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This work was supported by the Regional Government of Castilla y León and the EU-FEDER [CLU 2017-09 and UIC 071]. The author was supported at the University of Oviedo by a European H2020-MSCA-IF-2016 Fellowship [UE-18-VANRESTREP- 740080].

First Detection of Vancomycin Resistant Enterococcus faecium in Latvia
Enterococci have become one of the most important nosocomial pathogens in advanced treatment facilities. Though they are not considered as very pathogenic bacteria, their high levels of antimicrobial resistance are the subject of major concern. Particularly epidemiologically important are vancomycin-resistant enterococci (VRE) due to high risk of transmission of vancomycin resistance genes to staphylococci. We describe the first outbreak of VRE in a Latvian multidisciplinary hospital.

ABSTRACT Background and Objective: The emergence of vancomycin resistance among gram-positive organisms over the past 10 years has raised serious health concerns worldwide. In response, several government organizations have developed recommendations for the appropriate use of vancomycin. The goal of this study was to assess the appropriateness of vancomycin use at 2 tertiary care teaching hospitals in relation to a set of modified guidelines.Methods: All adult patients receiving vancomycin at the Health Sciences Centre and St Boniface General Hospital in Winnipeg, Manitoba, between October 1 and November 30, 1999, were eligible for prospective or retrospective chart review. Patients were identified during order entry and by means of the pharmacy information system. Each patient's vancomycin therapy was assessed according to modified Centers for Disease Control and Prevention and Laboratory Centre for Disease Control guidelines.Results: A total of 199 courses of vancomycin therapy were assessed. Vancomycin was started for prophylaxis in 54 (27%) cases, empiric use in 116 (58%) cases, and documented infections in 28 (14%) cases (indication was unknown in one case). Vancomycin use was inappropriate in 89 (45%) of 199 courses of therapy. Inappropriate empiric use (52 courses) and prophylatic use (27 courses) accounted for the majority of these inappropriate cases (58% and 30%, respectively).Conclusions: Vancomycin was prescribed inappropriately in almost half of all cases in these 2 institutions. These results are comparable to previously reported assessments of vancomycin use. Despite availability of guidelines on vancomycin use, it appears that clinician education, improved ß-lactam allergy workup, and vigilance are warranted, even in the absence of vancomycin resistance.RÉSUMÉ Historique et objectif : L'émergence de bactéries Gram-positives résistant à la vancomycine au cours des dix dernières années a soulevé de sérieuses préoccupations pour la santé partout dans le monde. Nombre d'organisations gouvernementales ont réagi en mettant de l'avant des recommandations sur l'utilisation appropriée de la vancomycine. L'objectif de cette étude était d'évaluer, à partir de lignes directrices modifiées, la pertinence de l'utilisation de la vancomycine dans deux hôpitaux universitaires de soins tertiaires.Méthodes : Tous les patients adultes du Health Sciences Centre et de l'Hôpital général St-Boniface de Winnipeg, au Manitoba, qui ont reçu de la vancomycine entre le 1er octobre et le 30 novembre 1999, étaient admissibles à l'étude prospective et rétrospective de leurs dossiers médicaux. Les patients ont été identifiés lors de la saisie des ordonnances et à l'aide du système d'information de la pharmacie. Pour chacun des patients, le traitement à la vancomycine a été évalué en fonction des lignes directrices modifiées des Centers for Disease Control and Prevention et du Laboratoire de lutte contre la maladie.Résultats : Au total, 199 traitements à la vancomycine ont été évalués. La vancomycine a été prescrite comme traitement prophylactique dans 54 (27 %) cas, comme traitement empirique dans 116 (58 %) cas et dans 28 (14 %) cas documentés d'infections (aucune indication n'était spécifiée dans un des cas). L'utilisation de la vancomycine était inappropriée dans 89 (45 %) des 199 traitements. Cinquante-deux traitements empiriques et 27 traitements prophylactiques représentaient la plupart de ces cas inappropriés (respectivement 58 % et 30 %).Conclusions : La vancomycine a été prescrite de façon inappropriée dans près de la moitié des cas dans ces deux établissements. Ces résultats sont comparables à ceux d'études antérieures sur l'utilisation de la vancomycine. Malgré la disponibilité de lignes directrices sur l'utilisation de la vancomycine, il semble que l'éducation des cliniciens, de meilleurs tests d'allergie aux ß-lactamines et la vigilance s'imposent, même en l'absence de résistance à la vancomycine.

Antibiotic resistance currently presents one of the biggest threats to humans. The development and implementation of strategies against the spread of superbugs is a priority for public health. In addition to raising social awareness, approaches such as the discovery of new antibiotic molecules and the elucidation of resistance mechanisms are common measures. Accordingly, the two-component system (TCS) of Streptomyces coelicolor AbrB1/B2, offer amenable ways to study both antibiotic production and resistance. Global transcriptomic comparisons between the wild-type strain S. coelicolor M145 and the mutant ΔabrB, using RNA-Seq, showed that the AbrB1/B2 TCS is implicated in the regulation of different biological processes associated with stress responses, primary and secondary metabolism, and development and differentiation. The ΔabrB mutant showed the up-regulation of antibiotic biosynthetic gene clusters and the down-regulation of the vancomycin resistance gene cluster, according to the phenotypic observations of increased antibiotic production of actinorhodin and undecylprodigiosin, and greater susceptibility to vancomycin. The role of AbrB1/B2 in vancomycin resistance has also been shown by an in silico analysis, which strongly indicates that AbrB1/B2 is a homolog of VraR/S from Staphylococcus aureus and LiaR/S from Enterococcus faecium/Enterococcus faecalis, both of which are implied in vancomycin resistance in these pathogenic organisms that present a serious threat to public health. The results obtained are interesting from a biotechnological perspective since, on one hand, this TCS is a negative regulator of antibiotic production and its high degree of conservation throughout Streptomyces spp. makes it a valuable tool for improving antibiotic production and the discovery of cryptic metabolites with antibiotic action. On the other hand, AbrB1/B2 contributes to vancomycin resistance and is a homolog of VraR/S and LiaR/S, important regulators in clinically relevant antibiotic-resistant bacteria. Therefore, the study of AbrB1/B2 could provide new insight into the mechanism of this type of resistance. ; Our laboratory was funded by projects BIO2015-66958- R (MINECO/FEDER), PID2019-107716RB-I00, SA036G19 (Regional Government of Castile and Leon) and, from the Regional Government of Castile and Leon/FEDER program ("Escalera de Excelencia" CLU-2017-03/14-20) to the Institute of Functional Biology and Genomics (IBFG). SA was supported by a fellowship awarded by the Regional Government of Castile and Leon (grant CSI099A12-1) and, RSN has been supported by an FPU fellowship from Spanish Ministry of Education, Culture and Sport (FPU17/02862).

The current study aimed to study the resistance of some species Bacterial resistance to the antibiotic vancomycin. 121 samples were collected and grown on Chocolate Agar medium for isolating pathogenic bacteria. and then It was grown on Nutrient Agar medium for pure colonies. These bacteria were diagnosed using phenotypic methods, biochemical tests, and 16SrRNA gene. The results reported that 40 (33.3%) resistant strains appeared, of which 13 were males with a percentage of (32.5%), while the number of female samples was 27 with a percentage (67.5%) and the rest were sensitive to this antibiotic. done during the study The current study obtained four types of bacteria resistant to vancomycin: 24 strains (60%) belonging to Pseudomonas aeruginosa bacteria, 11 strains (27.5%) belonging to Proteus mirabilis bacteria, 4 strains (10%) of Staphylococcus aureus bacteria, and one strain (2.5%) for Actinomyces sp. As for the presence of resistance genes, Vancomycin, where the current study recorded the presence of 17 bacterial strains containing both VanA and VanB genes (42.5%), while the VanA gene was present in 8 strains (20%), and the VanB gene was present in 6 strains (15%), and 9 appeared Strains (22.5%) do not possess either of the two genes (VanA and VanB), although they were resistant to vancomycin, and this may be due to their possession of other resistance genes or other mechanisms of resistance to this antibiotic.

Abstract
Background
Bacterial drug resistance represents a significant global concern, with vancomycin-resistant Enterococcus faecalis posing a particularly grave threat to contemporary healthcare systems. This study aims to reveal the reasons for the prevalence of VRE in China.

Methods
This study collected data from the China Antimicrobial Resistance Detection System, China Statistical Yearbook, and China Meteorological Network. The collected data are meticulously organized and subjected to both single-factor and multi-factor analyses. An accurate multiple linear regression model was developed by utilizing this comprehensive dataset.

Results
Single-factor analysis revealed significant regional variations in the resistance rate of vancomycin-resistant Enterococcus faecalis (P = 0.003). Specifically, there were noteworthy disparities observed between regions experiencing temperate and monsoon climates (P = 0.029; P = 0.005). Furthermore, multi-factor regression analysis demonstrated a negative correlation between the drug resistance rate and both rainfall and rGDP, while a positive correlation was observed with nPI.

Conclusion
We successfully established a prediction model for the VRE and found that the resistance rate was low in areas with high rainfall and high per capita economic income, but high in areas with many specialized public health institutions. This is critical for public health strategies and helps policymakers and healthcare practitioners tailor antibiotic resistance approaches to local geography, meteorology, economic conditions.

Vancomycin-resistant Enterococcus faecium (VREfm) is a major cause of nosocomial infection and is categorized as high priority by the World Health Organization global priority list of antibiotic-resistant bacteria. In the past, livestock have been proposed as a putative reservoir for drug-resistant E. faecium strains that infect humans, and isolates of the same lineage have been found in both reservoirs. We undertook cross-sectional surveys to isolate E. faecium (including VREfm) from livestock farms, retail meat, and wastewater treatment plants in the United Kingdom. More than 600 isolates from these sources were sequenced, and their relatedness and antibiotic resistance genes were compared with genomes of almost 800 E. faecium isolates from patients with bloodstream infection in the United Kingdom and Ireland. E. faecium was isolated from 28/29 farms; none of these isolates were VREfm, suggesting a decrease in VREfm prevalence since the last UK livestock survey in 2003. However, VREfm was isolated from 1% to 2% of retail meat products and was ubiquitous in wastewater treatment plants. Phylogenetic comparison demonstrated that the majority of human and livestock-related isolates were genetically distinct, although pig isolates from three farms were more genetically related to human isolates from 2001 to 2004 (minimum of 50 single-nucleotide polymorphisms [SNPs]). Analysis of accessory (variable) genes added further evidence for distinct niche adaptation. An analysis of acquired antibiotic resistance genes and their variants revealed limited sharing between humans and livestock. Our findings indicate that the majority of E. faecium strains infecting patients are largely distinct from those from livestock in this setting, with limited sharing of strains and resistance genes.IMPORTANCE The rise in rates of human infection caused by vancomycin-resistant Enterococcus faecium (VREfm) strains between 1988 to the 2000s in Europe was suggested to be associated with acquisition from livestock. As a result, the European Union banned the use of the glycopeptide drug avoparcin as a growth promoter in livestock feed. While some studies reported a decrease in VREfm in livestock, others reported no reduction. Here, we report the first livestock VREfm prevalence survey in the UK since 2003 and the first large-scale study using whole-genome sequencing to investigate the relationship between E. faecium strains in livestock and humans. We found a low prevalence of VREfm in retail meat and limited evidence for recent sharing of strains between livestock and humans with bloodstream infection. There was evidence for limited sharing of genes encoding antibiotic resistance between these reservoirs, a finding which requires further research.

Background: Methicillin resistant Staphylococcus aureus (MRSA) is a common pathogen which has increased both morbidity and mortality in hospitals and out-door patients. Objective: Aim of our study is to measure prevalence of MRSA in in-door patients and out- door patients, as well as its sensitivity against gentamycin, vancomycin and ciprofloxacin. Methods: A sample of 194 S. aureus was taken retrospectively from Pathology lab of a tertiary care hospital. MRSA was identified and further subjected against gentamycin, vancomycin and ciprofloxacin. Result: 65.9% of S. aureus isolates were MRSA. 22.7%, 35.7%, 99.1% of MRSA were susceptible to ciprofloxacin, gentamycin and vancomycin, respectively. 75.8% MRSA was from pus samples. 66% MRSA was from in-door patient department (IPD). Conclusion: MRSA was more prevalent in IPD. MRSA prevalence is escalating. Vancomycin is losing its effectiveness against MRSA as one resistant case was found. Inappropriate use and unprofessional prescriptions for antibiotics can be the main cause. Proper legislative action is required to keep in control the prescriptions for antibiotics.

Legislation aimed at controlling antimicrobial-resistant pathogens through the use of active surveillance cultures to screen hospitalized patients has been introduced in at least 2 US states. In response to the proposed legislation, the Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology, Inc., (APIC) have developed this joint position statement. Both organizations are dedicated to combating health care-associated infections with a wide array of methods, including the use of active surveillance cultures in appropriate circumstances. This position statement reviews the proposed legislation and the rationale for use of active surveillance cultures, examines the scientific evidence supporting the use of this strategy, and discusses a number of unresolved issues surrounding legislation mandating use of active surveillance cultures. The following 5 consensus points are offered. (1) Although reducing the burden of antimicrobial-resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE), is of preeminent importance, the APIC and the SHEA do not support legislation to mandate use of active surveillance cultures to screen for MRSA, VRE, or other antimicrobial-resistant pathogens. (2) The SHEA and the APIC support the continued development, validation, and application of efficacious and cost-effective strategies for the prevention of infections caused by MRSA, VRE, and other antimicrobial-resistant and antimicrobial-susceptible pathogens. (3) The APIC and the SHEA welcome efforts by health care consumers, together with private, local, state, and federal policy makers, to focus attention on and formulate solutions for the growing problem of antimicrobial resistance and health care-associated infections. (4) The SHEA and the APIC support ongoing additional research to determine and optimize the appropriateness, utility, feasibility, and cost-effectiveness of using active surveillance cultures to screen both lower-risk and high-risk populations. (5) The APIC and the SHEA support stronger collaboration between state and local public health authorities and institutional infection prevention and control experts.

The rise of antibiotic resistance is not only a challenge for human and animal health treatments, but is also posing the risk of spreading among bacterial populations in foodstuffs. Farmed fish-related foodstuffs, the food of animal origin most consumed worldwide, are suspected to be a reservoir of antibiotic resistance genes and resistant bacterial hazards. However, scant research has been devoted to the possible sources of diversity in fresh fillet bacterial ecosystems (farm environment including rivers and practices, and factory environment). In this study bacterial communities and the antibiotic resistance genes of fresh rainbow trout fillet were described using amplicon sequencing of the V3-V4 region of the 16S rRNA gene and high-throughput qPCR assay. The antibiotic residues were quantified using liquid chromatography/mass spectrometry methods. A total of 56 fillets (composed of muscle and skin tissue) from fish raised on two farms on the same river were collected and processed under either factory or laboratory sterile filleting conditions. We observed a core-bacterial community profile on the fresh rainbow trout fillets, but the processing conditions of the fillets has a great influence on their mean bacterial load (3.38 ± 1.01 log CFU/g vs 2.29 ± 0.72 log CFU/g) and on the inter-individual diversity of the bacterial community. The bacterial communities were dominated by Gamma- and Alpha-proteobacteria, Bacteroidetes, Firmicutes, and Actinobacteria. The most prevalent genera were Pseudomonas, Escherichia-Shigella, Chryseobacterium, and Carnobacterium. Of the 73 antibiotic residues searched, only oxytetracycline residues were detected in 13/56 fillets, all below the European Union maximum residue limit (6.40–40.20 μg/kg). Of the 248 antibiotic resistance genes searched, 11 were found to be present in at least 20% of the fish population (tetracycline resistance genes tetM and tetV, β-lactam resistance genes bla(DHA) and bla(ACC), macrolide resistance gene mphA, vancomycin resistance genes vanTG and vanWG ...

International audience ; The rise of antibiotic resistance is not only a challenge for human and animal health treatments, but is also posing the risk of spreading among bacterial populations in foodstuffs. Farmed fish-related foodstuffs, the food of animal origin most consumed worldwide, are suspected to be a reservoir of antibiotic resistance genes and resistant bacterial hazards. However, scant research has been devoted to the possible sources of diversity in fresh fillet bacterial ecosystems (farm environment including rivers and practices, and factory environment). In this study bacterial communities and the antibiotic resistance genes of fresh rainbow trout fillet were described using amplicon sequencing of the V3-V4 region of the 16S rRNA gene and high-throughput qPCR assay. The antibiotic residues were quantified using liquid chromatography/mass spectrometry methods. A total of 56 fillets (composed of muscle and skin tissue) from fish raised on two farms on the same river were collected and processed under either factory or laboratory sterile filleting conditions. We observed a core-bacterial community profile on the fresh rainbow trout fillets, but the processing conditions of the fillets has a great influence on their mean bacterial load (3.38 ± 1.01 log CFU/g vs 2.29 ± 0.72 log CFU/g) and on the inter-individual diversity of the bacterial community. The bacterial communities were dominated by Gamma- and Alpha-proteobacteria, Bacteroidetes, Firmicutes, and Actinobacteria. The most prevalent genera were Pseudomonas, Escherichia-Shigella, Chryseobacterium, and Carnobacterium. Of the 73 antibiotic residues searched, only oxytetracycline residues were detected in 13/56 fillets, all below the European Union maximum residue limit (6.40-40.20 μg/kg). Of the 248 antibiotic resistance genes searched, 11 were found to be present in at least 20% of the fish population (tetracycline resistance genes tetM and tetV, β-lactam resistance genes bla (DHA) and bla (ACC), macrolide resistance gene mphA, vancomycin resistance genes vanTG and vanWG and multidrug-resistance genes mdtE, mexF, vgaB and msrA) at relatively low abundances calculated proportionally to the 16S rRNA gene.

Background: Methicillin resistant Staphylococcus aureus (MRSA) is a common pathogen which has increased both morbidity and mortality in hospitals and out-door patients.Objective: Aim of our study is to measure prevalence of MRSA in in-door patients and out- door patients, as well as its sensitivity against gentamycin, vancomycin and ciprofloxacin. Methods: A sample of 194 S. aureus was taken retrospectively from Pathology lab of a tertiary care hospital. MRSA was identified and further subjected against gentamycin, vancomycin and ciprofloxacin. Result: 65.9% of S. aureus isolates were MRSA. 22.7%, 35.7%, 99.1% of MRSA were susceptible to ciprofloxacin, gentamycin and vancomycin, respectively. 75.8% MRSA was from pus samples. 66% MRSA was from in-door patient department (IPD).Conclusion: MRSA was more prevalent in IPD. MRSA prevalence is escalating. Vancomycin is losing its effectiveness against MRSA as one resistant case was found. Inappropriate use and unprofessional prescriptions for antibiotics can be the main cause. Proper legislative action is required to keep in control the prescriptions for antibiotics. Keywords: Methicillin-Resistant Staphylococcus aureus, Bacterial drug resistance, Antimicrobial drugs

Objective: In order to combat with antimicrobial resistance, some measures should be taken and determination of the current status is one of them. National antimicrobial resistance surveillance system (NAMRSS) was established for this purpose in Turkey. It was targeted to be useful for guidence of ampirical therapy, create antimicrobial usage policies, provide data to the guidebooks, and supply initial information to evaluate the efficasy of the measures taken. Methods: Data of resistance was collected from 55 hospital, from blood and cerebrospinal fluid isolates, which were S. aureus, E. faecalis and E. faecium, S. pneumoniae, E. coli, K. pneumoniae and P. aeruginosa. The antimicrobials and test methods were chosen in accordance with international surveillance systems. The collected data was analysed by WHONET software. Results: S. aureus (1437); meticillin resistance was 31.5%, rifampin, linezolid and vancomycin resistance were 65.3%, 2.3%, and 0.0%, respectively. E. faecalis (n=760) resistance of ampicillin was 9.7%, linezolid, vancomycin, teicoplanin were lower than 1%, high level (HL) aminoglycoside was around 30%. E. faecium (n=756) resistance of ampicillin was 88,1%, linezolid, teicoplanin were lower than 1%, vancomycin 17%, HL aminoglycoside was around 50%. S. pneumoniae (n=128) with non-meningitis breakpoints; resistance were lower than 5.2% for all antimicrobials other than erythromycin (32%), with meningitis breakpoints: resistance increased to 14,3-44,8%. E. coli (2280) and K. pneumoniae (1307), extended spectrum beta-lactamase (ESBL) was 51.6% and 54.0%, respectively. P. aeruginosa (825) resistance were changed in between 8.4% (amikacin) and 36.4% (piperacillin). Conclusion: The resistance was higher among the countries in close geographical region and increased in time, indicating the need for developing policies to combat with it. Besides, the results will also be valuable to monitor the usefulness of the measures taken. © 2018 Refik Saydam National Public Health Agency (RSNPHA).Amaç: Antimikrobiyal direnç ile mücadele için bazi önlemler alinmalidir, mevcut durumun saptanmasi da bunlardan biridir. Türkiye'de ulusal antimikrobiyal direnç surveyans sistemi bu hedefle kurulmuştur. Ampirik tedaviyi desteklemek, antimikrobiyal kullanim politikalari oluşturmak, rehber kitaplara veri sağlamak, alinmiş olan önlemlerin etkinliğini değerlendirmek için başlangiç bilgilerini sağlamak amaçlanmiştir. Yöntem: Elli beş hastaneden, kan ve beyin omurilik sivisindan izole edilen Staphylococcus aureus, Enterococcus faecalis, Enterococcus faecium, Streptococcus pneumoniae, Escherichia coli, Klebsiella pneumoniae ve Pseudomonas aeruginosa izolatlarinin direnç verileri toplanmiştir. Antimikrobiyaller ve test yöntemleri uluslararasi surveyans sitemleri ile uyumlu olacak şekilde seçilmiştir. Toplanan veriler WHONET programi ile analiz edilmiştir. Bulgular: S. aureus (n = 1437); metisilin direnci ,5, rifampin, linezolid ve vankomisin direnci sirasi ile ,3; %2,3 ve %0,0, bulunmustur. E. faecalis (n = 760) ampisilin direnci %9,7, linezolid, vankomisin, teikoplanin direnci %1'in altinda, yüksek düzey (YD) aminoglikozid civarinda bulunmuştur. E. faecium (n = 756) ampisilin direnci ,1; linezolid ve teikoplanin %1'den az, vankomisin , YD aminoglikozid civarinda bulunmuştur. S. pneumoniae (n = 128) nonmenenjit sinir değerler için eritromisin () dişinda tüm antimikrobiyaller için direnç %5,2'den düşüktür, menejit sinir değerler için direnç ,3-44,8'a yükselmiştir. E. coli (2280) ve K. pneumoniae (1307) için genişlemiş spektrumlu beta-laktamaz (GSBL) direnci sirasi ile ,6 ve ,0 bulunmuştur. P. aeruginosa (825) direnci %8,4 (amikacin) ve ,4 (piperacillin) arasinda değişmektedir. Sonuç: Direnç Türkiye'ye yakin coğrafyadaki ülkelerden yüksek bulunmuş ve zaman içinde artiş göstermiş olup bununla mücadele için politikalar geliştirmek gerektiğine isaret etmektedir. Ayrica, alinan önlemlerin yararliliğini izlemek için de sonuçlar değerli olacaktir. © 2018 Refik Saydam National Public Health Agency (RSNPHA).

Rosemary is a well-known aromatic and medicinal plant used to treat various ailments. This study evaluated Rosmarinus officinalis essential oil for its phytochemical and antibacterial properties. The essential oil was analysed by using a gas chromatography-mass Spectrometry (GC-MS) that revealed the common chemicals containing verbenone 36.20% and 1,8-cineol (Eucalyptol) 12.14%. Extracted essential oils were tested for antibacterial activity against vancomycin intermediate Staphylococcus aureus (VISA), a strain of bacteria obtained locally from bacteremia patients. Three isolates were found to be VISA positive using the E-test (strips) and the population analysis profile method (PAP). VISA showed lower resistance to the essential oils (MIC: Minimum inhibitory concentration, MIC = 1.5 mg/ml). Overall, the genetic influence of VISA was evaluated by looking at the hld gene expression after being isolated from blood samples and RNA extraction for qRT-PCR to determine hld gene expression. R. officinalis gene expression was analysed and calculated by using real-time PCR of RNA which revealed that it had decreased.