株。值得注意的是,96.07 %的分离株多重抗生素耐药指数(MAR)大于0.2,表明多重耐药革兰氏阴性菌负担显著。21.56 %对所有抗生素均耐药,指标大于1.0。结论本文重点介绍了肠杆菌分离株耐药模式的最新信息。由于耐粘菌素菌株的出现,治疗革兰氏阴性菌的最后手段正日益失去其有效性。因此,必须开发替代疗法,如噬菌体治疗或其他抗菌剂,以对抗这些超级细菌。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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