Burden of Carbapenem Resistant Acinetobacter baumannii Harboring blaOXA Genes in the Indian Intensive Care Unit

Carbapenem was originally regarded as a cornerstone therapeutic for Gram-negative bacterial infections that could be fatal, but these pathogens are rapidly acquiring resistance to it by various methods such as forming biofilms, mutations in porin channels, overexpression of efflux pumps, altering or modifying antibiotics, and by horizontal gene transfer of resistance biomarkers. Among Gram-negative pathogens, the World Health Organization has prioritized Acinetobacter baumannii as a “pathogen of concern.” A. baumannii strains have a variety of antibiotics resistance pathways, making them resistant to the majority of antibiotics. Antibiotics are used indiscriminately and excessively, causing extensive natural selection pressure and allowing just the most versatile variants of A. baumannii to flourish. Evolutionary changes are unavoidable, but the widespread utilization of antimicrobials in communities, hospitals, and agriculture industries is certainly contributing to the outbreak. Antibiotic resistance has resulted in a number of adverse outcomes such as inadequacy of antimicrobials, persistent infections, and physical ailments that cause the patients to lose momentum, longer stay in the hospital, increased mortality, and morbidity, as well as increased cost that can overburden the patients and even the hospitals. Therefore, optimizing efficient alternate natural antibacterial compounds is a critical aspect of addressing the problem of antibiotic resistance. Various studies (in vitro) done by scientists and researchers have illustrated the efficacy of plant extracts and their essential oils against A. baumannii and other pathogens. The most urgent need is to do research in vivo and more screening of natural products or plant parts, which might lead to the discovery of novel therapeutically efficient antibacterial agents against resistant bacterial infections.

Efficacy of Plant Extracts against Carbapenem Resistant Acinetobacter baumannii: A Notorious Pathogen in the Intensive Care Unit

Paneri,

Sevta,

Yagnik

2023

Overview of β-Lactam-Resistance Genes in Pandemic Multidrug-Resistant Acinetobacter baumannii: A Troublesome Pathogen in the Indian Intensive Care Unit

Paneri,

Sevta,

Yagnik

et al. 2024

Objectives: Acinetobacter baumannii is responsible for many infections in admitted patients, especially in the intensive care unit (ICU). Several risk factors may lead to an enhanced risk of A. baumannii colonization and infections. β-lactam antibiotics are frequently administered to treat Gram-positive and Gram-negative bacterial infections due to their minimum side effects, but the acquisition of β-lactamase genes has been the most challenging and troublesome situation and an imminent threat to the world as it increases mortality, medical expenses, and hospital stays. Hence, the present systematic review focused on the screening of β-lactam resistance genes that have been identified in the A. baumannii isolates’ genome and the nosocomial infections they cause in the Indian ICU. Material and Methods: This review has been done according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline 2020. After screening, 317 genomes were included in this systematic review. We downloaded data from the bv-brc.org website on an Excel spreadsheet for statistical analysis. We presented categorical data in percentages (%) and in the form of a graph and pie chart. Results: Among the 317 isolates, pneumonia was caused by 189 strains (59.62%), bacteremia was caused by 109 strains (34.38%), respiratory infection by 12 isolates (3.79%), sepsis by 5 isolates (1.58%), and wound infection by 2 isolates (0.63%), which indicated that A. baumannii strains are highly involved in pneumonia followed by bacteremia. We did comparative genome analysis and found 26 β-lactamase genes; among them, the ADC2 gene was found to be in higher frequency (312) and was identified in 98.42% of A. baumannii isolates, followed by the OXA23 gene (303), which was found in 95.58% of isolates. The NDM-1 gene was identified in 181 (57.09%) isolates. OXA66 was found in 156 (49.21%) isolates. Our findings show a higher frequency of the ADC2 gene, followed by the OXA23 gene, in all these nosocomial infections. We have found that NDM-1, ADC2, OXA23, and OXA-66 genes coexisted in higher frequency in the A. baumannii isolates (137; 43.21%), followed by OXA23, OXA-66, and ADC2 (52; 16.40%). Conclusion: A. baumannii is a notorious pandemic pathogen, designated as a “priority of concern” by the World Health Organization. Our study indicates a high prevalence of the ADC2 gene, which gives resistance against the cephalosporin group and co-existence of β-lactamase genes (ADC2, OXA23, OXA66, and NDM-1) in various A. baumannii isolates’ genomes. This is a worrisome situation. Global molecular surveillance and the “One Health Concept” are crucial, as are research studies on plant extracts’ in vitro and in vivo efficacy against A. baumannii. Combating multidrug-resistant A. baumannii requires a multifaceted approach that involves infection control measures, antimicrobial stewardship, surveillance, education, research, and collaboration. Implementing these strategies and staying vigilant in the face of this resilient pathogen is essential to minimize its impact on health-care systems and public health.

Incidence of Ventilator-Associated Pneumonia and its Bacterial Characterization – Intervention Based Prospective Study

Ramakrishnan,

Jahagirdar,

Ravisankar

et al. 2023

Objectives: Ventilator-associated pneumonia (VAP) is a widely recognized and potentially fatal healthcare-related infection that occurs in all high-dependency units. Mechanically ventilated patients are at an elevated risk of developing VAP, which has a high death and morbidity rate. The prevalence of VAP varies greatly depending on the location and diagnostic approach. Radiological and clinical markers impact VAP diagnosis accuracy. Reliable sampling and confirmation of microbes are highly recommended. The purpose of this study was to document the incidence, patient distribution, bacteriological profile, and antibiotic susceptibility pattern of VAP patients. Material and Methods: A prospective observational study was done between January 2016 and December 2019. Critically, ill patients on mechanical ventilation for more than 48 hours were included in the study. Based on the initial baseline, positive end-expiratory pressure, and fraction of inspired oxygen were followed by three-tier VAP criteria as per NSHN guidelines. Results: Out of 1220 VAP-suspected patients (mechanically ventilated), 49 patients developed hospital-acquired VAP. The incidence of VAP significantly reduced from 10.7 to 1.4 VAP/1000 ventilator days with continuous intervention and auditing over some time. Elderly males aged 51–66 years were found to be in higher risk groups. Klebsiella pneumoniae and Pseudomonas aeruginosa were found to be the most common pathogen. The majority of Enterobacterales (79%) were found to be resistant to third-generation cephalosporin, 69% were resistant toward fluoroquinolone and cotrimoxazole, followed by 55% resistance to beta-lactam and beta-lactamase inhibitor combination. Conclusion: Targeted strategies with implementable policies, such as the care bundle approach, will reduce the in-patient days. It might improve patient outcomes and reduce the incidence of VAP.