Introduction Neonatal blood stream infections (BSI) are major cause of morbidity and mortality in developing countries. It is crucial to continuously monitor the local epidemiology of neonatal BSI to detect any changes in patterns of infection and susceptibility to various antibiotics. Objective To examine the etiology of BSI in two neonatal intensive care units (NICU) in the Republic of Georgia, a resource-poor country, and to determine antibiotic susceptibility of the isolated organisms. Methods Cross-sectional study among all septic infants was conducted in NICU of two pediatric hospitals in Tbilisi between 09/2003-09/2004. Results A total of 200 infants with clinical signs of sepsis were admitted in two NICUs. Of these, 126 (63%) had confirmed bacteremia. Mortality rate was 34%. A total of 98 (78%) of 126 recovered isolates were Gram-negative organisms, and 28 (22%) were Gram-positive. Klebsiella pneumoniae was the most common pathogen, accounting for 36 (29%) of 126 isolates, followed by Enterobacter cloacae – 19 (15%), and S. aureus – 15 (12%). The gram-negative organisms showed high degree of resistance to commonly used antibiotics such as ampicillin, amoxicillin/clavulanate, and comparatively low resistance to amikacin, ciprofloxacin, carbapenems, and gentamicin; 40% of S. aureus isolates were methicillin resistant (MRSA). In multivariate analysis only umbilical discharge was a significant risk factor for having positive blood culture at admission to NICU (PR=2.25, 95% CI 1.82-2.77). Conclusions Neonatal BSI was mainly caused by gram-negative organisms, which are developing resistance to commonly used antibiotics. Understanding the local epidemiology of neonatal BSI can lead to the development of better medical practices, especially more appropriate choices for empiric antibiotic therapy, and may contribute to improvement of infection control practices.

ObjectivesThere is a large spectrum of viral, bacterial, fungal, and prion pathogens that cause central nervous system (CNS) infections. As such, identification of the etiological agent requires multiple laboratory tests and accurate diagnosis requires clinical and epidemiological information. This hospital-based study aimed to determine the main causes of acute meningitis and encephalitis and enhance laboratory capacity for CNS infection diagnosis.MethodsChildren and adults patients clinically diagnosed with meningitis or encephalitis were enrolled at four reference health centers. Cerebrospinal fluid (CSF) was collected for bacterial culture, and in-house and multiplex RT-PCR testing was conducted for herpes simplex virus (HSV) types 1 and 2, mumps virus, enterovirus, varicella zoster virus (VZV), Streptococcus pneumoniae, HiB and Neisseria meningitidis.ResultsOut of 140 enrolled patients, the mean age was 23.9 years, and 58% were children. Bacterial or viral etiologies were determined in 51% of patients. Five Streptococcus pneumoniae cultures were isolated from CSF. Based on in-house PCR analysis, 25 patients were positive for S. pneumoniae, 6 for N. meningitidis, and 1 for H. influenzae. Viral multiplex PCR identified infections with enterovirus (n = 26), VZV (n = 4), and HSV-1 (n = 2). No patient was positive for mumps or HSV-2.ConclusionsStudy findings indicate that S. pneumoniae and enteroviruses are the main etiologies in this patient cohort. The utility of molecular diagnostics for pathogen identification combined with the knowledge provided by the investigation may improve health outcomes of CNS infection cases in Georgia.

Non-typhoidal Salmonella present a major threat to animal and human health as food-borne infectious agents. We characterized 91 bacterial isolates from Armenia and Georgia in detail, using a suite of assays including conventional microbiological methods, determining antimicrobial susceptibility profiles, matrix assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry, serotyping (using the White-Kauffmann-Le Minor scheme) and genotyping (repetitive element sequence-based PCR (rep-PCR)). No less than 61.5% of the isolates were shown to be multidrug-resistant. A new antimicrobial treatment strategy is urgently needed. Phage therapy, the therapeutic use of (bacterio-) phages, the bacterial viruses, to treat bacterial infections, is increasingly put forward as an additional tool for combatting antibiotic resistant infections. Therefore, we used this representative set of well-characterized Salmonella isolates to analyze the therapeutic potential of eleven single phages and selected phage cocktails from the bacteriophage collection of the Eliava Institute (Georgia). All isolates were shown to be susceptible to at least one of the tested phage clones or their combinations. In addition, genome sequencing of these phages revealed them as members of existing phage genera (Felixounavirus, Seunavirus, Viunavirus and Tequintavirus) and did not show genome-based counter indications towards their applicability against non-typhoidal Salmonella in a phage therapy or in an agro-food setting.

No abstract

Phage therapy is one of the promising "new" methods of treatment, which attracts more attention abroad. Despite the fact that phage therapy is traditionally used in former Soviet countries, its importance in Western countries began to be assessed with the advent of a multitude of antibiotic-resistant forms of bacteria that are no longer being treated. In this regard, the number of deaths among patients exposed to antibioticresistant infections increases every year. Phage terapy can be used as an alternative method of treatment. Numerous literature sources indicate that resistance to antibiotics and bacteriophages does not match. However, little is known about how specific the bacteriophages are to various bacterial serotypes, which are simultaneously characterized by multiple drug resistance (MDR).

The study aimed to evaluate epidemiology of nosocomial pathogens and their resistance patterns at four major tertiary care centers in Tbilisi, Georgia. Out of 3452 samples included in the study 1607 positive culture results were documented (46.6%). Study showed considerable burden of nosocomial infections on Georgian health care system.

Neonatal mortality continues to be a significant public health burden worldwide. Each year 4 million neonates die during the first 4 weeks of life. Developing countries account for 98% of reported worldwide neonatal deaths [1]. Neonatal infections currently cause about 1.6 million deaths annually in the developing world, and the major cause of newborn mortality is sepsis [2,3]. In the Republic of Georgia, a former Soviet state, little data exists on causes of infant mortality. Newborns up to 8 weeks of age with severe acute illness are sent to NICUs from maternity houses (birthing places) and pediatricians' offices. No data from the Republic of Georgia has been published on evaluation of the risk factors associated with neonatal mortality in NICUs.We recently published the results of our study conducted at the NICUs of two pediatric hospitals in Tbilisi, capital city of Georgia, between 09/2003 and 09/2004, in an article by Macharashvili et al. [4] in International Journal of Infectious Diseases. The study evaluated the etiology of neonatal blood stream infections (BSI) in septic neonates, and determined antibiotic susceptibility of the isolated organisms. In this study we found a high overall mortality rate of 34% (68 of 200 neonates died).We conducted analysis of risk factors for mortality in NICU. Data were analyzed using SAS software version 9.1 (SAS Institute, Cary NC). Prevalence ratios with 95% confidence intervals for risk factors of having positive blood culture were estimated with bivariate and multivariate log-binomial regression modeling. Evaluated risk factors and results of bivariate analysis are shown in Table 1. In multivariate analysis independent predictors of neonatal mortality included: age \7 days at NICU admission (PR = 1.68; 95% CI 1.07-2.63; P = .02), Apgar score of B6 (PR = 2.15; 95% CI 1.48-3.13; P \ .001), and a positive blood culture (PR = 1.98; 95% CI 1.22-3.10; P = .005).This study demonstrated an important contribution of neonatal bacteremia in high mortality rates among NICU patients in Tbilisi: 76% of newborns who died had positive blood cultures compared to 56% of survived newborns. Age \7 days at NICU admission and an Apgar score of B6 as independent predictors of neonatal mortality were likely multifactorial, but beyond the scope of this study.Effort to reduce the risk of infection is of paramount importance to improved material and newborn care.