Effective Antimicrobial Solutions for Eradicating Multi-Resistant and β-Lactamase-Producing Nosocomial Gram-Negative Pathogens

Abstract

Antimicrobial resistance (AMR) remains one of the greatest public health-perturbing crises of the 21st century, where species have evolved a myriad of defence strategies to resist conventional therapy. The production of extended-spectrum β-lactamase (ESBL), AmpC and carbapenemases in Gram-negative bacteria (GNB) is one such mechanism that currently poses a significant threat to the continuity of first-line and last-line β-lactam agents, where multi-drug-resistant GNB currently warrant a pandemic on their own merit. The World Health Organisation (WHO) has long recognised the need for an improved and coordinated global effort to contain these pathogens, where two factors in particular, international travel and exposure to antimicrobials, play an important role in the emergence and dissemination of antibiotic-resistant genes. Studies described herein assess the resistance patterns of isolated nosocomial pathogens, where levels of resistance were detected using recognised in vitro methods. Additionally, studies conducted extensively investigated alternative biocide (namely peracetic acid, triameen and benzalkonium chloride) and therapeutic options (specifically 1,10-phenanthroline-5,6-dione), where the levels of induced endotoxin from E. coli were also studied for the latter. Antibiotic susceptibility testing revealed there was a significant association between multi-drug resistance and ESBL production, where the WHO critical-priority pathogens, namely E. coli, K. pneumoniae, A. baumannii and P. aeruginosa, exhibited among the greatest levels of multi-drug resistance. Novel compound 1,10-phenanthroline-5,6-dione (phendione) shows promising antimicrobial activity, with MICs determined for all bacterial species, where levels of induced endotoxin varied depending on the concentration used. Tested biocide agents show potential to act as intermediate-level disinfectants in hospital settings, where all tested clinical isolates were susceptible to treatment.

Analysis of Microbiological and Clinical Characteristics of Bacterial Infection in Patients with Pulmonary Infection

“…As most of the elderly are complicated with multiple underlying diseases, with concealed onset, rapid progress, and high mortality, empirical anti-infective treatment should be administered as soon as possible once pulmonary infection is diagnosed [ 25 ]. The choice of anti-infective regimens is critical, and studies by Alvarez et al show that about 44% of patients need to adjust their anti-infective regimens after initial empirical anti-infective therapy, of which 62% are multidrug resistant bacterial infections [ 26 ]. Most of the elderly are prone to drug-resistant bacterial infection due to repeated hospitalization, long hospitalization time, and low immunity [ 27 ].…”

Antibacterial and Anti-Biofilm Activities of Essential Oil Compounds against New Delhi Metallo-β-Lactamase-1-Producing Uropathogenic Klebsiella pneumoniae Strains

“…It is estimated that approximately 70–95% and 5–10% of UTIs are caused by Escherichia coli and K. pneumoniae , respectively [ 2 ]. Nevertheless, according to the World Health Organization (WHO) K. pneumoniae is one of the high-priority species due to a growing global problem of antimicrobial resistance [ 3 ]. New Delhi metallo-β-lactamase-1 (NDM-1) is the most recently discovered carbapenemase capable of hydrolyzing almost all β-lactams present in Gram-negative pathogens produced mainly by K. pneumoniae , and responsible for hospital and acquired infections in community.…”

Bacteriophages and Food Production: Biocontrol and Bio-Preservation Options for Food Safety

“…Shiga toxin producing E. coli (STEC) as a foodborne pathogen resulted in 34 outbreaks, 208 cases, 30 hospitalisations and 1 death reported in 2020 [ 26 ]. The emergence of AMR in pathogenic species is also coupled with biocidal resistance which means disinfection regimes have become less reliable particularly for Gram-negative species [ 27 ]. Foods are recognised as important reservoirs of many Gram-negative species including E. coli , Klebsiella spp., and Acinetobacter spp.…”

“…Disinfection commonly in use in food production include quaternary ammonia compounds (QACs) dodecyldimethylammonium chloride (DDAC) and benzalkonium chloride (BAC), hypochlorite’s, iodophors and chlorine dioxide-based solutions [ 29 ]. Resistance to QACs and BAC has emerged in MDR species of Pseudomonas and Enterobacteriaceae due to the presence of qac genes [ 27 ]. Indeed, many of the WHO high priority “ESKAPE” pathogens ( Enterococcus spp., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.)…”

“…Indeed, many of the WHO high priority “ESKAPE” pathogens ( Enterococcus spp., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.) associated with foodborne transmission are also multidrug-resistant (MDR), extensively drug-resistant (XDR), and pan drug-resistant (PDR) species also displaying biocidal resistance [ 27 ]. Methicillin resistant Staphylococcus aureus (MRSA) is also a common foodborne pathogen.…”