Osong Public Health and Research Perspectives

Original Articles

Prevalence, multidrug resistance, and biofilm formation of Vibrio parahaemolyticus isolated from fish mariculture environments in Cat Ba Island, Vietnam: Kim Cuc Thi Nguyen, Phuc Hung Truong, Hoa Truong Thi, Xuan Tuy Ho, Phu Van Nguyen; Osong Public Health Res Perspect. 2024;15(1):56-67. Published online February 19, 2024; DOI: https://doi.org/10.24171/j.phrp.2023.0181

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Objectives
Vibrio parahaemolyticus is a major foodborne pathogen in aquatic animals and a threat to human health worldwide. This study investigated the prevalence, antimicrobial resistance, antimicrobial resistance genes (ARGs), and biofilm formation of V. parahaemolyticus strains isolated from fish mariculture environments in Cat Ba Island, Vietnam. Methods: In total, 150 rearing water samples were collected from 10 fish mariculture farms in winter and summer. A polymerase chain reaction assay was used to identify V. parahaemolyticus, its virulence factors, and ARGs. The antimicrobial resistance patterns and biofilm formation ability of V. parahaemolyticus strains were investigated using the disk diffusion test and a microtiter plate-based crystal violet method, respectively. Results: Thirty-seven V. parahaemolyticus isolates were recovered from 150 samples. The frequencies of the tdh and trh genes among V. parahaemolyticus isolates were 8.1% and 21.6%, respectively. More than 90% of isolates were susceptible to ceftazidime, cefotaxime, and chloramphenicol, but over 72% were resistant to ampicillin, tetracycline, and erythromycin. Furthermore, 67.57% of isolates exhibited multidrug resistance. The presence of ARGs related to gentamicin (aac(3)-IV), tetracycline (tetA) and ciprofloxacin (qnrA) in V. parahaemolyticus isolates was identified. Conversely, no ARGs related to ampicillin or erythromycin resistance were detected. Biofilm formation capacity was detected in significantly more multidrug-resistant isolates (64.9%) than non-multidrug-resistant isolates (18.9%). Conclusion: Mariculture environments are a potential source of antibiotic-resistant V. parahaemolyticus and a hotspot for virulence genes and ARGs diffusing to aquatic environments. Thus, the prevention of antibiotic-resistant foodborne vibriosis in aquatic animals and humans requires continuous monitoring.

Citations

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A New Strategy: Antibiotic Circumstances for Rational Drug use Against Clinical Aeromonas hydrophila And Bacterial Properties of This Bacteria on Different Agars
Nurdan Filik, Fethi Filik, Ayşegül Kubilay
Acta Aquatica Turcica.2024;[Epub] CrossRef
Passive immunoprophylaxis with Ccombodies against Vibrio parahaemolyticus in Pacific white shrimp (Penaeus vannamei)
Wanna Sirimanapong, Prawporn Thaijongrak, Chiranan Sudpraseart, Dennis Berbulla Bela-ong, Abigail Joy D. Rodelas-Angelia, Mark Rickard N. Angelia, Seungbeom Hong, Jaesung Kim, Kim D. Thompson, Tae Sung Jung
Fish & Shellfish Immunology.2024; 154: 109973. CrossRef

Drug resistance and the genotypic characteristics of rpoB and katG in rifampicin- and/or isoniazid-resistant Mycobacterium tuberculosis isolates in central Vietnam: Thi Binh Nguyen Nguyen, Thi Kieu Diem Nguyen, Van Hue Trương, Thi Tuyet Ngoc Tran, van Bao Thang Phan, Thi Tuyen Nguyen, Hoang Bach Nguyen, Viet Quynh Tram Ngo, Van Tuan Mai, Paola Molicotti; Osong Public Health Res Perspect. 2023;14(5):347-355. Published online October 18, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0124

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Graphical Abstract Abstract PDF: Objectives
Tuberculosis (TB) and drug-resistant TB (DR-TB) are national health burdens in Vietnam. In this study, we investigated the prevalence of rifampicin (RIF) and/or isoniazid (isonicotinic acid hydrazide, INH) resistance in patients with suspected TB, and applied appropriate techniques to help rapidly target DR-TB. Methods: In total, 1,547 clinical specimens were collected and cultured using the BACTEC MGIT system (Becton Dickinson and Co.). A resazurin microtiter assay (REMA) was used to determine the proportions of RIF and/or INH resistance. A real-time polymerase chain reaction panel with TaqMan probes was employed to identify the mutations of rpoB and katG associated with DR-TB in clinical isolates. Genotyping of the identified mutations was also performed. Results: A total of 468 Mycobacterium tuberculosis isolates were identified using the REMA. Of these isolates, 106 (22.6%) were found to be resistant to 1 or both antibiotics. Of the resistant isolates, 74 isolates (69.8%) were resistant to isoniazid (INH) only, while 1 isolate (0.94%) was resistant to RIF only. Notably, 31 isolates (29.24%) were resistant to both antibiotics. Of the 41 phenotypically INH-resistant isolates, 19 (46.3%) had the Ser315Thr mutation. There were 8 different rpoB mutations in 22 (68.8%) of the RIF-resistant isolates. The most frequently detected mutations were at codons 531 (37.5%), 526 (18.8%), and 516 (6.3%). Conclusion: To help prevent new cases of DR-TB in Vietnam, it is crucial to gain a comprehensive understanding of the genotypic DR-TB isolates.

Review Article

Strategies to combat Gram-negative bacterial resistance to conventional antibacterial drugs: a review: Priyanka Bhowmik, Barkha Modi, Parijat Roy, Antarika Chowdhury; Osong Public Health Res Perspect. 2023;14(5):333-346. Published online October 18, 2023; DOI: https://doi.org/10.24171/j.phrp.2022.0323

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Graphical Abstract Abstract PDF

The emergence of antimicrobial resistance raises the fear of untreatable diseases. Antimicrobial resistance is a multifaceted and dynamic phenomenon that is the cumulative result of different factors. While Gram-positive pathogens, such as methicillin-resistant Staphylococcus aureus and Clostridium difficile, were previously the most concerning issues in the field of public health, Gram-negative pathogens are now of prime importance. The World Health Organization’s priority list of pathogens mostly includes multidrug-resistant Gram-negative organisms particularly carbapenem-resistant Enterobacterales, carbapenem-resistant Pseudomonas aeruginosa, and extensively drug-resistant Acinetobacter baumannii. The spread of Gram-negative bacterial resistance is a global issue, involving a variety of mechanisms. Several strategies have been proposed to control resistant Gram-negative bacteria, such as the development of antimicrobial auxiliary agents and research into chemical compounds with new modes of action. Another emerging trend is the development of naturally derived antibacterial compounds that aim for targets novel areas, including engineered bacteriophages, probiotics, metal-based antibacterial agents, odilorhabdins, quorum sensing inhibitors, and microbiome-modifying agents. This review focuses on the current status of alternative treatment regimens against multidrug-resistant Gram-negative bacteria, aiming to provide a snapshot of the situation and some information on the broader context.

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Efficacy of new generation biosorbents for the sustainable treatment of antibiotic residues and antibiotic resistance genes from polluted waste effluent
Barkha Madhogaria, Sangeeta Banerjee, Atreyee Kundu, Prasanta Dhak
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Short Communication

Epidemiological characteristics of carbapenemase-producing Enterobacteriaceae outbreaks in the Republic of Korea between 2017 and 2022: Hyoseon Jeong, Junghee Hyun, Yeon-Kyeng Lee; Osong Public Health Res Perspect. 2023;14(4):312-320. Published online August 21, 2023; DOI: https://doi.org/10.24171/j.phrp.2023.0069

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Graphical Abstract Abstract PDF

Objectives
We aimed to describe the epidemiological characteristics of carbapenemase-producing Enterobacteriaceae (CPE) outbreaks in healthcare settings in the Republic of Korea between 2017 and 2022.
Methods
Under the national notifiable disease surveillance system, we obtained annual descriptive statistics regarding the isolated species, carbapenemase genotype, healthcare facility type, outbreak location and duration, and number of patients affected and recommended interventions. We used epidemiological investigation reports on CPE outbreaks reported to Korea Disease Control and Prevention Agency from June 2017 to September 2022.
Results
Among the 168 reports analyzed, Klebsiella pneumoniae (85.1%) was the most frequently reported species, while K. pneumoniae carbapenemase (KPC, 82.7%) was the most common carbapenemase genotype. Both categories increased from 2017 to 2022 (p<0.01). General hospitals had the highest proportion (54.8%), while tertiary general hospitals demonstrated a decreasing trend (p<0.01). The largest proportion of outbreaks occurred exclusively in intensive care units (ICUs, 44.0%), and the frequency of concurrent outbreaks in ICUs and general wards increased over time (p<0.01). The median outbreak duration rose from 43.5 days before the coronavirus disease 2019 (COVID-19) pandemic (2017–2019) to 79.5 days during the pandemic (2020–2022) (p=0.01), and the median number of patients associated with each outbreak increased from 5.0 to 6.0 (p=0.03). Frequently recommended interventions included employee education (38.1%), and 3 or more measures were proposed for 45.2% of outbreaks.
Conclusion
In the Republic of Korea, CPE outbreaks have been consistently dominated by K. pneumoniae and KPC. The size of these outbreaks increased during the COVID-19 pandemic. Our findings highlight the need for continuing efforts to control CPE outbreaks using a multimodal approach, while considering their epidemiology.

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Comparison of clinical outcomes of patients with serial negative surveillance cultures according to a subsequent polymerase chain reaction test for carbapenemase-producing Enterobacterales
H. Seo, S. Kim, Y.W. Lee, H.S. Oh, H-S. Kim, Y.K. Kim
Journal of Hospital Infection.2024; 146: 93. CrossRef
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Min Hyung Kim, Jaewoong Kim, Heejin Ra, Sooyeon Jeong, Yoon Soo Park, Dongju Won, Hyukmin Lee, Heejung Kim
Emerging Infectious Diseases.2024;[Epub] CrossRef
Antimicrobial activity of ceftazidime-avibactam against KPC-2-producing Enterobacterales: a cross-combination and dose-escalation titration study with relebactam and vaborbactam
Min Seo Kang, Jin Yang Baek, Jae-Hoon Ko, Sun Young Cho, Keon Young Lee, Young Ho Lee, Jinyoung Yang, Tae Yeul Kim, Hee Jae Huh, Nam Yong Lee, Kyungmin Huh, Cheol-In Kang, Doo Ryeon Chung, Kyong Ran Peck, Bobby G. Warren
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Performance comparison of BD Phoenix CPO detect panel with Cepheid Xpert Carba-R assay for the detection of carbapenemase-producing Klebsiella pneumoniae isolates
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BMC Microbiology.2024;[Epub] CrossRef

Review Article

Carbapenem resistance in critically important human pathogens isolated from companion animals: a systematic literature review: Angie Alexandra Rincón-Real, Martha Cecilia Suárez-Alfonso; Osong Public Health Res Perspect. 2022;13(6):407-423. Published online December 16, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0033

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Abstract PDF

This study aimed to describe the presence and geographical distribution of Gram-negativebacteria considered critical on the priority list of antibiotic-resistant pathogens publishedby the World Health Organization, including carbapenem-resistant Enterobacteriaceae,carbapenem-resistant Acinetobacter spp., and carbapenem-resistant Pseudomonas aeruginosa.A systematic review of original studies published in 5 databases between 2010 and 2021 wasconducted, including genotypically confirmed carbapenem-resistant isolates obtained fromcanines, felines, and their settings. Fifty-one articles met the search criteria. Carbapenemresistant isolates were found in domestic canines and felines, pet food, and on veterinarymedical and household surfaces. The review found that the so-called “big five”—that is, the5 major carbapenemases identified worldwide in Enterobacterales (New Delhi metallo-βlactamase, active-on-imipenem, Verona integron-encoded metallo-β-lactamase, Klebsiellapneumoniae carbapenemase, and oxacillin [OXA]-48-like)—and the 3 most importantcarbapenemases from Acinetobacter spp. (OXA-23-like, OXA-40-like, and OXA-58-like) hadbeen detected in 8 species in the Enterobacteriaceae family and 5 species of glucose nonfermenting bacilli on 5 continents. Two publications used molecular analysis to confirmcarbapenem-resistant bacteria transmission between owners and dogs. Isolating criticallyimportant human carbapenem-resistant Gram-negative bacteria from domestic canines andfelines highlights the importance of including these animal species in surveillance programsand antimicrobial resistance containment plans as part of the One Health approach.

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First report of a blaNDM-5-carrying Escherichia coli sequence type 12 isolated from a dog with pyometra in Japan
Kazuki Harada, Tadashi Miyamoto, Michiyo Sugiyama, Tetsuo Asai
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Epidemiological analysis and prevention strategies in response to a shigellosis cluster outbreak: a retrospective case series in an alternative school in the Republic of Korea, 2023
Yeongseo Ahn, Sunmi Jin, Gemma Park, Hye Young Lee, Hyungyong Lee, Eunkyung Shin, Junyoung Kim, Jaeil Yoo, Yuna Kim
Osong Public Health and Research Perspectives.2024; 15(1): 68. CrossRef
Carbapenem Resistance in Animal-Environment-Food from Africa: A Systematic Review, Recommendations and Perspectives
Komla Dossouvi, Ayawovi Selom Ametepe
Infection and Drug Resistance.2024; Volume 17: 1699. CrossRef
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Alyaa Sabti Jasim, Abeer Laily Mohammed, Wameedh Hashim Abbas, Hanaa Khaleel Ibraheim, Hasanain A.J. Gharban
Veterinary World.2024; : 1629. CrossRef
The European Union Summary Report on Antimicrobial Resistance in zoonotic and indicator bacteria from humans, animals and food in 2020/2021

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Resistome-based surveillance identifies ESKAPE pathogens as the predominant gram-negative organisms circulating in veterinary hospitals
Flavia Zendri, Cajsa M. Isgren, Jane Devaney, Vanessa Schmidt, Rachel Rankin, Dorina Timofte
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One Health & Implementation Research.2023; 3(4): 161. CrossRef

Original Article

Epidemiological characteristics of carbapenem-resistant Enterobacteriaceae and carbapenem-resistant Acinetobacter baumannii in a tertiary referral hospital in Korea: Sollan Kang, Ihn Sook Jeong; Osong Public Health Res Perspect. 2022;13(3):221-229. Published online June 30, 2022; DOI: https://doi.org/10.24171/j.phrp.2022.0097

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Abstract PDF

Objectives
This study aimed to identify the epidemiological characteristics of patients with carbapenem-resistant Enterobacteriaceae and Acinetobacter baumannii (CRE/ CRAB) isolates in a tertiary referral hospital in Korea. Methods: We collected and analyzed data from 528 adults admitted to a tertiary referral hospital from August 1, 2018 to February 29, 2020. The CRE/CRAB isolates were confirmed as being present at the time of patients’ admission or acquired during hospitalization based on their medical records. The t-test, chi-square test, or Fisher exact test and stepwise multiple logistic regression were performed. Results: While the proportion of community-acquired CRE/CRAB was low (6%), 20% of CRE/ CRAB isolates were identified in patients at the time of hospitalization. The risk of CRAB isolation was positively associated with mechanical ventilator use (odds ratio [OR], 3.52; 95% confidence interval [CI], 1.96−6.33) and total parenteral nutrition use (OR, 3.64; 95% CI, 1.87−7.08). Conclusion: Over 20% of CRE/CRAB isolates in a tertiary referral hospital in Korea were found at the time of patients’ admission. Furthermore, patients with mechanical ventilation and/or total parenteral nutrition tended to acquire CRAB more frequently. Thus, active surveillance for CRE/CRAB at the time of hospitalization is strongly required, particularly for patients who are expected to require mechanical ventilation or total parenteral nutrition.

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Epidemiological analysis and prevention strategies in response to a shigellosis cluster outbreak: a retrospective case series in an alternative school in the Republic of Korea, 2023
Yeongseo Ahn, Sunmi Jin, Gemma Park, Hye Young Lee, Hyungyong Lee, Eunkyung Shin, Junyoung Kim, Jaeil Yoo, Yuna Kim
Osong Public Health and Research Perspectives.2024; 15(1): 68. CrossRef
Epidemiology and Risk Factors of Carbapenemase-Producing Enterobacteriaceae Acquisition and Colonization at a Korean Hospital over 1 Year
Hye-Jin Kim, Jung-Hee Hyun, Hyo-Seon Jeong, Yeon-Kyeng Lee
Antibiotics.2023; 12(4): 759. CrossRef

Review Article

Yersinia pestis antibiotic resistance: a systematic review: Chen Lei, Suresh Kumar; Osong Public Health Res Perspect. 2022;13(1):24-36. Published online February 18, 2022; DOI: https://doi.org/10.24171/j.phrp.2021.0288

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Abstract PDF

Yersinia pestis, the cause of plague and a potential biological weapon, has always been a threatening pathogen. Some strains of Y. pestis have varying degrees of antibiotic resistance. Thus, this systematic review was conducted to alert clinicians to this pathogen’s potential antimicrobial resistance. A review of the literature was conducted for experimental reports and systematic reviews on the topics of plague, Y. pestis, and antibiotic resistance. From 1995 to 2021, 7 Y. pestis isolates with 4 antibiotic resistance mechanisms were reported. In Y. pestis 17/95, 16/95, and 2180H, resistance was mediated by transferable plasmids. Each plasmid contained resistance genes encoded within specific transposons. Strain 17/95 presented multiple drug resistance, since plasmid 1202 contained 10 resistance determinants. Strains 16/95 and 2180H showed single antibiotic resistance because both additional plasmids in these strains carried only 1 antimicrobial determinant. Strains 12/87, S19960127, 56/13, and 59/13 exhibited streptomycin resistance due to an rpsl gene mutation, a novel mechanism that was discovered recently. Y. pestis can acquire antibiotic resistance in nature not only via conjugative transfer of antimicrobial-resistant plasmids from other bacteria, but also by gene point mutations. Global surveillance should be strengthened to identify antibiotic-resistant Y. pestis strains by whole-genome sequencing and drug susceptibility testing.

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A novel sORF gene mutant strain of Yersinia pestis vaccine EV76 offers enhanced safety and improved protection against plague
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Original Articles

Prevalence of plasmid-mediated AmpC β-lactamases among uropathogenic Escherichia coli isolates in southwestern Iran: Nabi Jomehzadeh, Khadijeh Ahmadi, Zahra Rahmani; Osong Public Health Res Perspect. 2021;12(6):390-395. Published online December 1, 2021; DOI: https://doi.org/10.24171/j.phrp.2021.0272

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Abstract PDF

Objectives
This study was undertaken to evaluate AmpC β-lactamase-producing Escherichia coli urine isolates and to characterize the frequency of plasmid-mediated AmpC (pAmpC)-encoding genes.
Methods
Antimicrobial susceptibility tests were performed using the disk diffusion technique. AmpC β-lactamase production was assessed with a phenotypic inhibitor-based method. The presence of 6 pAmpC-encoding cluster genes was detected by multiplex polymerase chain reaction (PCR).
Results
The proportion of antibiotic resistance of E. coli isolates ranged from 7.4% to 90.5%, and more than half (51.6%) of the total isolates were multidrug-resistant (MDR). Among the 95 E. coli isolates, 60 (63.2%) were found to be cefoxitin-resistant, but only 14 (14.7%) isolates were confirmed as AmpC β-lactamase-producers. In the PCR assay, pAmpC-encoding genes were found in 15 (15.8%) isolates, and blaDHA was the most prevalent type. However, blaFOX, blaMOX, and blaACC genes were not detected in the isolates.
Conclusion
Our findings contributed valuable information concerning antibiotic resistance, confirmatory phenotypic testing for AmpC production, and pAmpC β-lactamase gene content in E. coli isolates in southwestern Iran. The level of MDR recorded in AmpC-producing strains of this study was worrying; therefore, implementing strong infection control approaches to reduce the MDR burden is recommended.

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Sina Nasrollahian, Jay P. Graham, Mehrdad Halaji
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Nabi Jomehzadeh, Khadijeh Ahmadi, Hasti Shaabaninejad, Gholamali Eslami
Biomedical and Biotechnology Research Journal (BBR.2022; 6(4): 582. CrossRef

Characterization of Antimicrobial Susceptibility, Extended-Spectrum β-Lactamase Genes and Phylogenetic Groups of Enteropathogenic Escherichia coli Isolated from Patients with Diarrhea: Erfaneh Jafari, Saeid Mostaan, Saeid Bouzari; Osong Public Health Res Perspect. 2020;11(5):327-333. Published online October 22, 2020; DOI: https://doi.org/10.24171/j.phrp.2020.11.5.09

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Abstract PDF

Objectives

Infectious diarrhea is one of the most common causes of pediatric death worldwide and enteropathogenic Escherichia coli (EPEC) is one of the main causes. There are 2 subgroups of EPEC, typical and atypical, based on the presence or absence of bundle forming pili (bfp), of which atypical EPEC is considered less virulent, but not less pathogenic. Antimicrobial resistance towards atypical EPEC among children is growing and is considered a major problem. In this study the pattern of antibiotic resistance in clinical isolates was determined.

Methods

Using 130 isolates, antibiotic resistance patterns and phenotypes were assessed, and genotypic profiles of extended spectrum β-lactamase (ESBL) production using disc diffusion and PCR was carried out. Phylogenetic groups were analyzed using quadruplex PCR.

Results

There were 65 E. coli isolates identified as atypical EPEC by PCR, among which the highest antibiotic resistance was towards ampicillin, followed by trimethoprim-sulfamethoxazole, and tetracycline. Multidrug resistance was detected in 44.6% of atypical EPEC isolates. Around 33% of isolates were determined to be extended spectrum β-lactamase producers, and in 90% of isolates, genes responsible for ESBL production could be detected. Moreover, the majority of atypical EPEC strains belonged to Group E, followed by Groups B1, B2 and C.

Conclusion

High rates of multidrug resistance and ESBL production among atypical EPEC isolates warrant periodical surveillance studies to select effective antibiotic treatment for patients. It is considered a critical step to manage antibiotic resistance by avoiding unnecessary prescriptions for antibiotics.

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Analysis of Resistance to Macrolide–Lincosamide–Streptogramin B Among mecA-Positive Staphylococcus Aureus Isolates: Mahmoud Khodabandeh, Mohsen Mohammadi, Mohammad Reza Abdolsalehi, Azadeh Alvandimanesh, Mehrdad Gholami, Meysam Hasannejad Bibalan, Abazar Pournajaf, Ramin Kafshgari, Ramazan Rajabnia; Osong Public Health Res Perspect. 2019;10(1):25-31. Published online February 28, 2019; DOI: https://doi.org/10.24171/j.phrp.2019.10.1.06

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Abstract PDF

Objectives

Genetic determinants conferring resistance to macrolide, lincosamide, and streptogramin B (MLS_B) via ribosomal modification such as, erm, msrA/B and ereA/B genes are distributed in bacteria. The main goals of this work were to evaluate the dissemination of MLS_B resistance phenotypes and genotypes in methicillin-resistant Staphylococcus aureus (MRSA) isolates collected from clinical samples.

Methods

A total of 106 MRSA isolates were studied. Isolates were recovered from 3 hospitals in Tehran between May 2016 to July 2017. The prevalence of MLS_B-resistant strains were determined by D-test, and then M-PCR was performed to identify genes encoding resistance to macrolides, lincosamides, and streptogramins in the tested isolates.

Results

The frequency of constitutive resistance MLS_B, inducible resistance MLS_B and MS_B resistance were 56.2%, 22.9%, and 16.6%, respectively. Of 11 isolates with the inducible resistance MLS_B phenotype, ermC, ermB, ermA and ereA were positive in 81.8%, 63.6%, 54.5% and 18.2% of these isolates, respectively. In isolates with the constitutive resistance MLS_B phenotype, the prevalence of ermA, ermB, ermC, msrA, msrB, ereA and ereB were 25.9%, 18.5%, 44.4%, 0.0%, 0.0%, 11.1% and 0.0%, respectively.

Conclusion

Clindamycin is commonly administered in severe MRSA infections depending upon the antimicrobial susceptibility findings. This study showed that the D-test should be used as an obligatory method in routine disk diffusion assay to detect inducible clindamycin resistance in MRSA so that effective antibiotic treatment can be provided.

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High Prevalence of Class 1 to 3 Integrons Among Multidrug-Resistant Diarrheagenic Escherichia coli in Southwest of Iran: Mohammad Kargar, Zahra Mohammadalipour, Abbas Doosti, Shahrokh Lorzadeh, Alireza Japoni-Nejad; Osong Public Health Res Perspect. 2014;5(4):193-198. Published online August 31, 2014; DOI: https://doi.org/10.1016/j.phrp.2014.06.003

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Abstract PDF

Objectives
Horizontal transfer of integrons is one of the important factors that can contribute to the occurrence of multidrug-resistant (MDR) bacteria. This study aimed to determine the prevalence of integrons among MDR Escherichia coli strains isolated from stool specimens and investigate the associations between the existence of integrons and MDR properties in the southwest of Iran.
Methods
There were 164 E. coli strains isolated from January 2012 to June 2012. Fecal specimens identified as E. coli by the conventional methods. Subsequently the antibiotic resistance was assessed using Clinical and Laboratory Standard Institute criteria. The presence of class 1–3 integrons and embedded gene cassettes was verified using specific primers by multiplex polymerase chain reaction assay.
Results
Among a total of 164 studied samples, 69 (42.07%) isolates were multidrug resistant. Class 1 and class 2 integrons were present in 78.26% and 76.81% MDR isolates, respectively. For the first time in Iran, class 3 integron was observed in 26.09% MDR isolates. Significant correlations were identified between: class 1 integron and resistance to amikacin, gentamicin, chloramphenicol, ampicillin, tetracycline, nalidixic acid, and co-trimoxazole; class 2 integron and resistance to aminoglycosides, co-trimoxazole, cefalexin, ampicillin, and chloramphenicol; and class 3 integron and resistance to gentamicin, kanamycin, and streptomycin.
Conclusion
Our results indicate that integrons are common among MDR isolates and they can be used as a marker for the identification of MDR isolates. Therefore, due to the possibility of a widespread outbreak of MDR isolates, molecular surveillance and sequencing of the integrons in other parts of the country is recommended.

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In Vitro Antibacterial Efficacy of 21 Indian Timber-Yielding Plants Against Multidrug-Resistant Bacteria Causing Urinary Tract Infection: Monali P. Mishra, Rabindra N. Padhy; Osong Public Health Res Perspect. 2013;4(6):347-357. Published online December 31, 2013; DOI: https://doi.org/10.1016/j.phrp.2013.10.007

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Abstract PDF

Objectives
To screen methanolic leaf extracts of 21 timber-yielding plants for antibacterial activity against nine species of uropathogenic bacteria isolated from clinical samples of a hospital (Enterococcus faecalis, Staphylococcus aureus, Acinetobacter baumannii, Citrobacter freundii, Enterobacter aerogenes, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, and Pseudomonas aeruginosa).
Methods
Bacterial strains were subjected to antibiotic sensitivity tests by the Kirby–Bauer's disc diffusion method. The antibacterial potentiality of leaf extracts was monitored by the agar-well diffusion method with multidrug-resistant (MDR) strains of nine uropathogens.
Results
Two Gram-positive isolates, E. faecalis and S. aureus, were resistant to 14 of the 18 antibiotics used. Gram-negative isolates A. baumannii, C. freundii, E. aerogenes, E. coli, K. pneumoniae, P. mirabilis, and P. aeruginosa were resistant to 10, 12, 9, 11, 11, 10, and 11 antibiotics, respectively, of the 14 antibiotics used. Methanolic leaf extracts of Anogeissus acuminata had the maximum zone of inhibition size—29 mm against S. aureus and 28 mm against E. faecalis and P. aeruginosa. Cassia tora had 29 mm as the zone of inhibition size for E. faecalis, E. aerogenes, and P. aeruginosa. Based on the minimum inhibitory concentration and minimum bactericidal concentration values, the most effective 10 plants against uropathogens could be arranged in decreasing order as follows: C. tora > A. acuminata > Schleichera oleosa > Pterocarpus santalinus > Eugenia jambolana > Bridelia retusa > Mimusops elengi > Stereospermum kunthianum > Tectona grandis > Anthocephalus cadamba. The following eight plants had moderate control capacity: Artocarpus heterophyllus, Azadirachta indica, Dalbergia latifolia, Eucalyptus citriodora, Gmelina arborea, Pongamia pinnata, Pterocarpus marsupium, and Shorea robusta. E. coli, followed by A. baumannii, C. freundii, E. aerogenes, P. mirabilis, and P. aeruginosa were controlled by higher amounts/levels of leaf extracts. Phytochemicals of all plants were qualitatively estimated.
Conclusions
A majority of timber-yielding plants studied had in vitro control capacity against MDR uropathogenic bacteria.

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Articles

Comparison of Antimicrobial Resistance in Escherichia coli Strains Isolated From Healthy Poultry and Swine Farm Workers Using Antibiotics in Korea: Seung-Hak Cho, Yeong-Sik Lim, Yeon-Ho Kang; Osong Public Health Res Perspect. 2012;3(3):151-155. Published online June 30, 2012; DOI: https://doi.org/10.1016/j.phrp.2012.07.002

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Abstract PDF

Objectives
The aim of this study is to compare the antibiotic resistance of Escherichia coli isolates from faecal samples of workers who often use antibiotics.
Methods
A total of 163E coli strains isolated from faecal samples of livestock workers (poultry and swine farm workers) and restaurant workers in the same regions as a control group were analyzed by agar disc diffusion to determine their susceptibility patterns to 16 antimicrobial agents.
Results
Most of the tested isolates showed high antimicrobial resistance to ampicillin and tetracycline. The isolates showed higher resistance to cephalothin than other antibiotics among the cephems. Among the aminoglycosides, the resistance to gentamicin and tobramycin occurred at higher frequencies compared with resistance to amikacin and netilmicin. Our data indicated that faecal E coli isolates of livestock workers showed higher antibiotic resistances than nonlivestock workers (restaurant workers), especially cephalothin, gentamicin, and tobramycin (p < 0.05). Moreover, the rates of the livestock workers in the association of multidrug resistance were also higher than the rates of the restaurant workers.
Conclusion
This study implies that usage of antibiotics may contribute to the prevalence of antibiotic resistance in commensal E coli strains of humans.

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The Emergence of Oseltamivir-Resistant Seasonal Influenza A (H1N1) Virus in Korea During the 2008-2009 Season: Woo-Young Choi, Inseok Yang, Sujin Kim, Namjoo Lee, Meehwa Kwon, Joo-Yeon Lee, Chun Kang; Osong Public Health Res Perspect. 2011;2(3):178-185. Published online December 31, 2011; DOI: https://doi.org/10.1016/j.phrp.2011.11.042

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Abstract PDF

Objectives
To monitor antiviral drug resistance among seasonal influenza viruses isolated in Korea during the 2008-2009 influenza season, we examined influenza isolates collected through Korea Influenza Surveillance Scheme for antiviral drug susceptibility.
Methods
For genetic analysis of antiviral drug resistance, the matrix (M2) and neuraminidase (NA) genes of each isolate were amplified by reverse transcription-polymerase chain reaction and followed by nucleotide sequencing. For phylogenetic analyses, the sequences of hemagglutinin (HA) and NA genes of each isolate were aligned using multiple alignment program. For phenotypic analysis of antiviral drug resistance, drug susceptibilities against M2 inhibitor (amantadine) and NA inhibitors (oseltavimir and zanamivir) were determined by virus yield reduction assay and fluorometric NA inhibition assay, respectively.
Results
In Korea, the resistant influenza viruses against oseltamivir were first detected in sealsonal influenza A(H1N1) viruses on Week 48 of 2008. Since then, the number of oseltamivir-resistant A(H1N1) viruses was continuously increased and had reached the highest peak on Week 52 of 2008. 533 (99.8%) of 534 A(H1N1) viruses were resistant to oseltamivir and all of them harbored the H275Y mutation in the NA gene during the 2008-2009 season. The oseltamivir resistance identified by sequencing was confirmed by NA inhibition assay. Genetic analysis based on HA gene of the resistant A(H1N1) viruses revealed that the viruses were identified as A/Brisbane/10/2007-like strain which was vaccine strain for the 2008-2009 season.
Conclusions
The oseltamivir-resistant A(H1N1) viruses were first emerged in Europe in November 2007 and then circulated globally. One year later, the oseltamivir-resistant A(H1N1) viruses were first detected in Korea in November 2008 and continued circulating until the Week 7 of 2009 during the 2008-2009 season. Considering the pandemic preparedness, it should be continued to monitor the emergence and the characterization of antiviral drug resistant influenza viruses.

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Original Article

Prevalence of Antibiotic Resistance in Escherichia coli Fecal Isolates From Healthy Persons and Patients With Diarrhea: Seung-Hak Cho, Yeong-Sik Lim, Mi-Sun Park, Seong-Han Kim, Yeon-Ho Kang; Osong Public Health Res Perspect. 2011;2(1):41-45. Published online June 30, 2011; DOI: https://doi.org/10.1016/j.phrp.2011.05.003

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Abstract PDF

Objectives
This study aimed to investigate the prevalence of antibiotic resistance in fecal Escherichia coli isolates from healthy persons and patients with diarrhea.
Methods
E. coli isolates (n = 428) were obtained from fecal samples of apparently healthy volunteers and hospitalized patients with diarrhea. Susceptibility patterns of isolates to 16 antimicrobial agents were determined by agar disc diffusion.
Results
Most E. coli isolates exhibited less than 10% resistance against imipenem, cefotetan, aztreonam, cefepime, cefoxitin, amikacin and netilamicin, although greater than 65% were resistant to ampicillin and tetracycline. No significant difference in resistance rates for all tested antibiotics was found between isolates from the healthy-and diarrheal-patient groups, including for multi-drug resistance (p = 0.22). The highest number of resistant antibiotics was 12 antibiotics. No significant differences in antibiotic resistance were found among the sex and age strata for isolates from healthy individuals. However, antibiotic resistance rates to cefoxitin, cefotaxime, amikacin, and netilamicin were significantly higher in the isolates of men than those of women (p < 0.05) in isolates from patients with diarrhea. Furthermore, isolates from patients with diarrhea older than 40-years of age showed higher resistance to cefepime and aztreonam (p < 0.05).
Conclusion
High resistance to the antibiotics most frequently prescribed for diarrhea was found in isolates from patients with diarrhea and apparently healthy individuals without any significant difference.

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