Carbapenems are a group of last-resort antibiotics used to treat serious life-threatening infections. The emergence of resistance to carbapenems is a major public health threat. However, comprehensive information on the prevalence and molecular epidemiology of carbapenem resistance (CR) among Asian countries is lacking. Therefore, we aimed to determine the prevalence of CR and associated molecular determinants quantitatively among Asian countries. In this systematic review and meta-analysis, we searched published reports in electronic databases such as PubMed, ScienceDirect, the Cochrane Library, and Web of Science from 1st of January 2014 to 31st of January 2024 that fulfilled these criteria; original studies conducted in Asian countries including clinical isolates, and published in English. Data extraction and risk-of-bias assessment were performed by two independent reviewers. The pooled prevalence of CR with 95% confidence interval (CI) was computed with a random effects model. Heterogeneity across studies was determined by I2. The geographical location, income level, publication year, and sample size were analyzed as subgroups. We identified 2518 eligible studies, of which 37 assessed the CR prevalence data of 10,433 patients. The pooled prevalence (PPr) of CR was 31.3% (95% CI: 0.22 to 0.40; I2 = 99.9%; P = 0.00). A trend of CR incidence was observed from 2004 to 2023, with PPr values ranging from 7.4% to 50.6%. A variation in the distribution of CR genes was observed, with blaNDM being the most common gene, followed by blaOXA and blaKPC. Univariate meta-regression analysis indicated that geographical location, income level, publication year, and sample size did not significantly affect heterogeneity (P < 0.05). The results suggest that surveillance of CR among Asian countries is essential to reduce the burden of antibiotic resistance. Mitigating the impact of CR infections will safeguard the efficacy of carbapenems for future generations and reduce further dissemination of CR genes. PROSPERO CRD42024515806.

Detecting SARS-CoV-2 using a simple real time molecular assay will be helpful for the mitigation efforts in low / middle income countries during the pandemic. We have developed and validated a rapid and simple real time loop mediated isothermal amplification assay (LAMP) for screening of SARS-CoV-2 infection in known infected and non-infected individuals. Six sets of primers were designed targeting the N-gene of the SARS-CoV-2 (Accession ID MN994468). LAMP reactions were performed using Warm Start 2X Master Mix and real-time PCR machine at 65 °C for 60 cycles with 15 s for each cycle. Results were read by visualizing turbidity under ultraviolet light and real time fluorescence detection through FAM channel of the real time PCR machine. We tested a total of 320 including 240 SARS CoV-2 positive (Ct values <40) and 80 SARS CoV-2 negative samples as tested by a real time RT-PCR using the newly developed LAMP assay. A total of 206 out of 240 SARS CoV-2 positive samples were tested positive by the newly developed LAMP assay with a sensitivity of 86%. All 80 SARS CoV-2 negative samples were tested negative by the newly developed LAMP assay with a specificity of 100%. The newly developed real time LAMP assay has a sensitivity of 86% and specificity of 100% compared to the real time RT-PCR for the detection of SARS CoV-2. The new assay will be useful to screen large number of samples if adopted to minimize the time and cost.

Introduction Carbapenems are used to treat multidrug-resistant organisms as last-resort antibiotics. Resistance to carbapenems is an emerging public health threat worldwide, with alarming reported rates in Asian countries. To minimise further spread of resistant strains and guide interventions, it is important to understand the prevalence rates and causative molecular determinants. Therefore, the systematic review and meta-analysis arising from this protocol will aim to comprehensively describe the available surveillance data on carbapenem resistance in Asian countries to provide an in-depth overview of the carbapenem resistance status in this region. Methodology and analysis A systematic review and meta-analysis will be conducted via PubMed, ScienceDirect, Cochrane Library and Web of Science databases. Additional articles and grey literature will be searched in Google Scholar, OpenGrey and Google Chrome by manually searching the reference lists of selected studies. The review question was designed according to components in the ECLIPSE (E-expectations, C-client, L-location, I-impact, P-profile and S-service) framework. Studies conducted with samples other than clinical samples will be excluded. Only original articles published in the English language will be included. The Joanna Briggs Institute critical appraisal tool will be used to assess the quality of the included studies. A random-effects meta-analysis will be performed if the data are sufficiently homogenous. Heterogeneity between studies will be assessed via the I² statistic. The subgroup analysis will be performed considering the type of sample, pathogen type, region/country where the studies were conducted and genetic determinants. Ethics and dissemination As this study is conducted on the basis of published data, ethical approval is exempt. The findings of this study will be disseminated in a peer-reviewed journal with the intention of providing summarised data on the globally emerging threat of carbapenem resistance and emphasising the need to introduce alternative, more effective treatment options. PROSPERO registration number CRD42024515806.

Aim: Study determined the nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA) and associated factors among a cohort of nurses in a Sri Lankan Hospital. Study Design: A hospital based, cross-sectional study was conducted including nurses attached to different wards at a Sri Lankan hospital, located in the capital of the country. Place and Duration of the Study: University Hospital Kotelawala Defence University (UHKDU), from October 2022 to January 2023 Methodology: After obtaining written informed consent, a total of 80 nurses were included in the study. Relevant socio-demographics and behavioral data were collected using a self-administered pre-tested questionnaire. Nasal swabs were collected and processed to identify MRSA according to laboratory protocols and Clinical Laboratory Standards Institute guidelines. Associations between categorical variables were assessed by chi-square test using SPSS version 25 software. Results: Majority of the participants were females (73.8%) and the mean age was 31.93 ± 8.99 years. Coagulase negative Staphylococcus spp. were 41 (50.62%) while 14 (17.28%) were Staphylococcus aureus out of which, seven were MRSA with a colonization rate of 8.6%. None of the demographics or behavioral factors showed a statistically significant association (p > 0.05) with the presence of MRSA nasal colonization. Conclusion: This is the first-time screening of nurses at this hospital for MRSA colonization. These findings can be used as a baseline for future studies to minimize further transmission of MRSA colonizers and to strengthen the infection control measures. In addition, antibiotic stewardship programs can be implemented towards early identification of MRSA positive cases. Lack of statistically significant associations between considered factors raises the requirement of additional investigations with larger sample size for comprehensive understanding. The study findings help to identify the trends of MRSA colonization among nurses as they can be treated and prevent further spread to the community, health care workers and immunocompromised critical patients.

Fosfomycin is an effective treatment for urinary tract infections (UTIs). It is not currently used in Sri Lanka to treat UTIs. Hence, this study was conducted to assess the fosfomycin susceptibility for E. coli in urinary isolates, with an aim to find the usability of fosfomycin in the context of high antibiotic resistance. E. coli isolates were identified by the colony appearance and by performing biochemical tests for the urinary coliform isolates collected from two different hospitals in Western Province Sri Lanka, during the period of November 2021 to February 2022. Susceptibility to fosfomycin 200 μg disc was performed following the Clinical Laboratory Standard Institute (CLSI) disc diffusion method. A total of 101 E. coli isolates from both oncology patients (52.5%) and non-oncology patients (47.5%) were identified and included in the study. The study sample showed majority of females (63.3%). Ampicillin showed the highest resistance rate (72.2%) while fosfomycin was the only antibiotic that showed 100% in vitro susceptibility to all the tested clinical isolates. The overall presence of multidrug-resistant (MDR) and carbapenem-resistant (CR) E. coli were 47.5% and 9.9% respectively. Fosfomycin is a potential antibiotic option especially for MDR and CR organisms, with 100% in vitro susceptibility. Further studies involving multiple centers, with larger sample size and clinical efficacy studies would be important to assess the potential use of fosfomycin especially for the treatment of UTI-causing MDR and CR organisms.